Viverette: This is the FaithHealth Learning Forum Podcast, a podcast series designed to offer insights into the vision of FaithHealth NC, a dynamic partnership between Faith Communities, Wake Forest Baptist Medical Center, and other healthcare providers focused on improving health. I’m Emily Viverette, Director of FaithHealth Education. This particular series focuses on mining the wisdom of key leaders within the division of FaithHealth Ministries at Wake Forest Baptist Health. Today I’m talking to Dr. Gary Gunderson, Vice President of the Division of FaithHealth Ministries and our visionary leader. He became in public health through his work with former President Jimmy Carter in Atlanta when he directed the Interfaith Program at the Carter Center for a decade. Gary’s had many experiences since then, but if I go on too long about his background and credentials, he won’t stick around, so I’ll jump right in. Thanks for being here Gary.

Gunderson: Thanks Em.

Viverette: I know that the work of FaithHealth stands on the shoulders of many giants, there are incredibly long streams of deep theory undergirding the work along with lots of immensely compassionate hearts, so it’s hard to summarize. But I would wonder, if you kind of go back to your work right before you came to Wake Forest in Memphis, and talk a little bit about the Memphis Model, which is why were recruited to Wake Forest to begin with.

Gunderson: Yeah, and why I was recruited to Memphis, was the great CEO of Methodist Le Bonheur Healthcare Gary Shorb, United Methodist layperson, actually went to church, called me up one day while I was happily working away at Emory and the Carter Center and he read my books with all this theory stuff, and he said, “So Gary, can you actually do this stuff?” And I said, “well how would I know?” These are community scale ideas and they needed community in order to work. He said, “would you come to Memphis and help us figure out what faith is for, in a faith-based hospital, in a really tough town?” And I knew, that the faith in the hospital, was only important if it could connect to the super abundant faith scattered in what we guessed were about two thousand congregations within an hour and a half of downtown Memphis.

So Memphis has lots of stuff that it’s not proud of, but it’s extraordinary deep in networks of faith, especially black Baptists, Church of God in Christ, the hospital itself was governed by the three United Methodist conferences. So the sort of simple idea was, let’s connect all that stuff and turn the hospital inside out, not to manage the community, but to be connectable to the community, back and forth. So the Memphis Model has continued to grow, even today, but it’s about seven hundred congregations with a signed covenant of mercy and justice, sharing for the care of members and neighbors.

Well, among other things, it’s another, like long podcast about the evidence base and I know you’ve talked to TC [Teresa Cutts] a little bit about that. But we saw in hard data, that when you connect all that stuff, amazingly good things happen. And that’s really why I was recruited to Wake Forest.

Wake Forest Baptist Hospital, the hospital called by most people in North Carolina, The Baptist, has a deep, rich faith tradition, and I came here and found myself surrounded by a deep, long tradition of thoughtful, professional development of roles, credentialed that you lead… you’ve been trained in those roles, and this is probably the largest ensemble of FaithHealth assets anywhere in the world when you count CareNet and FaithHealth, and the students and the ground game, and the Center for Congregation Health, all the folks here interviewing, it’s an amazing ensemble, and the whole point here is to connect all that stuff.

Viverette: So when you did come to connect this thing, there were some assumptions you came from Memphis with, and some things we kind of tried to start in the beginning, but we discovered it was a very different ground game. So what were some of your biggest learnings, and our biggest learnings?

Gunderson: Yeah, well the most basic one was in Memphis, the way the hospitals signaled in humility, that it wanted an enduring covenant, that was the language of covenant. Well, we signed it, we signed a covenant. The clergy had spent about a year helping us co-write it and develop it, that was really the heart and soul of how we connected.

