The Value of Chaplaincy: Metrics, The Value of Chaplaincy: Metrics, Measurement, and ProductivityMeasurement, and Productivity

Rev. Dean V. Marek, BA, BCCRev. Dean V. Marek, BA, BCC

Mayo Clinic, Rochester MNMayo Clinic, Rochester MN

OverviewOverview

A.A. Patient Centered CarePatient Centered Care

B.B. Chaplain Centered IssuesChaplain Centered Issues

C.C. MetricsMetrics

D.D. Methods of MeasurementMethods of Measurement

Part A. Part A. Patient Centered CarePatient Centered Care

1.1. What do patients want from a chaplain?What do patients want from a chaplain?a)a) Has anyone asked?Has anyone asked?b)b) Results?Results?

2.2. Mayo Patient Expectation Surveys 1994 Mayo Patient Expectation Surveys 1994 and 2006and 2006

3.3. WHO Categories WHO Categories

““The needs of the patient come The needs of the patient come first.”first.”

A. 1.A. 1. What do patients want from a chaplain? What do patients want from a chaplain?

a)a) Have you surveyed patients? What Have you surveyed patients? What kind of surveys/questions?kind of surveys/questions?

b)b)Results?Results?

c)c)Has your practice changed?Has your practice changed?

1994 1994 Patient Expectations Regarding Patient Expectations Regarding Chaplain ServicesChaplain Services

Mayo Clinic HospitalsMayo Clinic Hospitals

1550 surveys sent - 42% response rate 1550 surveys sent - 42% response rate

A. 2:A. 2: Mayo Patient Expectation Surveys Mayo Patient Expectation Surveys 19941994, , 20062006

19941994 Patient Expectation Survey Patient Expectation SurveyGenderGender

Reasons patients want to see a chaplain:Reasons patients want to see a chaplain:

Female: Male:Female: Male:

• To remind me of God’s care:To remind me of God’s care: 75%75% 71% 71%

• To pray or read scripture with me: To pray or read scripture with me: 67% 67% 61% 61%

• To be with me at times of anxiety:To be with me at times of anxiety: 67%67% 54% 54%

• To listen to me:To listen to me: 55%55% 49% 49%

• To meet my ritual needs:To meet my ritual needs: 56%56% 48% 48%

• To counsel with ethics:To counsel with ethics: 38%38% 33% 33%

19941994 Patient Expectation Survey Patient Expectation Survey AgeAge

Reasons patients want to see a chaplain:Reasons patients want to see a chaplain:

16-35 36-55 55-75 Over 16-35 36-55 55-75 Over 7575

• To remind me:To remind me: 74% 74% 81%81% 68% 70% 68% 70%

• To pray with me:To pray with me: 64%64% 64% 65% 63% 64% 65% 63%

• To be with me:To be with me: 76%76% 66% 58% 49% 66% 58% 49%

• To listen to me:To listen to me: 76%76% 66% 44% 37% 66% 44% 37%

• To meet ritual needs: To meet ritual needs: 57% 59% 51% 45%57% 59% 51% 45%

• To counsel me:To counsel me: 51%51% 44% 31% 46% 44% 31% 46%

19941994 Patient Expectation of a Patient Expectation of a Chaplain VisitChaplain Visit

• 48% expected to see a chaplain without 48% expected to see a chaplain without having to request a visithaving to request a visit

• 47% did not expect a chaplain to visit 47% did not expect a chaplain to visit unless they requested itunless they requested it

20062006 Patient Expectations Regarding Patient Expectations Regarding Chaplain ServicesChaplain Services

1500 surveys sent - 36% response rate1500 surveys sent - 36% response rate

A. 2:A. 2: Mayo Patient Expectation Surveys Mayo Patient Expectation Surveys 19941994, , 20062006

20062006 Patient Expectation Survey Patient Expectation SurveyGenderGender

Reasons patients want to see a chaplain:Reasons patients want to see a chaplain: Female: Male:Female: Male:

19941994 2006 2006 19941994 2006 2006

• To remind me of God’sTo remind me of God’s care:care: 75%75%-88%-88% 71%71%-81%-81%

• To pray or read scripture:To pray or read scripture: 67%67%-77%-77% 61%61%-63%-63%

