Chaplain s Impact on Emotional and Spiritual Needs: Job Security in a world of Scarce Resources Beverly M. Beltramo, D.Min, BCC System Director of Spiritual Support Services Oakwood Healthcare System Objectives - To help you: Become the recognized experts in addressing emotional & spiritual needs. Be able to show how what we do impact core measures. Learn some techniques to raise patient satisfaction scores The Genesis of this talk 1
I wish my chaplains understood this Why does this matter? Who here has Enough chaplains to do the work? Big enough budget? Happy patients? Purpose: to offer one model to help you achieve the above. 2
Some context: Chaplaincy as a profession is facing significant challenges: 2010 American Hospital Association Study Financial Cutbacks Hospitals which made no cutbacks Hospitals which made both administrative and staff cuts Hospitals which made other budget cuts Changing religious landscape in US Americans are more Pluralistic/less Religiously Observant: Changing religious landscape: unchurched adults up by more than 50% between 1991 2011(Barna, 2011) Of 100 million unchurched, approximately 37% avoid churches because of negative past experiences in church or with church people (Barna Group, 2011, p. 2). My anecdotal information confirms yours; as we deal with members being late for renewal, we do get members who let us know that hours have been cut D. Lichter, Exec Dir., NACC 3
Lack of standardization in defining What is a Chaplain? NACC/NAJC/ACPE/APC MA/M.Div +CPE IFOC Mission Statement Trained and licensed chaplains will provide counsel, education, advocacy, life improvement skills and recovery training. = 47 hr Chaplaincy course Association of Christian Counselors offers chaplain licensing through ODB Ministries. Appears to only require a HS diploma. Before we go any further Take off your chaplain hat And put on your administrator hat 4
In our organizations, we measure what we value: ratings, safety, errors, customer or employee satisfaction. We measure what we hope to influence. - Benson In a world of measurables chaplaincy is hard to quantify Few quantitative studies: Vandecreek (2004) PSI-C patient satisfaction with the chaplain not chaplain s impact on patient satisfaction. HCAHPS- communication questions Press Ganey Emotional needs (no mention of spiritual ) 5
And emotional spiritual.right??? Well, research tells us differently Difference (between emotional need and spiritual need ) not clearly established within literature, nor, (per Clark Drain & Malone), well differentiated within the minds of most patients.* Study asked patients to rate how well chaplain addressed emotional needs and how well chaplain addressed spiritual needs. Every one of the seven measures correlated more highly with emotional needs than spiritual/religious needs including praying with the patient. * *Clark, Drain & Malone (2003) *Flannely, et al, (2009) 6
A single self: Emotional Spiritual SELF Physical Mental Clark, 4/9/2012 Press Ganey Preceptor 13 So OK: emotional (sometimes). spiritual But do emotional needs matter? (remember ) 7
$$$ - evidence shows relationship between patient satisfaction with emotional and spiritual care and profitability (Press Ganey, 2003) LOYALTY - When chaplains are involved, patient more likely to choose that institution again for future hospitalization (Gibbons, et al, 1991). PATIENTS SAY SO Joint Commission Journal of Quality Improvement,: Information and emotional support needs were more important to patients than all other care delivery needs or concerns. (2003) QOL - Balboni of the Dana-Farber Cancer Institute found that patients whose spiritual needs are effectively addressed have better QOL and are 3X s more likely to accept hospice care in lieu of futile aggressive care (Balboni, et al., 2010). OUTCOMES - Koenig, (Handbook of Religion and Health) found spirituality and religion play a critical role in how patients cope with illness and result in positive outcomes. SO to recap: We value what we can measure Emotional needs not differentiated from spiritual Emotional needs matter How do we measure satisfaction with emotional needs? 8
Press Ganey! 1. ALL hospital staff--but chaplains legitimately the experts. 2. ALL patients have emotional and spiritual needs. 3. Satisfaction w/emotional needs highly correlated w/ Overall satisfaction. I wish my chaplains understood this 9
Are there things which chaplains do which impact patient s satisfaction with emotional & spiritual needs? If we want staff to care they have to feel cared about. chaplains know a thing or two about that Any examples? 10
Chaplains know how to care for staff: Port in the storm Teach self care? Model self care? Teach staff to care for each other? Other? We need to find the wow s. 11
A few chaplain wow s Handmade Blankets/Baby clothes Music Pet visitation EOL care Hospitality Other?? We may need to invite others Chaplain : patient ratio (ouch!) Volunteers not just helpers a ministry of their own. Help them hear how God has called them. CPE for volunteers Scripting 12
Teach OTHERS what we know... The question doesn t say Did the chaplain come and say a prayer with you? Chaplains understand patients emotional & spiritual needs Making sense Control Connection & Care EOL Hope A search for MEANING & PURPOSE Harold Koenig Meeting the Spiritual Needs of Patients 13
