Dear Hospital Leader:
For the last several years, we have had an HCA Pastoral Care Steering Committee. This committee has consisted of a representative group of clinical chaplains from our hospitals.
This excellent group believed that it would be useful to our hospitals to prepare some background information about pastoral care programs. This document is the result of their work. We want to express our appreciation to the members of the committee for creating this resource material. There is also a videotape on this subject.
We would encourage the leadership of our hospitals to consider this information from time to time as you evaluate the manner in which the pastoral care needs of our patients are met.
Sincerely,
Richard M. Bracken. Milton Johnson Alan R. Yuspeh
Chairman and President and Senior Vice President,
Chief Executive Officer Chief Operating Officer Chief Ethics and Compliance Officer
Body, Mind, and Spirit: Caring for the Whole Person
The Role of Professional Chaplaincy in HCA Facilities
Healthcare is all about meeting people’s needs: physical, emotional, and spiritual…the three are inextricably bound to one another. An effective pastoral care program recognizes this and provides a cadre of clergypersons [to address] the emotional and spiritual needs of the patient, the patient’s family, and staff….
– James C. Scoggin, Jr., Executive Vice-President,
Methodist Healthcare System, San Antonio, Texas
COMPASSION, KINDNESS, HONESTY, INTEGRITY, FAIRNESS, LOYALTY, RESPECT, DIGNITY
HCA’s core values are most evident in the provision of quality physical, mental, and spiritual care. Our core values, as reflected in our Code of Conduct, recognize the importance of spiritual care for patients, their families, and hospital staff.
The Role of Professional Chaplaincy in HCA Facilities
Table of Contents
The Role of Professional Chaplaincy in HCA Facilities 3
The Role of the Chaplain in Healthcare 4
Benefits of a Clinical Chaplaincy Pastoral Care Program 6
Assessing Pastoral Care Needs 7
Program Models for Pastoral Care 8
Level One: Full Service Pastoral Care Program 8
Level Two: Departmental Status plus CPE Residency Status 8
Level Three: Pastoral Care Department Status 9
Level Four: Limited Pastoral Care 9
Level Five: Coordinated Local Clergy 10
Level Six: Random Uncoordinated Local Clergy Visitation 10
Recruitment of a Clinical Chaplain 11
Conclusion 12
Additional Resources 13
The Role of the Chaplain in Healthcare
Chaplains work to help others, through words, acts, and relationships, to experience as fully as possible the reality of God’s presence and love in their lives.
– Lawrence Holst
The clinical or professional chaplain is a religiously affiliated person (ordained or lay) who has theological training as well as specialized training in healthcare settings. The professional chaplain is usually credentialed by a national certifying body, and may also be endorsed and ordained by the chaplain’s faith group. Integrated into the work and life of the institution, the professional chaplain “tends to the soul of the institution.” While others may serve as chaplains, clinical or professional chaplains offer quality care sensitive to the nuances of the crisis of illness.
The chaplain’s role is to provide spiritual care for patients, their families, and the staff caught in the crisis of illness. The chaplain seeks to bring each person’s faith resources to bear in the journey towards healing.
The work of the chaplains within an institution may variously be referred to as pastoral care or services, spiritual care or services, or chaplaincy services. These terms are used interchangeably in this document. All refer to the multidimensional task of using spiritual and faith resources in caring for the institution: patients, their families, staff, and the community. The work of chaplaincy expresses itself in many ways:
§ Presence
§ Listening
§ Counseling
§ Liaising
§ Mediating
§ Advocacy
§ Proclamation
A clinical chaplaincy program includes the following attributes:
§ Patient Centered
A central task of the chaplain is to ensure that the right spiritual resources reach the right patient at the right time. Many religious resources are available, but not all resources are appropriate for all patients. Those who visit patients with a religious purpose (to evangelize or provide sacramental ministry, for instance) provide potentially valuable religious services that may not be universally applicable. Clinical chaplains do not impose their beliefs on others; rather, they are trained and ethically bound to assist the individual patient in the exploration of the depth and potential of her or his own beliefs and their application to the treatment and healing process.
§ Staff Trained for the Clinical Setting
In addition to schooling in theology and pastoral care, a chaplain usually receives specialized, supervised training in a clinical setting. This training may consist of additional graduate studies or Clinical Pastoral Education (CPE). Certification is provided by either the National Association of Catholic Chaplains (NACC) or the Association of Professional Chaplains (APC).
