Forging Relationships of Understanding

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

2. Workshop Description • Often chaplains are unable to explain exactly what they do or how they make a difference. • 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 . . . • 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.

3. What NOT to Expect • Easy, “cookie cutter,” or “one-size-fits-all” applications. • Rather, I will outline an approach so that you can tailor performance & productivity measures and reports to fit your unique situation. • Quick, “magic bullet,” fixes to a situation already gone bad. • 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.” • The real heart of the workshop will be hands-on. • You will design your own solutions.

4. Workshop Goals • 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.

5. Welcome To the FOUR hour tour

6. Discussion • 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?”

7. Don’t Be Afraid to Change

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

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

10. AIO (or EI AIO) ExcellentInteractions = AIO • Assessment • Needs • Spiritual • Emotional • Social/cultural • Interventions • How needs are met • Outcomes • The result of the interventions

11. AIO • Add this: Performance Measures • Value to the patient/family • Value to the staff • Value to the institution • Value to the community

12. Case Study • Read the case • Performance: Identify what was done - tasks • Assessment • Interventions • Intensity

13. Case Study • Productivity: Identify the efficiency • What were the outcomes? • Value to patient • Value to staff • Value to institution • Time • Complexity

14. The CHI Report • “Measures of Chaplain Performance and Productivity” • Study began February 2001 • Report published June 2002

15. The CHI Report • Four Purposes • 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

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

17. The CHI Report • Index card for reporting

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

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

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

21. The CHI Report • Learnings • 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

22. The CHI Report • Recommendations • 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

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

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

25. St. Vincent Health System AIO

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

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

28. St. Vincent Health System AIO • Result of evaluation • 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 • Impact • Value • Elements of spirituality were lacking

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

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

31. St. Vincent Health System AIO

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

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

34. UMAS Medical Center • Outpatient clinic documentation • Logician • Documentation template • Menu form – AIO • Narrative form – AIO • Inpatient documentation • Sunrise interface – April 2008 • Documentation template • Menu form – AIO • Narrative form – AIO

35. UMAS Medical Center • Both Outpatient & Inpatient • Chaplain visit documentation in patient’s chart • Provides a searchable database

36. UMAS Medical Center • Provides a searchable database • 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

37. UAMS Medical Center

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

39. UMAS Medical Center • Sample report – June 2009 • Number of total chaplain visits 758 • Visits by individual chaplain • A 126 • B 127 • C 130 • D 124 • E 119 • F 132 • Referral sources • Staff/RN 253 • Physician 98 • Family/Patient 198 • Chaplain 102 • Other 4

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

41. UMAS Medical Center • Sample report – June 2009 • Types and numbers of symptoms • Anger 256 • Anxiety 167 • Apathy 143 • Confusion 243 • Depression 242 • Guilt 267 • Grief 345 • Other ritual 53 • Prayer 523 • Referral/faith contact 428 • Sacrament 93 • Sustaining presence 676

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

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

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

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

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

47. The End