More stuff we know Let go of the stuff before you enter Emotional vulnerability Listening Guard dignity Acknowledge (and respond to) emotion. Compassion matters. Honor silence. Caring interventions we can teach Preferred name Sit Good touch Empathy Cultural Competence Know when to refer Clark (Hosp & Health network) & Dingman ( Jrnl of Nursing admin) 14
What it can look like Not so long ago or far away Our patient satisfaction goal was 75 th percentile Scores hovered in the 30 s Chaplains were charged with the Emotional Needs question (help!) 15
First, we began to do things differently. CPE training for volunteers Scripting Day 2 Spiritual Assessment 16
Day 2 went from THIS (Introduction) Brochure Prayer (pretty much always!) Outta there TO THIS (Introduction) Religious pref. Contact pastor? Stuff? Open it up Anything we can do? Prayer (maybe)? Our H & P went from this Do you want to see the chaplain? 17
To this We trained others: PowerPoint which we presented to (almost) all RN s on all clinical units Modified content for a 30 min presentation @ New Hire Med Resident training As value of PowerPoint was recognized, was asked to present to all departments both clinical and non clinical. scores started to climb. 18
In short We taught staff what chaplains know about caring for people. We reached out to care for staff if they feel cared for, they will do a better job of caring for others ( the chocolate brigade ). We affirmed it when we saw it! 4/9/2012 37 DID IT WORK? 19
Hospital B Percentile Rankings Total n=2547 120 100 80 60 40 20 0 Overall Satisfaction Emotional Needs Chaplain In place Training Completed Oct 2008 So then we launched in four underperforming units at another hospital 20
Mean Score: Intervention Units vs. Overall Hospital - Emotional Needs 88 87 86 85 84 Units: 4S, 8S, 9S, 10S Whole Hospital 83 82 81 Q3 2010 Q4 Q1 2011 Q2 Q3 Mean Score: Intervention Units vs. Overall Hospital - Overall Satisfaction 88 87 86 85 84 Units: 4S, 8S, 9S, 10S Whole Hospital 83 82 81 Q3 2010 Q4 Q1 2011 Q2 Q3 21
A final note nursing satisfaction American Nurse Association: almost half of respondents exhausted and discouraged when they leave work. Making a difference in a patient s life, gives nurses the feeling of reward. The neglect of the whole person in modern health care creates widespread dissatisfaction which is certainly affecting the skyrocketing rates of burnout of nurses. (Koenig 2003) 4/9/2012 43 So in summary Emotional and spiritual needs matter. Chaplains are the experts at addressing those needs. Emotional needs scores overall satisfaction. This patient satisfaction and clinician satisfaction too! 4/9/2012 44 22
Implications of this work Emotional needs highly important to patients Chaplains play key role in addressing emotional/ spiritual needs Emotional/ spiritual satisfaction = high R w/ overall satisfaction Higher patient satisfaction = reimburse - ment + QOL @ EOL + patient loyalty Bibliography American Nurses Association. Analysis of ANA Staffing Survey www.ana.org/staffing/ana_pdf. (2/01) Astrow, Alan, et al, Is Failure to Meet Spiritual needs Associated with Cancer Patients Perceptions of Quality of Care and Their satisfaction with Care? Jrnl of Clinical Oncology, 10/2007 Balboni, Tracy, et al; Provision of Spiritual Care to Patients with Advanced Cancer: Assoc with Medical Care and QOL near Death, Jrnl of Clinical Oncology, Jan 20, 2010 Clark, Paul; Treating the Patient s Emotions, Hosp & Health Networks, accessed 1/2010 Clark Paul, et al; Addressing Patient s Emotional and Spiritual Needs, Joint Commission Journal on Quality and Safety, 12/03 Clark, Paul, Press Ganey Knowledge Summary: Patient Satisfaction with Emotional and Spiritual Needs, Press Ganey Preceptor, undated. Denollet, J., Emotional Distress and Coronary Heart Disease, European Jrnl of Personality, 2/97 Dingman, Sharon, et al; Implementing a Caring Model to Improve Patient satisfaction, Jrnl of Nursing Admin, 12/99. 4/9/2012 46 23
Gustafson, D.H., Increasing Understanding of patient Needs During and After hospitalization, Jt Commission Jrnl of Qual Improv, 2/01 Koenig, Harold; Meeting the Spiritual Needs of Patients, Temple Univ Press 2003. Lanser, Peter, Strategies for Coping with Today s Nursing Crisis, The Satisfaction Monitor, Jul 2001. Levine, C., Life but no Limb: Aftermath of Medical Error, Health Affairs, Jul 2002 Miller, W.R., Spirituality, religion & Health, An Emerging Research Field, Am Psychology, 58(1) Mills, A, & Blaesing, S. A Lesson from the Last Nursing Shortage: The Influence of Work Values on Career Satisfaction with Nursing. Jrnl of Nursing Admin. 6/06 Malone, Mary P, Best Practices: After the Oops, The Satisfaction Monitor, Jan 2002. Puchalski, Christine, et al; Improving the Quality of Spiritual Care as a Dimension of Palliative Care, Jrnl of Palliative Med, vol 12, #10, 2009 Ross, L., The Spiritual Dimension: its Importance to Patient s Health, Well-being and QOL and its Implications for Nursing Practice, Intnational Jrnl of Nursing Studies, 1995 Speck, Peter; Spiritual Needs in Health Care, British Medical Journal, Jul 2004 Taylor, EJ, Nurses Caring for the Spirit: patients with Cancer and Family caregivers Expectations, Oncology Nurse Forum, 2003. 4/9/2012 47 24