Problem and Purpose Founding values and principles can help organizations stay focused on fulfilling their mission. This is especially true in faith-based organizations that seek to continue their founding principles as a governing commitment to their core identity. This study identified Adventist healthcare founding principles in Ellen G. White's early health visions and explored how Adventist healthcare leaders perceived these principles as governing principles applied to current Adventist healthcare practices. Conceptual Framework and Research Design Two metaphors and three areas of literature review guided my approach of this qualitative study of Adventist healthcare founding principles. My first metaphor of DNA helped me think about Adventist healthcare as having an original DNA that could guide its growth and identity as it interacted with the environment across time. The second metaphor I chose was metamorphosis, a biological process where the phenotype of an organism can change dramatically but the organism's identity and DNA stay the same. This metaphor applied to organizations would suggest that noticeable change could take place that makes the organization almost unrecognizable from its earlier original form. But even here, there could be evidence of original identity. Both these metaphors framed my study. Three areas of scholarship guided my conceptual framework. The first was sociology of organizations and how they are formed and change over time. I focused on organizational identity. The second area was social science scholarship on the nature and practice of faith-based organizations, especially healthcare institutions. The final area reviewed literature on SDA healthcare identity. My method included document analysis and focus groups. I distilled 12 principles from Ellen White's early visions on health and then secured feedback on my document analysis from Adventist historians. Second, I did focus group interviews with Adventist healthcare leaders and asked them what they thought of these 12 founding governing principles and if and how they applied to Adventist healthcare. Finally, I had two physicians and a Ph.D. scholar check or "triangulate" my process and findings. Results I distilled 12 principles from Ellen White's early visions on health: (a) health education and preventive medicine, (b) healthcare for Seventh-day Adventist (SDA) members, (c) indirect witnessing to non-believers patients, (d) sustain financial and administration model despite attention to all social classes, (e) unwavering biblical principles, (f) wholistic perspective, (f) physical activity as part of treatment, (g) preparing people to be whole before God, (h) prayer combined with treatment and obedience to the laws of health, (i) God-fearing personnel, (j) therapeutic nature interaction, and (k) altruistic and trusting institutional model. I labeled these as Adventist healthcare funding governing principles. I then used three experts' suggestions to make changes. I then asked four focus groups to comment on these 12 principles and explore their application to current Adventist healthcare. Several principles were seen as now universally shared by most healthcare institutions. Those were: (f) wholistic perspective, (a) health education and preventive medicine, and a general respect for the place of spiritual & religious integration in medical practice. Other principles were seen as challenging to apply to modern Adventist healthcare. This included (b) Adventist Healthcare for SDA members, (d) sustaining financial and administration model despite attention to all social classes, (f) Physical activity as part of treatment, (h) prayer combined with treatment and obedience to the laws of health, (i) God-fearing personnel, (j) therapeutic nature interaction and (k) altruistic and trusting institutional model. Finally, a few principles seemed to have limited or different application to modern practices. For example, it was hard to envision how (j) Physical activity as part of treatment would be appropriate as most hospitals have such acute care patients and (g) preparing people to be whole before God. Discussion, Conclusions, and Recommendations I drew five main conclusions. First, I found widespread support for these founding principles present among Adventist healthcare leaders. Second, many of the founding principles of Adventist healthcare were seen by these Adventist leaders as now widely accepted and practiced in many healthcare systems today. Third, there were some principles that Adventist healthcare struggle to apply, even as they believe in the essence of those principles. For example, employing God-fearing personnel. There were some differences and even resistance to a few of these principles as applied to modern Adventist healthcare systems because of the nature of acute care, insurance companies, local regulations, or other factors. For example, getting patients to work in a garden or other labor seemed unlikely given the acute care nature of the modern hospital patient. I recommended to Adventist healthcare leaders on ways to help institutions identify, celebrate, and promote founding governing principles, including ways to adapt to the international and intercultural difference in applying these principles. I also made recommendations for how further research on governing principles could use existing records from founders such as Ellen G. White to expand the analysis of governing principles through other stages in history.
Patients' roles in governance of learning: Results from a qualitative study of 16 learning healthcare systems