Unlikely Entrepreneurs: Catholic Sisters and the Hospital Marketplace, 1865–1925 (review)

Most of the more than six hundred Catholic hospitals and clinics that serve our country today had their origins in the work of pioneering Catholic sisters. Barbra Wall chronicles their beginnings in the Midwest, Texas, and Utah by drawing on the stories of the Sisters of St. Joseph Carondelet, the Sisters of Charity of the Incarnate Word, and the Sisters of the Holy Cross—three congregations that owned and operated more than forty hospitals in the period under review. This groundbreaking effort was achieved by women who were, in many cases, immigrants serving an immigrant population in railroad towns, mining camps, and frontier outposts. Their story illustrates a number of important themes relevant today: the significance of religion and spirituality to health care; the organization of health care as a market commodity; the role of women as entrepreneurs and administrators in the marketplace and in a hierarchical church; and the development of the professions of nursing and medicine.

For the sisters, their work was first of all a religious ministry. While they welcomed persons of all faiths or of none, they recognized that times of sickness, injury, or death could be occasions of spiritual awakening or consolation for the patient or family members. Hence every hospital had its chapel, and religious symbols and images were found throughout. The sister herself, in her religious habit, was a kind of symbol of God's provident care.

With the scientific and technical advances in health care in the decades studied, the hospital came to replace the private home as the preferred venue for childbirth, surgery, and recovery from illness. Specialized facilities were needed, and new and creative methods of financing care had to be developed. Wall illustrates all of this with many examples drawn from the hospitals studied. Sisters who had never gone to business school discovered "on the job" how to borrow and manage investments, how to design and build larger and larger facilities, how to organize medical staffs and boards of trustees, how to market their services, how to comply with government regulations and professional standards, how to attract donors, and so forth. At the same time, they were operating within a church that expected women to be subservient to priests and bishops, and here their creativity and professional mettle were tested in new ways. In the process the identity of American Catholic women religious as dedicated leaders, capable of intelligent and mature judgment, was forged.

The chapter dealing with the hospital standardization movement was especially interesting to this reader, since it includes a discussion of the formation of the Catholic Hospital Association in 1915. Sisters recognized the need to improve medical and nursing education and, in general, to embrace modernization and standardization. The CHA was founded to support this effort.

The text is lively and well written, carefully researched, but never ponderous. The author includes early failures and setbacks as well as successes. Well-chosen illustrations enliven the pages. All in all, this is a wonderful window into a decisive time in the formation of the American health system.