By Brian P. Smith
The National Association of Catholic Chaplains and the Catholic Health Association have been formally working together for over 10 years. Members of both associations first met during the CHA/NACC Pastoral Care Summit in Omaha in 2007 to determine how to measure the effectiveness of pastoral care that chaplains provide. The summit produced a Metrics Task Force that in 2008 developed standard questions to be used across the ministry to assess spiritual care in patient/resident satisfaction surveys — “If you were visited by a hospital chaplain during your stay, rate your satisfaction with the spiritual care the chaplain provided” — and a workplace spirituality question in associate engagement surveys —“This organization offers me opportunities for spiritual and personal growth.” These questions were widely accepted by major Catholic health systems and incorporated into their survey tools.
Seeing the value of continued collaboration across the Catholic healthcare ministry, CHA’s board of trustees created the Pastoral Care Advisory Committee in 2010 to advise CHA’s president and board on issues of spiritual care. The PCAC comprises 12 people from mission integration and spiritual care representing the continuum of care (acute, post-acute, long-term care, physician practices/clinics, hospice/palliative care) as well as various organizational levels (system, regional and facility). The committee meets several times a year in person or by teleconference. The committee has been co-chaired by CHA’s senior director of mission integration and NACC’s executive director since its inception.
From 2013-2016, the PCAC was organized around three subcommittees: staffing, quality, and communications.
Both CHA and NACC are often asked, “How many chaplains should I have for my facility?” After years of time studies, surveys of senior leaders and clinicians, and gathering the staffing models from over a dozen Catholic health systems, CHA published an article in 2014 in its journal Health Progress. While there is no quick and easy answer to the question, the PCAC gave a framework for the factors that must be considered when staffing a spiritual care department, including number of patient/family/staff encounters; acuity of the patient/resident; type of setting; responsibilities of chaplains for prayer, ritual, education, and staff formation; and local and geographic considerations. The research also showed that chaplains are moving out of the traditional acute and long-term care settings into post-acute, primary care, and outpatient settings. Spiritual care departments need to look at how they are staffing across the continuum of care and what competencies are needed by spiritual care providers in these various settings.
CHA and NACC have also collaborated on quality measures for spiritual care providers. This model requires that spiritual care providers partner with the quality improvement initiatives of their health systems to learn how to set standards for spiritual care interventions, measure the outcome of an intervention, and see how performance compares to standards. This allows a spiritual care team to develop a continuous improvement mentality for the care they offer patients, residents, and staff. It is also the language that clinicians and senior leaders are looking for.
The Quality Subcommittee formed a task force to look at the spiritual care assessment tools used in the various electronic health records. The hope was that a common set of questions could be used across the various EHRs, to collect and compare data from a common platform across the Catholic health ministry. However, the companies who have created these tools are reluctant to change their questions. But looking ahead, the Quality Subcommittee is trying to develop a common set of spiritual care screening questions for use in an outpatient setting. We hope that we can develop the questions before the vendors assign the questions to the EHRs that physicians use in their offices.
The PCAC and NACC have also collaborated on how to better communicate the value of spiritual care to key stakeholders. One of the fruits of this effort was an e-learning module on the CHA website: “Spiritual Care: Essential to Catholic Identity.” The 20-minute module is intended for senior leaders, clinicians, and front-line associates to show why spiritual care is one of the distinctive features of Catholic healthcare and how everyone, with increasing levels of responsibility and competency, culminating in board-certified chaplains, has a role in providing holistic care. Another communication tool developed in partnership is short “elevator speeches” that help chaplains and mission leaders briefly communicate to key stakeholders the value of spiritual care. Each of these scripts provides a concise summary of the key issue, research, and data and what a chaplain/mission leader would want this key stakeholder to know. These elevator speeches can be found here on the NACC website.
In 2016, the PCAC reorganized its work to meet new perceived needs facing the ministry: staff support, patient support, and chaplain development.
There is a growing recognition that the impact of constant and rapid change in healthcare, mergers and acquisitions, and compassion fatigue are affecting those who work in healthcare. We believe that the holistic care we offer our patients and residents should also be provided for our clinicians and staff. In 2016, the subcommittee gathered resources around spirituality in the midst of change and placed them on the CHA website. In 2017, the subcommittee is committed to gathering resources to deal with compassion fatigue and burnout and to help build the case for organizations to devote resources to burnout prevention, workplace spirituality, and staff wellness.
This subcommittee is really the continuation of the Quality Subcommittee. This committee is committed to advancing research that will demonstrate the impact spiritual care interventions have on patients, residents, and staff. The subcommittee hopes to publish an article in Health Progress in 2017, and CHA is looking at devoting an entire issue to spiritual care in 2018.
This subcommittee is looking at ongoing competency development for chaplains and other spiritual care providers that could be jointly developed by NACC and CHA. There is a special focus on developing the leadership competencies of chaplains who wish to pursue leadership roles within their organizations.
The CHA and NACC are also co-sponsoring a survey of chaplains within Catholic health to take place in 2018. The survey will be part of a wider look at succession planning (recruitment, training, and retention) of chaplains for the Catholic health ministry.
The collaborative relationship between NACC and CHA has been a fruitful one for both associations. Working on common challenges has resulted in efficiency of member resources, sharing of practices across the Catholic ministry, and identifying and addressing member needs in a more timely fashion. I have found this collaboration personally satisfying, and I am confident that during the next 10 years, this partnership will be even more productive and exciting!
Brian P. Smith is senior director of mission integration and leadership formation for the Catholic Health Association of the United States.