Craig T. Kocher and Keith Kocher: How can the church learn from the emergency room?

Busy emergency room

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It might sound far-fetched to look for Christian leadership lessons in the emergency room, but two brothers -- one a university chaplain, the other a doctor -- find similarities in how to achieve excellence in both settings.

The metaphor of the church as hospital is a rich one, and the relationship between curing the body and caring for the soul lives in the anatomy of Christian tradition.

The medieval church birthed the first hospitals, and biblical scholars and theologians regularly liken the work of the Christian minister to that of a doctor, one who welcomes the sick, binds up the broken and soothes the suffering.

The Gospel writer Luke was trained as a physician, which may explain why the famous example of the Good Samaritan, who bandages and cares for the beaten and bloody man by the side of the Jericho road, appears in his Gospel and no other. Likewise, Luke’s medical training surely influenced his account of the early church as possessing healing power in the book of Acts.

And this connection continues to the present day. From our vantage points as a university chaplain and a medical researcher, we see how the hospital -- in particular, the emergency room -- can offer lessons to leaders of the church.

Keith was the lead investigator on a University of Michigan study that looked at differences in patient outcomes for those cared for in emergency rooms. The hypothesis: Those ERs that are exposed to higher volumes of patients and certain types of critical conditions show improvements in their patient care.

What the study found was that patients are less likely to die if hospitalized through busier emergency rooms. While that might seem counterintuitive (you might think that a slower ER would offer more benefits), researchers in fact found that busier ERs likely allow the entire team to develop more experience with any particular illness. That also can put in place the resources to more quickly and efficiently respond to particular types of time-critical illnesses, such as heart attacks, strokes, overwhelming infections and injuries. Key in this process is for the entire health care team to function with a consistent and coordinated approach. This type of coordinated emergency care requires experience, organization and repetition.

One of the major challenges (and thrills) Keith finds working in the ER is the rapid identification and sorting of the true emergencies from the lesser urgencies that require treatment but not immediate intervention.

For example, most patients with chest pain are not having a heart attack, yet they all need a speedy assessment. A small minority of those are experiencing a particular type of heart attack that could benefit immediately from clot-busting drugs or angioplasty. In those cases, the ER team has to manage the patient’s current condition while also seeking response from a separate health care team that may not even be at the same hospital.

Emergency room personnel need hard skills that are developed over time through experience and repetition, reflection and action, and organizational focus. It’s not far-fetched to see a parallel to the emphasis on the formation of Christian practices that has emerged in recent years as a means to talk about Christian leadership and personal discipleship.

Aristotle and other philosophers and theologians across the centuries have suggested that excellence of skill and character is the product of good habits. In the same way, Christians and the institutions they serve become more like Jesus by doing Christlike things in Christlike ways again and again.

We suggest that these research findings about excellence in health care point to three lessons for Christian leaders and their teams.

First, regular challenges are an opportunity for practice and improvement. Physicians and religious leaders alike encounter constant challenges, though in different forms. In the ER the difficulty may be the proper diagnosis of a potential heart attack, while in the Christian institution it may be the faithful handling of a conflict with staff, gaps between present realities and missional aspirations, or cultural trends that are destabilizing assumed patterns of ministry.

Institutional leaders would do well to assume that they will face repeated challenges -- and then welcome those challenges as part of an unfolding story of strengthening and progress. Hidden in each experience of disruption may be a medicine to improve the health of the organization.

Second, improvement happens through reflection and constructive action. Just as health care teams in effective emergency rooms gather to reflect on specific experiences and probe what might be done to improve processes and outcomes, so Christian leaders would do well to build in regular opportunities for personal and corporate reflection in response to challenges within the life of the institution.

Third, teams need to understand strengths and limitations. The research suggests that busier ERs deliver better care in certain circumstances, but that does not make them better in all circumstances. Patients will receive better care at different places depending on a patient’s particular needs and an institution’s distinct capacities. This insight speaks to the core of organizational mission.

No institution can be all things to all people. Leaders and their teams should regularly assess their fundamental purpose in light of their internal abilities, knowing that other institutions will serve other worthy aspirations.

One of the challenges Craig faced in his first year as chaplain at the University of Richmond dealt with the proper role of Christian worship in a largely secular university. The traditional 11 a.m. Sunday chapel service had languished.

Significant numbers of influential alumni and some faculty and staff assumed that Craig’s responsibility was to “fix” that service and re-create a grand mainline Protestant expression, complete with a lengthy choral procession, rumbling organ music and 800 students dressed in their Sunday best.

Other influential voices assumed that university-sanctioned Christian worship had no place in modern academia and voiced strong opposition to any suggestion to the contrary.

Craig’s response was to listen widely and move slowly, recognizing that the question at stake was less about Christian worship specifically and more about who and what the university chaplaincy would be in the midst of a historically Baptist school that now actively welcomes people of all religious backgrounds.

Eventually, Craig’s team started an understated Christian service that is generously orthodox in theology and gathers at the student-friendly and culturally insignificant time of 8 p.m. on Tuesdays, thus satisfying the desires of the first group while calming the anxieties of the second.

What felt like a crisis became an opportunity to reflect and take constructive action, grounded in a careful assessment of mission, strengths and limitations, allowing them to get better at who they were and move toward what they aspired to be as an organization.

Christian leaders and communities have much to learn from other institutions, especially those who share a common mission of bringing healing and wholeness to God’s people. The emergency room may be a helpful metaphor for Christian leaders and the institutions they serve.

Welcoming each challenging experience as an opportunity for improvement, developing healthy habits of reflection and action, and discerning strengths and limitations as a means of calibrating missional focus can help cultivate specific practices that lead to a more excellent way of serving the kingdom.