Gary Gunderson & Dora Barilla

Dora Barilla is Group Vice President, Community Health Investment for Providence St. Joseph Health, Senior Fellow for the Institute for Health Policy and Fellowship at Loma Linda University Health. Gary Gunderson is Vice President for FaithHealth at Wake Forest Baptist Medical Center, Secretary of Stakeholder Health and author of numerous books, including the newly published Speak Life.

Gunderson: The conversation, Dora and I are going to talk for a little bit, we are actually part way in to the Stakeholder podcast process and we realized we hadn’t actually interviewed each other. And I consider Dora one of the most interesting people in the broad faith/health movement and so I was intrigued by the opportunity to talk a little bit.

So, we’re just going to go back and forth in the conversation. But let me start with the first conversation. So, Dora, you are these days a big deal nationally known leader in one of the largest healthcare systems in the United States and are also a big deal consultant to many other healthcare systems. But you didn’t like start that way. The part of your story that fascinates me is you came into this field of healthcare and pop health from the direction of caring about community health and community dynamics and community development and healthy communities. How did you do that? Tell me about that?

Barilla: Well, I think it’s always in interesting journey. I started really, I was going to make everyone eat right and exercise, Gary, I was really an exercise physiologist looking at sports medicine. And if you really look at what creates health, I think that was a part of my journey. It’s so much more and you take kind of your naïve self in terms of what’s going to create health and you really look at, it’s so interconnected with your family, your community, the social support system.

I started in healthcare really looking at, we didn’t call it population health in the early 90s, but it was really looking at how do we manage or high utilizers and manage care and really saw my path from the healthcare system, really outside the walls seeing that if we’re going to improve people’s health, we’ve got to look at the sidewalks. We’ve got to look at each individual’s story, the stories of communities. And so, it really was an organic way of looking at how do you define health. And so it has been an interesting journey, it’s not been an easy one because having this-

Gunderson: You were doing this in San Bernardino, the very first city in the United States to go bankrupt.

Barilla: Yeah.

Gunderson: And you weren’t doing like, people who talk like you were just talking are normally from Boulder, Colorado, not San Bernardino. So the toughness, the grittiness, the sheer labor of hoping for health in a really tough city like San Bernardino. Connect that part of the story.

Barilla: I did my undergraduate work in Malibu, California and came out to San Bernardino county.

Gunderson: That’s so much better, that explains everything.

Barilla: It was really that moment where you go, it was really an enlightening moment in my early 20s where, again, going back to where I was going to help everybody eat right and exercise. And it was a 16-year-old girl with type 2 diabetes in San Bernardino county, we were counseling her on her diet and exercise and as I actually went into her community to sit down with her, I realized that it was filled with fast food restaurants, that the sidewalks were not safe probably to let your dog walk on. And then as we had a conversation, she went into the details of a lot of sexual molestation that happened in her past. It was that moment where you really look at if this is, this is not easy stuff. This is complex. And if we’re not looking at the whole person and the whole community, we’re really not looking at the real issue. We’re just putting band aids on healing our communities.

And so, that’s really a part of the journey where you open your eyes and you say, “What’s in your community, the good and the bad.” Because we also found a lot of great… as you identify and have the conversations in a community like San Bernardino, Gary, you begin to look at… there’s a lot great people there as well. And I think that’s kind of, Gary, I always say he often gave me language to my career because it was so odd and I was all over the place and I was really looking at community, faith communities, municipalities, and it was your book, Deeply Woven Roots, that I read years ago, that said it was the “aha moment,” that like this was the language, this is what we’re trying to do.

And so I know you’ve been on a crazy journey as well, Gary, and that book was, I think, really a historic moment for me. And I know that you’ve journeyed a lot in your path and that you’re on a new journey with looking at, what do we call it? A road trip to look at the bright spots in America. Want to tell me a little bit about that?

Gunderson: Yeah, I’ve always had a bad case of curiosity and I’ve never been able to look away from something once it really caught my attention. So, from my entry, you know I’ve been almost 15 years as an accidental hospital executive, playing a senior role in these billion dollar things called hospitals. And before that I was at Emory and the Carter Center, so these look like prestigious jobs. You would think someone in that job would actually be qualified to do something. The actual truth of my so-called adult life has been what I’m really good at is curiosity. And then trying to find language to allow me and friends who share that curiosity to figure out how to think about it and walk about something that’s sort of right now off the map.

