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Measurement and Mystery

Measurement and Mystery. May 31, 2013 National Association of Catholic Chaplains Day for Professional & Spiritual Enrichment Orange, California. Introduction. Why chose theme? Challenge in the healthcare arena Work that has been done to date Ongoing efforts. Leadership Issues.

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Measurement and Mystery

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  1. Measurement and Mystery May 31, 2013 National Association of Catholic ChaplainsDay for Professional & Spiritual EnrichmentOrange, California

  2. Introduction • Why chose theme? • Challenge in the healthcare arena • Work that has been done to date • Ongoing efforts

  3. Leadership Issues • Catholic Healthcare • Mission = Business • Financial Realities • Culture • Competition • Mission Leaders

  4. Mystery • Can one really measure the work of spiritual care? • What is the theological basis?

  5. Theological Grounding • Nature and grace • Incarnation • John 1:14 Word became flesh and dwelt among us. • Incarnation • Tell John what you saw. • Sacramental • Outward sign of an invisible grace

  6. Theological Grounding • Time • Chronos – Time spent on earth • Chairos – Time of salvation • Doing a time-study of the Jesus of the Gospels

  7. Productivity? What is being done by chaplains? Quality? Is what being done contributing to overall patient quality and satisfaction? Effectiveness? Is what is being done effective? Impact? Can one identify and measure the outcomes of spiritual care? Challenge: Defining/Demonstrating the Value Proposition

  8. Quality Improvement • Fundamental to HC • Across all facets of HC • SC providers take the lead in creating a culture of care and measure quality of SC services • Three perspectives for measuring quality • Process Measures • Outcome Measures • Performance against Standards

  9. Integration Process Measures Outcome Measures Performance Against Standards

  10. Process Measures • Process Measures- a measure which focuses on a process that leads to a certain outcome. Can you answer the questions: - Did you do it (services complete)? - Did you do it right?

  11. Outcome Measures 2.Outcome Measures - a measure of the results of a system, relative to aim. Can you answer the question: - Did the process you completed get the outcome desired/expected?

  12. Performance against Standards 3. Performance against Standards Can you answer the question: - What are the measurable standards agreed upon across the profession that demonstrate effectiveness in spiritual care?

  13. Acute Care Setting Example Spiritual Care Department is an integral component of the Palliative Care Team. • Process Measure: Palliative Care team initiates contact with chaplain upon patient admission to services within 24 hours. • Outcome Measure: Chaplains track number of palliative care patients seen. Patient encounter included with other quality data that shows variables in patients seen and not seen by chaplain. • Performance to Standards:Annually conduct an evaluation with Palliative Care team of chaplain performance against Standards 1-6. (Standards of Practice for Professional Chaplains in Acute Care.)

  14. Non Acute Care Setting Example Spiritual Care department to provide training to clinic staff on spiritual distress screening tools. Staff screenings are designed to generate spiritual care referrals. • Process Measure: Report number of staff trained to utilize spiritual distress assessment tool and count number of referrals made to Spiritual Care staff. • Outcome Measure: Staff take pre and post test indicating level of comfort with detecting spiritual care distress. • Performance to Standards: Screening and referral tools and processes in place, with training of all (100%) of staff. Can build in year cycles (year one =50%, year two = 80%, year three = 100%)

  15. Core Elements for System Standards I. Preamble: Acknowledge work • Benefits, challenges • Purpose: one voice II. Introduction: ERDs • Spiritual care in context of Catholic health care: work of God • Part Two: respect human dignity, holistic, integral III. Organization/System Level • Plan, policy, education of all staff importance/role • Organization chart, lines of responsibility • Full range of services, integrated into all services, facilities • Spiritual care models showing entire staff responsibilities • Support of all, screening by staff, specialist service of chaplains

  16. Core Elements for System Standards, cont.. IV. Spiritual Care Department • Plan • Model, staff composition • Qualified leader • Staff personnel, preparation, competencies • Job descriptions • Partnership with faith communities • Services covered based on 9 essential chaplain functions • Standards of Practices • Budget

  17. Core Elements for System Standards, cont.. • Care Delivery • Scope of service clearly communicated • Extent of services • Collaborations and Relationships • Board Certified Chaplain part of interdisciplinary care team • Role on Ethics Committee • Orientation of new employees • Screening and referral tools and processes • Spiritual/emotional diagnosis part of interdisciplinary care team deliberations • Spiritual care assessment, care plan, all notes part of documentation (EMR)

