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How Do You Make a Difference?
Rev. Jeffrey R. Funk, M.Div., P.C.C.
Healthcare Chaplains Ministry Association
Sadly, some Chaplains have lost their jobs through cutbacks this past year. As a competent Chaplain, you may have made great strides in learning and utilizing your pastoral care skills. However, you might not have been so effective in promoting and selling your pastoral care value and benefits to those whose decisions make or break your pastoral care program.
After the Director of a Pastoral Care Department made a presentation to the Board of Trustees of a hospital, this is what an administrator said:
These are business people. Their concern is the financial well-being of the hospital and what affects that. What you told us was nice, but we don't know how necessary. You told us what you do and how much, but you didn't tell us what difference it makes.
So how do you clarify the fact that what you do does make a difference to a hospital's bottom line?
First, you need to CLAIM that what you do positively impacts the hospital's bottom line. Here are some ways that your dynamic pastoral care program probably makes a difference at your facility.
- Patient/Family Satisfaction.
- Patients expect competent and compassionate spiritual care services. Therefore, your spiritual care ministry enhances the image of your healthcare organization.
- In an age of high medical technology, brief hospitalizations, and shortened contacts with physicians and other healthcare professionals, your pastoral care offers one of the few opportunities for patients and families to discuss their personal and spiritual concerns.
- When you help a patient's family, they are more likely to visit that institution again for a future hospitalization.
- Studies indicate that between one-third and two-thirds of all patients want to receive spiritual care (Carey, 1985; Fitchett, Meyer &Burton, 2000).
- Spiritual Abuse.
- Codes of professional ethics stipulate that Chaplains themselves must respect the diverse beliefs and practices of patients and families.
- Your pastoral care program can reduce and prevent spiritual abuse. You act as a "gatekeeper" to protect patients from unwanted proselytizing.
- Shortened Length of Stay.
- Research has consistently shown that Chaplains help patients "get better faster" and enhance their "readiness to return home" because the visits help them feel more hopeful.[1]
- One study showed a savings of over $4,000 per patient/day.
- Staff Retention and Productivity.
- Losing staff is costly to a hospital. But pastoral care encourages staff so that they persevere. You play an important role in helping staff cope with personal problems. Your supportive consultation can enhance morale and decrease staff burnout. This reduces employee turnover and the use of sick time. (Note: One Human Resource Department figured that it cost them $50,000 to replace and retrain one nurse.)
- You provide sensitive, supportive spiritual care to patients and family during potentially stressful times for staff (e.g., terminal illness, codes, death, oncology, etc.). This pastoral care intervention allows these specialists to attend to their duties.
- Employee Assistance.
- Some staff don't take advantage of hospital assistance programs. However, they do turn to you for counsel.
- When there's a need for a staff memorial service, you provide a valuable service to the hospital and their staff.
- Risk Management and Litigation.
- You play an important role in mitigating situations of patient/family dissatisfaction involving risk management and potential litigation.
- When patients or their family become angry or threatening, You are often able to mediate and defuse these intense feelings in ways that conserve valuable organizational resources by reducing risk and potential litigation.
- Death Care.
- No other healthcare provider is as highly trained to deal with grieving families as the you are-this is one of your specialties.
- The pastoral care provided to families near or at the time of death helps free the hospital staff to do their job.
- Accreditation Standards.
- You help healthcare organizations fulfill a variety of accreditation standards of the Joint Commission on Accreditation of Health Care Organizations (JCAHO), including those associated with patient's rights for spiritual care and support.
- Mission Statement.
- You help your organization develop their mission and values statements that promote healing for the body, mind and spirit.
- You promote mission awareness and enhancement.
- Medical Ethics Support.
- You help patients and family members identify their values regarding end-of-life treatment choices. You also communicate this information to the healthcare staff.
- Families respond better and in a timelier manner to end-of-life situations when your pastoral support is provided.
- Clarifying values and improving communication helps reduce expensive and unwanted care.
- Community Impact.