Well you come to North Carolina, and here in North Carolina it’s mostly, North Carolina is essentially four or five pretty big small cities, and hundreds of small towns. And In North Carolina culture, you know the relationship between the structures of faith and mill towns, was radically different than in Memphis. People don’t like to sign covenants. It’s kind of like, “Uh, why would you ask me to sign a covenant, don’t we, you know we know each other, why would we, why do I have to sign this entanglement?” And there was a whole lot of the company, town, and religion confusion. And so we found it was a little bit of an insult to ask people to sign a covenant. It wasn’t an honor, it was kind of like an insult. It didn’t take real long to figure that out. North Carolina people are polite, but they were pretty clear that they felt a little bit insulted by this. We totally blew up the covenant entanglement and replaced it with a more functional keeping track of who actually partnered in sharing for the mission. So we literally track congregations who share in the care of one of our patients. Maybe not be one of their members. People in North Carolina love taking care of anybody in the community. They’re less focused on inside the congregation care much more about how the congregation is part of the community fabric. So in some ways, it’s just like perfect for FaithHealth logic.

Viverette: Yeah. There are, you mentioned there’s just so many cool things that happens when we start piecing together pieces that haven’t been put together before, and you know, it makes sense to us that we’re kind of doing the right thing. I’m curious, there are lots of health systems, like you’re part Stakeholder Health, which is a part of Stakeholder Health, which is a learning collaborative of systems that are doing this FaithHealth work all over the country. Why are hospitals invested in it? Why does it make sense for the hospital to do this?

Gunderson: So in my early tenure as an accidental hospital executive in Memphis, I was sitting through, I think it was probably my second year of budget meetings, and your mind tends to wander in meetings like that, and I looked down and I realized that the single largest number in the operating budget was charity care, people who don’t pay anything. And there wasn’t anybody’s name next to that, and so I walked down the hall to talk to Gary Shorb, I said, “is it true that this largest single line item in our operating budget is unmanaged?” I said, “Bad management would be an improvement. I can do that.”

But the actual story behind the joke was, hospitals have normally regarded the care for the poor as essentially an unmanaged liability, an unmanageable liability, because most of it comes in the door of the emergency room, you can’t lock that door. And you have to provide care legally. And so they basically regard it sort of like the weather. You can’t manage it, you might be able to prepare for it, you can budget it, you can sort of expect it, but you can’t manage it.

And the promise of FaithHealth was we have friends in tough places, and those are friends that care about the very same people that we do. We might call them horrible names, like super utilizers, and congregations don’t call them names like that. They actually know them by real names. They’re Bob and Sue, and people who they know personally, their cousins, they’re connected to the congregation even if they’re not members.

And so, we help the hospitals connect to their community in a way that they can’t even actually fathom. And in our exact moment, right now, we’re going through a time of radical transformation of the architecture of relationship between the government, especially through Medicaid, and the very poor people who are on Medicaid, and the uninsured, and the not-for-profit hospitals. Most hospitals in North Carolina are not-for-profit entities, and all of those relationships are being radically changed. FaithHealth is the ground game. We have the friends in tough places, and actually systematically making those friends in tough places, connectable to the provider systems, that’s a very high art. And it requires all of the moving parts. It requires people of character and decency and curiosity inside the provider systems, it requires the clergy to be open to a very different conversation they’ve had before. But FaithHealth at Wake, that’s like our… we love doing that. And part of it is, we deeply respect the people in all of those different roles, and know that this isn’t just something you can buy and stick into a community. It’s actually connecting and animating all of the different assets that God’s placed in our community, and making them function as a system.

Viverette: So FaithHealth is the right thing to do, it’s the faithful thing to do. It’s a fiscally responsible thing to do for medical centers.

Gunderson: It turns out to be smart, in all of those different areas.

Viverette: Right. And, it took some seed money, actually more than seed money to get this all started. So as your thinking about medical systems or folks out there in the world who want to get this started, what do you suggest for looking for funding?

