Values-based Decision-making Process
Catholic Health East
Colleagues across Catholic Health East (CHE) make daily, critical clinical and organizational decisions.
No matter how large or small the decision, each touches the core of who we are and what we are about. Whether
we are members of a board or management team, clinicians, or business office colleagues, we must strive to
ensure that the decisions we make are consistent with the Mission and Core Values of our organization. The
process described here is designed to assist us in this endeavor.
Why a process is necessary
All decisions should follow a consistent pattern that promotes the mission of CHE. CHE is a
transforming, healing presence for individuals and the communities it serves, and so a decision-making process
should produce choices that advance this healing ministry. This reflective process gives evidence that it is open
and guided by God’s spirit. Since this ministry is a collaborative effort among many different colleagues, the
institution needs a method of decision making that is reflective and supportive of its core mission. Sometimes
this process can be as a simple as evaluating how a decision sustains the Core Values. At other times the
decision-making process should be more formally structured, as, for example, when complex choices affect a
large internal and external community.
In addition to connecting choices to Mission and values, the use of a decision-making process promotes
other objectives. Decision making supports the value of participation, a core value of Catholic social teaching.
Participatory decision making shows reverence for human dignity by hearing those likely to be affected by a
decision. Decision making also relies on checks and balances to assure that many perspectives and insights will
enhance the quality of the decision made. Whether the process is formal or not, the pattern of reasoning serves
as both model and message to old and new members of the institution that CHE prizes thoughtfulness and
reflection.
Finally, and perhaps most importantly, healthcare decisions in the current business environment are
often viewed as simply industry decisions, but it is imperative to express they are much more than that. CHE is a
faith-based organization, guided by the Spirit to carry out the healing ministry of Jesus, a ministry embodied in
the Sponsors’ heritage. A prayerful and reflective process bears witness to the important goals we have been
called to promote and proclaim.
The Decision-Making Process
The model described here is a pattern for all decision making within CHE and should be used definitely
for large decisions that touch at the core of who we are and what we are about. Decisions that involve services
essential to our Mission and which affect a number of constituents, (e.g., patients, community, staff, and
Church) require a formalized process. The decision-making process should be used, for example, in decisions
regarding the opening or closing of a service line, financial planning, or changes in strategic direction. A pattern
of decision making should encompass three phases: (I) Preparation, (II) Decision making, and (III) Follow
through.
Phase I: Preparation
Before the decision-making phase begins, decision makers should estimate the complexity and
magnitude of the issue, as well as the size of the community to be affected to determine whether a formal
process is required and, if so, who should participate in it. In the current healthcare environment, the pressures
of time and resources can frequently force decision makers into rapid choices before there is adequate
consideration of the weight and complexity of the issue, thus precluding a process that would optimally provide
guidance. While not all decisions warrant a formal process, decision makers should consider that the greater the
impact an issue can create (on, for example, Mission and Core Values, constituents, strategic direction) the
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greater the need for a formalized decision-making process. The process can be applied with variety of
participants and management structures depending on the decision. For example, at times the process could be
utilized by an existing management team and at other times an ad hoc committee could be composed of those
whose expertise could contribute to the decision. When considering when a formalized process is warranted,
decision makers should consider the following variables:
 Number of persons/groups impacted (Does it affect a department or the institution?)
 Duration of the impact (Does the impact last a few years or the span of the ministry?)
 Depth or weight of impact (Does the question affect the entire ministry or a portion of it?)
 Closeness to Core Values (Does the question directly jeopardize a value?)
 Degree of complexity
 Past commitments (Does the question positively or negatively affect past commitments?)
 Relationship to strategic direction
Adequate preparation also requires consideration of the community of those who are concerned; first those
who can enhance the decision making; and second, those who will be affected by the decision. It is important to
distinguish whose voices need to be heard and who needs to participate in the decision. The identification of
representative perspectives does not mean that the decision process be conducted as a representative democracy,
but rather as a process that is inclusive of perspectives—for example of those who could be affected by the
decision or of those who bring a mission perspective. By acknowledging the community of those who are
concerned, decision making highlights the importance of participation and solidarity, two core values of the
Catholic social teaching. In other words, by promoting participation at the right level of involvement, the
process recognizes and respects the human dignity of all those affected and creates the solidarity that the
community values. In determining who should participate, the following questions should be considered:
 Based on the nature of the issue, what other individuals or groups need to be part of the process?
 What is the nature and frequency of the connection between the groups and the question?
 What departments will be affected?
 What departments might have insight?
 What other entities will be affected by the decision?
 Who would have insights to the Mission and tradition as it applies to this decision?
Phase II: Decision Making
The following decision-making steps focus and harness the complexity both of the issue and of the
community.
1. Pray, reflect, identify question, and clarify authority of decision-making group.
 Prayer and reflection are necessary because the group believes that it is God’s spirit that is guiding and
perfecting the many decision-making talents brought to the table. A spirit of prayerful reflection centers
the group on the fact that they are continuing the healing, transforming ministry of Jesus.
