Transcript No Slide Title

The Value of Chaplaincy: Metrics,
Measurement, and Productivity
Rev. Dean V. Marek, BA, BCC
Mayo Clinic, Rochester MN
Overview
A. Patient Centered Care
B. Chaplain Centered Issues
C. Metrics
D. Methods of Measurement
Part A. Patient Centered Care
1. What do patients want from a chaplain?
a) Has anyone asked?
b) Results?
2. Mayo Patient Expectation Surveys 1994
and 2006
3. WHO Categories
A. 1. What do patients want from a chaplain?
a) Have you surveyed patients? What
kind of surveys/questions?
b)Results?
c)Has your practice changed?
“The needs of the patient come
first.”
A. 2: Mayo Patient Expectation Surveys
1994, 2006
1994 Patient Expectations Regarding
Chaplain Services
Mayo Clinic Hospitals
1550 surveys sent - 42% response rate
1994 Patient Expectation Survey
Gender
Reasons patients want to see a chaplain:
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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%
1994 Patient Expectation Survey
Age
Reasons patients want to see a chaplain:
16-35 36-55 55-75 Over 75
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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%
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
A. 2: Mayo Patient Expectation Surveys
1994, 2006
2006 Patient Expectations Regarding
Chaplain Services
1500 surveys sent - 36% response rate
2006 Patient Expectation Survey
Gender
Reasons patients want to see a chaplain:
Female:
1994 2006
• To remind me of God’s care: 75%-88%
• To pray or read scripture:
67%-77%
• To be with me at times of
anxiety and uncertainty:
• To listen to me:
• To meet my ritual needs:
• To counsel:
Male:
1994 2006
71%-81%
61%-63%
67%-83%
54%-70%
55%-73%
49%-58%
56%-57%
48%-46%
38%-51%
33%-43%
2006 Patient Expectation Survey
Age
Reasons patients want to see a chaplain:
16-35
36-55
55-75
Over 75
1994 2006 1994 2006 1994 2006 1994 2006
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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%
Reasons Patients Want to
See a Chaplain
1994 2006
1.
2.
3.
4.
5.
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
2006 - Reasons Catholic
Patients Want to See a Chaplain
All Catholic
1.
2.
3.
4.
5.
6.
7.
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%)
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
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To be with them at times of anxiety and
uncertainty - when they are “scared to death!”
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To listen to them (and validate their spiritual
beliefs)
Comment
4. They are relatively uninterested in rituals or
sacraments (except Catholics) 14% said meeting
ritual or sacramental needs was Very Unimportant)
5. 23% do not want counsel concerning moral or
ethical concerns or decisions –
30 % Neutral – neither important or unimportant
11% Somewhat Unimportant
12% Very Unimportant
A. 3: World Health Organization (WHO)
Pastoral Intervention (PI) Coding
1. Pastoral Assessment
2. Pastoral Ministry – the provision of the
primary ministry of presence and
expression of service, etc.
3. Pastoral Counseling or Education –
personal and familial counsel, ethical
consultation, review of one’s spiritual
journey
4. Pastoral Ritual / Worship
Part B. Chaplain Centered Issues
Rank in your order of importance:
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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
Part C. Metrics
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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?
Reasons for Developing Metrics
• Accountability; Budget
• Continuous Improvement
• Patient Satisfaction
• Productivity Measures
• Research
• Staffing Plan
• Supervision
What if you were in
business for
yourself?
• 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?
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."
Again, “What if you were in
business for yourself?”
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!”
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.
Part D. Methods for Measuring
1.
2.
3.
4.
5.
6.
7.
Press Gainey
Mayo Care Program (UOS)
SPIRIT Program
Providence Everett (SCU)
HealthCare Chaplaincy
Clinical Governance System
CHI Study 2002
1. Press Gainey
• CHA/NACC Summit in Omaha
• Metrics Task Force
• Standardized Question
• Proposed:
Data Collection Program Criteria
Any data collection program is based on the
following:
1. What do we need to measure and for
what reason/s?
