Hospitals have a long history in the charity business. In fact, modern-day hospitals have their roots in late nineteenth century religious societies which provided care for the poor. While they were never purely altruistic ventures, nowadays they focus on the business of business: maximizing profits, cutting costs, tending to the bottom line. In an atmosphere of growing market pressure, many wonder whether the original benevolent mission of nonprofit health care institutions has been lost. The line between for-profit and not-for-profit is blurry, and sometimes the mission gets lost entirely. A few years back, the Wall Street Journal made famous the derogatory nickname "Sisters of Currency" attached to the wheeling-and-dealing, St. Louis-based Sisters of Charity.

Says Gerard Broccolo, vice president for spirituality at Catholic Health Initiatives in Denver and a frequent speaker on integrating business and faith values, "The dominant model has been that, on the one hand, the people who run faith-based health care institutions often have lots of values, spirituality, and good intentions, but with the other hand, they're doing business as usual."

Yet the opposition between altruism and greed, between mission and money, is false. The two do not exist in separate worlds, and the profit-driven, hard-nosed business types can learn from the spiritual, values-based folks. Not only must they learn from each other, but they must integrate to achieve justice in health care. Just how to bring about that integration—without the one (usually the mission) being taken over by the other (usually the money)—is tricky.

The first thing that must be recognized by those concerned with spirituality and justice is, according to Broccolo, "You're going to have to talk about bond ratings, efficiency, and the bottom line if you're going to do business in the United States. Health care institutions, whether for-profit or not, exist within a market economy, and while there are ways to advocate for change of that system, it still must be dealt with."

To begin the integration process, it is vital to understand what the money men do is measure and monitor. "While spirituality can't be measured, while you can't see someone's soul on a radar screen, you can see certain behaviors, both in terms of strategic planning and performance measurement," says Broccolo.

For instance, in their strategic planning, many faith-based organizations are integrating their espoused values with the indicators of business strategies.

"Now, if that's the kind of health care an organization is good at delivering," asks Broccolo, "is there a market for it? The answer, as we're coming to see, is yes. If religious convictions really shape the way you do business, the way you deliver health care, there is a marketing niche for it.

But what about safely integrating business values into a faith-based workplace? What can the nonprofit world learn from Wall Street?

"First," says Broccolo, "nonprofit institutions can learn to focus on outcomes, not just good intentions. Second, they must learn discipline, a value imposed by the efficiency of the marketplace. This can result in a kind of ruthlessness, because managers have to make decisions based on outcomes, instead of nepotism or personalism."

There's a rigor in the business world that nonprofits could stand to emulate. "For instance," says Broccolo, "most people in nonprofits say they spend too much time in meetings, that their meetings are useless. In a bottom-line business, when there's big bucks at stake, they can't afford that garbage and tend to have fewer, much more efficient meetings."

Ultimately, integrating mission and money depends on the ability to do two seemingly contradictory things at once: cutting costs and streamlining while maintaining a positive, open spirit. Just as it is possible for an individual to be tough and firm and still convey that they love a person, organizations can balance these competing values.

Dan Perreten teaches at DePaul University and is pursuing his degree in theological ethics at the University of Chicago.