...are the ones that make the biggest difference



These articles are a few days old, but they caught my eye and, in large part, are confirming what I'm currently experiencing at work. The first article reports on a study that finds non-profit healthcare providers consistently outpeform their for-profit counterparts.

Authors writing in the journal Health Affairs found that a systematic analysis of 162 studies of nonprofit versus for-profit health care providers supports the concept that a facility's ownership status makes a difference in outcomes and in the cost of health care....the analysis found a pattern of differences between nonprofits and for-profits in cost, quality and accessibility...In what they called the biggest review of the literature to date, authors reported that eight studies found nonprofit hospitals have lower mortality rates, versus one study finding for-profits have lower rates of death.

There are many factors that enter into the relative quality or "success" (a difficult to define term in medicine) of healthcare, but a huge factor is the morale of the direct care providers and their ability to effectively do their jobs. Which is why the second article, which discusses a lawsuit filed by the countries largest nurses union against some of the bigger hospital chains for intentionally colluding to depress wages, is so troubling. Even though the nursing shortage has increased over the last decade "....[w]age increases for nurses have been insignificant during the decade-long shortage, experts said. Wages stagnated in 2003 and then fell 6.4 percent in 2004, leading to a decline in nurses working at hospitals..." Which is unfortunate, because that is precisely where the patients who need the hightest quality of care actually are.

Which brings me to my current employment situation. Our clinical director (basically the head nurse) and corporate director both recently quit at the same time. We currently have 2 interim people from other hospitals filling those roles who are, to say the least, corporate lap-dogs. They have instituted a variety of changes, including pressuring our clinical educator to leave by cutting back on his hours, cutting back on staffing (the cause of my being downstaffed each of the last 3 Fridays) and trying to push down costs on needed patient-care equipment. As an example of the last, we have a patient that needs a specialty bed & mattress due to some very aggravated wounds on his hips, lower back and butt, but since this rental is very expensive they wanted to discontinue the bed even though lower cost beds were not helping him. The staffing cuts, however, have been worse. Most of our patients are coming directly out of the ICU and have a high acuity level, which basically means they are in pretty bad shape - lots of meds, lots of labs to be drawn, IV's, vents, you name it. Our nurses normally handle 3-4 patients, 5 in those instances where the patients are in good shape (ICU nurses generally only handle 2). Now, regardless of their acuity level, corporate has mandated each nurse will carry 5 patients. This makes the nursing staff much, much busier, means there are fewer nurses on the floor to help each other with difficult procedures or to watch patients during a break, and greatly increases the stress level of everyone on the floor. Morale is down, people calling-in for work is up, and for me personally, I'm being run ragged most days of the week - and what I do doesn't have the potential to kill anyone.

So connecting the dots between the quality level provided by for-profits versus non-profits isn't hard to do. Where cost is the prime concern, neither patients nor the staff can be. The staff is too busy to provide high quality care though they'd like to and are more likely to make mistakes or miss something important in a patient's status. A humanitarian endeavor like medicine can be very poorly served by becoming a business.

What makes a Protestant Protestant?

Via an email exchange with a Lutheran blogger (I haven't asked if its ok to quote him, so I won't link his blog), he made the rather startling comment that he does not consider Lutheranism to be Protestant. Rather, he considered it be a "kind of Catholic." I heard a similar point on a Lutheran radio show while the host was *reviewing a taped testimony of a Lutheran convert to Orthodoxy. He took issue with the convert lumping Lutherans in with Protestants and later described Lutherans as "evangelical catholics" and "a confessing movement within the church catholic". He explained those statements like this: "we hold to the 3 ecumenical creeds, to the confessions, to the fathers, to everything that has been taught since the very beginning - that's catholic. The centrality of Christ's atoning sacrifice - that's evangelical."

Which, of course, makes me wonder - what makes a Protestant Protestant? How is that really defined? There is obviously the element of protesting-against or dissenting-from that is necessarily a part of the definition. But that doesn't fully encapsulate the movement, either, because there are a great many Protestant bodies that are positively for something and not just against the Catholic church. Is Protestantism defined more as a set of beliefs in and of themselves? Or is it more accurately defined in relation to (or opposition to) some other Christian entity? The latter clearly seems to have been much more accurate during the early years of the Reformation, although it must be granted that the Reformers did not just see themselves acting against the abuses of the Catholic Church, but as searchers after the original faith (their success is arguable, obviously). But now that many groups seem either to not care much about Catholicism one way or the other, and other groups are actively engaging the Church for areas of commonality with an eye to potential unity, the latter definition doesn't seem to apply.

Its an interesting claim, and one I will have to think much more about.

*If you're interested, it was the June 6th program during the 2nd hour. He addresses the convert's story at about 38:00, and speaks more about Lutheranism as catholic around 51:00+.


The trouble with monergism

I spent a goodly part of this morning at Border's doing some reading on Lutheranism, or rather, on Luther and his beliefs, and I must say I found what I read a little difficult to understand and accept. It seems that Luther is a bit of a monergist. I say "a bit" because both analyses that I read (one from Pelikan's masterful 5-part history of the church, this one being the 4th volume on the Reformation, the other The Cambridge Companion to Martin Luther) seemed a bit muddled on this point. Some of the stuff he said was apparently quite monergist and others a tad synergistic even though he expressly denied any form of synergism. But he also expressly rejected the monergism of Calvinism (speaking of which, I've gotten into a bit of a debate with Troy on the matter). The doctrine FAQ on the Lutheran Church-Missouri Synod doesn't clear things up so well, either. Take this question and answer:

Q. Is it accurate to say that Lutherans believe that we are first given the ability to believe in Christ as Lord and Savior through the Holy Spirit and then it is our choice and responsibility to choose to believe in Christ, or am I off here?

