Forging Relationships of Understanding Communicating what Chaplains Do Through Performance &...

Forging Relationships of Forging Relationships of UnderstandingUnderstanding

Communicating what Chaplains Do

Through Performance & Productivity Measures

PresenterChaplain Al Henager, BCC, BCCC

Association of Professional Chaplains Annual Conference 2008

Workshop DescriptionWorkshop 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.

What NOT to ExpectWhat 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.

Workshop GoalsWorkshop 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.

WelcomeWelcome

To the FOUR hour tour

DiscussionDiscussion

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?”

Don’t Be Afraid to ChangeDon’t Be Afraid to Change

DefinitionsDefinitions

PerformancePerformance ““What is done”What is done” Intensity of the taskIntensity of the task StandardsStandards

How does what is done compare to How does what is done compare to what is expected?what is expected?

CompetenciesCompetencies What is the effectiveness of what is What is the effectiveness of what is

done?done?

DefinitionsDefinitions

ProductivityProductivity Amount of what is doneAmount of what is done Time it took to do itTime it took to do it Complexity of the taskComplexity of the task How efficiently it is doneHow efficiently it is done OutcomesOutcomes

What is the result of what is done?What is the result of what is done? What is the added value of what is What is the added value of what is

done?done?

AIO (or EI AIO)AIO (or EI AIO)

AAssessmentssessment NeedsNeeds

SpiritualSpiritual EmotionalEmotional Social/culturalSocial/cultural

IInterventionsnterventions How needs are metHow needs are met

OOutcomesutcomes The result of the interventionsThe result of the interventions

Excellent Interactions = AIO

AIOAIO

Add this: Add this: Performance Performance MeasuresMeasures Value to the patient/familyValue to the patient/family Value to the staffValue to the staff Value to the institutionValue to the institution Value to the communityValue to the community

Case StudyCase Study

Read the caseRead the case

Performance: Performance: Identify what was Identify what was done - tasksdone - tasks AssessmentAssessment InterventionsInterventions IntensityIntensity

Case StudyCase Study

Productivity:Productivity: Identify the Identify the efficiencyefficiency What were the outcomes?What were the outcomes?

Value to patientValue to patient Value to staffValue to staff Value to institutionValue to institution

TimeTime ComplexityComplexity

The CHI ReportThe CHI Report

““Measures of Chaplain Measures of Chaplain Performance and Productivity”Performance and Productivity” Study began February 2001Study began February 2001 Report published June 2002Report published June 2002


Four PurposesFour Purposes To help market-based directors of To help market-based directors of

spiritual/pastoral care be more effective in spiritual/pastoral care be more effective in managing the performance and productivity of managing the performance and productivity of their chaplainstheir chaplains

To explain in simple, common language just To explain in simple, common language just what chaplains do and their work’s added what chaplains do and their work’s added value to an organization, to warrant the value to an organization, to warrant the allocation of resourcesallocation of resources

To raise chaplains’ awareness of the To raise chaplains’ awareness of the complexity and value of what they do so they complexity and value of what they do so they can be more “intentional” in managing time can be more “intentional” in managing time and priorities in their ministryand priorities in their ministry

To affirm and promote the professionalism of To affirm and promote the professionalism of CHI chaplains by highlighting the CHI chaplains by highlighting the competencies they bring to their ministrycompetencies they bring to their ministry


Need to better articulate:Need to better articulate: What chaplains do (standards & What chaplains do (standards &

competencies)competencies) What outcomes typically result What outcomes typically result

(their added value to the (their added value to the organization)organization)

The most appropriate units of The most appropriate units of service to measure their efficiencyservice to measure their efficiency

All of the above in a language All of the above in a language chaplains believe is appropriate chaplains believe is appropriate and other health care disciplines and other health care disciplines can readily understandcan readily understand


Index card for reportingIndex card for reporting

The CHI ReportThe CHI Report MethodMethod

Phase one – Sept. to Dec. 2001Phase one – Sept. to Dec. 2001 9 pilots sites9 pilots sites 56 chaplains56 chaplains 35,000 pastoral interactions35,000 pastoral interactions

Phase two – Feb. to May 2002Phase two – Feb. to May 2002 To improve our ability to articulate what To improve our ability to articulate what

chaplains do and their work’s added value chaplains do and their work’s added value in in a common languagea common language

Feedback fromFeedback from ChaplainsChaplains CEOsCEOs Nursing staffNursing staff NOK of patients who had diedNOK of patients who had died


Findings of Phase 2Findings of Phase 2 Amazing consensus and a Amazing consensus and a

common language among those common language among those closest to the site of care deliveryclosest to the site of care delivery

Clear consensus among Clear consensus among administrators of valuing chaplains administrators of valuing chaplains for their “symbolic role”for their “symbolic role”


