Loading in 2 Seconds...
Loading in 2 Seconds...
Professional Chaplains and Health Care Quality Improvement: Tales of a Research Project. Nancy Berlinger, Ph.D., M.Div The Hastings Center Themes in Pastoral Theology February 5, 2009. Overview . Research project on chaplaincy and quality Core Values Three roles of the chaplain
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Nancy Berlinger, Ph.D., M.Div
The Hastings Center
Themes in Pastoral Theology
February 5, 2009
There are strong similarities between chaplains’ core values and the values of patient-centered care, including:
The Tension: Measurement is Impossible but Necessary
“I was struggling with the quality issue too, of how do we define it. What is it? Is it patient satisfaction? Is it perception of value? And who’s doing that perception?”
Only patients can tell us when their spiritual needs have been met
Surveys are the voice of the patients
Departmental surveys may better capture service provision
Patients don’t always recognize what spiritual care is
Patients and families may be poor judges of quality
Surveys don’t measure all dimensions of spiritual careTension: Patient Satisfaction Surveys are “useless” yet “rough indicators” of quality
“It's a requirement for all departments to do a quality improvement project each year. It's usually not well received by my chaplains. They basically hate it, because it's very hard to quantify what we do.”
Chaplain as Shepherd
Bedside care of patients and families
Chaplain as Administrator
Institutional insider, shaping mission and culture
Chaplain as Prophet
“We skillfully facilitate an openness for persons to explore their spirituality, and particularly in regards to the crisis that they are facing in the moment, paying attention with listening skills and intervention techniques.”
“…We're not here to preach…We're here to travel with you, in your health care situation.”
“My ministry is not just to the patients. My ministry is to the family members, to the staff, to administration, to people from the community coming into the hospital.”
“You know, [the Saintliness Healthcare System] has a mission statement.… I think finding our role in the mission statement is also very helpful.… A positive way of asserting the role of chaplains, I think, is building on a mission statement.”
“The ideal for what a hospital should be as a healing environment.”
“Patients were treated as the appendectomy or the heart patient, and they were just sort of a machine that needed to be fixed. My goal… is to teach… the staff that spirituality is treating the whole person, the mind, body and spirit.”
“I was thinking about wasting time with someone.… [Patients tell us] thanks for spending the time, you spend a lot of time with me [and] it's almost an ‘I'm not worthy for this’.”
It may be helpful to keep these three different roles in mind as we think about what the chaplains told us about the problems of measuring quality in spiritual care.
As we heard, finding ways to measure quality in the chaplains’ shepherding role with patients and families is a challenge.
However, because many models for QI focus on what happens in the clinician-patient encounter, it may be an even greater challenge to find ways to measure quality for the chaplains’ administrative and prophet functions.
“I carry a pocket card. They're in a goldenrod color. You just can't miss them. It's just a protocol of when to call the chaplain, and who's available.…So it's just a little thing and every time…when I'm with somebody who's new [I give them a card, saying], ‘This is when you call the chaplain’."
“[A colleague] and I did a presentation to a palliative care conference.… And what we did was [role play] a verbatim.… We brought down the house, because, it was like they never…experienced a chaplain's visit before.… I think we're going to try and do that for the new employee orientation, or the nurses, or whatever. Just so that they understand what it is we do.”
“I think it would be helpful…to have a conversation [with] organizations like APC [to] come up with some suggested matrix in terms of like, ratios…Again, I keep going back to the standardized piece because again I’m trying to go along with the culture of the hospital, and all these other disciplines have these standardized practices.”
“We need researchers to help us [develop] targets so that we can break it down into bite-size pieces and get some kind of numbers and expectations that are reasonable and experiential and, and outcome-based and evidence-based and all of [those] buzz words that get thrown around in science today.”
“…If [the chaplain] is staying with a patient because of either a trauma or around a very complicated death issue, it’s not just a visit, it’s a visit times this [weighting factor] so that it doesn’t look as though you, well you’ve only seen three people. You’re an inadequate chaplain if you’ve only seen three people, but the, but the formulary says they were three complicated deaths.”
“In October our institution stopped using Press Ganey.…We are moving into [another company], which has no provision [for satisfaction with spiritual care services] whatsoever. So in the absence of any standardized…thing, with [the help of a local researcher], we've developed our own patient satisfaction and staff satisfaction surveys as a check on our performance and to demonstrate what we do.”
The intrinsic value of quality patient, family, and staff care
The transcendent value of spiritual care as a profession and vocation
The instrumental value of quantitative & qualitative measures of quality to show the value of spiritual care
Translational value; in dialogue with administrators and other healthcare professionalsConclusions: Living with a Paradox
“To survive we have to come up with something measurable, because to certain people, that’s the only language they can speak. Our job is to come as close to finding something that’s measurable that actually makes a difference in what we do. To me, it’s up hill all the way.”