The Teaching Hospital Model

Michael Metzger

Americans enjoy relatively good health care, a bountiful food supply, and secure borders. What’s rarely recognized is that these three accomplishments, along with the rest of the greatest success stories in human civilization, used an identical approach. So it’s odd when faith organizations ignore this when seeking to change the world.

Americans owe their health care to the teaching hospital model. This system has three overlapping networks: research, teaching, and making the rounds. It’s a process that begins with theorists but is based in how effectively it helps practitioners (doctors) with real-life problems. This is a distinction with a big difference. You’ll see why shortly.

The teaching hospital model was developed in response to newly minted doctors wanting to apply the latest research coming out of research institutions to their practices. The new model coupled universities conducting research and development with teachers in medical schools. These teachers then translated research into a medical school curriculum for students. Residency programs in teaching hospitals then required newly minted physicians to make the rounds to apply knowledge in real-life situations under the supervision of a teacher-clinician.

This model changed the game. It accounts for why students from all over the world come to the U.S. to become doctors—and why the majority of graduates stay in the U.S. to practice medicine. In fact, the teaching hospital model created a problem of sorts: living longer means more mouths to feed. The solution was the second American accomplishment: a system helping farmers feed the world.

The American agriculture system uses the same approach as the teaching hospital. University-based departments of agriculture prepare research and advance knowledge for growing crops. This research is linked to Agricultural Experiment Stations, where county agents teach and tailor the findings to fit the needs of farmers. County agents do this by making the rounds and delivering the new technologies (seeds, methods of plowing, etc.) to the farmer in the field. This unique approach has been copied around the world. It has reduced food scarcity around the world. But not everywhere.

Food scarcity remains a problem in some places today. Think of North Korea. Scarcity threatens global security, making the agricultural problem political. Security in Western nations has been strengthened by a strong military presence, the product of the U.S. developing a system identical to the teaching hospital. The American advanced weapons system uses university-based departments of physics and engineering (research) to teach basic research to the military. This research makes the rounds in on-site testing and evaluation at federal weapons labs such as Los Alamos or Sandia, making sure the systems work in real-life conditions. This system has proven to be an effective deterrent against global insecurity. It’s why the West enjoys relative security.

All three culture-changing systems—medicine, agriculture, and weapons—share the same structure—educators, translators, and practitioners. In his book To Change The World: The Irony, Tragedy, and Possibility of Christianity in the Late Modern World, James Davison Hunter writes that the decisive factor in changing the world is overlapping networks. But not just any networks. “In a very crude formulation, the process begins with theorists who generate ideas and knowledge; move to researchers who explore, revise, expand, and validate ideas; moves on to teachers and educators who pass those ideas on to others, then passes those ideas to popularizers who simplify ideas and practitioners who apply those ideas.” The upside of Hunter’s crude formulation is clarity: it’s the same system that advanced medicine, agriculture, and weapons.

There’s an irony here. Another institution committed to making the world a better place—the faith community—overlooks this model. It does start with theorists but rarely measures how effectively they help practitioners with real-life problems. This error derives from three assumptions in modem Western thought. The first is called “Hegelian idealism,” the view that ideas move history. Not so. Faith communities should be teaching hospitals—networking theorists with translators and measuring how effectively they help practitioners produce shalom in, say, Google. Measuring shalom would mean ascertaining whether Google takes a biblical definition of reality seriously and acts on it.

Faith communities also err when they look primarily to individual theorists to lead the way. This is “Lockean individualism”—an assumption that an aggregate of gifted theorists, leading “conversations” that rain abstractions from heaven like rain, will produce solutions springing from the soil of society. Not so. These theorists have no dirt under their fingernails. Faith communities should be agricultural stations, measuring how effectively they’re helping practitioners with real-life problems.

