From Sisters to Misters: The Transition of Catholic Hospitals to Lay Administrators

Mary Kelly RSM, Dr. P.H., and PhD Maureen Anthony

Background: Catholic women religious were responsible for building an extensive hospital system throughout the United States beginning in the 19th century. Following the establishment of hospital accreditation and the introduction of Medicare in 1965, regulation of health care administration became complex and fewer Sisters were available for education in hospital management at the graduate level. This required a transition in leadership from women religious to masters-prepared lay administrators. 


Purpose: To hear Catholic religious women as they describe their experiences of transitioning Catholic hospitals from being administered by their religious orders, for sometimes over 100 years, to lay administrators.


Design and Methods: A qualitative approach is being used to understand the experiences of Catholic women religious during the time the administration of Catholic hospitals to lay administrators. Interviews take place at the homes of the Sisters or by phone and last 30-60 minutes.  They are recorded using an audio recorder.  A semi-structured interview schedule with open-ended questions is used to guide the interviews. Between September 2012 and March 2013, the researchers interviewed 33 women religious from four orders in 15 states. All interviews are being transcribed word-for-word and transcripts are read immediately so that ideas generated can guide questions in subsequent interviews.


Emerging Themes and Illustrating Quotes:


The increasing complexity of hospital administration following the establishment of hospital accreditation and the introduction of Medicare and Medicaid (1965) required that administrators be educated at the Master’s level.


“The really big change was going from a Sister Nursing Administrator to a Sister with a Masters in Hospital Administration—and dealing with Medicare!”

“The Doctors complained to the Order about lack of management training; we tried to patch up what we could, for example with summer courses.”


After Vatican II, Sisters were drawn to direct care of the poor, and few were interested in hospital administration positions.


“In 1961 there were Sister Administrators in every hospital with a Sister as the head of every department; then all of a sudden in 1966 there were no Sisters.”

“The religious preferred the hands-on ministries.”

 “We went from ‘Yes, Mother’ to a time when Sisters’ choices prevailed.”

“The catalyst for change to lay leadership was need; there were no others prepared.  Sisters wanted direct service and the hospital needed the involvement of people in its community.”


Sustaining the mission was of paramount importance and was often ensured through lengthy preparation of a “second in command” lay administrator who then took the reins.


“We began in 1976 with lay CEOs; we graduated from the concept of Sisters on duty.”

“The first lay administrators were groomed by association; the second generation were products of formal formation programs.”


 “I had no personal concerns—only that the laity have a good foundation in the charism.”

“The lay people were engaged and proud to be appointed; they also thought we were more connected to Rome than we were.”


“We had to strengthen sponsorship of the health ministry with lay participation, not by having more Sisters in control.  The Sisters wanted out; it felt like Big Business”.


“I thought when we make this change, it will be the last time this ministry will be led by those with a vow to serve.  Then I realized this is not true:  every baptized Catholic is committed to service.”