• To be with me at times of To be with me at times of anxiety anxiety and uncertainty:and uncertainty: 67%-67%-83%83% 54%54%-70%-70%

• To listen to me:To listen to me: 55%-55%-73%73% 49%49%-58% -58%

• To meet my ritual needs:To meet my ritual needs: 56%56%-57%-57% 48%48%-46%-46%

• To counsel: To counsel: 38%38%-51% -51% 33%33%-43%-43%

20062006 Patient Expectation Survey Patient Expectation SurveyAgeAge

Reasons patients want to see a chaplain:Reasons patients want to see a chaplain:

16-35 36-55 55-75 Over 7516-35 36-55 55-75 Over 75

19941994 2006 2006 19941994 2006 2006 19941994 2006 2006 19941994 20062006

• To remind:To remind: 74%-74%-72% 72% 81%-81%-80%80% 68%-68%-85%85% 70%-70%-88%88%

• To pray: To pray: 64%-64%-43% 43% 64%-64%-67% 67% 65%-65%-72% 72% 63%-63%-73%73%

• To be with:To be with: 76%-76%-76% 76% 66%-66%-73% 73% 58%-58%-75% 75% 49%-49%-82% 82%

• To listen:To listen: 76%-76%-62% 62% 66%-66%-64% 64% 44%-44%-65% 65% 37%-37%-68%68%

• To meet: To meet: 57%-57%-24% 24% 59%-59%-49% 49% 51%-51%-51% 51% 45%-45%-61%61%

• To counsel: To counsel: 51%-51%-52% 52% 44%-44%-45% 45% 31%-31%-46% 46% 46%-46%-51%51%

Reasons Patients Want to Reasons Patients Want to See a ChaplainSee a Chaplain

1994 20061994 2006

1.1. Remind me of God’s care and presence:Remind me of God’s care and presence:72% 72% - 84%- 84%

2.2. Be with me at times of particular anxiety:Be with me at times of particular anxiety:62%62% - 76% - 76%

3.3. Listen to me: Listen to me: 52%52% - 66% - 66%

4.4. Meet my ritual or sacramental needs: Meet my ritual or sacramental needs: 80% 80% 53%53% - - 51% 51% 87%87%

5.5. Counsel with moral/ethical decisions: Counsel with moral/ethical decisions: 36%36% - 47% - 47%

In 1994 48% expected a visit without requestingIn 1994 48% expected a visit without requesting

In 2006 36% expected a visit without requestingIn 2006 36% expected a visit without requesting

20062006 - Reasons - Reasons CatholicCatholic Patients Want to See a ChaplainPatients Want to See a Chaplain

All CatholicAll Catholic

1.1. Remind me of God’s care and presence:Remind me of God’s care and presence:84% 84% - 88%- 88%

2.2. Be with me at times of particular anxiety:Be with me at times of particular anxiety:76%76% - 82% - 82%

3.3. Listen to me: Listen to me: 66%66% - 69% - 69%

4.4. Meet my ritual or sacramental needs: Meet my ritual or sacramental needs: 51%51% - - 87%87%

5.5. Counsel with moral/ethical decisions: Counsel with moral/ethical decisions: 47%47% - 52% - 52%

6.6. Pray/read scripture:Pray/read scripture: 69%69% - 73% - 73%

7.7. Expected a visit without requestingExpected a visit without requesting 36%36% - 41% - 41%

(in ’94 - 55%)(in ’94 - 55%)

CommentComment

Patients expect those services from chaplains Patients expect those services from chaplains that more serve their spiritual needs:that more serve their spiritual needs:

• They want the chaplain to remind them of God’s They want the chaplain to remind them of God’s care and presencecare and presence

• To be with them at times of anxiety and To be with them at times of anxiety and uncertainty - when they are “scared to death!”uncertainty - when they are “scared to death!”