 Identification of the question is essential because each decision maker will perceive and state the
question differently. If the question is inaccurately identified at the outset of decision making, or not
agreed upon, then the ensuing process will be counterproductive.
 The decision-making group should be clear about its scope of authority. Do they have the ultimate
decision-making authority, or are they a consultative group that provides information to the ultimate
decision maker(s)?
2. Determine primary and secondary communities of concern and their interests.
 While there may be a large community of concern, not everyone in that community has the same
interests. The decision-making group should assess the manner and degree to which a sub-community
will be affected positively and/or negatively.
 The decision-making group should consider how those who are poor and vulnerable will be affected by
the decision.
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3. Pinpoint and gather needed information and data.
 What essential data have been gathered already?
 What essential data have yet to be gathered?
 Once data are gathered, does the group agree on its relevance, accuracy, and completeness?
4. Identify key moral commitments and values, as well as conflicts among them.
 Identify the question in terms of trade-offs between one or more values. For example, consider your
decision in terms of human dignity and identify the dignity trade-offs in the various options that you are
weighing.
 Identify the major consequences of this dignity trade-off in terms of individuals and groups; in terms of
long- and short-term burdens and benefits; or in terms of money, morale and relationships, etc.
5. Establish priorities among commitments and values.
 The moral commitments and values that deserve priority will flow from consideration of strategic
goals/objectives, core values, historical commitments, the broader religious tradition, and special
circumstances.
 List each priority and provide the rationale for why it is a priority.
6. Develop options that support the priorities.
 Identify options that promote the moral commitments and values deserving priority.
 Examine carefully the major options and evaluate the positive and negative consequences of these
options on the identified priorities.
 Consider not only the burdens and benefits of the preferred option but all of the options.
 Do any of the options preserve and protect a majority of the identified priorities?
7. In silence reflect and then listen to viewpoints.
 To ensure that the Spirit has guided the discussion and to promote the voice of any reservations or
opposition, a quiet time of reflection should be offered during which group members consider the
discussion in light of the faith tradition and personal conviction.
 Consider the following reflective questions:
o Have I listened to the facts and appreciated the viewpoints of others?
o Have I opened myself to the workings of the Spirit?
o Have I sought the good of the entire ministry and then the particular good of others?
 Has input been elicited from all decision makers?
8. Gain consensus on decision.
 Invite all members to express which option should be pursued and why. Discussion should be held until
every member has had an opportunity to voice an opinion.
 At the conclusion of the participatory decision making, estimate if a consensus exists, and if not,
identify the points of disagreement and allow for additional conversation for clarification.
 If a consensus is reached, identify the values that will suffer because of the choice. Discuss how to
mitigate the harms.
Phase III: Follow Through
Assign accountabilities to specific persons for each component to be realized.
 Build a plan for monitoring and reporting with measurable outcomes.
 Build a communication plan for community of concern with key messages and methods.
 Build a plan that connects to the larger meaning and purpose.
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Applying the Values-based Decision-Making Model:
The Case of Retirement benefits
St. Somewhere is deliberating about whether is should modify its retirement benefit, moving from a
traditional “defined benefit” to a “matching contributions plan.” Currently, St. Somewhere’s defined benefit
retirement plan allows employee contribution; however, only 27% of employees contribute and only 1 in 5
employees at St. Somewhere have enough retirement benefits to cover 50% of their retirement. Management
proposes the move for three reasons. First, many workers stay at St. Somewhere from 3 to 5 years and never
qualify for the pension plan. Management believes that providing the matching benefit will make the institution
more competitive with the other health institutions. Second, the Human Resource department believes that with
the new plan it will be able to move the number of employees contributing from 27% to 70%. Third, while the
institution will continue to fund the traditional defined benefit plan for those who are retired or soon to retire, it
will also contribute to the matching plan at the same rates as the traditional plan. Nonetheless the institution
will not bear the long-term financing of the matching plan as is required by traditional defined benefit plans.
Employees are uncertain whether the move will be just. How will St. Somewhere decide whether the
move to the new plan is defensible? The CEO has appointed an ad hoc group to advise management on its
deliberations.
Phase I: Preparation
As the ad hoc group applies the values-based decision making model to the insurance issue, the first task
will be to consider whether all the communities of interest (e.g., those who will be affected by the decision or
have insight into the decision) have their voice heard during deliberations. In order for them to conduct a
thorough analysis, the ad hoc group should be sufficiently aware of the concerns and perspectives of all those to
be affected by a change.
Phase II: Decision Making
1. Pray, reflect, identify question, and clarify authority of decision-making group.
 As the ad hoc group turns to the decision, they will need to remind themselves of their scope of
authority, which is as an advisory group to management.
 Next the ad hoc group will need to identify the possible moral questions. They might include:
o Should St. Somewhere move to a partnership model of provision of retirement benefits and
away from a parental view?
o What is the obligation of St. Somewhere for the long-term pension benefits of its employees?
o Is it morally defensible to move from a plan that currently places the long-term risk on St.
Somewhere to a plan that places the long-term risk on employees?
o What are the moral benefits and burdens for all parties by remaining with a defined benefit plan,
or by moving to a plan that includes matching contributions?
