2. The Value of Chaplaincy: Metrics, Measurement, and Productivity Rev. Dean V. Marek, BA, BCC Mayo Clinic, Rochester MN

3. Overview A. Patient Centered Care B. Chaplain Centered Issues C. Metrics D. Methods of Measurement

4. Part A. Patient Centered Care 1. What do patients want from a chaplain? a) Has anyone asked? b) Results? 2. Mayo Patient Expectation Surveys 1994 and 2006 3. WHO Categories

5. “The needs of the patient come first.” A. 1. What do patients want from a chaplain? a) Have you surveyed patients? What kind of surveys/questions? b) Results? c) Has your practice changed?

6. 1994 Patient Expectations Regarding Chaplain Services Mayo Clinic Hospitals 1550 surveys sent - 42% response rate A. 2: Mayo Patient Expectation Surveys 1994, 2006

7. 1994 Patient Expectation Survey Gender Reasons patients want to see a chaplain: Female: Male: Female: Male: To remind me of God’s care:75% 71% To remind me of God’s care:75% 71% To pray or read scripture with me: 67% 61% To pray or read scripture with me: 67% 61% To be with me at times of anxiety:67% 54% To be with me at times of anxiety:67% 54% To listen to me:55% 49% To listen to me:55% 49% To meet my ritual needs:56% 48% To meet my ritual needs:56% 48% To counsel with ethics:38% 33% To counsel with ethics:38% 33%

8. 1994 Patient Expectation Survey Age Reasons patients want to see a chaplain: 16-35 36-55 55-75 Over 75 16-35 36-55 55-75 Over 75 To remind me:74% 81% 68% 70% To remind me:74% 81% 68% 70% To pray with me:64% 64% 65% 63% To pray with me:64% 64% 65% 63% To be with me:76% 66% 58% 49% To be with me:76% 66% 58% 49% To listen to me: 76% 66% 44% 37% To listen to me: 76% 66% 44% 37% To meet ritual needs: 57% 59% 51% 45% To meet ritual needs: 57% 59% 51% 45% To counsel me: 51% 44% 31% 46% To counsel me: 51% 44% 31% 46%

9. 1994 Patient Expectation of a Chaplain Visit 48% expected to see a chaplain without having to request a visit 48% expected to see a chaplain without having to request a visit 47% did not expect a chaplain to visit unless they requested it 47% did not expect a chaplain to visit unless they requested it

10. 2006 Patient Expectations Regarding Chaplain Services 1500 surveys sent - 36% response rate A. 2: Mayo Patient Expectation Surveys 1994, 2006

11. 2006 Patient Expectation Survey Gender Reasons patients want to see a chaplain: Female: Male: 1994 20061994 2006 To remind me of God’scare: 75%-88% 71%-81% To remind me of God’scare: 75%-88% 71%-81% To pray or read scripture: 67%-77% 61%-63% To pray or read scripture: 67%-77% 61%-63% To be with me at times of anxiety and uncertainty: 67%-83% 54%-70% To be with me at times of anxiety and uncertainty: 67%-83% 54%-70% To listen to me: 55%-73% 49%-58% To listen to me: 55%-73% 49%-58% To meet my ritual needs: 56%-57% 48%-46% To meet my ritual needs: 56%-57% 48%-46% To counsel: 38%-51% 33%-43% To counsel: 38%-51% 33%-43%

12. 2006 Patient Expectation Survey Age Reasons patients want to see a chaplain: 16-35 36-55 55-75 Over 75 16-35 36-55 55-75 Over 75 1994 2006 1994 2006 1994 2006 1994 2006 1994 2006 1994 2006 1994 2006 1994 2006 To remind: 74%-72% 81%-80% 68%-85% 70%-88% To remind: 74%-72% 81%-80% 68%-85% 70%-88% To pray: 64%-43% 64%-67% 65%-72% 63%-73% To pray: 64%-43% 64%-67% 65%-72% 63%-73% To be with: 76%-76% 66%-73% 58%-75% 49%-82% To be with: 76%-76% 66%-73% 58%-75% 49%-82% To listen: 76%-62% 66%-64% 44%-65% 37%-68% To listen: 76%-62% 66%-64% 44%-65% 37%-68% To meet: 57%-24% 59%-49% 51%-51% 45%-61% To meet: 57%-24% 59%-49% 51%-51% 45%-61% To counsel: 51%-52% 44%-45% 31%-46% 46%-51% To counsel: 51%-52% 44%-45% 31%-46% 46%-51%