And the confluence, the intersection between faith and health was in a place that there wasn’t language for, it was off the map. So I knew that the way professionals and technicians talked about faith communities stripped out of the reality of faith communities, all of their strengths, they were sort of seen as a passive venue that might be a good place to practice public health or preventive health. And I knew that they were more than that so I invented this language, this strengths of congregations. And I’ve done that over and over and over again.

Now that I live inside these health systems, I still look out the window and I’m fascinated and curious about what is already going on in the communities, as you described San Bernardino, what is already going on the ground there that is strong and powerful and hopeful. It needs connection. But it doesn’t need beginning, it’s already going on.

So the whole point of this See2See Road Trip comes out of the premise that what if everything we hope for is already happening? It radically changes what our work is as leaders and people of influence. And it puts us in a more humble position. But it’s also like a way more hopeful position. You know, we don’t have to start a national movement in 3,000 counties. It’s already there, it’s already happening.

And so this came out of sort of a bluff that I called on myself when I said, “If I got in a Winnebago in Wilmington, North Carolina and drove all the way to Venice Beach, I could stop every single hour along the way and I could get out and find something going on in that community that would be worthy of putting on one of these elite, high-profile panels that normally are held at national meetings and hotels in Washington D.C.”

Well, it turned out that it’s true. So we are literally, yesterday Tom and TC and Maureen Kersmarki, all Stakeholder friends, literally were going stop by stop from San Diego, we started in the west and are coming east. And mapped 3,300 miles of a discovery journey. I know what we’ll see all along the way is stuff that’s already going, and we’ll find what you found in San Bernardino that in the very toughest communities that you can imagine, that look like, “Well, who could live here and who would ever hope for here,” you’ll find someone who’s lived there, given their life to making something happen here. And they don’t know what a big deal they already are.

So the whole point of the See2See is everything we hope for is already happening, let’s go look and learn and listen and be part of the movement that’s really waiting for strengthening. But it’s not waiting for us to start it.

Barilla: You know, that’s such a powerful narrative, Gary. Cause I think, you know, as we work in these big systems and we begin to move from the conversation of healthcare to health, it’s a little foreign for lots of people that have been trained in that. And I think that there’s this hesitance to embark and actually plant a flag around improving health because there, it’s so much outside of the locus of control of a health system. I’m just curious what words of wisdom you have to some leaders that are embarking upon this? Really shifting the mental model from having control over something to helping to shape something that’s already happening?

Gunderson: Last night I had the privilege of doing a Tuesday night book study at the little Methodist church that TC and I go to, Green Street United Methodist. And Green Street’s one of the classic little congregations that looks like it ought to be half dead, but it’s not! It’s like way vital and alive and has this dynamic flow of energy that has been clicking around for about 100 years.

There were about 25 people there and the book study was on my book so I had to like read my book and I kind of liked it actually. What I was saying to them, they were asking almost your identical question, “So where do we start? How do we do that?” I said, “Well, if you drew a quarter-mile circle around this very congregation, there’s some strong parts of the community but there’s a lot of really tough parts of that community. And if you go out and ask the question, if you stand out on the front door of the church and look out and say, ‘Wow, let’s prioritize what’s wrong, let’s figure out what the biggest problem is and the really screaming biggest source of pain,’ you will find an answer to that.”

But most professionals, hospital folks especially, who ask that kind of questions and they look out at the community, what they usually do is they, it’s like looking, you know Schweitzer’s story of looking for Jesus down a well. You’re looking at, the water at the bottom of the well reflects back the face of who’s looking. Professionals are like when we look at communities. We look out and we say, “You know what this community really needs is someone like me.”

And if you look for the needs, you will never, ever get to the strengths and the assets. But if you go to the community and you say, “What’s already here? What’s alive, who are the generative leaders who are already here? Who is giving their life quietly for the other people in this community? What’s already, where’s the heart that’s already beating here?” You will absolutely find what’s happening. You’ll also be acquainted in a deeper, sort of with a lot more pathos, the tragedy and the historic traumas that have afflicted the people there.

So, Green Street Methodist is also… we’re the home base for the harm reduction coalition of Winston-Salem. So, we’re the needle exchange church to a lot addicts who are looking for a safe place to have a chance. So the local city councilman tried to shut down our needle exchange program cause he though we were bringing the wrong kind of people into his voting district. It turned out that 85 percent of the people who were doing the needle exchange in our church were living within blocks of the church, his district was very different than he understood.

