Living Stones Call for Living Mortar
My neighbor Claudina’s garage is one of the older buildings in my neighborhood in Jellico, Tennessee. A ramshackle structure made of red boards, it sits on the hilly land common in this area. Its foundation looks like a jumble of stones and mortar, but it must be pretty well-constructed since her garage has withstood the stresses of weather and use for a long time.
The stones and mortar such as those in Claudina’s foundation hold little significance for most of us. We take these common building materials for granted unless, of course, we are stonemasons or we happen upon a structure that is crumbling. Thinking about stones and mortar may seem a little like becoming preoccupied with the electrons that make e-mail possible.
Like buildings constructed of stones and mortar, ministries that serve the poor usually comprise a number of committed persons with a passion for service. The cohesive effort of many individuals working together towards a common goal is critical to the organization’s mission and health.
The apostle Peter uses Old Testament passages to make concrete what it means to work together in the ministries of the Kingdom of God. Consider 1 Peter 2:4 (English Standard Version) and note the concepts familiar to those in the building trades:
As you come to him, a living stone rejected by men but in the sight of God chosen and precious, you yourselves like living stones are being built up as a spiritual house, to be a holy priesthood, to offér spiritual sacrifices acceptable to God through Christ jesus. For it stands in Scripture:
Behold, I am laying in Zion a stone, a cornerstone chosen and precious, and Whoever believes in him will not be put to shame (Isaiah 28:16).
So the honor is for you who believe, but for those who do not believe, the stone that the builders rejected has become the cornerstone (Psalm 118:22), and,
A stone of stumbling, and rock of offense. (Isaiah 8:14)
They stumble because they disobey the word as they were destined to do. But you are a chosen race, a royal priesthood, a holy nation, a people for his own possession, that you may proclaim the excellencies of him who called you out of darkness into his marvelous light [emphasis mine].
Although this letter of Peter is addressed to churches in Asia Minor, the concepts in this passage could also be addressed to Christian ministries. To grasp the relevance of the concepts, let’s together think more about stones and strUctures and the mortar that holds them together.
STONES AND MORTAR
If Peter ever watched builders construct a house, he would have seen them begin by laying out the rough dimensions of the home. The builders would have devoted great care to choosing and laying the cornerstone, both the first stone laid and the benchmark for all future measurements. The builders would have then chosen from a pile of sun-baked bricks or irregularly shaped field stones to construct the walls. Mortar, initially the consistency of thick oatmeal, would be spread on the - sides of the stones as they were being fitted into the structure.
The image of stones and mortar aptly describes Christian ministries, especially those that serve the poor. Although some ministries are made up of those with a similar mission and goals who readily unite around ministry (like the uniform brick wall), most are made up of diverse individuals who vary significantly in their approach to mission, goals, theology, and work; thus, they resemble the image of dissimilar stones joined together to form a Functional and pleasing structure. How can we be conjoined in a way that strikes that crucial balance that allows for freedom and unity, solidity and flexibility?
The function of mortar is actually more complex than meets the eye. When a wall is built of similar stones, such as today’s brick, mortar is necessary, but the demands made on it are not as great since the stones are perfectly consistent in shape and size. But when stones vary widely in shape and size, properly constituted mortar becomes vitally important. It allows irregular stones to be laid next to and on top of each other, fills in the spaces and, when dry, forms each wall into a unified, stable structure. Mortar, when dry, also permits walls to flex in response to shifting and settling after the building is completed. In fact, if the mortar is too rigid or hard, walls will crack and crumble. Mortar must strike a balance between not being too rigid or hard on the one hand, and not being too soft and flexible on the other.
The image of stones and mortar aptly describes Christian ministries, especially those that serve the poor. Although some ministries are made up of those with a similar mission and goals who readily united around ministry (like the uniform brick wall), most are made up of diverse individuals who vary significantly in their approach to mission, goals, theology, and work; thus, they resemble the image of dissimilar stones joined together to form a functional and pleasing structure. How can we be conjoined in a way that strikes that crucial balance that allows for freedom and unity, solidity and flexibility?
Dayspring Family Health Center in Jellico, Tennessee (the ministry for which I work), exemplifies the diversity of dissimilar stones. Although the similarities of the health care providers might initially seem most obvious, the dissimilarities quickly become apparent. We present very different faith backgrounds. Some of us came with a good deal of practice experience while some are in their first post-residency practice. Some came to Jellico expressly to be among and serve the poor; others came to serve out a National Health Service Corp commitment. Several physicians arrived as long-time CCHF members, while others learned of CCHF after their arrival here. While some came expecting to work long hours, others came planning to work shorter hours. Some seek leadership roles; others prefer to leave leadership to others. Personality differences are also significant.
