Journal of Sacred Work

Caregivers have superpowers! Radical Loving Care illuminates the divine truth that caregiving is not just a job. It is Sacred Work.

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In 1997, I was invited by my longtime friend, Tracy Wimberly, to join a weekend retreat at the Fetzer Institute on Relationship-Centered Care (www.fetzer.org). “I’m not entirely sure you’re ready yet,” Tracy told me.

“After all these years in health care, how could I not be ready?” I asked.


At the retreat, I learned the answer.


On the first day, about thirty of us,
doctors, nurses, administrators and other caregivers from all over the
country, gathered in a circle.
Tracy invited each of us to check-in, one at a time, moving clockwise
around the circle. The only question she posed to us was, “How are you
doing?” A nice question, but what did this have to do with the topic of the seminar?…

How many times a day do we hear the How ya’ doin’ question? We pass someone in the hallway or on the street or we encounter someone in a meeting, “How ya’ doin’?” we ask, not wanting much beyond a one or two word reply. My friend, Dr. Keith Hagan, always answers that question with my favorite one-word response: “Blessed,” he says to anyone who asks.

Still, how many of us can accurately describe how we’re doing in one word? And how many times on any day do we get the chance to say how we’re doing with more than a few words – and to answer it with someone who will listen?


I presumed this check-in at the retreat would last about an hour and that then we would begin discussing the real purpose of the meeting – Relationship-Centered Care. I was mistaken.


All day long, and into the night, the same question passed around the circle, first clockwise, then counter-clockwise at the end of each session. With each journey around the circle, each person’s answer became deeper. As each individual spoke, everyone else listened in complete and often compassionate silence.


Like the Peacemaking Circles used at Oasis Center in Nashville, each person spoke what  was on his or her heart, sharing stories of grief and joy. Very nice, I thought, but when are we going to talk about Relationship-Centered Care? After all, I was a veteran CEO. It was time for us to do something. The question rang louder and louder and louder so that midway through the second day, I couldn’t stand it any longer.

“When are we going to talk about the purpose of this meeting?” I blurted out when my turn came. The rest of the group stared back at me as if I’d drawn a pistol and shot out the candle burning in the center of the circle. No one answered my question except one person who criticized my effort to  change the energy of the group.

I left the circle and left early from the retreat. It took months, even years, for me to appreciate two things: 1) The practice of sharing around the circle was relationship-centered care, 2) Circle-sharing is a centerpiece practice in the teaching of compassion.


But how does a leader integrate circles into the frantic bureaucratic squares of hospital protocols? When I became President & CEO of the Baptist Hospital System in Nashville in 1998, I invited Tracy to join our leadership team. We initiated circle-practice into every meeting of our 150 person leadership group, dividing the group into about twelve teams, each with a facilitator.

We continued the practice for years. Did everyone like it? No. Did almost everyone benefit? I would say the answer is a clear yes. Did the organization become more successful through this (and other) leadership training? The answer to that is a fact-based and resounding yes.

Baptist Hospital System improved dramatically in every measure – from clinical competency, to patient and employee satisfaction, to bottom line performance.

How do you teach compassion into the middle of a complex organization with a lofty mission statement and pressures to meet bottom line goals? One of the best ways is by weaving circles of sharing into the square fabric of doing and performing.


This is how an organization travels from obsessive and robotic doing to a balance of doing and being. This is how an organization travels from good to great. This is how a bureaucracy becomes a caring community devoted to healing with love. And this is what I learned through my friend, Tracy.

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3 responses to “Best Practices Essay: Relationship-Centered Care – How Circles Balance Squares.”

  1. liz Wessel RN, MS SJHS Home Health Network, Orange, CA Avatar
    liz Wessel RN, MS SJHS Home Health Network, Orange, CA

    Funny, but this topic just came up at work yesterday. I posed the possibility of beginning a sharing circle, as described in your book. I did not realize the depth of sharing that can occur in these circles. I think that could scare some people. However, I imagine the process of deeper sharing happens gradually over time as trust develops? This meditation will be very helpful for me to share with others as our conversation continues.

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  2. Karen York Avatar
    Karen York

    Isn’t it sad that so few of us really listen to someone else? Some of us are afraid to say what is really on our hearts when asked how we’re doing. Some of us are afraid of the answer that someone might give if they really DID say what was on their hearts. Quite honestly, I can count on one hand the number of people that I feel safe in answering truthfully that question. Even then, I don’t think they always want to be burdened by the weight of my heart. Thank you for this reminder of honest caring and nurturing of one another by providing a safe space for open sharing.
    Karen York
    Alive Hospice, Nashville

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  3. Erie Chapman Avatar
    Erie Chapman

    Thanks for both of these comments. It is true that the sharing process can be “scary” for some. That is why only those organizations truly committed to building cultures of loving care should start this practice. It is important to build some safety, continuity and support around the groups so that people who choose to share more deeply don’t feel betrayed.
    In the end, the circles, properly run, are powerful trust builders. And that’s why they’re an essential practice for organizations committed to living their mission.

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