The Value of Chaplaincy: Metrics, Measurement, and Productivity

1. The Value of Chaplaincy: Metrics, Measurement, and Productivity Rev. Dean V. Marek, BA, BCC Mayo Clinic, Rochester MN

2. Overview • Patient Centered Care • Chaplain Centered Issues • Metrics • Methods of Measurement

3. Part A. Patient Centered Care • What do patients want from a chaplain? • Has anyone asked? • Results? • Mayo Patient Expectation Surveys 1994 and 2006 • WHO Categories

4. “The needs of the patient come first.” A. 1.What do patients want from a chaplain? Have you surveyed patients? What kind of surveys/questions? Results? Has your practice changed?

5. A. 2:Mayo Patient Expectation Surveys 1994, 2006 1994 Patient Expectations Regarding Chaplain ServicesMayo Clinic Hospitals 1550 surveys sent - 42% response rate

6. 1994 Patient Expectation SurveyGender Reasons patients want to see a chaplain: Female: Male: • To remind me of God’s care: 75% 71% • To pray or read scripture with me: 67% 61% • To be with me at times of anxiety: 67% 54% • To listen to me: 55% 49% • To meet my ritual needs:56% 48% • To counsel with ethics: 38% 33%

7. 1994Patient Expectation Survey Age Reasons patients want to see a chaplain: 16-35 36-55 55-75 Over 75 • To remind me: 74% 81% 68% 70% • To pray with me: 64% 64% 65% 63% • To be with me: 76% 66% 58% 49% • To listen to me: 76% 66% 44% 37% • To meet ritual needs: 57% 59% 51% 45% • To counsel me: 51% 44% 31% 46%

8. 1994 Patient Expectation of a Chaplain Visit • 48% expected to see a chaplain without having to request a visit • 47% did not expect a chaplain to visit unless they requested it

9. A. 2:Mayo Patient Expectation Surveys 1994, 2006 2006 Patient Expectations Regarding Chaplain Services 1500 surveys sent - 36% response rate

10. 2006 Patient Expectation SurveyGender Reasons patients want to see a chaplain:Female: Male: 1994 2006 1994 2006 • To remind me of God’s care: 75%-88% 71%-81% • To pray or read scripture: 67%-77% 61%-63% • To be with me at times of anxiety and uncertainty: 67%-83%54%-70% • To listen to me: 55%-73% 49%-58% • To meet my ritual needs:56%-57% 48%-46% • To counsel: 38%-51% 33%-43%

11. 2006 Patient Expectation SurveyAge Reasons patients want to see a chaplain: 16-35 36-55 55-75 Over 75 19942006 19942006 19942006 19942006 • To remind: 74%-72% 81%-80%68%-85%70%-88% • To pray: 64%-43% 64%-67% 65%-72% 63%-73% • To be with: 76%-76% 66%-73% 58%-75% 49%-82% • To listen: 76%-62% 66%-64% 44%-65% 37%-68% • To meet: 57%-24% 59%-49% 51%-51% 45%-61% • To counsel: 51%-52% 44%-45% 31%-46% 46%-51%

12. Reasons Patients Want to See a Chaplain 1994 2006 • Remind me of God’s care and presence: 72% - 84% • Be with me at times of particular anxiety: 62% - 76% • Listen to me: 52% - 66% • Meet my ritual or sacramental needs: 80% 53%- 51% 87% • Counsel with moral/ethical decisions: 36% - 47% In 1994 48% expected a visit without requesting In 2006 36% expected a visit without requesting

13. 2006 - Reasons Catholic Patients Want to See a Chaplain All Catholic • Remind me of God’s care and presence: 84% - 88% • Be with me at times of particular anxiety: 76% - 82% • Listen to me: 66% - 69% • Meet my ritual or sacramental needs: 51%- 87% • Counsel with moral/ethical decisions: 47% - 52% • Pray/read scripture: 69% - 73% • Expected a visit without requesting 36% - 41% (in ’94 - 55%)

14. Comment Patients expect those services from chaplains that more serve their spiritual needs: • They want the chaplain to remind them of God’s care and presence • To be with them at times of anxiety and uncertainty - when they are “scared to death!” • To listen to them (and validate their spiritual beliefs)

15. Comment • They are relatively uninterested in rituals or sacraments (except Catholics) 14% said meeting ritual or sacramental needs was Very Unimportant) • 23% do not want counsel concerning moral or ethical concerns or decisions – 30 % Neutral – neither important or unimportant 11% Somewhat Unimportant 12% Very Unimportant

16. A. 3:World Health Organization (WHO) Pastoral Intervention (PI) Coding • Pastoral Assessment • Pastoral Ministry – the provision of the primary ministry of presence and expression of service, etc. • Pastoral Counseling or Education – personal and familial counsel, ethical consultation, review of one’s spiritual journey • Pastoral Ritual / Worship

17. Part B. Chaplain Centered Issues Rank in your order of importance: • Report the number of services provided • Chart in the medical record • Record the number of patients seen • Measure chaplain productivity • Give an accounting to supervisor and administration • Measure outcomes • Conduct research for best practice • Practice self care

18. Part C. Metrics • Why record chaplain activity? • What is measured, counted, reported? • How measure patient needs? • How measure unmet patient needs? • How measure patient satisfaction and outcomes? • How does research determine patient needs and appropriate staffing response?