Such dissimilarities make Dayspring the norm rather than the exception. Most community health centers and most Christian ministries that serve thepoor are not made up of similar bricks; instead the structure is made up of stones that vary widely in shape and size. Dissimilarities can be grating, or they can be a cause of celebration (and at times they are both). Bringing dissimilar people together requires persistence, hard work, strong leadership, and God’s grace. In fact, consider this continuum of experiencing and acting on dissimilarity or diversity:
Rejection ↔ Resignation ↔ Tolerance
Acceptance ↔ Celebration
Although much more can be said about working together as dissimilar individuals, paying attention to what brings us together and what holds us together is critical.
THE CENTRAL QUESTION
This question then becomes central: What kind of mortar holds these stones together? Furthermore, how do stones of widely varying shape and size form a strong and unified structure, and how can the wall flex in response to the various stresses that challenge its integrity? Finally, how can the structure be aesthetically pleasing to those on the outside?
Some situations suggest that leaders of Christian ministries struggled in their task as masons and builders:
1. Employed physicians and mid-level practitioners stay for two to four years and then move
2. Members of a ministry work side by side but engage in little spiritual conversation.
3. Professional staff and local staff do not socialize outside of work.
4. Conflicts exist between various members and groups within the organization.
5. A mission or ministry statement gathers dust in the CEO’s file cabinet.
6. Most significantly, members of the ministry fail to work in a unified way towards its mission or goals.
Dayspring’s twenty-year-plus history as a community health center includes examples of each of the above.
A ministry that serves the poor is best served if its leaders intentionally, consistently, creatively, and actively build a strong sense of shared purpose, work, standards, and life. This is the vital mortar of the organization.
How can living stones and the mortar of a ministry be gathered, laid, and maintained in such a way that its structure is strong, cohesive, and able to sustain the stresses that threaten it? And how can the edifice be beautiful? Four considerations are central. They are:
1. Purpose and design — the effort of the architect and others;
2. Building well — the work of the engineer;
3. Shared decision-making — the commitment of the builders;
4. Conversing together — the challenge of the workers.
1. PURPOSE AND DESIGN
Discussions around purpose and design take place at beginnings. In building a solid, functional, and pleasing structure, architects must clearly understand both the intent and the limitations of the project. These discussions will center on the intended use of the building as well as limitations imposed by site, costs, materials, and aesthetics. However, once the structure is built, discussions of purpose and design should continue. Changes in the planned use of the building, damage to the structure, alterations, or renovations all occasion additional discussions around purpose and design.
Likewise, in building ministries an obvious beginning occurs as the mission of the ministry is being conceived. However, ongoing discussions around purpose and design should continue to take place as the ministry grows and changes. About eight years ago, and after a twenty-one-year history as a community health center, the leadership atDayspring facilitated an extended dialogue around its mission and goals. Staff members actively participated in these discussions of purpose and design. Two years later, members of the professional staff and leadership wrote a ministry statement. Both these efforts took place long after Dayspring was already functioning. Nevertheless, they served as a vital mortaring together of Dayspring’s living
Consideration of purpose and design also takes place at other times in the life of a ministry. All phases of staff recruitment necessitate such discussions if the ministry is to truly have the potential for a unified organization. Such beginning discussions do not ensure unity but in their absence, unity is unlikely.
One member of Dayspring’s leadership team, Doug Brown, holds a vital role in facilitating purpose and design discussions. These dialogues take place both in groups and as individuals. For example, Wednesday morning at 7 A.M. may seem like an unlikely time for discussions of purpose and design. However, members of Dayspring’s staff have committed themselves to a weekly meeting at this time for, among other things, holding ourselves accountable for understanding and acting out the goals of this ministry. These discussions have centered on our mission or ministry statement at times, allowing us to revisit, refine, and redefine concepts in these important documents. Doug also invites members of the professional staff to meet regularly with him for the same purpose.
Purpose and design discussions are a vital part of the active mortar that holds Dayspring’s living and dissimilar stones together. They permit us to both meet the challenges of and celebrate our diversity. If such ongoing dialogue did not occur, the structure and function of Dayspring would be threatened. To the extent that it does take place, it feeds the sense that we are an important part of a structure that is bigger and more vital than any one of us.