• To listen to them (and validate their spiritual To listen to them (and validate their spiritual beliefs)beliefs)

CommentComment

4.4. They are relatively uninterested in rituals or They are relatively uninterested in rituals or sacraments sacraments (except Catholics)(except Catholics) 14% said meeting 14% said meeting ritual or sacramental needs was Very Unimportant)ritual or sacramental needs was Very Unimportant)

5.5. 23% do not want counsel concerning moral or 23% do not want counsel concerning moral or ethical concerns or decisions – ethical concerns or decisions –

30 % Neutral – neither important or 30 % Neutral – neither important or unimportantunimportant

11% Somewhat Unimportant11% Somewhat Unimportant

12% Very Unimportant12% Very Unimportant

1.1. Pastoral Assessment Pastoral Assessment

2.2. Pastoral MinistryPastoral Ministry – the provision of the – the provision of the primary ministry of presence and primary ministry of presence and expression of service, etc.expression of service, etc.

3.3. Pastoral Counseling or EducationPastoral Counseling or Education – – personal and familial counsel, ethical personal and familial counsel, ethical consultation, review of one’s spiritual consultation, review of one’s spiritual journeyjourney

4.4. Pastoral Ritual / WorshipPastoral Ritual / Worship

A. 3:A. 3: World Health Organization (WHO) World Health Organization (WHO) Pastoral Intervention (PI) Pastoral Intervention (PI) CodingCoding

Part B. Part B. Chaplain Centered IssuesChaplain Centered IssuesRank in your order of importance:Rank in your order of importance:

Report the number of services providedReport the number of services provided Chart in the medical recordChart in the medical record Record the number of patients seenRecord the number of patients seen Measure chaplain productivityMeasure chaplain productivity Give an accounting to supervisor and Give an accounting to supervisor and

administrationadministration Measure outcomesMeasure outcomes Conduct research for best practiceConduct research for best practice Practice self carePractice self care

Part C. Part C. MetricsMetrics

• Why record chaplain activity?Why record chaplain activity?• What is measured, counted, reported?What is measured, counted, reported?• How measure patient needs?How measure patient needs?• How measure unmet patient needs?How measure unmet patient needs?• How measure patient satisfaction and How measure patient satisfaction and

outcomes?outcomes?• How does research determine patient How does research determine patient

needs and appropriate staffing needs and appropriate staffing response?response?

Reasons for Developing MetricsReasons for Developing Metrics

• Accountability; Budget Accountability; Budget

• Continuous ImprovementContinuous Improvement

• Patient SatisfactionPatient Satisfaction

• Productivity MeasuresProductivity Measures

• ResearchResearch

• Staffing PlanStaffing Plan

• SupervisionSupervision

What if you were in What if you were in business for business for

yourself?yourself?

• what kind of salary would you expect?what kind of salary would you expect?

• who would pay you?who would pay you?

• how much would you charge for a patient how much would you charge for a patient consultation?consultation?

• how much for 5 minutes of prayer?how much for 5 minutes of prayer?

• how much for an anointing of the sick?how much for an anointing of the sick?

• how would you advertise your availability?how would you advertise your availability?

Saints Cosmas Saints Cosmas and Damienand Damien

They saw in every patient a They saw in every patient a brother or sister in Christ, brother or sister in Christ,

showed great charity to all, and showed great charity to all, and treated their patients to the best treated their patients to the best

of their ability. of their ability.

Yet no matter how much care a Yet no matter how much care a patient required, they never patient required, they never

accepted any money for their accepted any money for their services. services.

Thus, they were called anargyroi Thus, they were called anargyroi in Greek, which means "the in Greek, which means "the

penniless ones."penniless ones."

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

Is what we Is what we do some do some kind of kind of Secret?Secret?

““We don’t want toWe don’t want to have to tell you what have to tell you what

to do, you tell us to do, you tell us what you do!”what you do!”

Question: What Do We Do?Question: What Do We Do?• We know what we do - and we need to We know what we do - and we need to

describe it clearly.describe it clearly.

• When we know and value our work we will When we know and value our work we will communicate it authentically.communicate it authentically.

• When we document what services we When we document what services we provide we are able to know what remains provide we are able to know what remains undone. undone. ( # of patients per chaplain?)( # of patients per chaplain?)

• When we know what we can do with current When we know what we can do with current staff we are able to ask for additional staff to staff we are able to ask for additional staff to do what remains undone.do what remains undone.

