I remember some time ago in a long-term care facility having a conversation with one of the residents. Joe was gazing out the window. I asked what he was thinking about, and he said, “I just remembered an incident with my brother that happened 30 years ago, and how rude and short-sighted I was at that time because of a personal hurt that had nothing to do with him. My brother died last year. I am just asking God and my brother for forgiveness. I am good, and so is God.” Then he remarked, “I can’t wait for tomorrow to learn more about my yesterdays, and hand them over to God.” I was touched by his candor, inspired by his self-reflection, and enlightened by his comment, I can’t wait for tomorrow to learn more about my yesterdays, and hand them over to God.
Every New Year is an invitation for a tomorrow, and an invitation to learn about and let go of our yesterdays. In preparing this column, I looked back at my January-February columns of past years. I did this last year also. Last year I wrote:
“I was struck by the themes of these issues: 2008 was Solutions to Charting, 2009 was Reaching Out to the Immigrant, 2010 was Small Workplace, Big Challenges, and 2011 was the Profession of Chaplaincy. These are still vital themes for our members. Thirdly, the topics of my columns were: 2008 – promoting the value of pastoral care. 2009 – our NACC 2009 goals, 2010 – the call to leadership within NACC, and 2011 – what characteristics make chaplaincy a profession.”
Last year’s theme was on how spiritual care ministry in healthcare is responding to the needs of the poor. It paralleled well the 2009 theme on Reaching Out to the Immigrant, as both focused our attention on those we serve, especially society’s marginalized. This year’s theme examines how our members are called through and on behalf of their institutions to relate to the broader community within which the institution is situated. Do you notice a pattern too?
About five years ago, the phrase “from bedside to boardroom” challenged the common notion of the chaplain’s work to be mostly bedside ministry. It called us to embrace and communicate the realization that chaplaincy is part of the spiritual leadership efforts throughout the institution, working with mission leaders and others to promote the spirituality of the organization.
More recently the call for chaplaincy is not only from bedside to boardroom, but to beyond the walls of the institution and into the community, whether it is in clinics, outpatient settings, community health centers, homes, mobile units, and more. As we know, healthcare reform emphasizes prevention and wellness, and one delivery model will be the medical home model of care.
One of our challenges will be to be seen and experienced as one of the providers in the medical home model of care. It is not surprising that on websites that explain the medical home model of care, spiritual care providers are most often not mentioned. For example:
As Medicaid spending continues to overwhelm state budgets, the medical home model of care offers one method of transforming the healthcare delivery system. Medical homes can reduce costs while improving quality and efficiency through an innovative approach to delivering comprehensive patient-centered preventive and primary care.
Also known as the patient-centered medical home (PCMH), this model is designed around patient needs and aims to improve access to care (e.g., through extended office hours and increased communication between providers and patients via email and telephone), increase care coordination and enhance overall quality, while simultaneously reducing costs.
The medical home relies on a team of providers – such as physicians, nurses, nutritionists, pharmacists, and social workers – to meet a patient’s healthcare needs. Studies have shown that the medical home model’s attention to the whole-person and integration of all aspects of healthcare offer potential to improve physical health, behavioral health, access to community-based social services and management of chronic conditions.
This particular site also notes that health information technology (HIT) is a key to success because it makes possible a virtual network of providers. Unless chaplaincy charting and spiritual assessments are integrated into HIT, we will not be part of the team of providers. Also, they note that the focus on quality of patient outcomes rather than volume will drive payment. So do care plans and their evidence-based outcomes of quality include spiritual care?
In the coming months and years, we will need to devote our efforts to being a strategic partner in our organizations when they are designing pilot projects and service models to provide care beyond the walls. We are grateful to the many systems that have been including chaplaincy in this process, from ensuring that spiritual care is part of the design of their HIT, to exploring models to ensure chaplaincy care is part of the services offered.
We have an exciting and vital challenge ahead of us! Bring on 2013!
David A. Lichter, DMin
Executive Director, NACC