By Jennifer W. Paquette, DMin, BCC
NACC members who form part of the Catholic Health Association’s Pastoral Care Advisory Committee Staffing Subcommittee presented a workshop titled “Models for Determining Adequate Staffing” at the 2013 NACC National Conference.
Julie Jones (Mercy), Jim Letourneau (Trinity Health), and Tim Serban (Providence Health & Services) noted that staffing has been and continues to be a work-in-progress, a subject around which research and design continue to flourish, and a topic that encourages the input of every healthcare entity in which chaplaincy serves. Today, there exists no definitive model. And so the discussion and consideration of various approaches continue.
What has been learned is that the models that do not work well for evaluating chaplaincy staffing are as important as those that can offer value. First, a few things that don’t seem to work well:
- The ratio of chaplain to staffed beds or census is insufficient because this model does not consider the whole of the ministry (worship services, bereavement groups and other services), staff ministry and/or acuity of the population served.
- A “Unit of Service” (UOS) is insufficient because there is no agreement of measurement using chaplain’s worked days, patient days, or a unit cost.
- The view of consultants is frequently insufficient as their recommendations are often predicated on data that cannot be verified.
The Research and Design Model that the Pastoral Care Advisory Committee Staffing Subcommittee is recommending encourages development of multiple models simultaneously, models that would be shared and tested across many healthcare entities, and subsequently evaluated for use in additional environments. A few models shared by the presenting healthcare systems included:
- Providence Health & Services
Providence Everett Hospital developed a model that showed the relationship between census and staff ministry. When the census declines, chaplains become more attentive to staff ministry. The model was able to demonstrate to administration that chaplains focus beyond patient care while demonstrating to the chaplains the shifts in their work.
- Dignity Health
Dignity was able to conceptualize spiritual care as a three-legged stool of “who we are” (Mission Integration), “a positive factor in patient outcomes” (Strategic Integration), and account for a core staffing standard (Stewardship). Each of these encouraged the spiritual care leaders to consider their importance to administration as well as providing a system level formula of expectations for spiritual care.
Mercy conceptualized staffing in order to show the influence of acuity in planning for chaplaincy support. For example, a 100-bed NICU would staff differently than the same number of staffed beds in a general medical-surgical area.
This presentation evoked considerable discussion. One approach suggested from the audience was simply not to spend too much time stressing over staffing measurements. Know your budget. The spiritual care budget will likely be miniscule compared to the total for the institution. Given the low budgetary impact of spiritual care, the energies spent toward developing measurements might be better spent elsewhere. Another person believed it far more important to ensure a good relationship with the executive team, the kind of relationship that provides frequent contact to tell the story of spiritual care. Indeed, there was considerable sentiment toward ensuring the stories of spiritual care were heard by the hospital executive team. Stories should include areas of creativity and innovation evident within spiritual care, especially where they support the goals of the organization. Another recommendation was to borrow measurement approaches from other disciplines, such as nursing.
Clearly, the staffing topic continues to be of significant interest among leaders of spiritual care across healthcare organizations, who are under pressure to justify their staffs. Being “Catholic” does not exempt chaplaincy from financial pressures.
Certainly, there are successes toward the goal of developing staffing models, but no overarching model under which they all can fit. Nor is there a linking model in which others can easily participate. Your help is needed! In your environment, what has been tried that has offered some success? What have you learned? Why did it work? Was it environment specific? If something was tried and found to be inadequate, why did it not meet expectations? Please share your results with the subcommittee members. They would appreciate hearing from you.
Jennifer W. Paquette is director of spiritual care at Providence Mount St. Vincent in Seattle, WA.