Part D. Part D. Methods for MeasuringMethods for Measuring

1.1. Press GaineyPress Gainey2.2. Mayo Care Program (UOS)Mayo Care Program (UOS)3.3. SPIRIT ProgramSPIRIT Program4.4. Providence Everett (SCU)Providence Everett (SCU)5.5. HealthCare ChaplaincyHealthCare Chaplaincy6.6. Clinical Governance SystemClinical Governance System7.7. CHI Study 2002CHI Study 2002

1. 1. Press GaineyPress Gainey

• CHA/NACC Summit in OmahaCHA/NACC Summit in Omaha

• Metrics Task ForceMetrics Task Force

• Standardized QuestionStandardized Question

• Proposed: Proposed:

Data Collection Program CriteriaData Collection Program Criteria

Any data collection program is based on the Any data collection program is based on the following:following:

1.1. What do we What do we needneed to measure and for to measure and for what reason/s?what reason/s?

2.2. What do we What do we wantwant to measure and for to measure and for what reason/s?what reason/s?

Counting and reporting numbers says Counting and reporting numbers says nothing about patient needs, the nothing about patient needs, the intervention, or the quality of careintervention, or the quality of care

Program CriteriaProgram Criteria

• User friendly; uncomplicatedUser friendly; uncomplicated

• IntuitiveIntuitive

• ReliableReliable

• Tailored to your need; customized; Tailored to your need; customized; adaptableadaptable

• A tool for communicationA tool for communication

• Research capabilityResearch capability

2. 2. Mayo CARE Program (UOS)Mayo CARE Program (UOS)

• Budget; Expense per Unit of ServiceBudget; Expense per Unit of Service

• ProductivityProductivity

• AccountabilityAccountability

• StaffingStaffing

• SupervisionSupervision

• ResearchResearch

Refer to Spiritual Care Refer to Spiritual Care Interventions asInterventions as

Service Events – Not Visits Service Events – Not Visits

Mayo Service Events (Direct)Mayo Service Events (Direct)• AM AdmitAM Admit

• AnointingAnointing

• Associated DeathAssociated Death

• BereavementBereavement

• Care ConferenceCare Conference

• Code 45Code 45

• Crisis CareCrisis Care

• DeathDeath

• Ethics ConsultEthics Consult

• Ethics ContactEthics Contact

• Family CareFamily Care

• Funeral/WakeFuneral/Wake

• Group FacilitationGroup Facilitation

• Home VisitHome Visit

• Hospice Home Care Hospice Home Care

• Office Drop InOffice Drop In

• Pastoral ContactPastoral Contact

• Pre-surgical CarePre-surgical Care

• Public WorshipPublic Worship

• Research Intervention Research Intervention

• Retreat Care GroupRetreat Care Group

• Ritual/SacramentRitual/Sacrament

• Spiritual AssessmentSpiritual Assessment

• Spiritual CareSpiritual Care

• Staff Care/Staff Care GroupStaff Care/Staff Care Group

• Staff Development/TeachingStaff Development/Teaching

Service Events (Indirect)Service Events (Indirect)

• AdministrationAdministration

• CPE AdministrationCPE Administration

• CPE MeetingCPE Meeting

• CPE PreceptorshipCPE Preceptorship

• CPE SupervisionCPE Supervision

• CPE TeachingCPE Teaching

• MeetingMeeting

• Mission Support Mission Support

• Preparation Time Preparation Time

• Professional OrganizationsProfessional Organizations

• ResearchResearch

• RoundsRounds

• SupervisionSupervision

• Volunteer CoordinationVolunteer Coordination

WHO Pastoral Intervention Codings WHO Pastoral Intervention Codings (2002)(2002)

• Pastoral AssessmentPastoral Assessment – an appraisal of the spiritual – an appraisal of the spiritual wellbeing, need and resources of a person within the wellbeing, need and resources of a person within the context of a pastoral encounter.context of a pastoral encounter.

• Pastoral MinistryPastoral Ministry – the provision of the primary – the provision of the primary ministry of presence and expression of service, which ministry of presence and expression of service, which may include: establishing of relationship / engagement may include: establishing of relationship / engagement with another, hearing the story, and the enabling of with another, hearing the story, and the enabling of pastoral conversation in which spiritual wellbeing and pastoral conversation in which spiritual wellbeing and healing may be nurtured, and companioning / healing may be nurtured, and companioning / supporting persons confronted with profound human supporting persons confronted with profound human issues of death and dying, loss, meaning, and issues of death and dying, loss, meaning, and aloneness.aloneness.

