The purpose of this study was to investigate how a non-profit U.S. Catholic healthcare institution (CHI) addressed secularization and homogenization threats to its distinguishably Catholic culture and identity. The problem consisted of two issues—the waning presence of CHI founding religious orders and cultural catalysts, and the preparedness of CHI laity to transmit and sustain a distinguishable Catholic culture and identity. Specifically, this research studied the cohort-based Legacy intervention, a multi-strata ("CEO to service worker") Catholic laity formation initiative at Holy Cross Hospital (HCH) in Fort Lauderdale, Florida. Through Legacy, HCH is attempting a whole system culture shift to sustain its Catholic identity and culture of Christ-like compassionate care as the presence of the Sisters of Mercy lessens. Three cohorts of participants were studied. Cohort 1 had completed the intervention, Cohort 2 was in year two of the two-year program, and Cohort 3 was the quasi-baseline sample.

Using a quasi-experimental, mixed method approach and a purposeful sample from Legacy cohorts 1(n=15), 2 (n=19), and 3(n=24), data was collected using an original survey instrument (n=58), the Stratified Universe Survey (SUS), and interview guide (n=33) named the Thoughtful Conversation (TC). The SUS Catholic identity scale and subscales (people, symbols, and content) demonstrated reliability using Cronbach's Alpha with Spearman-Brown prophecy and good construct validity using exploratory and confirmatory factor analysis (EFA, CFA). Responses from the SUS were analyzed quantitatively using descriptive and inferential statistics (ANOVA). Qualitative data analysis used a hybrid approach to Boyatzis' Thematic Analysis consisting of both theory-driven deductive analysis and data-driven inductive analysis. A theoretical framework for Catholic identity sustainment and institutional identity evolutionary model were constructed.

The results of this study found that Cohort 2 had stronger overall Catholic identity than either Cohort 1 or Cohort 3, and Cohort 1 had stronger Catholic identity than Cohort 3. Taken together, these results suggest that the Legacy intervention is efficacious, since participants who have experienced the intervention have stronger Catholic identity than those who have not. Also, these results suggest that the intervention has a natural decay in efficacy (i.e., Cohort 1 had weaker Catholic identity than Cohort 2) indicating the need for a periodic "booster" session following program completion. Finally, this study supports the contention that a laity intervention can reinforce collective Catholic identity—by transferring distinguishable values and beliefs that result in individual behaviors and practices, which reinforce values and beliefs.