13. Reasons Patients Want to See a Chaplain 1994 2006 1. Remind me of God’s care and presence:72% - 84% 2. Be with me at times of particular anxiety:62% - 76% 3. Listen to me: 52% - 66% 4. Meet my ritual or sacramental needs: 80% 53% - 51% 87% 5. Counsel with moral/ethical decisions: 36% - 47% In 1994 48% expected a visit without requesting In 2006 36% expected a visit without requesting

14. 2006 - Reasons Catholic Patients Want to See a Chaplain All Catholic All Catholic 1. Remind me of God’s care and presence:84% - 88% 2. Be with me at times of particular anxiety:76% - 82% 3. Listen to me: 66% - 69% 4. Meet my ritual or sacramental needs: 51% - 87% 5. Counsel with moral/ethical decisions: 47% - 52% 6. Pray/read scripture:69% - 73% 7. Expected a visit without requesting36% - 41% (in ’94 - 55%) (in ’94 - 55%)

15. Comment Patients expect those services from chaplains that more serve their spiritual needs: They want the chaplain to remind them of God’s care and presence They want the chaplain to remind them of God’s care and presence To be with them at times of anxiety and uncertainty - when they are “scared to death!” To be with them at times of anxiety and uncertainty - when they are “scared to death!” To listen to them (and validate their spiritual beliefs) To listen to them (and validate their spiritual beliefs)

16. Comment 4. They are relatively uninterested in rituals or sacraments (except Catholics) 14% said meeting ritual or sacramental needs was Very Unimportant) 5. 23% do not want counsel concerning moral or ethical concerns or decisions – 30 % Neutral – neither important or unimportant 11% Somewhat Unimportant 12% Very Unimportant

17. 1. Pastoral Assessment 2. Pastoral Ministry – the provision of the primary ministry of presence and expression of service, etc. 3. Pastoral Counseling or Education – personal and familial counsel, ethical consultation, review of one’s spiritual journey 4. Pastoral Ritual / Worship A. 3: World Health Organization (WHO) Pastoral Intervention (PI) Coding

18. Part B. Chaplain Centered Issues Rank in your order of importance:  Report the number of services provided  Chart in the medical record  Record the number of patients seen  Measure chaplain productivity  Give an accounting to supervisor and administration  Measure outcomes  Conduct research for best practice  Practice self care

19. Part C. Metrics Why record chaplain activity? Why record chaplain activity? What is measured, counted, reported? What is measured, counted, reported? How measure patient needs? How measure patient needs? How measure unmet patient needs? How measure unmet patient needs? How measure patient satisfaction and outcomes? How measure patient satisfaction and outcomes? How does research determine patient needs and appropriate staffing response? How does research determine patient needs and appropriate staffing response?

20. Reasons for Developing Metrics Accountability; Budget Accountability; Budget Continuous Improvement Continuous Improvement Patient Satisfaction Patient Satisfaction Productivity Measures Productivity Measures Research Research Staffing Plan Staffing Plan Supervision Supervision

21. What if you were in business for yourself?

22. what kind of salary would you expect? what kind of salary would you expect? who would pay you? who would pay you? how much would you charge for a patient consultation? how much would you charge for a patient consultation? how much for 5 minutes of prayer? how much for 5 minutes of prayer? how much for an anointing of the sick? how much for an anointing of the sick? how would you advertise your availability? how would you advertise your availability?

23. Saints Cosmas and Damien They saw in every patient a brother or sister in Christ, showed great charity to all, and treated their patients to the best of their ability. Yet no matter how much care a patient required, they never accepted any money for their services. Thus, they were called anargyroi in Greek, which means "the penniless ones."

24. Again, “What if you were in business for yourself?”

25. Is what we do some kind of Secret? “We don’t want to have to tell you what have to tell you what to do, you tell us what you do!”

26. Question: What Do We Do? We know what we do - and we need to describe it clearly. We know what we do - and we need to describe it clearly. When we know and value our work we will communicate it authentically. When we know and value our work we will communicate it authentically. When we document what services we provide we are able to know what remains undone. ( # of patients per chaplain?) When we document what services we provide we are able to know what remains undone. ( # of patients per chaplain?) When we know what we can do with current staff we are able to ask for additional staff to do what remains undone. When we know what we can do with current staff we are able to ask for additional staff to do what remains undone.