2. BUILDING WELL
How long a structure lasts is a silent tribute to the standards with which it was built. My brother, who is an engineer, tells me that to be certain that they endure, engineered structures in the United States may be built three or four times stronger than anticipated stress demands. Engineers impose high standards on the design and construction of a structure-an approach that builders of ministries would do well to emulate. Obviously well-built and beautiful buildings bring credit to the engineers that designed them. Although an engineer does not lay the stones and mortar, his or her planning allows the structure to hold up under the stresses that threaten it.
Just as the composition and application of the mortar around stones must be carefully planned and executed, so staff that serve the poor require high standards in all areas of the health care ministry’s life to permit individuals to work together in a way that both broadly prospers and endures. If we health professionals are Christ-like in our demeanor and actions but cannot be respected for our standard of care, we do a disservice to both our ministry and to those we serve.
Upholding high standards requires ongoing commitment and hard work on the part of many, but especially among the leaders of an organization. Holding to a high degree of integrity and professionalism can bind members of a ministry together. Discussions regarding professional standards build a strong group ethic within an organization as consensus is achieved. Often we are scarcely aware of our colleagues’ practice styles and standards. As our awareness increases, we become able to achieve some degree of unity. Given that many have strong opinions regarding standards, some of these discussions may be difficult, but they can bring a professional staff together.
Dayspring engages in a number of activities and disciplines that hold us accountable to high professional and personal standards:
1. We meet once a month to critique our hospital-based obstetric care. Since we are the only OB practice at our hospital, this rigorous peer review activity takes place among the members of our group only. Although these discussions can be stressful to the ones under scrutiny, they build a level of comfort in engaging in conversations that hold us accountable no small thing in a profession as egocentric as medicine.
2. Our monthly professional staff meeting covers a number of discussions and presentations that center on agreed-upon standards and improving our performance in those areas. A monthly agenda item is, in fact, performance improvement.
3. We perform periodic surveys of office and hospital nurses, asking if Dayspring physicians are serving in a way that is consistent withboth high professional standards and our mission statement [see p. 11] that commits us to being “fair and gentle”. Naturally, we share these results with members of our medical staff.
4. Dayspring offers a two-month sabbatical to members of the professional staff who have served for at least five years. The objectives of this generous benefit are to provide respite to hard-working physicians and leaders as well as to provide opportunity for the staff member to serve Dayspring along different lines than his or her usual role. This respite acknowledges that we can burn out, and it allows hard-working professionals to persist in serving with the highest standards.
The mortar of extraordinary professional standards can provide both protection and respect from those outside the ministry. Like most other health care entities, Dayspring is held to certain standards from outside agencies such as the Bureau of Primary Health Care, Joint Commission on Accreditation of Health Care Organizations (JCAHO), third-party payers, and other health care agencies. Excellent performance against the standards of these groups allows us to continue to serve our community. In fact, as others become aware of our standards and performance, we win their respect.
3. SHARED DECISION MAKING
House, a book by Tracy Kidder, traces the conception and execution of a house plan. The book describes several heroes, one of which is The Apple Corps, the firm that actually builds the house. This four-member team assigns a leader to the job, but they also function as a micro-democracy in working to solve all the myriad of complex issues that accompany the construction of a house. They build a strong and beautiful house.
How a ministry makes decisions is critical to its health and unity. Decision-making can serve a vital mortaring function, or it can do just the opposite, causing the structure of the ministry to fail. Again, the issue of similar versus dissimilar stones comes up. Unique and strong-minded individuals - living and dissimilar stones - almost always wish to be included in making significant decisions. That might not be true were we more alike, but the fact that We are dissimilar stones makes this critically important.
Dayspring has adopted a decision-making environment that probably reflects a private-practice partnership more than it does a traditional community health center. Dayspring’s CEO pledges that all significant decisions receive input from each member of the professional staff. This obviously involves a good of effort and commitment on the part of leadership and professional staff. It does not lend itself to time efficiency (the downside), but it does promote unity and a sense of shared purpose.
Dayspring might appropriately be famous for its marathon professional staff meetings. A typical, monthly meeting starts around 6 PM. and ends sometime after midnight. Although we cover many regular agenda items, the reason that the meetings take such a long time is, among otherfactors, that we all desire to speak our minds on important subjects. The goal of the meetings is to allow Dayspring professional staff to work in unity by sharing information and striving for consensus. Although we all take pleasure in an occasional cancelled professional staff meeting, we would all become discontented if we could not participate in this vital function.