  18. Grateful to: Rose Shandrow, M.Div., Director, Spiritual Care Services, Franciscan Health System in Tacoma, WA Spiritual Care Services Process Improvement Team – Chaplain Measures Prepared by Gordon J. Hilsman, D.Min., former Manager of CPE, St. Joseph Medical Center in Tacoma, WA Measuring through AssessmentsCHI – Franciscan Health System, Tacoma WA

  19. Catholic Health Initiatives: Measures of Chaplain Performance and Productivity: Task Force Report published June 2002 Develop a common language to articulate what chaplains do and the value added Develop tools for managing performance and productivity Promote the professionalism of chaplains and the integration of spiritual care Integration of Spiritual Care

  20. Personal (Healthcare View)

  21. Framework of Spiritual Assessment Chaplain Functions Spiritual Care Outcomes Benefits of Framework Objectives 21

  22. Recordable Establish Rapport first Needs Focus (ad sedio) Partnering Endeavor Continued Learning Assumptions - Spiritual Care

  23. All that an individual values, practices, believes, and decides in order to cope with and enjoy what can’t be controlled, including relationships with oneself, other people, Transcendence and communities of importance Spirituality

  24. A ministry event consists of a person functioning as a caregiver addressing the spiritual need of another person experiencing a difficult life situation. Spiritual needs are seriously unsettling challenges to the human spirit of a given individual. Ministry to Spiritual Need

  25. What does this person need emotionally right now? What has this person lost, recently and historically? What are the ways this person maintains and nurtures her own human spirit? What does this person need that may be beyond my relationship with him? Basic Axis Questions

  26. What does this person need emotionally right now, (from me)? Axis One: Emotional Support

  27. 1. The Crisis Need for Stabilizing 2. The Expression Need to Engage and Share 5. The Regression Need to be Empowered EMOTIONAL SUPPORT 4. The Bewildering Need for Basic Information 3. The Anxious Need of Waiting Too Long

  28. Needing to cry, yell, share, or just tell somebody how you feel about what is happening to you 2. The Expression Need to Engage and Share

  29. 2. An Expressing person Function Desired Outcomes • Talks openly • Expresses feelings • Cries • Relaxes • Considers resources Supportive Validating

  30. 4. WaitingUpset feelings from waiting too long in an important situation 31

  31. 4. A person who is waiting too long Function Desired Outcomes • Expresses situation • Prays • Acknowledges limitations • Thankful • Calm Presence & Networking

  32. What has this person lost, recently and historically, that still disturbs her/him at times? Axis Two: Loss and Grief

  33. 7. Prior GriefMajor past loss being currently grieved

  34. 7. Prior Grief Function Desired Outcomes • Mentions previous loss • Expresses emotion • Receives validation • Shares reminiscences • Cries while talking about the lost loved one • Receives referral for further grief assistance • Expresses greater hope Grief Counseling

  35. 7. Grief Counseling Outcomes (%)

  36. How does this person maintain and nurture her own human spirit? Axis Three: Spiritual Resources

  37. The Need to feel the immediate positive presence of Transcendence 11. Religious Support

  38. Person who is needing God Function Desired Outcomes • Sacrament/ spiritual ritual • Spiritual leader of choice • Religious questions/problems • Prays Religious Support

  39. 15. Estrangement Need to re-connect with separated loved ones

  40. A person regretting estrangement Function Desired Outcomes • Talks about an estranged relationship • Agrees to receiving contact with an estranged person • Agrees to take initiative to contact an estranged person • Accepts the adequacy of one’s efforts at reconciling Reconciling

  41. What does this person need that may be beyond my relationship with her/him? Axis Four: Advocacy and Referral

  42. 19. Mental Health/Addictions Need to explore concerns about one’s mental health or mood altering chemical abuse

  43. 19. People with mental illness or addiction concerns Function Desired Outcomes • Concern verbalized • Feelings expressed • Calm conversation • Accepts consultation Referral

  44. 21. Love Life Pain Need for listening, advice or referral about one’s love life

  45. Documentation Training Resource Measurement Source Benefits of the Spiritual Assessment Framework

  46. Spiritual Assessment Form What are the needs? What did we provide? What is the plan of care?

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