So if you move with sort of optimistic curiosity about your own community, you’ll find what you have to work with. But you’ll also be reacquainted in a sort of deeper, personal way with where the real tragic stuff is too. But you won’t just look at the tragedy, you’ll see it through eyes of what you’re trying to do and that makes all the difference. So you’ll pick up energy as you engage, it won’t drain you away. You’re not going to do this stupid kind of calculation that happens in lots of professional needs assessments. “Well, we can only care about three or four things, and oops, mental health didn’t make it again.” These prioritizing of needs ends up making us stupid instead of making us smart.

That’s the counsel, look for the assets, look for the strengths, look for the life and that’s what you are trying to be a part of. If you keep that question right, then you can know what to do with the skills you’ve got too. That was a little bit of a sermon and you’re the last one on earth who needs a sermon. You work with sisters, what’s that like?

Barilla: That’s right. Oh, you know, it is so life giving to work with the sisters. You know, we have Sisters of Providence and Sisters of Saint Joseph. And they really energize the conversation so often, especially in our work, it’s a real privilege to have them be a part of… although they are not involved in operations, they are involved in so many things of the heart. Sister Susanne Hartung, she sits across from me, and she’s one of the last Sisters of Providence working as an employee in the health system. And I go and visit her every chance I get because she reminds us of our why. Why we did we go into this? It wasn’t that, you know, as you look at what we’re doing in terms of the traditional healthcare, she reminds us that we started so much of our ministry in the community and in partnership with other, and partnering with others that are trying to build community and improve health as well.

And in a sense that the conscious, the reminder… You know, I have Sister Mary Therese, Sister of Saint Joseph, said to me one day, “Dora, do you think God cares that an individual could get your prescription 15 minutes quicker?” Or, you know, referring to often some of the quality improvements in technology. And she said, “Or is that we should really care about how we get that prescription to that mother that doesn’t have transportation and has the sick child and can’t get off of work?” You know that really changes our ten-times-better experience if we’re framing it in terms of the poor and the vulnerable.

And that constant reminder of our why, I think it really energizes people as you look at, as every health system really is looking at, “How do we become more efficient?” It reminds us that we become more efficient so that we can serve better. We don’t become more efficient so that we can serve fewer. We recently re-crafted just the wording of our mission statement. Our mission has held true for 160 years. The sisters were adamant that we keep in our mission statement serving and that we’re steadfast in serving all, but especially those who are poor and vulnerable. And having that reminder that although we are here to serve, and we’re here to serve our communities, that we can’t forget those that need our help the most.

Gunderson: So the question I want to ask is many people who hear that focus on mission, focus on why, they sort of say, “Okay, okay, we got it. Thanks. Thanks for the why. Now we’ve got to go to work.” And what I want you to do is sort of unpack the relationship between the why and the how. Does clarity about the why make you smarter about the how?

Barilla: Absolutely. Because if your how is not grounded in your why, you forget. And your how’s become compromised and it’s easy to do when things get tight. It’s not easy to always serve those who have complex social issues because we have a health system filled with hammers and you know when you have a hammer, everything looks like a nail. And so, having the sisters with the reminder of the why really reminds us that perhaps we need to look at some other tools. And clearly people are presenting in the emergency department with heart disease or with gastrointestinal problems. But what’s the why behind that?

Gunderson: So, real times story you could probably add some intelligence to our little healthcare system, we’re like a rounding error compared to Providence, we’re only like three billion bucks. But it turns out we have about $230 million of un-reimbursed care and that’s a big number for us. And the revenue of chief who is charge of making that number go down, essentially all he has are negative, more restrictive policies. And this is a man with a gorgeous ethic, he’s a purple heart veteran and he’s got a really big heart. But his job is to find, clip out these unnecessary expenses. And I went and sat down with him and said, “Todd, you know, I can’t help you with people that we’re not in relationship to. I agree we’ve got to be more restrictive on some policies. But where we are in relationship to people, where we have congregations and what we like to call our ground game where we have our network of full- and part-time community health workers we call supporters of health. But we’ve got a ground game, you don’t have to just be restrictive. We could make the right thing happen quicker. And in fulfilling our mission of what we call proactive mercy, we’re actually going to help you save money.

