Forging Relationships of Understanding Communicating what Chaplains Do

Forging Relationships of Understanding Communicating what Chaplains Do Through Performance & Productivity Measures Presenter Chaplain Al Henager, BCCC Association of Professional Chaplains Annual Conference 2008

Workshop Description n Often chaplains are unable to explain exactly what they do or how they make a difference. n This workshop will help chaplains articulate what they do in a way that others, particularly in administration, can understand. The workshop will focus on ways to measure their productivity, common outcomes of their work, and a common language to describe what chaplains do. There will be an overview of. . . n n l l The report of the Catholic Health Initiatives Task Force on Chaplain Performance and Productivity The performance and productivity tools developed by the presenter and others for two large health systems.

What NOT to Expect n Easy, “cookie cutter, ” or “one-size-fitsall” applications. l n Quick, “magic bullet, ” fixes to a situation already gone bad. l l n Rather, I will outline an approach so that you can tailor performance & productivity measures and reports to fit your unique situation. There are no quick solutions to a situation already gone bad. My approach is proactive to head off problems before they begin. A completely passive workshop where solutions are “spoon-fed. ” l l The real heart of the workshop will be hands-on. You will design your own solutions.

Workshop Goals n n n Demonstrate the need and ability to document chaplain productivity and performance. Communicate effectively with administrators and others what chaplains do. Gain awareness and use of tools to capture, measure, and communicate chaplain performance and productivity.

Welcome To the FOUR hour tour

Discussion n Reasons why chaplaincy P&P measures should not be done Reasons why chaplaincy P&P measures are difficult Reasons why chaplaincy P&P measures should be put in place Question: Who’s afraid of the “Big Bad Change? ”

Don’t Be Afraid to Change

Definitions n Performance “What is done” l Intensity of the task l Standards l n How does what is done compare to what is expected? l Competencies n What is the effectiveness of what is done?

Definitions n Productivity Amount of what is done l Time it took to do it l Complexity of the task l How efficiently it is done l Outcomes l n What is the result of what is done? n What is the added value of what is done?

AIO (or EI AIO) Excellent Interactions = AIO n Assessment l Needs n Spiritual n Emotional n Social/cultural n Interventions l n How needs are met Outcomes l The result of the interventions

AIO n Add this: Performance Measures Value to the patient/family l Value to the staff l Value to the institution l Value to the community l

Case Study n Read the case n Performance: Identify what was done - tasks Assessment l Interventions l Intensity l

Case Study n Productivity: Identify the efficiency l What were the outcomes? n Value to patient n Value to staff n Value to institution Time l Complexity l

The CHI Report n “Measures of Chaplain Performance and Productivity” Study began February 2001 l Report published June 2002 l

The CHI Report n Four Purposes l l To help market-based directors of spiritual/pastoral care be more effective in managing the performance and productivity of their chaplains To explain in simple, common language just what chaplains do and their work’s added value to an organization, to warrant the allocation of resources To raise chaplains’ awareness of the complexity and value of what they do so they can be more “intentional” in managing time and priorities in their ministry To affirm and promote the professionalism of CHI chaplains by highlighting the competencies they bring to their ministry

The CHI Report n Need to better articulate: l What chaplains do (standards & competencies) l What outcomes typically result (their added value to the organization) l The most appropriate units of service to measure their efficiency l All of the above in a language chaplains believe is appropriate and other health care disciplines can readily understand

The CHI Report n Index card for reporting

The CHI Report n Method l Phase one – Sept. to Dec. 2001 n n n l 9 pilots sites 56 chaplains 35, 000 pastoral interactions Phase two – Feb. to May 2002 n n To improve our ability to articulate what chaplains do and their work’s added value in a common language Feedback from l l Chaplains CEOs Nursing staff NOK of patients who had died

The CHI Report n Findings of Phase 2 Amazing consensus and a common language among those closest to the site of care delivery l Clear consensus among administrators of valuing chaplains for their “symbolic role” l

The CHI Report n Report of “added value” from Sheer availability of chaplains who bring no agenda to care recipients l Support & comfort chaplains provide l Helpfulness of chaplain with “practical details” l Ability of chaplains to serve as facilitators of human development l

The CHI Report n Learnings l l Widespread lack of clarity & consistency in understanding, articulating, & measuring what chaplains do When dialogue between chaplains & others takes place, the expectation of activities & competencies are consistent Most measures of chaplain P&P are inadequate in depth & complexity Chaplains are willing to learn new ways to communicate their work

The CHI Report n Recommendations l l Consult with chaplains to clarify & define their roles, key activities, & competencies Get reps from other disciplines to help chaplains articulate performance expectations in a behavioral, common language Create a template that defines levels of task complexity Provide education needed for chaplains to develop skills in the competencies

St. Vincent Health System AIO n Process l Survey of our chaplains regarding their activities regarding n Assessment n Interventions n Outcomes l Series of dialogues with other professionals regarding how they understand what chaplains do n Examined terminology n Suggested alternatives

