'Those seeds were sown'

As fewer young Catholic women chose to enter the sisterhood in the decades after World War II, it became gradually inevitable that nuns would no longer be exclusively running Catholic healthcare facilities.

That didn't mean the transition would be easy.

But Sister Mary Roch Rocklage is among those who led Catholic healthcare across that bridge, while simultaneously leading a disparate group of hospitals across 28 cities into the integrated Sisters of Mercy Health System.

“We could see back then already that there would be fewer sisters,” says Rocklage, 75, who served as the health system's first president and CEO from 1986 to 1999 and board chair from 1999 to 2003.

“We wanted to make sure the structure we put in place would ensure that the purpose and mission would go forward. … We focused a lot on, ‘How do we prepare all of our leaders to be effective leaders, understand who we are, and best steward our resources?' ”

Although many in the sisterhood understood the need to make such a transition, Catholic healthcare institutions had a proud history with nuns taking the lead, says Charles Thoele, former chief operating officer and board member at Sisters of Mercy, who has known Rocklage for more than 40 years.

“Women in religious (orders) were in the forefront of developing hospitals in the United States,” Thoele says. “It was not easy for the nuns to turn over these places to laypeople. It had been their lives. They recognized they needed to do it. But it was not easy.”

“She had the foresight to recognize that the Sisters of Mercy presence would, in time, diminish,” agrees Sister Rose Elizabeth, who currently serves alongside Rocklage as health ministry liaison in the system, based in Chesterfield, Mo. “She helped in the formation and development of other leaders. That was a real contribution.”

In creating the integrated Sisters of Mercy system in the mid-1980s, Rocklage and other leaders carefully considered how to position and continue to strengthen the organization, both financially and in terms of human resources.

“Those seeds were sown,” she says. “They gave birth to everything we're doing today. God blessed us with leadership all along. It wasn't me; you ought to have a Hall of Fame for institutions. Nobody does anything alone. You just create the environment where everyone else's talents are given freedom to function, and you run interference for them and hold them accountable.”

The transition to the integrated system created a psychological hurdle for many of the individual hospital leaders who would no longer be the top executive in their respective institutions, says Rocklage, who served terms as the board chair of the American Hospital Association (2002) and Catholic Health Association (1984-85).

“It was like being the mayor of a city: You were in charge of everything,” she says. “To say, ‘I'm going to let go of this,' it was like they lost their sense of identity. That was a real struggle, to get these—at that time, mainly men—to be able to let go and say, ‘We're in this together.' ”

Rocklage began her career as a staff nurse at St. John's Mercy Medical Center in St. Louis and worked her way up to hospital president from 1969 to 1979. She says that experience gave her a sense of the “heart and soul, the guts of the operation,” which served her well as she rose to leadership.

“Prior to becoming an administrator, it was a real gift to understand how healthcare institutions functioned, from supplies, to how you staff a nursing unit,” says Rocklage, who received a master's in healthcare administration at St. Louis University. “At that time I didn't know it, but as I journeyed through administration, you learn that no decision is good unless it is a truly integrated decision.”

Once she became an executive, Rocklage says she felt blessed to have the unquestioning respect of her board, which enabled her to take chances.

“Our community really supports us: Fulfill the ministry to the best of your ability,” she says. “They give you the freedom to function.” Where her counterparts in other hospitals and systems might fret, “I wonder what the board would think about this,” Rocklage adds, “I never had to worry about that. I knew what we stood for. I never had a qualm about how I ought to vote on this.”

That solid ground gave her the strength to advocate for the integrated health system. “Everybody wasn't clapping their hands and clicking their heels about going to a system structure,” she says. But they realized that “if we're going to be a permeating presence for the future of healthcare, we needed to put it into a system.”

Rocklage's passion and charisma won people over, despite their hesitations and misgivings, recalls Lynn Britton, current president and CEO at Sisters of Mercy.

“She was the bold one and the courageous one who brought the system together,” Britton says. “She believed there could be a better healthcare model. … She always comes at it from a very human perspective: ‘How will the patient experience this?' She's a true inspiration. She could stand up in front of people and read the phone book, and people would stand up and clap. It's authentic. It's selfless fidelity to that struggle for a better healthcare system.”

Rocklage had great determination when she strongly believed in a particular course of action, Thoele says. “You've heard the saying, ‘Between a rock and a hard place?' That was Roch,” he says. “She digs her heels in, if it's a question of right or wrong, and she feels strongly and argues for the right.”

During her tenure as leader of the integrated system, Rocklage led implementation of sometimes-controversial initiatives, such as a central supply chain and physician integration into the institution, says Ron Ashworth, who succeeded Rocklage as CEO and has been board chairman since he retired in 2007.

“Mary Roch had persistence, diplomacy, and the ability to stay with it and believe in what was put forth, not backing off in the face of institutional or personal attacks,” Ashworth says. “Her vision and compassion for people stand out as two of her many attributes.”

Richard O'Hallaron, who served as associate director of St. John's when Rocklage was CEO, recalls another characteristic that helped to leaven difficult discussions and decisions. “She had a really keen sense of humor,” he says. “If work got tough, she always had a smile to keep everybody going.”

Rocklage contributed to the healthcare profession more broadly by helping to establish the not-for-profit Nurses for Newborns Foundation, which helps prevent infant mortality, child abuse and neglect in rural areas of Missouri and Tennessee.

“We had women and young girls coming in to deliver from outlying areas. They were very poor. They had no outlying care at all,” she says. “The nurses go directly to these outlying areas and work with them and their babies and husbands.”

As board chair at the AHA in 2002, Rocklage asked the association's leadership to “lay the groundwork to work toward establishing a vision of healthcare for the United States,” she says. “We still don't have that.”

As a leader in the AHA and CHA, Rocklage championed access to healthcare regardless of the ability to pay, Thoele recalls. “I'm not saying she was an advocate for a single-payer vs. a private-public system,” he says. “She was a strong proponent on the whole question of access to services for everyone.”

Britton remembers the first time he met Rocklage, when he flew up from Oklahoma City to a meeting, arrived late, and she stopped the meeting for 20 minutes to personally welcome him to the organization.

“To think the CEO would stop her message and send everyone on a break for 20 minutes to talk to me—that was authentic,” he says. “She was one of us—but also a bold, visionary leader.”

“Her greatest gift is her leadership ability,” Thoele adds. “People would literally follow her over a cliff. That's what makes her so remarkably effective.”