Measurement and Mystery May 31, 2013 National Association of Catholic Chaplains Day for Professional & Spiritual Enrichment Orange, California

2 Introduction  Why chose theme?  Challenge in the healthcare arena  Work that has been done to date  Ongoing efforts

3 Leadership Issues  Catholic Healthcare Mission = Business Financial Realities Culture Competition  Mission Leaders

4 Mystery  Can one really measure the work of spiritual care?  What is the theological basis?

5 Theological Grounding  Nature and grace  Incarnation John 1:14 Word became flesh and dwelt among us.  Incarnation ‒ Tell John what you saw.  Sacramental ‒ Outward sign of an invisible grace

6 Theological Grounding  Time Chronos – Time spent on earth Chairos – Time of salvation Doing a time-study of the Jesus of the Gospels

7  Productivity? What is being done by chaplains?  Quality? Is what being done contributing to overall patient quality and satisfaction?  Effectiveness? Is what is being done effective?  Impact? Can one identify and measure the outcomes of spiritual care? Challenge: Defining/Demonstrating the Value Proposition

8 Quality Improvement  Fundamental to HC  Across all facets of HC  SC providers take the lead in creating a culture of care and measure quality of SC services  Three perspectives for measuring quality Process Measures Outcome Measures Performance against Standards

9 Process Measures Outcome Measures Performance Against Standards Integration

10 1. Process Measures- a measure which focuses on a process that leads to a certain outcome. Can you answer the questions: - Did you do it (services complete)? - Did you do it right? Process Measures

11 2. Outcome Measures - a measure of the results of a system, relative to aim. Can you answer the question: - Did the process you completed get the outcome desired/expected? Outcome Measures

12 3. Performance against Standards Can you answer the question: - What are the measurable standards agreed upon across the profession that demonstrate effectiveness in spiritual care? Performance against Standards

13 Spiritual Care Department is an integral component of the Palliative Care Team.  Process Measure: Palliative Care team initiates contact with chaplain upon patient admission to services within 24 hours.  Outcome Measure: Chaplains track number of palliative care patients seen. Patient encounter included with other quality data that shows variables in patients seen and not seen by chaplain.  Performance to Standards: Annually conduct an evaluation with Palliative Care team of chaplain performance against Standards (Standards of Practice for Professional Chaplains in Acute Care.) Acute Care Setting Example

14 Spiritual Care department to provide training to clinic staff on spiritual distress screening tools. Staff screenings are designed to generate spiritual care referrals.  Process Measure: Report number of staff trained to utilize spiritual distress assessment tool and count number of referrals made to Spiritual Care staff.  Outcome Measure: Staff take pre and post test indicating level of comfort with detecting spiritual care distress.  Performance to Standards: Screening and referral tools and processes in place, with training of all (100%) of staff. Can build in year cycles (year one =50%, year two = 80%, year three = 100%) Non Acute Care Setting Example

15 I. Preamble: Acknowledge work Benefits, challenges Purpose: one voice II. Introduction: ERDs Spiritual care in context of Catholic health care: work of God Part Two: respect human dignity, holistic, integral III. Organization/System Level Plan, policy, education of all staff importance/role Organization chart, lines of responsibility Full range of services, integrated into all services, facilities Spiritual care models showing entire staff responsibilities  Support of all, screening by staff, specialist service of chaplains Core Elements for System Standards

16 IV. Spiritual Care Department Plan Model, staff composition Qualified leader Staff personnel, preparation, competencies Job descriptions Partnership with faith communities Services covered based on 9 essential chaplain functions Standards of Practices Budget Core Elements for System Standards, cont..

17 V. Care Delivery Scope of service clearly communicated  Extent of services Collaborations and Relationships  Board Certified Chaplain part of interdisciplinary care team  Role on Ethics Committee  Orientation of new employees  Screening and referral tools and processes  Spiritual/emotional diagnosis part of interdisciplinary care team deliberations  Spiritual care assessment, care plan, all notes part of documentation (EMR) Core Elements for System Standards, cont..