One outcome of a shared decision process is Dayspring’s policy of paying all physicians an equal salary regardless of position or length of service. Dialogue around that stance has been extensive and has taken place on a number of different occasions over several years. that decision has encouraged a sense of equality that builds each Dayspring professional staff member’s sense of being valued.
E-mail dialogues constitute another means by which we share opinions and decisions. Members of Dayspring’s leadership as well as any member of the professional staff (doctors and midlevel practitioners) can request input from other professional staff members. All of us check our e-mail throughout the day. Responding to queries is simple and natural.
In a building, mortar holds the individual parts of the structure together in a cohesive whole. Shared decision-making does the same.
The complex work of building demands a commitment to communicating with other team members. As the diversity of team members increases, so must the frequency with which conversations take place. Even simple tasks require agreement on purpose, design, pace, limits, and resources. Thorny tasks demand more.
To converse is to be human. Conversation are as much a part of us as leaves or needles are of life together. Not all conversations are pleasurable, although many are. Some difficult conversations require commitment and courage.
“It’s been weeks since I’ve spoken with her.” Sadly, such words in reference to a colleague are too common among busy, committed, well-intentioned health professionals or leaders in ministries that serve the poor. Certainly it is true that without a vision, the people perish - but it is also true that without conversations, a ministry languishes. One goal of an organization’s leadership should be to encourage and facilitate dialogue. This is most true for faith-based ministries where one’s motivationfor serving extends deeper than self-interest and where one’s faith heritage can affect many aspects of work.
At Dayspring, we have not always understood the importance of conversations. The past ten years, however, have witnessed an increasing commitment to significant conversations with each other. This still requires an intentional commitment on our part, but we have been abundantly rewarded for increasing our opportunities for dialogue together.
Many of our conversations are planned, and some of these have already been mentioned above. The following are worth reinforcing:
1. For many, meetings are the crabgrass in the lawn of life (not my original quote). Nonetheless, our Wednesday morning meetings have been a rich source of growth together. These dialogues have mortared us into the type of structure described in 1 Peter 2: “like living stones [that] are being built up as a spiritual house.” Although we discuss issues related to purpose and design as noted above, our more common topic of discussion has been our life together, specifically our spiritual life together. We have tried a number of means to facilitate that conversation, but gathering weekly is vital since conversing with each other is rarely an efficient process.
One of the most challenging dialogues in which we have engaged has been around the assumptions of our diverse faith traditions. Our ministry statement commits us to respecting each other’s faith. We had found that, even in the exam room, many of us acted in certain prescribed ways related to the spiritual heritage in which we were raised. This caused misunderstanding among our group that required an extended conversation to better understand.
We find that conversations often occur very naturally when we meet together in this way. However, over the years we also have utilized a variety of dialogue aids to help us begin talking. They have included articles from Health & Development, selections from Richard Foster’s Devotional Classics, 21 book by Henri Nouwen, and others. Most of us participate in these dialogues most of the time and, when a staff member has been unable or unwilling to participate, that has made the challenge of serving together greater.
2. Many cultures understand the power and place of stories much better than we do. Dayspring , stories acknowledge this importance. We begin each of our professional staff meetings with prayer, and then we offer a chance for each person present to share a story. The tale shared may shine a positive or negative light on our work at Dayspring. It may tell of a success or a failure. Some stories are confession; others are praise. We try to create an environment that is accepting and comfortable for the participants. Some of the narratives shared have become “classics,” stories that have become defining for us and that are offered to illustrate our values or our character as an organization.
3. One final conversation opportunity also takes place weekly. All of the families who make the Dayspring professional staff as well as other community families are offered opportunity to meet together for an evening of Bible study, prayer, and fellowship. This encourages our spouses and children to be part of our conversation, as well as involving other membars of the larger community.
Conversations serve as a vital mortar for individuals at Dayspring. The mortar we utilize at Dayspring may not be right for the living stones in every ministry. Regardless, mortaring disciplines and activities are a crucial need for each organization that lives out the gospel through health care among the poor. Investing resources in bringing staff together under a shared sense of ministry will lead to a rich reward.
David Bosscher, MD, works and lives in East Tennessee. Dave has grown in many ways through his long-term connection with CCHF. He is married, has two grown children, and equally enjoys both playing the piano and riding his mountain bike. He can be contacted at daveboss [at] hotmail [dot] com