Gunderson: So, the language we used early on—when we discovered that the powerful financial impact that we were observing in Memphis, we called that proactive mercy. And everybody gets it. Whether, anywhere you are on the political or theological spectrum. You sort of get the idea that being proactive is better than being reactive. It’s way better than being lazy. And hospitals are not lazy about anything except charity. Except care for the poor. And when they realized that they want the alternative, that’s being proactive.

When I came here, Ed Chadwick, a good Catholic layman, was our Chief Financial Officer, and I said, “Ed, I need something with which to be proactive. You can’t make bricks out of straw, you can’t be proactive with just chatter at the pulpit. I need six percent of your projected charity care spend for the next year.” It was sort of a made up number, but it adds up to about a million bucks, and Dr. McConnell, the CEO at the time came in my office not long after that, and said, “you know, we have an internal foundation here at Baptist Hospital, that has accumulated over the years. It’s about a thirty million dollar foundation. It pays out about a million bucks. And why don’t we, for five years, dedicate that fund to the work of FaithHealth, and population health?”

And so that million dollars was the risk capital, it was the innovation money, and it wasn’t, it was so significant because you have to learn your way in to doing this. Nobody else could do it exactly like we’re doing it at Wake Forest. You have to learn your way into the structures, and processes, the staffing. All of those things that actually cost cash. You can’t just copy them, you’ve got to learn your way into it. And so this flexible innovation money is the most critical thing.

And then you need the positional authority to redesign everybody’s work who’s relevant to this, and so you live through this. It’s rethinking. What’s CPE for, what’s chaplain training for, maybe it’s not chaplain training, maybe it’s FaithHealth education. What’s CareNet for? What’s it mean to do faith inspired, faith saturated therapy? Not just over there, but integrated in with the other systems. What do we do to develop congregations? Maybe we need a ground game, a community engagement. All of these are job descriptions that either have to be written from scratch, or rewritten in a new integrated logic. And you have to have some innovation money to allow you to do that. Hospitals are very nervous with the idea that you would have a budget for things you can’t exactly know. But that’s why they call it faith. But it takes some cash.

Well, we had an internal foundation that Dr. McConnell and the board of directors committed to this vision. And they did it for five years, and then they renewed that claim. Lots of hospitals have foundations, traditionally hospitals raise money to buy machines or buildings. And so the foundation apparatus that has been used in the past to buy equipment, can be used just as well to raise money for proactive mercy.

And actually, the Memphis foundation under Paula Jacobson, did that. They switched their sort of mission and logic and continued it long after I left. They still find that that vision resonates. Community foundations are generally much smaller than the hospital. So as hospitals move out in the community, the critical thing to beware, is not to compete with the very community partners that you’re trying to partner with. And sometimes hospitals have wealthy donors on our boards, and we’re connected to this and that, and some cases we can squeeze out and damage some of the very partners that are most critical for us to work with. So this work of attracting additional resources can be very dangerous for the very partnerships that are essential.

The key is the first step. The hospital is the biggest, it needs to take the biggest risk. And that’s why this connection between the work of FaithHealth and the poor, is absolutely critical to get right the financial relationship between that work of mercy and the hospital’s financial challenge with the very same people. And that’s the first thing you do, you make sure you understand where the hospital faces a challenge of its own, and FaithHealth can help with that challenge. So you’re not asking for a grant, you’re asking to be a partner and to have the hospital invest resources and dealing with its own fundamental challenge. That’s my first counsel to get that right.

Viverette: And in order to do all that, and get it right, you’ve already mentioned the word partner, and how to partner, and I’m curious, who have been some of the kind of most interesting partnerships, or different partnerships, or surprising partnerships, you’ve found even within the walls of the hospital, and outside the walls of the hospital to make this work?

Gunderson: In the olden days, you would call a chaplain, when someone was in, probably near death. So sort of automatic. If someone looks like they’re about to die, you call the chaplain. Well, these days, at Wake Baptist, when you just see someone who’s life is just a train wreck, this and that, complications, oh my goodness, oh they’ve got that, too. You call FaithHealth. And the people whose lives are train wrecks, aren’t just poor. You can be really rich, with family, and find yourself in just desperate isolated circumstances. And so FaithHealth lines up with the people who are most difficult for our formal systems to deal with.