- Some people choose a hospital because of its pastoral care program.
- You establish and maintain important relationships with the community clergy, who often make referrals of their parish people to the hospital.
- You make unique contributions by providing many community services (such as participation in wellness programs, support groups, guidance and support for parish nurse programs, educational programs for lay spiritual visitation, etc.).
- Bottom Line: The spiritual care you provide is cost effective—it's good for business.
- The only published chaplaincy cost study reported that the services of professional Chaplains range between $2.71 and $6.43 per patient visit (VandeCreek & Lyon, 1994-1995).
- Approximately three quarters of HMO executives surveyed reported that if spirituality (expressed through personal prayer, meditation and other spiritual and religious practices) can have a positive impact on well being, then it can helpfully impact cost containment (Yankelovich Partners, Inc., 1997).
Second, you need to COMPUTE or calculate that what you do represents a worth/revenue to the healthcare organization where you serve.
The pastoral care program is both a revenue-saving and revenue-generating department (as indicated above). Some specific figures and computations you need to consider:
- Compute what it costs your hospital per hour for your services. (You need to include salary, benefits, meals, parking, paper, printing, secretarial, TB tests, continuing education, etc.)
- Compute cost per day for a patient who stays longer than expected or necessary for insurance coverage, etc. One study showed that pastoral care intervention saved about $4,000 per day per patient.
- Compute the cost to replace a staff person who burns out without pastoral support. One study demonstrated that if cost the hospital about $50,000 to replace and retrain one nurse.
- Compute the cost of a lawsuit, even one that doesn't go to court. (This not only includes lawyer's fees and settlement fees, but also lost time from staff doing deputations and attending trials.)
- If you can prove that some patients choose your hospital because of your pastoral care program, what's that worth to the hospital?
- What about patient satisfaction scores on returned surveys? Satisfied customers come back. Pastoral care consistently receives the highest marks on these surveys.
Third, you need to COMMUNICATE your pastoral care story.
- And when you do, use business concepts. Think like a business person.
- FAB = Features (physical characteristics of a product or service), Attributes (the advantages of the product or service), and Benefits (the important payback).
- Communicate value and results. Explain not only what you're doing, but also why it's important to the hospital and the well-being of their patients, family and staff.
- Deliver this information personally with hospital leaders.
- Meet their needs pastorally. Minister to the administration. Pray for them (and tell them that you pray for them). Encourage them face-to-face.
- Meet their needs financially. Use a zero-based budget. Have a spirit of cooperation.
- Be a team player-not an adversary.
- Internal opportunities.
- Toot your own horn.
- Share written and verbal reports (both prescribed ones and otherwise) with administration. Give a five-minute positive report on what was done and the benefit to the hospital.
- E-mail the positive outcomes to administration and department directors.
- Take advantage of the National Pastoral Care Week. Make it a big deal. Expose the staff to who you are and what you do for the hospital.
- Educate the hospital about pastoral care.
- Employee orientation. The staff need to see you as a knowledgeable professional (specialist).
- Rounding with department heads. This influences those who impact and educate all other staff.
- Evaluate challenges. Encourage staff evaluations of pastoral care in four areas: attitude, courtesy, responsiveness and communication.
- External opportunities.
Finally, in conclusion, the following e-mail from administration, after a particularly intense intervention by pastoral care, communicates it quite well:
...we are all better people and a better organization because of you and your staff. I hope and pray that you and your staff live forever because you truly make a difference.
In a day and age when there are job layoffs in healthcare, there can be tremendous job security for you and your pastoral care department.
Endnotes:
- Florell, JL (1973). Bulletin of the American Protestant Hospital Association 37(2):29-36. Study shows empirical evidence of the effectiveness of a Chaplain working with surgery patients. Randomized patients were assigned to either Chaplain intervention, which involved Chaplain visits for 15 minutes/day/patient, or to a control group ("business as usual"). The Chaplain intervention reduced length of stay by 29%, Patient-initiated call on RN time to one-third, and use of PRN pain medications to one-third.
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