NHS Visiting Jesuit Chair: ‘Bring Our Moral Tradition to Bear’ Through Imagining Improved Health Systems
(March 4, 2022) — Using the gift of imagination and leaning into our Jesuit values can help us identify and solve problems within the health care system, said Rev. Michael Rozier, SJ, the School of Nursing & Health Studies’ first Visiting Jesuit Chair in the Department of Health Systems Administration, at the Values Based Lecture, held via Zoom on Feb. 24.
“My hope is that we can imagine a system that reminds everyone who enters it that they are sacred, worthy of dignity, a system that brings us together around a common purpose, a system that widely uses the many gifts we have been entrusted with,” Rozier said. “This won’t happen easily, but we know it is possible.”
The Values Based Lecture was sponsored by the School of Nursing & Health Studies Committee on Mission and Values as part of the celebration of the Ignatian Year, commemorating 500 years since the founder of the Jesuits, St. Ignatius of Loyola, had his conversion experience.
“The school’s Values Based Lecture is a wonderful excuse to step back from the minutiae of our research, clinical work, practice, studies — all of which are important — and to reflect on why we as a Jesuit university are engaged in the health sciences and how we might bring our moral tradition to bear on this subject matter,” Rozier said.
‘A Mutually Reinforcing Relationship’ Between Values and Systems
Our values and our social systems, including the health care system, have a mutually reinforcing relationship, wherein our values shape the system and the system shapes our values, Rozier said. But the longer that a system remains in place, people become more likely to adopt the system’s values as their own.
“When we see some groups dying earlier than others, when we experience some people getting better care than others, the system begins to subtly shape our own values,” he said. “By being exposed to something over and over, many people begin to adopt the values of that system.”
For example, people in the U.S. are not entitled to primary health care, but they are guaranteed medical treatment when faced with a life-threatening situation. “This creates a tragic situation where someone who wants to get preventative care for their diabetes might not have access to regular checkups or insulin, but once their foot is ready to be amputated, we will provide access,” Rozier said.
“As a scholar, I’m concerned with the technical aspects of our health care system and the way we solve them,” he said. “But as a human being, and perhaps particularly as a Jesuit, I’m concerned about whether we’re cultivating our collective imagination to shape our systems in ways that truly reveal who we are and who we want to be.”
The Gift of Imagination
Historically, most health care providers had written off alcoholism as a moral failure, until a nurse with the Sisters of Charity in Ohio recognized it as a medical problem that could be treated, Rozier said, adding that there are similar examples in health care related to mental health, HIV and hospice care.
“I believe the reform of our health care system requires the cultivation of this imagination,” Rozier said. “Students and professionals who are, of course, proficient in the technical skills associated with their chosen fields, but also people who have the ability and desire to see the world in a new way.”
Before Moses could lead the Hebrew people out of Egypt and before Jesus was joined by the first disciples, they both had to imagine that their lives could be different, just as an engaged couple imagines what their life will be like after they’re married, Rozier explained.
“Ignatian imagination has a way of pulling us out of ourselves,” he said. “We entrust ourselves to the moment and allow God to invite us to consider ourselves and the world in a way that we might not be able to do on our own.”
Making a Virtuous Cycle
Electronic health records (EHR) are an example of a system that’s part of a mutually reinforcing relationship with values. Research on EHR found that Black patients are 2.5 times more likely than white patients to have negative descriptors, embedding bias and subtly influencing the patient’s future health care providers.
“But the great thing is that like any system, it doesn’t have to create a vicious cycle,” Rozier said. “We can imagine a virtuous cycle where the system makes us better versions of ourselves.”
An EHR system could be designed to include a pop-up prompt when a user types a negative descriptor into a patient’s notes that suggests a different word. Such a system would benefit patients by reducing the odds that they will face bias and help providers by drawing attention to their bias.
“As with all technology, we might ask, does the device define our values or do our values define the device?” Rozier said. “Too often, it’s the former. The systems define us more than we define them. But we can, if we allow ourselves to imagine it, a virtuous cycle.”
“Our health care system needs to be reimagined,” Rozier added. “The values it reinforces are too often not the values that we should hold most dear. But a different system is possible.”