Report of “added value” fromReport of “added value” from Sheer availability of chaplains who Sheer availability of chaplains who

bring no agenda to care recipientsbring no agenda to care recipients Support & comfort chaplains Support & comfort chaplains

provideprovide Helpfulness of chaplain with Helpfulness of chaplain with

“practical details”“practical details” Ability of chaplains to serve as Ability of chaplains to serve as

facilitators of human developmentfacilitators of human development


LearningsLearnings Widespread lack of clarity & consistency Widespread lack of clarity & consistency

in understanding, articulating, & in understanding, articulating, & measuring what chaplains domeasuring what chaplains do

When dialogue between chaplains & When dialogue between chaplains & others takes place, the expectation of others takes place, the expectation of activities & competencies are consistentactivities & competencies are consistent

Most measures of chaplain P&P are Most measures of chaplain P&P are inadequate in depth & complexityinadequate in depth & complexity

Chaplains are willing to learn new ways Chaplains are willing to learn new ways to communicate their workto communicate their work


RecommendationsRecommendations Consult with chaplains to clarify & define Consult with chaplains to clarify & define

their roles, key activities, & their roles, key activities, & competenciescompetencies

Get reps from other disciplines to help Get reps from other disciplines to help chaplains articulate performance chaplains articulate performance expectations in a behavioral, common expectations in a behavioral, common languagelanguage

Create a template that defines levels of Create a template that defines levels of task complexitytask complexity

Provide education needed for chaplains Provide education needed for chaplains to develop skills in the competenciesto develop skills in the competencies

St. Vincent Health System AIOSt. Vincent Health System AIO

ProcessProcess Survey of our chaplains regarding Survey of our chaplains regarding

their activities regardingtheir activities regarding AssessmentAssessment InterventionsInterventions OutcomesOutcomes

Series of dialogues with other Series of dialogues with other professionals regarding how they professionals regarding how they understand what chaplains dounderstand what chaplains do Examined terminologyExamined terminology Suggested alternativesSuggested alternatives


ProcessProcess Created a templateCreated a template

See exhibit insertSee exhibit insert Met with Information TechnologyMet with Information Technology

Developed a computer program for Developed a computer program for data entrydata entry

Tied interventions to NACC Tied interventions to NACC standards of practicestandards of practice

Developed mechanism for generating Developed mechanism for generating reportsreports



FormsForms SVHS Spiritual Assessment FormSVHS Spiritual Assessment Form SVHS AIO CardSVHS AIO Card St. Anthony AIO CardSt. Anthony AIO Card

StandardsStandards NACC StandardsNACC Standards APC StandardsAPC Standards CHI StandardsCHI Standards


ProcessProcess Implemented procedureImplemented procedure

Each chaplain recorded all activitiesEach chaplain recorded all activities For a period of 3 monthsFor a period of 3 months Ran reportsRan reports Evaluated dataEvaluated data

Evaluated the programEvaluated the program Worked out the kinksWorked out the kinks Refined the toolsRefined the tools Adjusted the reporting methodsAdjusted the reporting methods


Result of evaluationResult of evaluation The AIO was too cumbersome with The AIO was too cumbersome with

too many choicestoo many choices The AIO took too long to enter dataThe AIO took too long to enter data The AIO lacked any true The AIO lacked any true

performance measure regardingperformance measure regarding ImpactImpact ValueValue

Elements of spirituality were lackingElements of spirituality were lacking


Fine tuningFine tuning AIO form revised with fewer AIO form revised with fewer

choiceschoices Many choices were combinedMany choices were combined

Wording was changed in order to Wording was changed in order to communicate more effectivelycommunicate more effectively

Layout of data entry screen made Layout of data entry screen made more user friendly for faster entrymore user friendly for faster entry

Standards were updated to Standards were updated to include those of CHIinclude those of CHI


Data EntryData Entry At first written in Microsoft AccessAt first written in Microsoft Access Transferred to HTML formatTransferred to HTML format

Data Entry ScreenData Entry Screen Basic identifiersBasic identifiers Note AIO formatNote AIO format Note addition of Performance Note addition of Performance

MeasuresMeasures Note incorporation of “Spirituality”Note incorporation of “Spirituality”

See Spirituality BrochureSee Spirituality Brochure



ReportsReports Summary for Summary for All ChaplainsAll Chaplains for for

November 2005November 2005 Summary for Summary for Individual ChaplainsIndividual Chaplains

for November 2005for November 2005 Executive Summary by Station for Executive Summary by Station for

November 2005November 2005 Full Summary by Station for Full Summary by Station for

November 2005November 2005 Competency SummaryCompetency Summary for 2005 for 2005


ApplicationsApplications Monthly executive reportsMonthly executive reports

AdministrationAdministration Nurse managersNurse managers

Yearly chaplain evaluationsYearly chaplain evaluations Justification for additional staffingJustification for additional staffing

SVHS Chaplaincy historySVHS Chaplaincy history SVHS financial historySVHS financial history Memo for justification of new staffMemo for justification of new staff Result of staffing requestResult of staffing request

UMAS Medical CenterUMAS Medical Center

Outpatient clinic documentationOutpatient clinic documentation LogicianLogician Documentation templateDocumentation template

