Background and Study Methodology

Background

For decades mission agencies and developing country churches have been struggling with the question of the future of their hospitals. Some have been more successful than others in creating satisfactory solutions; however, there is very little information being shared about how they are coping with the problem. 

There is a need to know which successes and failures have occurred and what are the lessons learned that others can apply. Most importantly, there is a need to develop a vision for the future for what today we know as Christian hospitals. Some of the key questions that Christian hospitals face are the following:
 

What is the role of the Christian hospital in improving the health status of the people it serves?

What is the role of the hospital in the ministry of the local church?

What institutional structures are appropriate for today and the near future?

What should be sustained, what can be sustained, and by whom?

Christian Connections for International Health (CCIH) has taken on the task of addressing these questions by organizing a research and consultation process for the purpose of providing mission agencies and churches with tools that can help them make productive and appropriate decisions about the future of their hospitals. 

A number of studies have been done by, for example, the World Council of Churches (Sustainability of Church Hospitals in Developing Countries, A Search for Criteria for Success, by Rexford Kofi Oduro Asante), Emmanuel Hospital Association, India and the Philippine Christian Health Association, that summarize problems and make recommendations for improving hospital management. CCIH did not intend to replicate these studies; rather, it decided to build on these studies and analyze the underlying issues that have precipitated the closing of hundreds of hospitals in the last decade. 

CCIH facilitated a process for addressing these problems by bringing together people who are at the forefront of setting the direction for Christian hospitals. CCIH engaged a group of leaders in dialog and analysis over a period of six months, culminating in a pre-conference symposium on June 13-17 prior to the annual conference of the Global Health Council.

Study Methodology

The research process began with a questionnaire that was sent by email to leaders and administrators who are at the forefront of setting the direction of Christian hospitals in Africa, Asia, the Pacific Rim and Latin America. The questionnaire addressed problems related to the following issues:

 a) the roles of local and expatriate people and agencies involved in hospital ministry;

 b) relationships with the local Church and Christian witness;

 c) organization structure and management of the hospital;

 d) finances;

 e) conditions in the physical environment, the social and cultural context, and the political environment;

 f) impact on the overall health of the people served by the hospital.

A convenience sampling technique was used for distributing the questionnaire, since no centralized database exists of Christian hospitals around the world. The mailing list for the questionnaire was created by obtaining addresses from CCIH members and from the broader network of relationships that members have in the Christian mission arena. CCIH intended to use email addresses as much as possible, and one interesting finding was the extent to which people are connected by this technology. After some trial and error, over 95% of the questionnaires were distributed by email. A total of 80 questionnaires were sent; of these, 42 were completed and returned. 

The data from the questionnaire were analyzed by using a content analysis technique. The responses to each question in the questionnaire were grouped into categories by two researchers. Each person had to agree to the groupings. These groupings were given labels that represented major problem categories under each question. The questions and their respective categories of problems were put in a document that was synthesized by an expert panel.

Following this first level of analysis, the CCIH Board of Directors selected a panel of fifteen leaders from around the world (see page 2) to serve as an expert panel to analyze, synthesize, and evaluate the data obtained from the questionnaires. The four tasks of this group were to: 

• group responses to questionnaires into major problem areas;
• identify guiding principles to address the problem areas;
• clarify assumptions about the foundation of Christian hospitals; and
• generate new ideas for addressing some of the major problems.

The core research group met in Washington, DC, June 12-14, 2000. The second day consisted of an open symposium of information sharing and brainstorming on the future of Christian hospitals that included nearly 50 participants. The panel members presented the work they had completed and received input from the symposium participants. The President of the Global Health Council also addressed this session.