Same’s true in the community. Very frequently the medical part of the work of a homeless shelter is extremely difficult. For them, it’s easy, for a hospital we’re taking care of the same people. You can build partnerships around where you can line up complementary strengths and complementary challenges, and really be very systematic about that. But that’s actual work, you have to understand what’s going on in your partner’s service, work, just thinking right now, we have pretty intimate knowledge of many ministries, in Winston-Salem where we understand where they struggle, where they’re great at it, we very frequently share congregations who volunteer in both places. But unpacking the actual strengths of that ministry and how it lines up with ours, and where their challenges line up with ours. That’s really the daytime work of figuring all this out.

Viverette: I was also thinking even about the partnerships and understanding the financial needs of the hospital, like Todd Bankhead, and coming alongside folks like him, so that they really understand where we’re coming from, and we understand their needs. We learn to speak in their language, and as much as we try to interpret what we’re doing, too.

Gunderson: That’s right. My experience with people on the finance and revenue side of the hospital have absolutely impeccable ethics, and in general these are enormously honorable people who are charged with an honorable task of trying to make a not-for-profit organization end up the year with ever so slightly more money than it started with. Todd’s a great example: a Purple Heart veteran, when he sees people in distress, he really sees them. He sees them. And it’s a worthy partnership to work with him.

But understanding the nature of their work, and our work. We’re currently negotiating Medicaid contracts with insurance companies, and in general FaithHealth has never been part of that dialog at all. In this season, in our hospital, at this point, Medicaid transformation, the work of FaithHealth is part of those conversations. How is it, you know, we have a ground game, we have friends in tough places, and if you actually have financial liability for the care of people who live there, you want what we’ve got. And it’s not ours, but we can help connect and animate the partnerships that are valuable not just to our hospital but also to others who face the challenges of caring for folks.

But the key to it is, really being very thoughtful, not assuming you know how a partner works, or what they need, or exactly what they do. Begin with the question of, how is it that they’re providing value to us, not just asking something from us. So it’s a very flat partnership, requires a lot of ubility, and that’s not something that comes easy to hospitals. But at this point in time, I promise you, we’re being humbled anyway by the complexities of healthcare in 2019.

Viverette: I only have a couple more questions. One kind of takes this in a little different direction. It’s one of the great gifts that I feel like you brought when you came to Wake, is this kind of attitude of abundance, you know, we live in a world where scarcity, everybody’s afraid of scarcity, but you really brought that and hold that and model that, for us, in the division and in the hospital, and in your life. So I’m curious, how do you do that, in kind of mean spirited times, and this fear of scarcity?

Gunderson: You know the book I wrote was Speak Life: Crafting Mercy in a Hard-Hearted Time, and the very first step of doing that, is to realize that the abundance is not fictional. It is not delusional to look around the community and realize, it’s not just us and our little programs fighting death. It’s life against death. And that makes it a fair fight, and if it’s life against death, the critical part of what we do is systematically align ourselves with the work of life. And life is super abundant. It’s just super abundant, and creative, and adaptive, and literally never-ceasing. And if we will stop jumping up and down on the flowers, they’ll grow.

So in our community, I find, you know, we just got back from driving thirty-four hundred miles in a very bumpy Winnebago, what we saw everywhere along the way, was communities aren’t waiting for hospitals, they aren’t waiting for national foundations, they certainly aren’t waiting for national political leaders, they’re going ahead and weaving together the life that you find in any community. Any place you have humans, you will have life, and the grown ups in that community, frequently inspired by their younger people that they love and care for, will find ways to weave together the assets.