WHO Pastoral Intervention Codings WHO Pastoral Intervention Codings (2002)(2002)

• Pastoral Counseling or EducationPastoral Counseling or Education – an expression of – an expression of pastoral care that includes personal or familial pastoral care that includes personal or familial counsel, ethical consultation, a facilitative review of counsel, ethical consultation, a facilitative review of one’s spiritual journey, and support in matters of one’s spiritual journey, and support in matters of religious belief or practice.religious belief or practice.

• Pastoral Ritual / WorshipPastoral Ritual / Worship – this intervention contains – this intervention contains the pastoral expression of informal prayer and ritual the pastoral expression of informal prayer and ritual for individuals or small groups, and the public and for individuals or small groups, and the public and more formal expressions of worship, including more formal expressions of worship, including Eucharist and other services, for faith communities Eucharist and other services, for faith communities and others.and others.

Developing Service TypesDeveloping Service Types

• Initiate a process with your staff to develop Initiate a process with your staff to develop unique service types for your institution unique service types for your institution

• Clearly define all service types to clearly Clearly define all service types to clearly distinguish them from each otherdistinguish them from each other

• Calculate a relative resource unit (RRU) Calculate a relative resource unit (RRU) based on timebased on time

• Determine the expense per unit of service Determine the expense per unit of service (UOS) and then the cost of each service (UOS) and then the cost of each service typetype

RRU FactorsRRU Factors

0.650.65 AM Admit AM Admit

2.132.13 Anointing Anointing

4.004.00 Associated Death Associated Death

3.513.51 Bereavement Bereavement

2.382.38 Care Conference Care Conference

4.374.37 Crisis Care Crisis Care

5.325.32 Death Death

1.861.86 Family Care Family Care

7.787.78 Funeral Funeral

3.303.30 Office Drop In Office Drop In

1.001.00 Pastoral Visit Pastoral Visit

2.172.17 Pre-surgical Visit Pre-surgical Visit

1.861.86 Research Intervention Research Intervention

1.841.84 Rituals/Sacraments Rituals/Sacraments

2.172.17 Spiritual Care Spiritual Care

1.861.86 Staff Care Staff Care

Expense per UOSExpense per UOS

• An An Expense per UOSExpense per UOS is a way of is a way of reporting direct patient care activity in reporting direct patient care activity in relation to the expenses budgeted for relation to the expenses budgeted for your departmentyour department

• It is a method of accountability to your It is a method of accountability to your administrationadministration

• It is expected that we meet or beat our It is expected that we meet or beat our Expense per UOSExpense per UOS on a monthly basis on a monthly basis

Greater “productivity” Greater “productivity” reducesreduces the Expense per the Expense per

Unit of Service!Unit of Service!

Greater “productivity” Greater “productivity” reducesreduces the Expense per the Expense per

Unit of Service!Unit of Service!

Greater “productivity” Greater “productivity” increasesincreases

department incomedepartment income !

Greater “productivity” Greater “productivity” increasesincreases

department incomedepartment income !

Collecting DataCollecting 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 The demonstration program on the CD will run as is with a limited data storage run as is with a limited data storage capacity. It is offered without cost to capacity. It is offered without cost to

recipients and will not be supported by the recipients and will not be supported by the distributor or any other entity or institution. distributor or any other entity or institution.

Recipients must agree to rely on their own Recipients must agree to rely on their own experience with Microsoft Access 2003 or experience with Microsoft Access 2003 or the Information Technology Department in the Information Technology Department in their institution to support and/or adapt the their institution to support and/or adapt the

program to their system.program to their system.

A Word of WisdomA Word of Wisdom

““Remember this and remember it Remember this and remember it well. Never do anything a computer well. Never do anything a computer can do better. Then you will be able can do better. Then you will be able to have time to do what a computer to have time to do what a computer cannot do.”cannot do.”