2. 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
Program Criteria
• User friendly; uncomplicated
• Intuitive
• Reliable
• Tailored to your need; customized;
adaptable
• A tool for communication
• Research capability
2. Mayo CARE Program (UOS)
• Budget; Expense per Unit of Service
• Productivity
• Accountability
• Staffing
• Supervision
• Research
Refer to Spiritual Care
Interventions as
Service Events – Not Visits
Mayo Service Events (Direct)
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AM Admit
Anointing
Associated Death
Bereavement
Care Conference
Code 45
Crisis Care
Death
Ethics Consult
Ethics Contact
Family Care
Funeral/Wake
Group Facilitation
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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
Service Events (Indirect)
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Administration
CPE Administration
CPE Meeting
CPE Preceptorship
CPE Supervision
CPE Teaching
Meeting
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Mission Support
Preparation Time
Professional Organizations
Research
Rounds
Supervision
Volunteer Coordination
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.
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.
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
RRU Factors
0.65 AM Admit
7.78 Funeral
2.13 Anointing
3.30 Office Drop In
4.00 Associated Death
1.00 Pastoral Visit
3.51 Bereavement
2.17 Pre-surgical Visit
2.38 Care Conference
1.86 Research Intervention
4.37 Crisis Care
1.84 Rituals/Sacraments
5.32 Death
2.17 Spiritual Care
1.86 Family Care
1.86 Staff Care
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
Collecting Data
The CARE Program:
Chaplain Activity Record Electronic
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.
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.
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
CARE
% of Patient Contacts
Unmet Patient Needs
• 60% (300 patients) receive
spiritual/pastoral care at least once during
their stay
• 40% (200 patients) do not
• If chaplains were to care for those 200
patients they would find that:
• 27% would result in a pastoral contact
• 73% would result in a significant
spiritual care intervention
3. SPIRIT Program www.spiritforchaplains.com
• Web based vendor
4. Providence Everett
• Creates a Spiritual Care Unit (SCU)
based on the intensity of the visit
• Uses an Excel Spreadsheet
• Green for Routine Initial Visits – 1
• Yellow for Extended Visits – 2
• Red for Intensive Visits – 4
• Tim Serban
4. Providence Everett
4. Providence Everett
4. Providence Everett
• simple one page per week in excel and
needs no minute by minute calculations
• “Too often statistic programs focus on
minutes spent with patients rather than
the intensity of such visits.” The SCU
“represents a weighted value of intensity
of visit.”
• “If time were reflected each SCU could
be closest to 15 minute increments.”
4. Providence Everett
• also measure the number of patients
who are in the hospital 3 days or longer
who have been seen by a chaplain as a
standard for measuring what we have
potentially missed rather than solely
reporting on what chaplains have done
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4. Providence Health System
• Spiritual Needs & Chaplaincy Services
• Rodriguez B., Rodrigues D., Casey
• 2000
5. HealthCare Chaplaincy
• In house data collection system that is web
based; research and publication driven
• Establish benchmarks for average length
of visits; % initial; % follow-up
• Referrals, from whom; why; presenting
issue; real issue; intervention; time
• The influence of the religion match
between chaplain and patient especially
relative to prayer
6. Clinical Governance System
What should be measured:
• Customers’ needs and wants
• Appropriate staffing and resources to meet
needs/wants
• Reasons for ‘failed’ visits
• Success in meeting client demand
• What has been planned has been carried
out
6. Clinical Governance System
What should not measured:
• How many clients did we see
• How many of this did we do
• How many did we refer to this department
Measuring the Effectiveness of Chaplaincy: What to Audit, James Duffy
and Gillian Munro, Scottish Journal of Healthcare Chaplaincy, Vol. 8.
No. 2. 2005
7. Catholic Health Initiatives
Have a good day or a
bad one -
whichever you
choose!
Better luck next
life!
Let me know what
works
[email protected]