So when he came to the board to present his plan, he presented the fifth… There were four sort of slides of restrictive policies. But he said, “There’s a fifth slide that I want to be clear where we’re in relationship to the poor, we can do more than that.” And so it was just gorgeous that that kind of partnership… now it takes a special kind of finance guy. But as you know, lots of finance guys actually have a heart and a value method. Just no one from the mission side has come alongside and reached out to them and said, “You know we can help.”

Barilla: Absolutely. And I think that’s just a beautiful story, Gary, because we have a very robust finance team at Providence Saint Joseph Health and we actually have about $1.3 billion in charity care and un-reimbursed Medicaid. That’s a lot of relationship opportunities. I constantly remind us that finance people aren’t always the hard… that was just their skill set. And that having them a part of the conversation about the mission and with the sisters, I found them to absolutely embrace, and I’ve often heard our finance leaders use those words as well. And you actually see the stress diminished on their face when they have the opportunity to lean into that why. And I’ve experienced that over and over.

I have a full team within finance that is helping me create proactive solutions to address so much of our communities and being thoughtful, creative and innovative in that space. So I think that’s just a beautiful story and I think that we can replicate that from around the country, around the country because I don’t think we can stereotype our finance people, or MBA’s, many people that go into this work have that skill set because they want to serve better. I think that we just need to expand that opportunity to more and more people.

Gunderson: We’re going to be, over the next year or so, probably having this kind of conversation with 50, 60, 80, maybe 100 people who we’ll be learning all sorts of amazing things from. When you look outside of Providence, outside of your immediate networks, where does your curiosity lead you in the country? It might even be outside of healthcare? Who’s would be talking to?

Barilla: We see so much polarization in our country. I think talking to our local communities.

There’s been a lot of conversation about health reform and the affordable care act, and I think it’s been such the wrong conversation in terms of what we want in our communities. And so I guess my curiosity is. I think everyone agrees that our traditional healthcare models aren’t serving everyone well. So I guess my curiosity would be, if we are going to deconstruct our current healthcare system, who are our partners? How can some of those nontraditional partners be a part of the solution and the conversation rather than polarization? Where are the coffee shops in America that are going to bring life to our solutions and communities versus the emergency departments or the acute care hospitals that we have relied on in the past?

Gunderson: You almost hit point by point when we thought about driving across the country and beyond the audacity of it and sort of mind numbing distance, when someone said, “So, what are you actually trying to learn? What are you looking for? What is the lens you’re looking for?” You almost clicked on all four of them.

The first thing I want to know is communities that are acting as their own healer. And I’m thinking especially all this amazing number of roles that are being invented of peers and community health workers and all these liaison roles, these sort of subclinical or para-clinical roles in which the community is learning how to be part of its own healing. Second, how communities that are finding ways to build serious collaborations across the lines that seem impossible to cross. But when you go to a real community, you find people creating collaborative networks that you would never imagine would be possible if you watch TV. The third thing is where is the spirit? Where is what I call the communities of spirit? Where are the people of faith, where faith is empowering them to actually be part of healing in amid conflict, not create more conflict. And very last is what’s the radical new positive framework for our work? And I think about leading causes of life as that. But you can see in healthcare right now just a hunger for some more powerful, integrative idea than the diseases with which we can build business models. And so those four things, I think, boy, I heard them in all your comments there.

Barilla: I couldn’t agree more, Gary, obviously. But I think as we look for health for a better world and some optimism that it’s changing our mental model and I just so thank you for looking for the prosperity and abundance versus the deficit because I think we need to be reminded as a country that there is so much goodness. And if we could… the old story of whichever wolf you feed grows. And I think it’s about time we start feeding the goodness in our communities. So, thank you for that great work that you’re doing in your road trip.

Gunderson: Well, I think you and I both have day jobs we’re supposed to go back to them and do the work you’re describing. So, we’ll bring this to a close. But I’m so excited. And you know, it dawns on me, we ought to talk to each other in this kind of an interview, maybe every month or so and see what we’re learning as we the podcasts and as other people come to visibility that we have these conversations with. So let’s just plan on talking to each other in this format again in a month and see what comes out.

Barilla: That’s a great idea. So we can continue to share with each other the wisdom from some of the great people around the country that are doing this great work.

Gunderson: Thanks, Dora.

Barilla: Well, thank you, Gary. Have a great one, take care.