19. Reasons for Developing Metrics • Accountability; Budget • Continuous Improvement • Patient Satisfaction • Productivity Measures • Research • Staffing Plan • Supervision

20. What if you were in business for yourself?

21. what kind of salary would you expect? • who would pay you? • how much would you charge for a patient consultation? • how much for 5 minutes of prayer? • how much for an anointing of the sick? • how would you advertise your availability?

22. Saints Cosmas and Damien They saw in every patient a brother or sister in Christ, showed great charity to all, and treated their patients to the best of their ability. Yet no matter how much care a patient required, they never accepted any money for their services. Thus, they were called anargyroi in Greek, which means "the penniless ones."

23. Again, “What if you were in business for yourself?”

24. Is what we do some kind of Secret? “We don’t want to have to tell you what to do, you tell us what you do!”

25. Question: What Do We Do? • We know what we do - and we need to describe it clearly. • When we know and value our work we will communicate it authentically. • When we document what services we provide we are able to know what remains undone. ( # of patients per chaplain?) • When we know what we can do with current staff we are able to ask for additional staff to do what remains undone.

26. Part D. Methods for Measuring • Press Gainey • Mayo Care Program (UOS) • SPIRIT Program • Providence Everett (SCU) • HealthCare Chaplaincy • Clinical Governance System • CHI Study 2002

27. 1. Press Gainey • CHA/NACC Summit in Omaha • Metrics Task Force • Standardized Question • Proposed:

28. Data Collection Program Criteria Any data collection program is based on the following: • What do we need to measure and for what reason/s? • What do we want to measure and for what reason/s? Counting and reporting numbers says nothing about patient needs, the intervention, or the quality of care

29. Program Criteria • User friendly; uncomplicated • Intuitive • Reliable • Tailored to your need; customized; adaptable • A tool for communication • Research capability

30. 2. Mayo CARE Program (UOS) • Budget; Expense per Unit of Service • Productivity • Accountability • Staffing • Supervision • Research

31. Refer to Spiritual Care Interventions as Service Events – Not Visits

32. AM Admit Anointing Associated Death Bereavement Care Conference Code 45 Crisis Care Death Ethics Consult Ethics Contact Family Care Funeral/Wake Group Facilitation Home Visit Hospice Home Care Office Drop In Pastoral Contact Pre-surgical Care Public Worship Research Intervention Retreat Care Group Ritual/Sacrament Spiritual Assessment Spiritual Care Staff Care/Staff Care Group Staff Development/Teaching Mayo Service Events (Direct)

33. Administration CPE Administration CPE Meeting CPE Preceptorship CPE Supervision CPE Teaching Meeting Mission Support Preparation Time Professional Organizations Research Rounds Supervision Volunteer Coordination Service Events (Indirect)

34. WHO Pastoral Intervention Codings (2002) • Pastoral Assessment – an appraisal of the spiritual wellbeing, need and resources of a person within the context of a pastoral encounter. • Pastoral Ministry – the provision of the primary ministry of presence and expression of service, which may include: establishing of relationship / engagement with another, hearing the story, and the enabling of pastoral conversation in which spiritual wellbeing and healing may be nurtured, and companioning / supporting persons confronted with profound human issues of death and dying, loss, meaning, and aloneness.

35. WHO Pastoral Intervention Codings (2002) • Pastoral Counseling or Education – an expression of pastoral care that includes personal or familial counsel, ethical consultation, a facilitative review of one’s spiritual journey, and support in matters of religious belief or practice. • Pastoral Ritual / Worship – this intervention contains the pastoral expression of informal prayer and ritual for individuals or small groups, and the public and more formal expressions of worship, including Eucharist and other services, for faith communities and others.

36. Developing Service Types • Initiate a process with your staff to develop unique service types for your institution • Clearly define all service types to clearly distinguish them from each other • Calculate a relative resource unit (RRU) based on time • Determine the expense per unit of service (UOS) and then the cost of each service type

37. 0.65 AM Admit 2.13 Anointing 4.00 Associated Death 3.51 Bereavement 2.38 Care Conference 4.37 Crisis Care 5.32 Death 1.86 Family Care 7.78 Funeral 3.30 Office Drop In 1.00 Pastoral Visit 2.17 Pre-surgical Visit 1.86 Research Intervention 1.84 Rituals/Sacraments 2.17 Spiritual Care 1.86 Staff Care RRU Factors

38. Expense per UOS • An Expense per UOS is a way of reporting direct patient care activity in relation to the expenses budgeted for your department • It is a method of accountability to your administration • It is expected that we meet or beat our Expense per UOS on a monthly basis

39. Greater “productivity” reduces the Expense per Unit of Service!

40. Greater “productivity” increases department income !

41. The CARE Program: Chaplain Activity Record - Electronic Collecting Data A model / example of the CARE program is available on CD at no cost. Your IT Department will need to adapt this Access Program to your environment.

42. The demonstration program on the CD will run as is with a limited data storage capacity. It is offered without cost to recipients and will not be supported by the distributor or any other entity or institution. Recipients must agree to rely on their own experience with Microsoft Access 2003 or the Information Technology Department in their institution to support and/or adapt the program to their system.

43. A Word of Wisdom “Remember this and remember it well. Never do anything a computer can do better. Then you will be able to have time to do what a computer cannot do.” Harold Kaiser, Health Care Futurist, 1988

44. CARE

49. % of Patient Contacts