18 Grateful to:  Rose Shandrow, M.Div., Director, Spiritual Care Services, Franciscan Health System in Tacoma, WA  Spiritual Care Services Process Improvement Team – Chaplain Measures  Prepared by Gordon J. Hilsman, D.Min., former Manager of CPE, St. Joseph Medical Center in Tacoma, WA Measuring through Assessments CHI – Franciscan Health System, Tacoma WA

19  Catholic Health Initiatives: Measures of Chaplain Performance and Productivity: Task Force Report published June 2002 Develop a common language to articulate what chaplains do and the value added Develop tools for managing performance and productivity Promote the professionalism of chaplains and the integration of spiritual care Integration of Spiritual Care

20 Personal (Healthcare View) Soul BodyMind

21 1. Framework of Spiritual Assessment 2. Chaplain Functions 3. Spiritual Care Outcomes 4. Benefits of Framework Objectives

22 1. Recordable 2. Establish Rapport first 3. Needs Focus (ad sedio) 4. Partnering Endeavor 5. Continued Learning Assumptions - Spiritual Care

23 All that an individual values, practices, believes, and decides in order to cope with and enjoy what can’t be controlled, including relationships with oneself, other people, Transcendence and communities of importance Spirituality

24  A ministry event consists of a person functioning as a caregiver addressing the spiritual need of another person experiencing a difficult life situation.  Spiritual needs are seriously unsettling challenges to the human spirit of a given individual. Ministry to Spiritual Need

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26  What does this person need emotionally right now?  What has this person lost, recently and historically?  What are the ways this person maintains and nurtures her own human spirit?  What does this person need that may be beyond my relationship with him? Basic Axis Questions

27 What does this person need emotionally right now, (from me)? Axis One: Emotional Support

28 1. The Crisis Need for Stabilizing EMOTIONAL SUPPORT 2. The Expression Need to Engage and Share 3. The Anxious Need of Waiting Too Long 4. The Bewildering Need for Basic Information 5. The Regression Need to be Empowered

29 Needing to cry, yell, share, or just tell somebody how you feel about what is happening to you 2. The Expression Need to Engage and Share

30 Function Desired Outcomes 2. An Expressing person Talks openly Expresses feelings Cries Relaxes Considers resources Supportive Validating

31 4. Waiting Upset feelings from waiting too long in an important situation

32 Presence & Networking Expresses situation Prays Acknowledges limitations Thankful Calm 4. A person who is waiting too long Function Desired Outcomes

33 What has this person lost, recently and historically, that still disturbs her/him at times? Axis Two: Loss and Grief

34 Major Losses 6.Acute Grief (in past 48 hours) 7.Prior Grief (Lost earlier) 8. Dying 9. Huge Life Adjustment

35 7. Prior Grief Major past loss being currently grieved

36 Mentions previous loss Expresses emotion Receives validation Shares reminiscences Cries while talking about the lost loved one Receives referral for further grief assistance Expresses greater hope 7. Prior Grief Function Desired Outcomes Grief Counseling

37 7. Grief Counseling Outcomes (%)

38 How does this person maintain and nurture her own human spirit? Axis Three: Spiritual Resources

39 Religious/ Spiritual Care 10. Instruction 11. Religious Support 12. Spiritual Support 13. Spiritual Counsel 14. Self Forgiveness 15. Estrangement

40 The Need to feel the immediate positive presence of Transcendence 11. Religious Support

41 Religious Support Sacrament/ spiritual ritual Spiritual leader of choice Religious questions/problems Prays Function Desired Outcomes Person who is needing God

Estrangement Need to re-connect with separated loved ones

43 Reconciling Talks about an estranged relationship Agrees to receiving contact with an estranged person Agrees to take initiative to contact an estranged person Accepts the adequacy of one’s efforts at reconciling A person regretting estrangement Function Desired Outcomes

44 What does this person need that may be beyond my relationship with her/him? Axis Four: Advocacy and Referral

45 Referral/ Ethics 16. Medical Ethics Concerns 17. Family Conflict 18. Advocacy 19. M. Health/ Addiction Concerns 20. Family Dysfunction Concerns 21. Love Life

Mental Health/Addictions Need to explore concerns about one’s mental health or mood altering chemical abuse

47 Referral Concern verbalized Feelings expressed Calm conversation Accepts consultation Function Desired Outcomes 19. People with mental illness or addiction concerns