§ Integration with the Culture of the Facility
The professional chaplain integrates the work of spiritual care into the life of the institution. As a part of the healthcare team, the chaplain strives to fulfill the mission of the hospital, and demonstrates the facility’s commitment to holistic care to the larger community.
§ Distinct from Congregational Clergy
When considering the mix of congregational, retired clergy, or professional chaplains to use in a pastoral care program, understanding their differences is vital. Most congregational clergy generally visit their own members in hospitals, but clinical chaplains have additional training and experience in healthcare and institutional ministry. The clinical chaplain is dedicated to the values of patient-directed, ecumenical, and interfaith ministry. Clinical chaplains are committed to respect patients’ rights and privacy, and are trained in the increasingly important areas of cross-cultural sensitivities and biomedical ethics. Congregational clergy can place only secondary importance on time given to a hospital, hospice, or nursing home by virtue of their primary focus on congregational ministry. Retired clergy may contribute valuable experience and skill in a healthcare setting, but they often lack training in the nuances and demands of the clinical setting.
§ Accountable to their Faith Group
Many denominations and faith groups offer endorsement for those members trained in professional chaplaincy. Endorsement ensures that the facility chaplain is qualified to minister by the standards of the chaplain’s faith tradition and is accountable to that faith group.
Benefits of a Clinical Chaplaincy Pastoral Care Program
HCA’s core commitment to create a culture of compassion, kindness, integrity, fairness, loyalty, respect, and dignity must always be the primary motivating factor in decisions to offer professional chaplaincy care to patients, families, and staff in any institution. However, the realities of finite resources and budgetary concerns cannot be ignored. In an environment of strict fiscal management, it is important to understand how clinical chaplaincy can positively affect the bottom line. Clinical chaplaincy programs can:
§ Increase patient and family satisfaction
§ Positively impact end-of-life decisions
§ Reduce litigation
§ Enhance conflict resolution
§ Increase staff retention
§ Increase staff efficiency
The above claims may seem bold, but all are documented through conventional research. Healthcare litigation often results from poor service and/or poor communication. A clinical chaplain is a trained listener, communicator, and crisis intervener. A chaplain can use these skills, enhanced by an attitude of compassionate care, to facilitate constructive expression of the patient’s or family’s emotions and provide opportunities for conflict resolution that don’t require litigation. The revenue saved by avoiding just two lawsuits per year can underwrite an entire chaplaincy program.
The chaplain is called upon to help families make decisions concerning initiation or termination of life support systems. The intent of the facility and the chaplain is not to dictate a particular decision but rather to help families make informed decisions within the context of a caring healthcare environment. One frequent byproduct of this pastoral care is reduced ventilator days.
Chaplains provide important services to patients, families, and staff during critical decision-making times through advance directives counseling and ethics consultation. A chaplain can be a trusted guide through unfamiliar and painful situations, producing better outcomes for all concerned.
Nurse retention is a national problem. Estimated recruiting costs vary between $10,000 and $25,000 per nurse. Providing pastoral care to nurses, in coordination with employee assistance programs, may significantly reduce burnout leading to resignations. Through pastoral counseling, the chaplain is in a unique position to hear the frustrations of staff and make recommendations to management without violating confidentiality. Most chaplains are skilled conflict mediators. Resolving conflict early can reduce turnover. A sufficiently staffed clinical chaplaincy program has a positive effect on a facility’s morale and productivity.
The chaplain is a liaison between the hospital, local clergy, and congregations to facilitate clergy contact with congregants in the healthcare setting. A chaplain can serve as an interpreter of the hospital culture to clergy and congregants as well as an interpreter of religious cultures to the staff.
Research has affirmed the efficacy of personal faith in healing. A chaplain is the staff member who can most directly bring this force to bear for the patient, which often results in better protocol compliance and outcomes.
Clinical chaplaincy has a positive impact on the bottom line. It expands the quality of service to patients and families. It provides support for hospital staff. It is a vital resource to the leadership team, physicians, staff, patients, and families. Clinical chaplaincy is an integral part of healthcare for the twenty-first century.
Assessing Pastoral Care Needs
Each healthcare setting has its own unique culture that will determine the manner in which spiritual care can best be offered in that facility. General guidelines may help determine appropriate levels of staffing, competencies, and programmatic expectations for individual facilities.
