By Tim Crowley
Almost a year ago, I presented a webinar for NACC membership on “What every chaplain should know about the business of healthcare.” Since then, the looming uncertainty over coming changes in the healthcare landscape has only grown.
With a system ripe for reform, the chaplaincy profession must make our case for how our services contribute to safe, efficient, effective and improved healthcare services. What we do makes a big difference, as healthcare is about much more than medical care. The spirit needs healing and care as well, and it’s our role to lead that effort in our organizations.
As a retired hospital executive and a recently minted chaplain, I’ve been asked to reflect on how our newly required competencies as chaplains interplay with organizational culture and business principles.
As a reminder, the revised standards of practice for chaplains include Standard 15, “Business Acumen: The chaplain values and utilizes business principles, practices and regulatory requirements appropriate to the chaplain’s role in the organization.” NACC (and the common standards) include standards 305.1, “Promote the integration of Pastoral/Spiritual Care into the life and service of the institution in which it resides,” and 305.3, “Articulate an understanding of institutional culture and systems, and systemic relationships.”
Standard 15 means that as a practicing chaplain, you need to be reasonably well versed in the business of the healthcare industry and how your own organization is regulated and financed. I suggest reading at least one general healthcare trade publication on a weekly basis (free subscriptions at HealthLeadersMedia.com or BeckersHealthcare.com) and have it come straight to your email account, so it becomes your routine. Ask your finance department to do an in-service for you on what you should know about the finances of your organization (and the issues are different in acute care, long-term care, hospice/palliative care, clinics/physician practices). Also, ask what you can do to make your organization more financially healthy. Reducing length of stay (cost reduction) or improving patient satisfaction scores (enhancing revenue) are prime examples, but there are many more. Ask your executive leadership how they view your contribution, and determine if they understand what you do.
Meet with your clinical leadership and educate them on the contributions you can make to an interdisciplinary care team — if you aren’t doing that already. Ask your compliance department about regulation. Interestingly, the leading accrediting agency for U.S. hospitals, The Joint Commission, pays little attention to the provision of spiritual care on their surveys, and the cognate groups are addressing with TJC how their surveyors would recognize consistent, effective spiritual care. To the best of my knowledge, chaplaincy is required by Medicare only for hospice providers. Unless we work for a religiously based organization that has spiritual care in its mission, we are optional.
Standard 305.1: In your own organization, you need to be able to articulate the value of your pastoral/spiritual care contribution to the overall effort. Remember, almost all of us work in environments that are in an ongoing quest to reduce expense. If you read Vision regularly, you know that we have been encouraged to become an active part of the interdisciplinary clinical team, to chart our work in the medical record (and help our colleagues understand its value), and to prove our contribution through participation in research around our profession. A critical aspect of this research is having reasonable, reliable measures of the quality and outcomes of the work we perform. In my hospital career, I heard far too many healthcare executives suggest that a full-time pastoral care department is a luxury, so why don’t we just ask the volunteer community clergy to take care of the spiritual care needs. Uninformed positions require education.
Standard 305.3: We have a vital role to play in many aspects of the culture of our organizations, from spiritual support and active listening with patients/residents and their families; to our own staff and physicians; to assistance in conflict resolution; to guidance with end-of-life decisions; to educating other members of the team to recognize spiritual distress; to grief support; to ethics issues; and religious services and celebrations. While we are doing this work for which the Lord has called each of us, we need to articulate its importance to our health system leaders.
I am proud to call NACC my new professional organization, and pray for our continued success.
Timothy J. Crowley is a staff chaplain at Twin Lakes Senior Living Community in Montgomery, OH, and is a retired hospital executive and a life fellow in the American College of Healthcare Executives.
