The Value of Chaplaincy: Metrics, Measurement, and Productivity

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The Value of Chaplaincy Metrics, Measurement,
and Productivity

• Rev. Dean V. Marek, BA, BCC
• Mayo Clinic, Rochester MN

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Overview

1. Patient Centered Care
2. Chaplain Centered Issues
3. Metrics
4. Methods of Measurement

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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

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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?

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

• Reasons patients want to see a chaplain
• Female Male
• To remind me of Gods 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

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1994 Patient 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

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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

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

• Reasons patients want to see a chaplain
  Female
  Male 1994 2006 1994 2006
• To remind me of Gods 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

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2006 Patient Expectation SurveyAge

• Reasons patients want to see a chaplain
• 16-35 36-55 55-75
  Over 75
• 1994 2006 1994 2006 1994 2006 1994 2006
• 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

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Reasons Patients Want to See a Chaplain

• 1994 2006
• Remind me of Gods 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

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2006 - Reasons Catholic Patients Want to See a
Chaplain

• All Catholic
• Remind me of Gods 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)

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Comment

• Patients expect those services from chaplains
  that more serve their spiritual needs
• They want the chaplain to remind them of Gods
  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)

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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

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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
   ones spiritual journey
4. Pastoral Ritual / Worship

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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

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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?

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Reasons for Developing Metrics

• Accountability Budget
• Continuous Improvement
• Patient Satisfaction
• Productivity Measures
• Research
• Staffing Plan
• Supervision

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What if you were in business for yourself?
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• 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?

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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."
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Again, What if you were in business for
yourself?
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Is what we do some kind of Secret?
We dont want to have to tell you what to do,
you tell us what you do!
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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.

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Part D. Methods for Measuring

1. Press Gainey
2. Mayo Care Program (UOS)
3. SPIRIT Program
4. Providence Everett (SCU)
5. HealthCare Chaplaincy
6. Clinical Governance System
7. CHI Study 2002

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1. Press Gainey

• CHA/NACC Summit in Omaha
• Metrics Task Force
• Standardized Question
• Proposed

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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

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Program Criteria

• User friendly uncomplicated
• Intuitive
• Reliable
• Tailored to your need customized adaptable
• A tool for communication
• Research capability

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2. Mayo CARE Program (UOS)

• Budget Expense per Unit of Service
• Productivity
• Accountability
• Staffing
• Supervision
• Research

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Refer to Spiritual Care Interventions as Service
Events Not Visits
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Mayo Service Events (Direct)

• 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

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Service Events (Indirect)

• Administration
• CPE Administration
• CPE Meeting
• CPE Preceptorship
• CPE Supervision
• CPE Teaching
• Meeting

• Mission Support
• Preparation Time
• Professional Organizations
• Research
• Rounds
• Supervision
• Volunteer Coordination

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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.

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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 ones 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.

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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

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RRU Factors

• 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

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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

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Greater productivity reduces the Expense per
Unit of Service!
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Greater productivity increases department
income !
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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.
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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.
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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

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CARE
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of Patient Contacts
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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

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3. SPIRIT Program www.spiritforchaplains.com

• Web based vendor

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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

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4. Providence Everett

•  

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4. Providence Everett

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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.

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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

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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

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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

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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

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7. Catholic Health Initiatives
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Have a good day or a bad one -
whichever you choose!
Better luck next life!
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• Let me know what works
• marek.dean_at_mayo.edu