Menu form – AIOMenu form – AIO Narrative form – AIONarrative form – AIO

Inpatient documentationInpatient documentation Sunrise interface – April 2008Sunrise interface – April 2008 Documentation templateDocumentation template

Menu form – AIO Menu form – AIO Narrative form – AIONarrative form – AIO


Both Outpatient & InpatientBoth Outpatient & InpatientChaplain visit documentation Chaplain visit documentation

in patient’s chartin patient’s chartProvides a searchable Provides a searchable

databasedatabase

UMAS Medical CenterUMAS Medical Center Provides a searchable databaseProvides a searchable database

Number of total chaplain visits for periodNumber of total chaplain visits for period What units or clinicsWhat units or clinics Number visits by each chaplainNumber visits by each chaplain Who made referralsWho made referrals Who was seen and how manyWho was seen and how many The reason for referrals The reason for referrals They types of symptoms presentedThey types of symptoms presented The types of interventions & numbersThe types of interventions & numbers The types and numbers of outcomesThe types and numbers of outcomes The types and numbers of performance The types and numbers of performance

measuresmeasures

UAMS Medical CenterUAMS Medical Center

Added to DocumentationAdded to Documentation

Productivity Measures:Productivity Measures: Patient/Family SatisfactionPatient/Family Satisfaction Clinical OutcomeClinical Outcome Connection/Value CommunityConnection/Value Community Employee SatisfactionEmployee Satisfaction Organizational Cost SavingsOrganizational Cost Savings Reminder/Catalyst Reminder/Catalyst

These WILL NOT be in the These WILL NOT be in the patient’s chartpatient’s chart Separate searchable data baseSeparate searchable data base

UMAS Medical CenterUMAS Medical Center Sample report – June 2009Sample report – June 2009

Number of total chaplain visits 758Number of total chaplain visits 758 Visits by individual chaplainVisits by individual chaplain

A 126A 126 B 127B 127 C 130C 130 D 124D 124 E 119E 119 F 132F 132

Referral sourcesReferral sources Staff/RNStaff/RN 253253 PhysicianPhysician 9898 Family/PatientFamily/Patient 198198 ChaplainChaplain 102102 OtherOther 44


Service provided toService provided to Patient/familyPatient/family 725725 StaffStaff 148148 Church/communityChurch/community 9797 Health systemHealth system 3333 OtherOther 66

Reason for serviceReason for service RoundsRounds 104104 OrdersOrders 407407 Follow upFollow up 5252 OtherOther 44


Types and numbers of symptomsTypes and numbers of symptoms AngerAnger 256256 AnxietyAnxiety 167167 ApathyApathy 143143 ConfusionConfusion 243243 DepressionDepression 242 242 GuiltGuilt 267267

GriefGrief 345345 Other ritualOther ritual 5353 Prayer Prayer 523523 Referral/faith contact Referral/faith contact 428428 SacramentSacrament 9393 Sustaining presence Sustaining presence 676676


Types and numbers of issues/needsTypes and numbers of issues/needs Belonging/communityBelonging/community 143143 CommunicationCommunication 167167 ControlControl 356356 ForgivingForgiving 243243 Purpose/meaningPurpose/meaning 742 742 Faith/hope/trust/ Faith/hope/trust/ 715715

transcendingtranscending ValueValue 523523 None assessedNone assessed 44


Types and numbers of Types and numbers of outcomesoutcomes Acceptance 243Acceptance 243 CatharsisCatharsis

87 87 Connection/ 342Connection/ 342 communitycommunity Comfort 423Comfort 423 Forgiveness 159 Forgiveness 159 GratitudeGratitude

682 682 HonestHonest 343 343 HopeHope 657 657 Healing 524Healing 524

Types and numbers of Types and numbers of outcomesoutcomes In control 265In control 265 Communication 143Communication 143 Peace Peace 568 568 Progress w/ 356Progress w/ 356 grievinggrieving Purpose 614Purpose 614 Transcendence 156 Transcendence 156 TrustTrust 686 686 ValueValue 523 523 WonderWonder 93 93


Performance measuresPerformance measures NOT in chartNOT in chart

Patient/Family SatisfactionPatient/Family Satisfaction 714714 Clinical OutcomeClinical Outcome

692692 Connection/Value CommunityConnection/Value Community 356356 Employee SatisfactionEmployee Satisfaction 143143 Organizational Cost SavingsOrganizational Cost Savings 356 356 Reminder/Catalyst Reminder/Catalyst 715715

Pitfalls to AvoidPitfalls to Avoid

Minute by minute accounting of Minute by minute accounting of chaplains’ timechaplains’ time

Micro managingMicro managing Chaplains are professionalsChaplains are professionals Treat them like professionalsTreat them like professionals

Data collection for data Data collection for data collection sakecollection sake

Closing ExerciseClosing Exercise

ID - roles, activities, ID - roles, activities, competencies of your workcompetencies of your work

Think like your colleagues from Think like your colleagues from other professionsother professions Translate your terms to theirsTranslate your terms to theirs Restate your performanceRestate your performance

Create your own templateCreate your own template Think of continuing educationThink of continuing education

The EndThe End

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