Love Life Pain Need for listening, advice or referral about one’s love life

49  Documentation  Training Resource  Measurement Source Benefits of the Spiritual Assessment Framework

50 What are the needs? What did we provide? What is the plan of care? Spiritual Assessment Form

51 INTERVENTIONS: Advanced Directive Information provided: (Single) __Yes __No Advanced Directive Comment: (Free text) __________________________________________________________________________________________________ EMOTIONAL SUPPORT: (Multi) __Anxiety reduction initiated __Emotional Health Education provided__Empathic Companioning __ Empowered patient __Established Trust __Family/ Significant Other supported __Guided Imagery provided __Hope” strengths identified__“Hope” struggles identified __Information provided __“Meaning” strengths identified__“Meaning” struggles identified __“Relationship” strengths identified __“Relationship” struggles identified __Other Emotional Comment (free text)____________________________________________________________________ CHANGE, ADJUSTMENT AND LOSS (Multi) __ Change, adjustment, loss education provided __End of life discussion/care __“Hope” with loss addressed __Life review facilitated __Loss & Grief (current) support provided __Loss and Grief (prior) support provided __Meaning” of the loss discussed__Referral provided __Relationships/Community/Support system discussed __Other Change, Adjustment and Loss Comment (Free text) ____________________________________________________________________________________ Spiritual Interventions

52 SPIRITUAL AND RELIGIOUS multi) __Anointing of the Sick__ Baptism provided __Beliefs/Values explored __Blessing/Ritual provided __Communion provided__Confession/Reconciliation provided __Ed. on Spiritual/Rel. issues provided__Forgiveness addressed __God/the spiritual strengths identified__God/the spiritual struggles identified __Holy texts/Scripture read/provided __Religious leader/community consulted __ Rosary shared/provided __Prayer shared __Spiritual/Religious life explored __Other Spiritual and Religious Comment (Free text) __________________________________________________________________________________________________ ETHICS, ADVOCACY AND REFERRAL(Multi) __Addiction discussed/referral/support made __Advocated for patient __Care now and/or in the future discussed__Ethical issues discussed __Ethics Committee called __ Ethics, advocacy or referral education provided __Family Conference facilitated __Healthcare team-Pt./Fam. communication facilitated __Referral provided __Resources provided __Relationship issues/conflict addressed __Other Ethics, Advocacy and Referral Comment (Free text) __________________________________________________________________________________________________ Intervention Comment/Summary Points (Free text) _________________________________________________ Spiritual Interventions, cont…

53 Data Collection Tool

54 Able to Identify the Workload of the Chaplains Pastoral Care Encounters Department

55 Types of Referrals

56 Spiritual Care Needs Addressed

57 Types of Functions to Address Needs - Emotional Support

58 Types of Functions to Address Needs - Loss/Adjustment

59 Types of Functions to Address Needs - Spiritual & Religious Support

60 Types of Functions to Address Needs - Advocacy & Referral

61 Chaplain Ima Nun Chaplain to Department Comparisons - Emotional Support Department

62 Chaplain Andy Wokswitme Chaplain to Chaplain Comparisons - Emotional Support Chaplain Ima Nun

63 Chaplain Sean Deaconery Year to Year Comparisons - Spiritual and Religious Support

64 StudentsChaplains Students to Chaplains Comparisons - Loss and Adjustment

65 Staff ChaplainPer Diem Chaplain Per Diem to Staff Chaplain Comparisons - Spiritual and Religious Support

66 Facility to Facility Comparisons St. Alan HospitalSt. Catherine Hospital

67 Spiritual Care Needs - Clinical Area

68 Spiritual Care Needs - Staff

69 Sources of Referrals-Combined Fiscal Year to Date

70 Categories of Spiritual Care Needs Addressed-Combined Fiscal Year to Date

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73 Division of Mission Operations/Spiritual Care Spiritual Care Interventions-Combined Fiscal Year to Date / n=60,778

74 A Means for Examining Effectiveness of Spiritual Care Functions  What are the desired outcomes for rendering a chaplain function?  To what degree do I see the desired outcomes from the services I provide?

75 Data Collection Tool

76 Summary of Observable Outcome

77 Results Gained from Spiritual Assessment Framework  Improved care to the patient/family/staff  Improved documentation  Identifiers for Growth and Development of Chaplains  Facilitated discussions in depth by staff chaplains regarding each of the Chaplain functions  Interdisciplinary Education  Community/Patient Education