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"The normal way that hospitals think about congregations is as a venue in which to do health education," says Gunderson. "We love it when that happens. We are actually building pathways so people can navigate their way into and out of the healthcare system. That is what is totally novel about this idea--having congregations as part of the system." Gunderson emphasized to the pastors that the program involves real work. "I personally did not see this as a mission project in the sense that we are merely being nice to them."

The budget for the network is approximately $500,000, and part of what the pastors receive is up to a 60 percent discount on healthcare charges--the same benefit already extended to United Methodist clergy. In the first six months of the program, 103 congregations of a variety of faiths signed the covenant, with the ultimate goal of reaching some 400 congregations in a city of approximately 2,000 churches. Methodist is also building a data network to track outcomes, including a line on the system's electronic medical record system to keep track by a patient's congregation.

It is too early to tell whether the churchgoing public is buying into the notion that the front door of the hospital can be found on Sunday at church, but Shorb feels confident in the plan that they eventually will.

"Most of the public views large health systems, even though they have a Baptist or Methodist name on them, as almost secular, as big businesses. We'll take some credit for ending up in that position. But we want to be very intentional about the fact that we'd like to change that."

Leading the mission

Beyond the need to reach into the congregations themselves, many faith-based systems are also faced with another group to "ground" in the mission: the hospital system's leadership. In many faith-based nonprofit systems, there are still requirements for the number of board members who must come from supporting congregations. But often, the work of making sure that the system matches its mission is left up to the CEO and senior leadership team.

In an era when CEO compensation and performance are continually evaluated on metrics, some faith-based systems have discovered that the hardest part to measure is adherence to the mission. St. Louis-based SSM Health Care, a Catholic system of 20 hospitals in four states sponsored by the Franciscan Sisters of Mary, has developed specific leadership training for lay leaders to understand the heritage and mission of SSM, says Michael Panicola, PhD, vice president for ethics at SSM. The training has taken on a new dynamic in recent years as SSM--like many other Catholic systems nationwide--has seen the number of sisters involved in leadership decline.

"Sisters are steeped in a tradition that saw healthcare as a basic good," Panicola says. "Viewing healthcare as a ministry was intuitive to them. Making decisions that benefited the community was intuitive to them. It was not driven purely by financial concerns. So we need to be more intentional in training our lay leaders, with our focus on the top to middle, and hope it will trickle down to others."