Harold Kaiser, Health Care Futurist, 1988Harold Kaiser, Health Care Futurist, 1988

CARECARE

% of Patient Contacts

Unmet Patient NeedsUnmet Patient Needs

• 60% (300 patients) receive 60% (300 patients) receive spiritual/pastoral care at least once during spiritual/pastoral care at least once during their staytheir stay

• 40% (200 patients) do not 40% (200 patients) do not

• If chaplains were to care for those 200 If chaplains were to care for those 200 patients they would find that:patients they would find that:• 27% would result in a pastoral contact27% would result in a pastoral contact• 73% would result in a significant 73% would result in a significant

spiritual care interventionspiritual care intervention

3. 3. SPIRIT ProgramSPIRIT Program www.spiritforchaplains.comwww.spiritforchaplains.com

• Web based vendorWeb based vendor

4. 4. Providence EverettProvidence Everett

• Creates a Spiritual Care Unit (SCU) Creates a Spiritual Care Unit (SCU) based on the intensity of the visitbased on the intensity of the visit

• Uses an Excel SpreadsheetUses an Excel Spreadsheet

• Green for Routine Initial Visits – 1Green for Routine Initial Visits – 1

• Yellow for Extended Visits – 2Yellow for Extended Visits – 2

• Red for Intensive Visits – 4Red for Intensive Visits – 4

• Tim SerbanTim Serban

4. 4. Providence EverettProvidence Everett

  

4. 4. Providence EverettProvidence Everett

  

4. 4. Providence EverettProvidence Everett

• simple one page per week in excel and simple one page per week in excel and needs no minute by minute calculationsneeds no minute by minute calculations

• ““Too oftenToo often statistic programs focus on statistic programs focus on minutes spent with patients rather than minutes spent with patients rather than the intensity of such visits.” The SCU the intensity of such visits.” The SCU “represents a weighted value of intensity “represents a weighted value of intensity of visit.”of visit.”

• ““If time were reflected each SCU could If time were reflected each SCU could be closest to 15 minute increments.”be closest to 15 minute increments.”

4. 4. Providence EverettProvidence Everett

• also measure the number of patients also measure the number of patients who are in the hospital 3 days or longer who are in the hospital 3 days or longer who have been seen by a chaplain as a who have been seen by a chaplain as a standard for measuring what we have standard for measuring what we have potentially missed rather than solely potentially missed rather than solely reporting on what chaplains have donereporting on what chaplains have done

•   

4. 4. Providence Health SystemProvidence Health System

• Spiritual Needs & Chaplaincy ServicesSpiritual Needs & Chaplaincy Services

• Rodriguez B., Rodrigues D., CaseyRodriguez B., Rodrigues D., Casey

• 20002000

5. 5. HealthCare ChaplaincyHealthCare Chaplaincy

• In house data collection system that is web In house data collection system that is web based; research and publication drivenbased; research and publication driven

• Establish benchmarks for average length Establish benchmarks for average length of visits; % initial; % follow-upof visits; % initial; % follow-up

• Referrals, from whom; why; presenting Referrals, from whom; why; presenting issue; real issue; intervention; timeissue; real issue; intervention; time

• The influence of the religion match The influence of the religion match between chaplain and patient especially between chaplain and patient especially relative to prayerrelative to prayer

6. 6. Clinical Governance SystemClinical Governance SystemWhat should be measured:What should be measured:

• Customers’ needs and wantsCustomers’ needs and wants

• Appropriate staffing and resources to meet Appropriate staffing and resources to meet needs/wantsneeds/wants

• Reasons for ‘failed’ visitsReasons for ‘failed’ visits

• Success in meeting client demandSuccess in meeting client demand

• What has been planned has been carried What has been planned has been carried outout

6. 6. Clinical Governance SystemClinical Governance System

What should not measured:What should not measured:

• How many clients did we seeHow many clients did we see

• How many of this did we doHow many of this did we do

• How many did we refer to this departmentHow many did we refer to this department

Measuring the Effectiveness of Chaplaincy: What to Audit, James Duffy Measuring the Effectiveness of Chaplaincy: What to Audit, James Duffy and Gillian Munro, Scottish Journal of Healthcare Chaplaincy, Vol. 8. and Gillian Munro, Scottish Journal of Healthcare Chaplaincy, Vol. 8.

No. 2. 2005No. 2. 2005

7. 7. Catholic Health InitiativesCatholic Health Initiatives

Have a good day or a Have a good day or a bad one -bad one -

Better luck next Better luck next life!life!

whichever you whichever you choose!choose!

Let me know what Let me know what worksworks

marek.dean@mayo.edumarek.dean@mayo.edu