Steve DeGruchy, a great friend from South Africa, always said you can’t build a community out of what it does not have. And so the first step, is not to project needs onto the community, but look with eyes of appreciation for what’s already there, for what I would say God has already placed there. And our job is to nurture and grow what is already there, not to act out of anxiety about what is not there. And then, when you do that, as you know in our division, we have just this insane super abundance of gifts and strengths, many of which aren’t contained within the job description. So we have all sorts of folks who, if you only knew them by their job description, you would only know a tiny fraction of what they really have to bring to this work of life. So I just love our work as a division, it’s so rich, and the more we know about each other, the more we realize that’s there to nurture, and much of what we have in the division are people who are deeply connected to the assets of community. And so it just keeps going on and on.

Viverette: Yeah, it really is a gift to work with the folks we have. So last question is, what’s next on the horizon? Where are we going?

Gunderson: Who knows? You know, I believe it was Einstein who said, if we knew what we were doing, we wouldn’t call it research. Well if we knew what we were doing, we wouldn’t call it FaithHealth. I can see the continued convergence and interweaving of all of these living assets, and what I understand is we’re getting more and more radical about appreciating what happens when you connect, align, animate, feed, nurture, the living assets of the community. And that’s really our work. And it’s hard to know exactly what will happen next, I mean we are in a hard hearted place in this time, and every day we hear the stories and see the people in the eyes of, who are the victims of genuinely violent and poisonous activity.

And we experience in FaithHealth, the enormous privilege of acting boldly. You know, we’ve called this year the year of living dangerously, and loving dangerously. And that’s our privilege to do that. And the surprising thing is, it is very rare for anyone in leadership positions in the hospital, in government, in foundations, and anywhere in the institutional apparatus we relate to, to look at FaithHealth and say, you need to calm down and get back in your cage, and go play your role, get back in your lane. Well, you know, no one tells us that.

And so our, what comes next for us, is to go to the next edge of where we can see there’s another right thing to do, and go ahead and lean over that edge and try to do something next. And part of the edge, part of what protects us, and gives people the confidence in what we’re trying to do, is we never just lean over an edge without being very careful about evaluating what happens, really noticing what the effect is in making sure that what we intended to do actually is sort of like, what happens.

So there’s a constant accountability for the enormous privileges that we have, when you act in the name of faith, when you act in the name of health, and then act in the name of FaithHealth, you tend to have a lot of freedom to work with and the key is don’t abuse it. Make sure you’re accountable to the folks who loaned you their trust, and continue to earn it.

Viverette: Thanks. Well, as we wrap up, is there anything you haven’t had a chance to share, or a story that stands out that you’d like to?

Gunderson: Well, I get way more credit for what actually almost two hundred people in FaithHealth actually do. My learning journey here has been to be continually humbled by the way that the very oldest parts of what happened at the Baptist are relevant in radical new ways in 2018, 2019, ’20, ’21, ’22. In ’22, it’ll be the hundredth year of the founding of this hospital.

And one of the initial things that went right here, after the churches of North Carolina invented the hospital, only twenty-five years after the birth of this institution, CPE was created. And it was a pretty radical idea at the time, that you know, you actually could train people to be competent in the clinical environment, and I’ve seen under your leadership, the stunning relevance of what it means to reflect on clinical practice, and all of the arts of humility that are at the heart of CPE in, now 2019. And so these very oldest practices, of reflecting thoughtfully and carefully on what it is you’re doing with your life, what it is you’re doing with the strengths you bring to people who are in a time of suffering.

That most basic work continues to be relevant, and the big difference between what’s happened in North Carolina and Memphis is, frankly, the strongest, deepest foundation in those arts, that we built on here. And that’s, you know, most of the folks who are leading the most radical parts of our work and farthest from the hospital in the middle of the night car wrecks, into the homes of the undocumented, were formed, and their courage was formed in the very arts, really of your leadership. So I appreciate the long years that have made, sort of this radical future possible.

Viverette: Well thanks, Gary, and thanks for the time and the opportunity. I look forward to what’s next.

Gunderson: Thanks.