By David Lewellen
When Mercy Health System realized that out of its 3.2 million annual patients, at least 95 percent were outpatients, the pastoral care department realized that something had to change.
All of its resources were concentrated in the system’s hospitals, but “we had to reach out beyond the bedside,” said Dorothy Sandoval, BCC, who recently retired as director of pastoral services for the system’s facilities in Missouri and Arkansas.
Ken Potzman, director of Mercy’s East Community, set up an email system for workers to reach out to chaplains, which has produced a steady stream of referrals.
Several pilot programs over the past five years have now advanced to the point where they can be expanded. Mercy assigned one chaplain, Kandi Mount, to serve an outpatient clinic headed by a doctor who thought holistically. Mount spent four hours a day rounding in the clinic, and was integrated into the color-coded flag system, so she could know which patient in which examining room had requested a chaplain. When patients had to be transported by ambulance to the hospital, she would wait with them and pray with them, and call ahead to the hospital’s pastoral care department.
Mount’s responsibilities expanded to five clinics in northwestern Arkansas, and the electronic records system allowed nurses to refer patients to her with the click of a mouse. In order to serve five clinics, she began doing visits by phone. “It’s been very well-accepted by chaplains and patients,” Sandoval said. “Everyone uses electronics nowadays. People are comfortable praying over the phone, and they’re comforted by the fact that we reached out and cared.”
The phone program has also been expanded to all new cancer diagnoses; one month later, trained volunteers call those patients, ask if they want to see a chaplain when they come in for infusion, and pray with them if requested.
Mercy wants to expand the program, but does not have the budget for more people, Sandoval said. So hospital-based chaplains have been assigned clinics to visit one day a week. “Building relationships and trust with the staff is very important,” she said. “You have to consistently show up on the day you’re supposed to.”
Chaplains have given 10-minute lunchtime presentations to clinic staff on how to recognize patients’ spiritual needs, and, Sandoval said, “Last year, we hit on our best idea. We would do the spiritual assessment, but [nurses] would do the screening. If we could make it simple and easy, they could put it in their workflow.” Now, along with taking blood pressure and asking about medication, nurses at participating clinics ask patients if they have spiritual or emotional needs. If the answer is yes and the distress fits one of seven or eight categories, “that’s an automatic referral,” Sandoval said. Since introducing the system, referrals at the participating clinics in six months have jumped from 75 to 245.
The next step, Sandoval said, is to make the referral as simple as clicking a button on the electronic record; right now, clinic staff need to call or email the pastoral care office. She is optimistic that that will soon follow, since the program is a finalist for a Mercy innovation award. “We were really excited to be up there with the cardiologists and so forth,” Sandoval said. “It felt like our Academy Awards.”
Throughout the system, everyone realizes that the center of gravity is moving from the hospitals to the clinics, and Sandoval said that even hospital-based chaplains, for the most part, now do only referrals instead of trying to visit everyone on their floor. “We’re teaching chaplains that they have to do ministry differently,” she said. “Some are on board; some are sitting on the fence; some have opted to retire or leave the system.” But, she continued, “There’s room for everyone. You’re still ministering on the phone; you’re still listening and caring.”
Mercy is also offering spiritual formation to clinic-based healthcare workers, which also serves to raise awareness of chaplaincy in new settings. Specialty clinics see the need more acutely, because their patients tend to have more life-threatening illnesses. “They’re so excited to have our services,” Sandoval said. “We’re an added resource for patients. Our clinics are desperate to give them every care they can give them. … When we get one or two who are open to it, the others see the results and follow.”