The Economy of Trust
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Maple City Health Care Center is not just a medical center; it’s a peace and justice organization, engaged in community development, whose entry point to the neighborhoods it serves is through health care. Many of the relationships and transactions involved are built on an “economy of trust”, the focus of this conversation with Dr. James Nelson Gingerich.
“Everything we’re doing is evolutionary — there is no model, and there is no fixed vision. It’s about being an envisioning community that grows together and is willing to take risks together for a common good. … We don’t create community — we can’t. But we do guard a space for it to happen. And we find that the one thing that we can always be assured of when we guard that space, is that something will surprise us.”
Introduction – A Foundation of Trust
“It was at every step of the way a kind of providential trust-building venture, and that built the spirit for the place to start with. We didn’t have a business plan with a balanced budget; we had a commitment to a community, and some relationships, and we kind of played with it to see what would happen.”
“The way I think about imagination is that it is always a manifestation of people having enough. The quickest killer of imagination is fear, and scarcity is at the heart of fear. And so part of working at fostering a community of imagination is fostering a community where there’s enough, and where people have that sense of there being enough.”
“The question came up, ‘So if people don’t have money, what do they have? What are the assets?’ And the obvious answer was ‘time’. … So within two weeks we had the More Than Money program, which was where people could volunteer anywhere in the community, and we would give them $10 per hour in credit on their health care center bill for their volunteer activity. And all of a sudden, we saw people coming back in for care who had been drifting away.”
A Collection of Stories
about Maple City Health Care Center
MCHCC has a Chief Storyteller responsible for harvesting, preserving, and sharing stories the stories that emerge from community work and interaction. These stories are woven throughout their website to illustrate their core values and practices. They are also cataloged here on the Goshen Guide to connect them to similar content that shares common ideas. Check out the collection prepared for this event to discover additional connections and stories.
“Story is how we remember who we are, and what we’re about. Then we don’t have to remember all the policies and procedures and everything we’re supposed to do all the time, because we can live out of our character as its shaped by that.”
“As we sat around this table eating this lovely, simple, Mexican feast, we suddenly realized that we were the guests and they were the hosts — and the tables had been turned, and the relationships transformed — and it changed everything. And it wasn’t because we had a program to do this, or a program to do that — it happened in the gaps; it happened in the space that was created in the midst of that by their initiative.”
“Trust isn’t about fixing things; trust is about being there.”
Trust-Based Community Development
“I don’t think there’s any human need that is much greater than the need to be needed — the need to have something to contribute to the human family — almost everybody wants wants to do that. … Whenever we face a situation that looks like scarcity, to my mind it’s a challenge to be more imaginative and look at that from a new perspective; and see there opportunity; and see there some gifts; see there some capacity for a different kind of engagement — a different economy.”
Circles of Care and Culture
“it was wonderful, because now all of a sudden people could only say one breath, and then you have to stop and hear it in the other language. And everything was said in Spanish was said in English for everybody; and everything that was said was said in Spanish for everybody. And pretty soon people were talking with much greater care and greater intentionality, and we were talking about all these wonderful cross cultural things that were going on.”
A Diverse Board
“I was writing a Grant application; there was a question on there that said ‘how is the diversity of your community reflected in the diversity of your board?’ [It wasn’t.] So we deliberately then used that as an opportunity to go back and look at where in our organization cross-cultural engagement was happening at its best, and we decided it was happening in the Pregnancy Circle. And so the question became ‘how do we reinvent our board in the image of a Pregnancy Circle?’”
“In organizations, we usually think that the first job of the board, the first job of the organization, or the administration — of everybody — is organizational survival, which is clinging to things because you’re afraid of dying. So organizationally, how do we die to the fear of organizational death? How do we move beyond that?”
“It’s an interchange between a model of care that fosters community and has great healthcare outcomes and great cost as side effects — and trying to be business smart about saying ‘so how do we leverage that for some outside investment?’”
From Bottom Line to Vision
“The hospital is fundamentally bottom line driven; we are fundamentally vision driven. And if I can keep the hospital persuaded that a healthy community is good for business, that we’re thinking about healthy community broadly and long-term, then we can maybe see an alignment between our approach and theirs; it’s not going to be the same, but we can see an alignment, so we can work together.”
Audience Q&A – Questions of Growth and Development
How do you envision Maple City Health Care Center continuing to grow?
Does Maple City have a geographic focus, and how has it influenced growth?
How has the Goshen City government played a role in your story over the years?
Why Goshen? What enabled MCHCC to take root here? Why aren’t there similar operations in more nearby communities?
“Now we’re constantly asked by people, ‘so how can we replicate your sliding fee? How do we replicate your model of team-based care? How do we replicate this? How do we replicate that? And I want to kind of say ‘you’re looking at the wrong stuff to replicate.’
I mean, there are ideas there — that are based in a philosophy of care and an approach to things — but what’s really critical here is that you start in a community, and you build relationships, and you build on the assets and passions of the people involved to address what’s going on in the community, and that that happens organismicly and grows with the community.”
Integrating Culture, Staff, and Community Health
“In terms of fostering healthy community, our primary work may not be in doing health care. In some ways, our primary work may be in what we do with our staff, and how we collect the staff and engage with the staff in ways that build a community of sufficiency and engagement and imagination where people really want to work together and work together well.”
Imagining Common Good Health Care in Goshen
“imagine, what would happen if we as a healthcare community (hospital, physicians, etc) said that in this community, no one will go without basic health care. We will make sure that we structure the provider community in such ways that everybody has a medical home that’s accessible and affordable.”
“I think [this work] is important to me because in some ways, this is where I am striving to experience the kingdom of God breaking into our world.”
A Health Care Home
A tale of two emergency cases, and an unexpected advocate
Additional Q&A recorded after the event
Sharing our Stories
“Table Fellowship is a powerful thing; and listening to each other stories is a powerful thing; and we find it touches the people on our board across all these things in a powerful way.”
How do you maintain a more level pay scale and still attract the doctors you need?
“There’s transformation that happens in these authentic engagements, and it happens in the cracks — and the cracks are what’s so valuable now.”
Does MCHCC represent an intersection of healthcare and restorative justice?
“What this is about is creating just social structures, and the healthcare stuff is just a manifestation of that. In many ways, I think the Gospel thing is ‘seek first the kingdom and all these things will be given unto you’ — and the healthcare is sort of part of what is given unto us if we seek first a healthy Community. … We are really working at trying to figure out ‘how do we create a model where marginalized peoples throughout our community are invited to sit at the head table?’”