Ultimately, the ad hoc group will need to settle on one moral question, for example, the defensibility of
moving from a defined benefit plan to a matching contributions plan.
2. Determine primary and secondary communities of concern and their interests.
 The ad hoc group will need to stratify the community because employees might have different interests.
The ad hoc group will need to assess the manner and degree to which the different communities would
be affected positively and/or negatively. For example, those who are already retired with the defined
benefits would not be affected by a change in plans. Employees close to retirement might be uncertain
and nervous; however, they could be reassured that money already placed in the defined benefit will
remain untouched. Employees near to retirement might be given additional matched contributions
because of years of service. Employees who stay at the institution for 3 to 5 years would be better
served by earlier vesting and portability.
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
The ad hoc group also needs to consider how those who are poor and vulnerable will be affected by the
decision, especially employees who currently do not place money in the matching plan. One possible
alternative to remediate the structural problem could be to use a “presumed consent” policy for the
institution to contribute 2% of base salary, unless the employee refuses.
3. Pinpoint and gather needed information and data.
 Many facts are articulated in this case narrative. In addition, the ad hoc group should explore the longand short-term consequences of a change in plans. Currently, St. Somewhere funds the retirement
program at $3.2 million per year and that would remain the same under both plans. If St. Somewhere
continued only with the defined benefit plan, each year the institution would have to make up any
shortfall between financial investments and the cost of paying benefits.
 85% of employees are female and the job market trend indicates that a significant proportion of these
employees remain at the institution from 3 to 5 years.
 Under the current plan, 4 out of 5 employees do not have sufficient retirement savings to fund
retirement and they are not aware of this fact.
4. Identify key moral commitments and values, as well as conflicts among them.
 The ad hoc group needs to identify the moral question in terms of trade-offs between one or more Core
Values. For example, the group could begin by examining management’s stated goals for the transition
and consider how those goals supported St. Somewhere’s Core Values and Catholic social teaching. The
stated values of the transition include:
o Predictable and sustainable costs that support the Core Value of stewardship for St.
Somewhere to continue its ministry.
o Achieve market competitiveness which supports several Core Values. By offering a benefit
that enables employees to be more actively engaged, the proposed plan supports the social
teaching values of participation and subsidiarity (i.e., letting smaller groups of people care for
themselves before the obligation is assumed by larger organizations). The values of
participation and subsidiarity promote a reverence for persons by encouraging personal
responsibility.
o Reward longer colleague service supports the Core Value of justice by demonstrating that
those with longer ties to St. Somewhere’s ministry should be shown appreciation for their
commitment.
o Reducing administrative costs supports the Core Value of stewardship.
o Consistent flexible plan which facilitates colleague transfer within a larger health system
would support the Core Value of the common good, i.e., that the community puts in place
policies that help in the flourishing of all communities involved.
o Share responsibility of retirement savings with colleagues again supports values from the
Catholic social tradition of participation and subsidiarity. This goal entails providing education
to employees to help them plan for retirement and such education squarely focuses on the Core
Value of reverence for persons.
5. Establish priorities among commitments and values.
 The ad hoc group would have to consider a priority of values. As a general matter, the Core Values
have equal weight. Therefore, the ad hoc group would need to consider establishing a priority based on
St. Somewhere’s particular circumstances. For example, the institution’s strategic plan, financial
situation, market competitiveness, and historic commitment to workers might help the ad hoc group
prioritize values. St. Somewhere’s ability to sustain its operations into the future is currently in
jeopardy, and consequently, the ad hoc group might give higher priority to the value of stewardship.
6. Develop options that support the priorities.
 After the ad hoc group has established priorities, the practical alternatives that flow from this ranking
will need to be explored. If the value of stewardship were given higher priority, then switching plans
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would be a strong alternative. The ad hoc group would also need to investigate the foreseeable
consequences of adopting the new plan especially for its ability to consistently support the value of
stewardship.
7. In silence reflect and then listen to viewpoints.
8. Gain consensus on decision.
 As the ad hoc group narrows its focus on the highest priority option, it would be important to evaluate
whether there is a consensus. Ethical decision making does not require an absolute consensus but rather
a functional consensus, that is, it needs to examine whether there exists any significant opposition to the
proposed course of action.
Phase IIII: Follow Through
The final tasks of the ad hoc group should include the identification of measurable outcomes, the
development of a communication strategy, and the provision of education. For example, in its final
recommendations to management the ad hoc group might suggest that management re-evaluate the plan after
one or several years of implementing matching contributions to the retirement plan and ask the following
questions:
 Has the new plan increased the number of employees who contribute from 27% to 70%?
 Has the new plan increased the number of employees who can fund 50% of their retirement?
As a communication strategy, the ad hoc group might consider the different ways to discuss this issue with
the different categories of employees (e.g., long-term and short-term) and retirees. Finally, whatever plan is
ultimately selected, the ad hoc group identified employees’ lack of awareness of their financial needs for
retirement. Any good follow through would require increased employee education about how to plan and direct
the finances for their retirement.
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