Recommended Ratios
The Association of Professional Chaplains, a national certifying body, recommends a chaplain/bed ratio of 1:50. The American Hospital Association has historically recommended a chaplain/bed ratio of 1:100. The level of acuity, crisis related work (emergency department, critical care), and the number of specialty programs (oncology, cardiac, neonatal, etc.) are also important factors to consider when establishing appropriate ratios for individual spiritual care programs.
Joint Commission on Accreditation of Hospital Organizations (JCAHO)
Hospitals place great importance on the results of JCAHO surveys. Currently, JCAHO does not require hospitals to employ clinical chaplains, but JCAHO has provided standards for spiritual care (JCAHO R.I.1.3.5):
§ Recognition of the spiritual needs and rights of the person is reflected in the policies, procedures, and the administration’s ability to articulate those needs and rights.
§ The pastoral services department has a personnel/bed ratio sufficient to meet and implement the goals and objectives of the pastoral care department.
§ A formal arrangement is documented when operational needs require pastoral personnel from outside the facility.
§ Members of the pastoral services staff are professionally trained and maintain or upgrade their skills consistent with other healthcare professionals.
§ Staff demonstrate the ability to minister with persons of diverse cultural and religious backgrounds.
§ The pastoral services director is certified by a national professional chaplaincy organization and has a graduate theological degree and four units of CPE.
§ Pastoral services have identified comprehensive resources available for pastoral counseling, spiritual direction, and other specific pastoral services.
§ The pastoral services staff documents their interventions in the record of the patient.
Program Models for Pastoral Care
Pastoral care exists in a variety of forms within a large healthcare organization such as HCA. Some forms comply with the intent of JCAHO, while others fall short. The Pastoral Care Steering Committee reviewed the various forms of pastoral care and developed the following Models of Pastoral Care as a tool to for improving the quality of pastoral care throughout the corporation. Six organizational structures are delineated below. They range from Level Six, which is the least structured to Level One, which models a fully integrated spiritual care program.
Level One: Full Service Pastoral Care Program
This is the highest level of pastoral care which enhances Level Two service by including a number of additional responsibilities such as a Pastoral Counseling Center, an Ethicist, an Employee Assistance Program with trained and licensed providers, a research component, etc. Level One pastoral care programs can generate some revenues. The staff is certified and licensed to perform its various types of ministries. The Director may serve at a vice-president level.
Strengths: As with Level Two, the entire hospital is covered with a pro-active approach to patient care. Chaplains and CPE Residents are usually assigned to units and other places of ministry. There is 24/7/365 on-call coverage in the hospital. There is a strong voice for spiritual care in the institution, and the chaplaincy’s work is interdisciplinary. Various members of the staff serve on hospital-wide committees. The staff has access to medical records and documents spiritual assessments and pastoral interventions. Trained chaplains provide religiously and culturally sensitive care as well as expertise in end-of-life and other sensitive ethical issues. Quality of pastoral care is assured through continuing education, quality monitoring, benchmarking, etc. The department has strong community ties. The program provides for more intensive staff education programs. Pastoral resources are available to the staff. This level can generate some revenue. This model provides additional resources to the institution, the staff, and the community through programs delineated above.
Weaknesses: Institutional responsibilities outside of patient and family visitation may dilute pastoral coverage.
Level Two: Departmental Status plus CPE Residency Status
The Pastoral Care Department includes total spiritual care for the patients, families, and staff with the addition of graduate education of local clergy and seminary students in a Clinical Pastoral Education Program or CPE. Services are provided through both full-time staff and clergy in training. The staff consists of Certified Chaplains and CPE Supervisors who work as a team in the accredited program. The Director may serve at a vice-president level.
Strengths: The entire hospital is covered with a pro-active approach to patient care. Chaplains and CPE Residents are usually assigned to units and other places of ministry. There is 24/7/365 on-call coverage in the hospital. There is a strong voice for spiritual care in the institution, and the chaplaincy’s work is interdisciplinary. Various members of the staff serve on hospital-wide committees. The chaplaincy staff has access to medical records and documents spiritual assessments and pastoral interventions. Trained chaplains provide religiously and culturally sensitive care as well as expertise in end-of-life and other sensitive ethical issues. Quality of pastoral care is assured through continuing education, quality monitoring, benchmarking, etc. The department has strong community ties based on training of local clergy. Program provides for more intensive staff education programs. Pastoral resources are available to the staff. This level can generate some revenue.