Faith communities commit a third error in assuming the key to culture-change is having one’s heart right before God. Not so. This is called “Christian pietism,” based on Hegelian idealism and Lockean individualism. There is significant truth in pietism, but winning the “culture war” is not merely a matter of hearts and minds. It’s also hands and habits—the stuff of culture. Faith communities should produce better weaponry.

These three errors prejudice our view of cultural change in ways that are fundamentally flawed. The reality is that the greatest success stories in human civilization have followed a teaching hospital model. To change the world, faith communities ought to measure how effectively they’re helping practitioners with real-life problems—not assess the ABCs (a faith community’s attendance, building, and cash).

“If one is serious about changing the world,” Hunter writes, “the first step is to discard this view of culture and how cultures change, for every strategy based upon it will fail—not most strategies, but all strategies.” Do faith communities believe this? How many are ready to discard the old model? Discarding might be easier if they knew why America enjoys good health care, feeds the world, and benefits from secure borders.


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  1. This piece makes me think, as do many of your posts, Mike.

    OK, so if I get this, we might consider “teaching churches” with pastors being the ones trained.

    Or in another way, every church becomes a “teaching community” with each attendee being the one trained.

    Either way (and there are many ways to apply the model, I’m sure), the way we tell if we are succeeding shifts from ABC or just doctrinal purity and personal transformation to include demonstrated results in the community.

    I can immediately think of several reasons why this wouldn’t work (yes, I find I have that tendency, often much to my dismay), but I’m captivated by the thought of a cadre of Christians trained and effective at leading change in their communities–and in all aspects of those communities: the arts, sports, education, commerce, politics, law, families, child raising. And those involved in those networks overlapping in our churches.

    Stunning, really.

  2. Mike,

    As always, great stuff! I love the hospital metaphor. And one can’t argue with the data – the model has show itself to work time and again, as you explain.

    So here’s a few questions…

    You say that the faith community “rarely measures how effectively they help practitioners with real-life problems.” You say we should be “measuring how effectively we help practitioners produce shalom…” Couldn’t agree more. So, what’s the right metric? Is it the tact that Willow Creek took in their REVEAL study – love for God and others? Or is it something else? And maybe too detailed, but I’d love to know… once we have the right metric how do we actually do assessments? I’m living where the rubber meets the road, in a congregation of 2000, and I’m looking for ways to put this stuff into practice.

    In their fantastic new book, “Switch: How to Change Things When Change Is Hard,” the Heath brothers suggest we seek “Bright Spots” or local successes and analyze these to seek what works. Do you see any “Bright Spots” in the faith community where things are as they should be – where the faith-community is functioning as a teaching hospital? A parachurch perhaps? A local congregation?

    Also, What about Willard’s assertion that we should make “spiritual formation in Christlikeness the exclusive primary goal of the local congregation” (Renovation of the Heart p. 235). He then follows with an explanation of the Great Commission (Mt 28:18-20). Does this contradict the error of “Christian pietism?” Or more likely I’m misunderstanding something…

    Under His Mercy,

  3. Very good article. I’m a law student at UGA and this rings very true to me. The law still heavily values clinical work to train law students (though not a required model per se), which is not identical to but has some similarities to the quality of a teaching model. I think the approach you discuss in churches would be great, especially dealing with real problems. I often hear too little thought based on too little evidence (research) coupled with too little experience that all results in a skewed view of what the world needs. Then I step into the courthouse and deal with the real hurting people while my church builds buildings the hurting will never see or use. Great article!

  4. It is unfortunate that in the current church culture does not encourage the type of critical thinking that enables wholesale culture change of the type that you suggest is needed. The church in this country seems to be in what Fowler would describe as a stage three faith… meaning that faith is not something that changes life, but is something that you do on Sunday because other people do it.

    We in the church do a very good job of discouraging this type of critical thinking by labeling people as heretics and discrediting them as much as possible (see Brian McLaren) when they ask the questions that need to be asked.