A. Lutherans consistently and deliberately avoid using language of human "choice" when speaking of conversion, since we believe that faith is a gift of God created by the Holy Spirit through the Gospel, not a matter of human "choice" or "decision." From a human perspective, of course--especially in the case of adults or older children--conversion may at times appear to involve certain (mental and emotional) aspects of "choosing," but spiritually speaking faith is not a "choice" we make but a free gift of God's grace created by the power of the Holy Spirit working through the means of grace. Ultimately, therefore, conversion is a miracle and mystery that we confess in accordance with what the Scriptures teach and in which we rejoice, but which we do not claim fully to understand or attempt to explain in ways that "make sense" to human reason (e.g., the question why some who hear the Gospel believe and others do not).

But to another question the role of choice, this is part of the response:

All of this, of course, does not mean that when the Holy Spirit creates faith in our hearts we are not the ones who believe. On the contrary, Lutheran theologians have often spoken of faith as something that is "active" (fides activa) to emphasize that humans are active subjects in the believing. Paradoxically, then, faith is a purely passive act: God alone can give us the power to believe, while we are the ones who believe.

Thus, there is no contradiction between saying that we in our sinful, unregenerate condition cannot choose to believe, but that we can choose to reject God's grace.
(emphasis mine)

The last line of this section seems to contradict the last line of the above section in that it does seem to speak to the reason why some people hear the Gospel and yet disbelieve: they reject the gift of faith. But they (the LCMS) seem quite insistent on negating human choice while trying to maintain the capacity for it, at least in the sense that one may reject faith, at the same time. Like this:

Others answer this question by pointing to God's sovereign will: God himself predestines from eternity some to be saved and others to be damned. Lutherans reject this answer as unscriptural because according to the Bible God sincerely desires all to be saved and has predestined no one to damnation.

So how do Lutherans answer this question? The answer is that Lutherans do not try to answer it, because (we believe) the Bible itself does not provide an answer to this question that is comprehensible to human reason. Lutherans affirm, with Scripture, that whoever is saved is saved by God's grace alone, a grace so sure that it excludes all human "action" and "choice" but rather rests on the foundation of God's action in Christ and his "choice" (predestination) from before the beginning of time. Lutherans also affirm, with Scripture, that those who are damned are damned not by God's "choice" but on account of their own human sin and rebellion and unbelief. From a human perspective, there is no "rational" or "logical" way to put these two truths together. Lutherans believe and confess them not because they are "rational" and "logical," but because this is what we find taught in Scripture.

I'm certainly no critic of a good bit of mystery in our faith & theology - it was one of the things that drew me to Orthodoxy in the first place. I do not feel a constant need to define & clarify & dogmatize what can only be speculatively ascertained, particularly when in so doing we have to reject or severely modify passages of Scripture. For instance, 1 Tim 2:4 is pretty clear on God's desire for all men to be saved, yet Calvinists are forced to "clarify" the plain meaning of the text in order to maintain their double predestination, which is not explicit in the Bible. They dogmatize the uncertain due not to sound exegesis, but a value-laden eisegesis, carrying their nice-sounding ideas about God's sovereignty into the text. But this mystery, this uncertainty is troubling me. Maybe because its unfamiliar, maybe because it seems to be rejecting my personal experience and the experience of many of the Christians I know who all most certainly had a moment when they decided to repent, to acknowledge Jesus as Lord and throw themselves on His mercy. Maybe that was an illusion. Maybe it wasn't a positive choice, just the absence of a negative choice, ie, resistance to the faith the Spirit was quickening, but it sure didn't feel like it.

I still have more reading and study to do, but in the meantime, any and all are welcome to comment - I welcome the input and challenges as we sort through our choice of church home. But I especially welcome the input of any Lutherans reading this that may be able to better clarify their position for me.


Back in the fort...

Fort Wayne, that is. We spent a wonderful, sometimes tense, week leading up to my brother's wedding on Saturday afternoon in Iowa. And it really was a wonderful week, being with almost my entire family the whole time. A few more popped in on Friday, which made it even better. I got to spend a lot of time with my brother, which I am grateful for. We had a last minute change in the rehearsal dinner venue which ended up being a far, far better choice - excellent food and great atmosphere. The wedding itself went off beautifully. A bright, sunny day without being too warm. The men, including myself as the co-officiant, were all in formal kilts - which is the kilt and a tuxedo-ish jacket, vest, shirt and bowtie, along with a "sporran" (a kind of man-purse that is tied around the waist which I found to be an uncomfortably great and useful item), dress shoes and knee-socks with little bits of cloth at the top called "flashes." (You can find a good picture of this ensemble here.) The jackets got a little warm, but there was a nice breeze which kept up some good circulation, if you catch my drift. The ladies wore a very pretty black & white dress which had some embrodery work that kept up the Scottish theme. The bride was in an elegant white dress with detached arms that hung low - it was very Celtic princess-ish - and her processional music was played by a real, live bagpiper.

I was able to do a great deal more in the ceremony than I had anticipated, including pronouncing them husband and wife. I started choking up right from the beginning and had to fight it off pretty hard the whole time. This kind of got my brother going, which I think is pretty funny. My brother is a rather large, mean looking fellow who has in the past taken on 4 guys at once and beaten them handily. He would not strike you as the kind of guy who would cry, even at his own wedding, so I was pleased to show everyone what a softy he really is. My message, which I almost entirely scrapped and rewrote the morning of the wedding, got a lot of compliments and what's more, was what I really wanted to say to them. I hope some of it penetrated and may get them thinking a bit more about God and faith in the future.

We stayed out late after the wedding, didn't get enough sleep before the brunch and before getting on the road for the 8 hour drive back home, so I'm more or less exhausted today. I'm now going to go take a nap.