Paradigm shift for pastoral providers: Use pilot programs to take spiritual care beyond hospital walls

By Jennifer W. Paquette, DMin, BCC

Julie M. Jones and Dorothy Sandoval presented a workshop at the 2013 NACC National Conference in which they described how, in 2011, St. Louis-based Sisters of Mercy Health System launched a progressive, yet exploratory, plan to provide pastoral care to their physician clinics. The workshop was titled “A New Model of Pastoral Care: Expanding into the Clinic Setting.”

Aware that healthcare was changing and that the role of the chaplain would necessarily evolve, they hoped to devise a model of providing spiritual care consistent with the goals of the larger Mercy organization. This meant a paradigm shift for pastoral providers, delivering spiritual care outside the traditional hospital walls.

For Mercy, this was no small task. The Mercy network spans four states (Kansas, Missouri, Oklahoma and Arkansas) with more than 400 clinics, some of them as much as two hours apart. Their metrics informed them that 96% of Mercy patient encounters occur outside of the hospital. It was clear that the traditional hospital model of chaplain presence to the patient would not work. Yet, their Spiritual Care Vision statement asserted that wherever Mercy patients were served, “attention to spiritual needs will be met.” This clearly meant a delivery system of pastoral care that could transform “relentlessly,” which is precisely the goal of the larger Mercy organization in order to get the healthcare experience “right” for the client. The spiritual care team was committed to trying something and determined that there would be no failures in the results, just learning.

In their first year, the chaplains embarked on pilot plans in a couple of clinics, learning to become more intentional and focused in the clinic setting. By the second year, they were piloting in 37 clinics and became more tightly coupled to the clinic staff. And by the third year (FY2013), they created and used “smart teams,” sharing successful practices, refining approaches to better serve unique clinic environments, such as the oncology clinic, developing promotional materials and discovering new ways to partner. Each year was a journey of learning. It is important to note that throughout this expansion neither their spiritual care budget nor the number of chaplains was expanding. Today, they are in 100 clinics and much has been learned.

Some of the lessons learned include:

• Make friends with the leadership. Cold calling into the clinics did not work. Spiritual care needed to build relationships and support within the leadership of the clinics, becoming partners with the administrative leadership, as well as the physicians, and demonstrating that they could deliver value for the clinic. The Mercy team also recommended developing a relationship with the mission leaders who could introduce the chaplaincy teams into the clinics. Additionally, the physicians understood a “team practice” in the hospitals and were coming to understand its benefits in the clinic setting.
• Adapt! Clinic settings are very different from the hospitals, so the chaplains had to build on what was already present. Intuitively or from prior experience, the clinic personnel frequently understood that the spiritual needs of the patient were important, a good starting point for including spiritual care. Learn the culture and rhythm of the clinics, because there will be individual differences. Be prepared for little additional space to accommodate spiritual care.
• Educate. Not all chaplains were enthusiastic about the move into the clinics. For those who were willing to be change agents, Mercy developed training. Moreover, the clinical staffs themselves needed training in order to understand the role that this new discipline could contribute to the team. Training for the clinical staff had to be brief to be successful. Mercy relied on the clinics to screen for patients who would benefit from contact with the chaplains. For example, individuals with high emotional but low medical needs who often took up significant clinician time became candidates. Other candidates might include patients with chronic illnesses, such as congestive heart failure or diabetes. Mercy developed screening tools to generate appropriate referrals. Moreover, once the clinicians understood the role and value of the chaplains, integration into the team flourished.
• Develop new staffing models. Without increased spiritual care funding and staffing, new models of chaplaincy staffing had to be developed, and they needed to be cooperative with the larger corporate initiatives for delivery of healthcare. As you might imagine, Mercy turned to technology for some of its solutions, sensitive to the limitations provoked by confidentiality concerns. The telephone works well for many patients as does email. They are also planning for the future through video consults. While the use of volunteers in the hospital was often successful, their practice of room-by-room visits did not transition well to the clinics. Mercy is networking with faith communities local to the clinics and building an additional infrastructure through them.
• Create a spiritual environment. Awareness of spiritual care for the patients had to be created separately at each clinic. Space for “Care Notes,” brochures and prayer boxes was identified.
• Pilot the model. Whatever the plan becomes for expanding pastoral care into the clinics, build the plan through the use of a “pilot project.” Pilots are excellent learning tools that can help ensure success.
• Gather feedback. Survey the clinicians. Mercy learned that over 96.5% of the respondents agreed that “spiritual care is important in overall patient care.” Moreover, 84% said that chaplains positively influence patient satisfaction and 81% acknowledged that chaplains play a positive role in supporting the staff.

Successful strategies include, according to the Mercy presenters:

1. If you desire to expand into the physician clinics, identify and build on the strengths you already have.
2. Share internal resources and ideas. For example, if you desire to communicate and market spiritual care into the clinics, use the internal resources in your organization with that expertise.
3. Try something! If you know you need to get started, don’t be afraid to step out and try something.
4. Pilot the project, being willing to accept small failures as keys to future successes. Moreover pilots help to clarify the planning.

Jennifer W. Paquette is director of spiritual care at Providence Mount St. Vincent in Seattle, WA.