    The question, in my mind, is this… How do we enable our people to have the critical thinking skills required to change the culture of our churches to the teaching hospital, instead of reverting back to Fowler’s stage three faith permanently?

  5. Matt:

    Dallas Willard says the church needs to start in reality. The sad truth is that the institutions more closely aligned with reality today are in business, medicine, etc. – not the church. If a local church, for example, started with the top five businesses in their city and asked: “How can we lead the league in assisting them to flourish?” – a great many things would change, including church programming and staff (see my column from last week). Most of the CEOs I know never look to the church for assistance in having their business flourish. The church will never develop the “critical thinking skills” (as you put it) until it is faces the brutal reality of its present situation. Sitting around and gabbing about it or studying it will not result in change. Reality drives change.

  6. I would agree with that… So, the question I have is what causes the pain that acts as a catalyst for a local body to re-enter reality and realize that change needs to happen?

    For too long I have seen churches that look around and realize that there are no “young people”… but are unwilling to do what needs to happen to include those “young people” into the body. They then fade off into oblivion. The city of Baltimore is filled with huge, beautiful old church buildings with solid endowments, but are empty on Sunday morning. What, or how, do we help people come back to reality?

  7. I often wonder if the current model of church as a business is becoming counterproductive to the commission from Christ. The teaching hospital sounds great, but how much good can the Hospital really do if it is hyper-concerned with meeting a quota of patients in order to remain operational? Also, I might be misunderstanding your comments about Christian Piety…you’re not saying that it isn’t necessary for Christians to have their hearts in a right relationship with God, are you? As for the “Culture War”, where does the Bible say we are to win the “Culture War”? Where does it say that we are to fight it? Doesn’t Peter call us “Strangers in the World”? Doesn’t 1 John tell us that we can’t love anything of this world and that the One in us is greater than the one in the world? I don’t read those passages and think “Wow, I need to make the culture of this world adhere to the truths revealed to me by the Holy Spirit.” I apologize if I sound cynical but I can’t think of any passage in God’s word that urges us to change THE WORLD. We need to share Christ’s love which will change individual hearts, but then that would mean that it IS the Christian Piety that changes the world. If those who commit atrocities come to know saving faith, would they not stop the atrocities? Will they stop because some Christians convinced them that what they do is wrong? Or will it be because the Lord has spoken to them? I’m not trying to be combative, but I think the Church is failing because it has lost the proper goals. Its not about creating a theocratic empire in this world, but about populating the Kingdom of God that IS and WAS and IS TO COME. Praise God!

  8. You don’t help people “come back” to reality. Reality is reality is reality. Everyone lives in it; but not everyone perceives it accurately and aligns with it well. A great many businesses don’t, for example, including most of the leading institutions in Baltimore. But, of course, the same indictment applies to the empty churches.

    The work of the church used to be to make key culture-shaping institutions aware of reality and help them act on it. Don’t go after young people, go after leaders of these center institutions. Younger people will follow. People are looking for reality. If faith communities were “assist leaders,” helping center institutions define reality and achieve success, they’d be full of life.

    If that begins to happen, the pain is positive. It is helping T Rowe Price, to cite one center institution in Baltimore, take a biblical definition of reality seriously and act on it. To accomplish this will prove very, very painful for most churches and their staff who haven’t a clue on how to do this. Read Dallas Willard’s “Knowing Christ Today.” Start with the last chapter. Shalom my friend.

  9. MIKE,

  10. Andy:

    It’s likely a combination, but I’d put shalom (i.e., culture-making) at the top of the list.


    I applaud the Willow study. Yes, we start with the Great Commandment (why in the world would give God give a hoot about our attendance figures if we’re not loving our neighbors?). But I’d urge you to re-read “Why Institutions Matter,” a seven-week a series we posted last summer, beginning in July. Even when faith communities seek to enact shalom, they do it via a bottom-up, individualistic approach. That’s exactly opposite of how the Hebrew mind worked – but re-read the series and tell me what you make of it.

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