This issue of Vision explores how pastoral care departments are stretching resources and taking steps to extend their reach. David Lewellen, our editor, invited contributions by asking, “As staffing levels shrink and patient loads increase, what is a chaplain to do?” This topic surfaced because so many of you have faced, are facing, or will face this challenge. Staffing is a critical issue.
Back in my consulting days, I was taught early that we could not be operation- or service-driven, but market-driven. An operation- or service-driven consultant firm would try to sell potential clients on the services it knew, and try to convince them they needed the services. But as a market-driven firm, we spent time learning what the potential clients needed, then designed our services to meet their needs. It was actually a much more creative and life-giving approach. We could not rely on templates of past services for proposals, but needed to tailor each one based on what we learned. The first part of our proposal always listed what we heard, the issues identified, the assumptions behind what we proposed, and then how we would design services to meet those needs. That proposal induced dialogue between us and the potential client. In the end they owned the service as well, as it reflected their reality, not a service we provided elsewhere.
I think back on that as we grapple with our spiritual care services and how we want to make the case of staffing in our current service environments. Do we just try to offer what we do the way we did then, or do we hear new needs and/or services asked for?
Over the past two-plus years, the Staffing Subcommittee of the CHA Pastoral Care Advisory Committee has struggled with the staffing question as well. Members of the committee are mission leaders in Catholic healthcare who are responsible for pastoral care within their systems. A couple of years ago, we dreamed of a TurboTax-type software that would allow all of us to plug in key data and get the exact right number of FTEs for a given institution. But that idea faded as we realized the complexity of the staffing issue.
The Staffing Subcommittee did an excellent job in preparing an article for the most recent issue of Health Progress (September-October, 2014) titled “Spiritual Care in the Midst of Health Care Reform.” It is a meaty article that highlights the multiple factors in spiritual care staffing. It provides no simple formula but offers concrete next steps for any system/hospital struggling with staffing. It reiterates the Ethical and Religious Directives’ insistence that “A Catholic health organization should provide pastoral care to minister to the religious and spiritual needs of all those it serves.”
As chaplains, we have provided service in a certain way – in acute care when beds were full. Now I find myself asking, How can we take a market-driven approach to our challenges today? How do we listen to our “potential clients” (in this case, our employers) to learn what they need from spiritual care and then design our services accordingly? Perhaps this article on staffing in Health Progress can be an opportunity for us to do some market listening.
I think we can be encouraged by the fact that the authors identified three core competencies for chaplains: spiritual assessment and care; education; and ritual ministry. The authors might be doing us a service in naming three, rather than reiterating our 13 standards of practice. Perhaps we can view these as a client needs assessment as well? Our services of spiritual assessment and care are needed in every setting. We are certainly familiar with ritual. But what about education? That is a service some of us might now do well, and others need to develop to meet their clients’ (employers’) needs. How do we not just sell what we have done before, but what we need to add? Let me quote from the article to help us envision what is needed (and being done everywhere):
In hospital as well as non-acute settings, chaplains assist in the orientation and formation of new staff, physicians, residents and medical and nursing students. They present the holistic care model and discuss integration of spiritual care in the patient care plan. They also educate clinical care providers on how to conduct a spiritual screening interview. This includes how to identify spiritual distress, what conditions indicate the need for a referral to spiritual care and what a chaplain’s formal spiritual care assessment and plan entail.
Some chaplains have created educational materials to help staff meet religious/cultural expectations of patients and families. In providing ethics education to clinical staff, chaplains can work with them to help patients and loved ones with values clarification around medical ethics decisions and the completion of advanced directives.
So, my friends, do these paragraphs reflect an opportunity to strengthen our competency as educators, and design services to meet a need?
Along with reading the wonderful contributions of our members to this issue on creative staffing, I encourage you to read the above-cited article, as well as another article in that same Health Progress issue titled “CHA Chaplaincy Surveys Offer Key Insights.”