27. Part D. Methods for Measuring 1. Press Gainey 2. Mayo Care Program (UOS) 3. SPIRIT Program 4. Providence Everett (SCU) 5. HealthCare Chaplaincy 6. Clinical Governance System 7. CHI Study 2002

28. 1. Press Gainey CHA/NACC Summit in Omaha CHA/NACC Summit in Omaha Metrics Task Force Metrics Task Force Standardized Question Standardized Question Proposed: Proposed:

29. Data Collection Program Criteria Any data collection program is based on the following: 1. What do we need to measure and for what reason/s? 2. What do we want to measure and for what reason/s? Counting and reporting numbers says nothing about patient needs, the intervention, or the quality of care

30. Program Criteria User friendly; uncomplicated User friendly; uncomplicated Intuitive Intuitive Reliable Reliable Tailored to your need; customized; adaptable Tailored to your need; customized; adaptable A tool for communication A tool for communication Research capability Research capability

31. 2. Mayo CARE Program (UOS) Budget; Expense per Unit of Service Budget; Expense per Unit of Service Productivity Productivity Accountability Accountability Staffing Staffing Supervision Supervision Research Research

32. Refer to Spiritual Care Interventions as Service Events – Not Visits

33. Mayo Service Events (Direct) AM Admit AM Admit Anointing Anointing Associated Death Associated Death Bereavement Bereavement Care Conference Care Conference Code 45 Code 45 Crisis Care Crisis Care Death Death Ethics Consult Ethics Consult Ethics Contact Ethics Contact Family Care Family Care Funeral/Wake Funeral/Wake Group Facilitation Group Facilitation Home Visit Hospice Home Care Office Drop In Pastoral Contact Pre-surgical Care Public Worship Research Intervention Retreat Care Group Ritual/Sacrament Spiritual Assessment Spiritual Care Staff Care/Staff Care Group Staff Development/Teaching

34. Service Events (Indirect) Administration Administration CPE Administration CPE Administration CPE Meeting CPE Meeting CPE Preceptorship CPE Preceptorship CPE Supervision CPE Supervision CPE Teaching CPE Teaching Meeting Meeting Mission Support Preparation Time Professional Organizations Research Rounds Supervision Volunteer Coordination

35. WHO Pastoral Intervention Codings (2002) Pastoral Assessment – an appraisal of the spiritual wellbeing, need and resources of a person within the context of a pastoral encounter. Pastoral Assessment – an appraisal of the spiritual wellbeing, need and resources of a person within the context of a pastoral encounter. Pastoral Ministry – the provision of the primary ministry of presence and expression of service, which may include: establishing of relationship / engagement with another, hearing the story, and the enabling of pastoral conversation in which spiritual wellbeing and healing may be nurtured, and companioning / supporting persons confronted with profound human issues of death and dying, loss, meaning, and aloneness. Pastoral Ministry – the provision of the primary ministry of presence and expression of service, which may include: establishing of relationship / engagement with another, hearing the story, and the enabling of pastoral conversation in which spiritual wellbeing and healing may be nurtured, and companioning / supporting persons confronted with profound human issues of death and dying, loss, meaning, and aloneness.

36. WHO Pastoral Intervention Codings (2002) Pastoral Counseling or Education – an expression of pastoral care that includes personal or familial counsel, ethical consultation, a facilitative review of one’s spiritual journey, and support in matters of religious belief or practice. Pastoral Counseling or Education – an expression of pastoral care that includes personal or familial counsel, ethical consultation, a facilitative review of one’s spiritual journey, and support in matters of religious belief or practice. Pastoral Ritual / Worship – this intervention contains the pastoral expression of informal prayer and ritual for individuals or small groups, and the public and more formal expressions of worship, including Eucharist and other services, for faith communities and others. Pastoral Ritual / Worship – this intervention contains the pastoral expression of informal prayer and ritual for individuals or small groups, and the public and more formal expressions of worship, including Eucharist and other services, for faith communities and others.

37. Developing Service Types Initiate a process with your staff to develop unique service types for your institution Initiate a process with your staff to develop unique service types for your institution Clearly define all service types to clearly distinguish them from each other Clearly define all service types to clearly distinguish them from each other Calculate a relative resource unit (RRU) based on time Calculate a relative resource unit (RRU) based on time Determine the expense per unit of service (UOS) and then the cost of each service type Determine the expense per unit of service (UOS) and then the cost of each service type

38. RRU Factors 0.65 AM Admit 2.13 Anointing 4.00 Associated Death 3.51 Bereavement 2.38 Care Conference 4.37 Crisis Care 5.32 Death 1.86 Family Care 7.78 Funeral 3.30 Office Drop In 1.00 Pastoral Visit 2.17 Pre-surgical Visit 1.86 Research Intervention 1.84 Rituals/Sacraments 2.17 Spiritual Care 1.86 Staff Care

39. Expense per UOS An Expense per UOS is a way of reporting direct patient care activity in relation to the expenses budgeted for your department An Expense per UOS is a way of reporting direct patient care activity in relation to the expenses budgeted for your department It is a method of accountability to your administration It is a method of accountability to your administration It is expected that we meet or beat our Expense per UOS on a monthly basis It is expected that we meet or beat our Expense per UOS on a monthly basis

40. Greater “productivity” reduces the Expense per Unit of Service!

41. Greater “productivity” increases department income department income !

42. Collecting Data The CARE Program: Chaplain Activity Record - Electronic A model / example of the CARE program is available on CD at no cost. Your IT Department will need to adapt this Access Program to your environment.