St. Vincent Health System AIO n Process l Created a template n See l exhibit insert Met with Information Technology n Developed a computer program for data entry n Tied interventions to NACC standards of practice n Developed mechanism for generating reports

St. Vincent Health System AIO

St. Vincent Health System AIO n Forms SVHS Spiritual Assessment Form l SVHS AIO Card l St. Anthony AIO Card l n Standards NACC Standards l APC Standards l CHI Standards l

St. Vincent Health System AIO n Process l Implemented procedure n Each chaplain recorded all activities n For a period of 3 months n Ran reports n Evaluated data l Evaluated the program n Worked out the kinks n Refined the tools n Adjusted the reporting methods

St. Vincent Health System AIO n Result of evaluation l l l The AIO was too cumbersome with too many choices The AIO took too long to enter data The AIO lacked any true performance measure regarding n Impact n Value l Elements of spirituality were lacking

St. Vincent Health System AIO n Fine tuning l AIO form revised with fewer choices n Many choices were combined Wording was changed in order to communicate more effectively l Layout of data entry screen made more user friendly for faster entry l Standards were updated to include those of CHI l

St. Vincent Health System AIO n Data Entry At first written in Microsoft Access l Transferred to HTML format l n Data Entry Screen Basic identifiers l Note AIO format l Note addition of Performance Measures l Note incorporation of “Spirituality” l n See Spirituality Brochure

St. Vincent Health System AIO

St. Vincent Health System AIO n Reports Summary for All Chaplains for November 2005 l Summary for Individual Chaplains for November 2005 l Executive Summary by Station for November 2005 l Full Summary by Station for November 2005 l Competency Summary for 2005 l

St. Vincent Health System AIO n Applications l Monthly executive reports n Administration n Nurse managers Yearly chaplain evaluations l Justification for additional staffing l n SVHS Chaplaincy history n SVHS financial history n Memo for justification of new staff n Result of staffing request

UMAS Medical Center n Outpatient clinic documentation Logician l Documentation template l n Menu form – AIO n Narrative form – AIO n Inpatient documentation Sunrise interface – April 2008 l Documentation template l n Menu form – AIO n Narrative form – AIO

UMAS Medical Center n Both Outpatient & Inpatient l Chaplain visit documentation in patient’s chart l Provides a searchable database

UMAS Medical Center l Provides a searchable database n n n n n Number of total chaplain visits for period What units or clinics Number visits by each chaplain Who made referrals Who was seen and how many The reason for referrals They types of symptoms presented The types of interventions & numbers The types and numbers of outcomes The types and numbers of performance measures

UAMS Medical Center

Added to Documentation n Productivity Measures: Patient/Family Satisfaction l Clinical Outcome l Connection/Value Community l Employee Satisfaction l Organizational Cost Savings l Reminder/Catalyst l n These WILL NOT be in the patient’s chart l Separate searchable data base

UMAS Medical Center l Sample report – June 2009 n n Number of total chaplain visits 758 Visits by individual chaplain l l l n A 126 B 127 C 130 D 124 E 119 F 132 Referral sources l l l Staff/RN Physician Family/Patient Chaplain Other 253 98 102 4

UMAS Medical Center l Sample report – June 2009 n Service l l l Patient/family Staff Church/community Health system Other n Reason l l provided to for service Rounds Orders Follow up Other 104 407 52 4 725 148 97 33 6

UMAS Medical Center l Sample report – June 2009 n Types l l l and numbers of symptoms Anger Anxiety Apathy Confusion Depression Guilt Grief Other ritual Prayer Referral/faith contact Sacrament Sustaining presence 256 167 143 242 267 345 53 523 428 93 676

UMAS Medical Center l Sample report – June 2009 n Types l l l l and numbers of issues/needs Belonging/community Communication Control Forgiving Purpose/meaning Faith/hope/trust/ transcending Value None assessed 143 167 356 243 742 715 523 4

UMAS Medical Center n Types and numbers of outcomes l l l l l Acceptance 243 Catharsis 87 Connection/ 342 community Comfort 423 Forgiveness 159 Gratitude 682 Honest 343 Hope 657 Healing 524 n Types and numbers of outcomes l l l l l In control Communication Peace Progress w/ grieving Purpose Transcendence Trust Value Wonder 265 143 568 356 614 156 686 523 93

UMAS Medical Center l Sample report – June 2009 n Performance n NOT l l l measures in chart Patient/Family Satisfaction Clinical Outcome Connection/Value Community Employee Satisfaction Organizational Cost Savings Reminder/Catalyst 714 692 356 143 356 715

Pitfalls to Avoid Minute by minute accounting of chaplains’ time n Micro managing n Chaplains are professionals l Treat them like professionals l n Data collection for data collection sake

Closing Exercise ID - roles, activities, competencies of your work n Think like your colleagues from other professions n Translate your terms to theirs l Restate your performance l Create your own template n Think of continuing education n

The End