43. The demonstration program on the CD will run as is with a limited data storage capacity. It is offered without cost to recipients and will not be supported by the distributor or any other entity or institution. Recipients must agree to rely on their own experience with Microsoft Access 2003 or the Information Technology Department in their institution to support and/or adapt the program to their system.

44. A Word of Wisdom “Remember this and remember it well. Never do anything a computer can do better. Then you will be able to have time to do what a computer cannot do.” Harold Kaiser, Health Care Futurist, 1988

45. CARE

50. % of Patient Contacts

53. Unmet Patient Needs 60% (300 patients) receive spiritual/pastoral care at least once during their stay 60% (300 patients) receive spiritual/pastoral care at least once during their stay 40% (200 patients) do not 40% (200 patients) do not If chaplains were to care for those 200 patients they would find that: If chaplains were to care for those 200 patients they would find that: 27% would result in a pastoral contact 27% would result in a pastoral contact 73% would result in a significant spiritual care intervention 73% would result in a significant spiritual care intervention

54. 3. SPIRIT Program www.spiritforchaplains.com Web based vendor Web based vendor

57. 4. Providence Everett Creates a Spiritual Care Unit (SCU) based on the intensity of the visit Creates a Spiritual Care Unit (SCU) based on the intensity of the visit Uses an Excel Spreadsheet Uses an Excel Spreadsheet Green for Routine Initial Visits – 1 Green for Routine Initial Visits – 1 Yellow for Extended Visits – 2 Yellow for Extended Visits – 2 Red for Intensive Visits – 4 Red for Intensive Visits – 4 Tim Serban Tim Serban

58. 4. Providence Everett

60. simple one page per week in excel and needs no minute by minute calculations simple one page per week in excel and needs no minute by minute calculations “Too often statistic programs focus on minutes spent with patients rather than the intensity of such visits.” The SCU “represents a weighted value of intensity of visit.” “Too often statistic programs focus on minutes spent with patients rather than the intensity of such visits.” The SCU “represents a weighted value of intensity of visit.” “If time were reflected each SCU could be closest to 15 minute increments.” “If time were reflected each SCU could be closest to 15 minute increments.”

61. 4. Providence Everett also measure the number of patients who are in the hospital 3 days or longer who have been seen by a chaplain as a standard for measuring what we have potentially missed rather than solely reporting on what chaplains have done also measure the number of patients who are in the hospital 3 days or longer who have been seen by a chaplain as a standard for measuring what we have potentially missed rather than solely reporting on what chaplains have done

62. 4. Providence Health System Spiritual Needs & Chaplaincy Services Spiritual Needs & Chaplaincy Services Rodriguez B., Rodrigues D., Casey Rodriguez B., Rodrigues D., Casey 2000 2000

63. 5. HealthCare Chaplaincy In house data collection system that is web based; research and publication driven In house data collection system that is web based; research and publication driven Establish benchmarks for average length of visits; % initial; % follow-up Establish benchmarks for average length of visits; % initial; % follow-up Referrals, from whom; why; presenting issue; real issue; intervention; time Referrals, from whom; why; presenting issue; real issue; intervention; time The influence of the religion match between chaplain and patient especially relative to prayer The influence of the religion match between chaplain and patient especially relative to prayer

64. 6. Clinical Governance System What should be measured: Customers’ needs and wants Customers’ needs and wants Appropriate staffing and resources to meet needs/wants Appropriate staffing and resources to meet needs/wants Reasons for ‘failed’ visits Reasons for ‘failed’ visits Success in meeting client demand Success in meeting client demand What has been planned has been carried out What has been planned has been carried out

65. 6. Clinical Governance System What should not measured: How many clients did we see How many clients did we see How many of this did we do How many of this did we do How many did we refer to this department How many did we refer to this department Measuring the Effectiveness of Chaplaincy: What to Audit, James Duffy and Gillian Munro, Scottish Journal of Healthcare Chaplaincy, Vol. 8. No. 2. 2005

66. 7. Catholic Health Initiatives

68. Have a good day or a bad one - Better luck next life! whichever you choose!

69. Let me know what works marek.dean@mayo.edu