Press Ganey Pulse Report 2010 - …



Best Practices: Associate SupportExecutive Summary by Glenn:Best thing we can do for clinical staff is be effective clinical chaplains, working in a way that actually improves the outcome for the patient, enhances the patient/staff interaction, or both.Best thing we can do for non-clinical staff (and next most important for clinical staff) is to enhance “employee engagement” - the linkage between the person’s own life mission and the mission of the organization Recognition: Personal, specific to exemplary work done; includes personal rounding 1:1 and participation in formal Recognition programsRounding to foster resilience and recovery from stressful work situations, effective use of resources and development, including giving attention to emotional stressors such as a nurse’s first death, ethical questions, difficult cases and difficult communications between team members. This requires both informal and formal Critical Incident Stress Debriefing (CISM), helping people Thrive on Change, developing No Fault Communication patterns, etc.LISTENING to concerns, modeling how we want patients treatedBeing “Pastor” to the congregation (In the chaplain’s congregation, Staff are the regular “members ,” where ongoing interactions occur over time; the patients are the “visitors.”) This includes being front line EAP, providing support and referral for family, mental health, financial, vocational crises.Best Practices to Keep Employees Happy: 4 ResponsesWritten by Bob Herman?| August 25, 2011 What's a hospital without its staff? Well, it's just a building then. Keeping a hospital employee base happy has numerous benefits, such as higher productivity, better quality of care and generally more positive dispositions. The following hospital CEOs shared their experiences on the best ways to keep employees satisfied. Diana Hendel, CEO of Long Beach (Calif.) Memorial Medical Center, Miller Children's Hospital Long Beach and Community Hospital Long Beach. ??? ?Just-in-time communication. Every month on the same day, I team up with my senior leaders to deliver updates on financials, strategic direction and changes to the board of directors, leadership team and the entire workforce during town hall meetings on all shifts. ??? ?Information readily available to all employees. We recap the town hall presentations, including Q&As, on the intranet in my "In the Loop" section for employees to access the rest of the month in case they missed the town hall. Also, any employee can ask any question and receive an answer within 72 hours in that section. ??? ?Hospital-wide professional development. Scores of in-person and online training and development programs, as well as management academies, to help staff and physicians expand their leadership capabilities are offered to clinicians, support staff and management. ??? ?Relentless focus on mission. I believe that when people are strongly in tune with an organization's mission, employees know how their role specifically supports the mission, and then engagement naturally and enthusiastically increases. ???? ?Listening to staff and patients. Our leadership team is continually seeking ways to really listen to staff — that's everyone who "works" in one of our hospitals, ambulatory facilities or community offerings — whether physician, employee or volunteer. When people feel listened to or understand why a decision is made, then they are more engaged. We've also instituted leadership rounds where senior leadership spends time talking with patients and then provides the feedback to staff (and 99 percent of time, it's extraordinarily positive, and the staff member gets to hear it directly from senior leaders). ??? ?Emphasizing wellness. Through the Good Life Program, our MemorialCare Health System offers employees myriad activities, options and incentives that give them a healthy life balance — from exercise, prevention and wellness programs to healthy food choices in the cafeteria and courses on how to improve the lifestyle for themselves and their families.??? ?Total engagement in creating solutions. Our hospitals engage in an inclusive culture.? All employees participate in identifying areas of improvement and contribute to solutions in a just-in-time culture that tracks and monitors progress regularly, assesses every new idea publicly, studies the feasibility versus the level of difficulty and provides instant feedback.Kurt Hofelich, president of Sentara Obici Hospital (Suffolk, Va.). Our answer is in three parts:??? ?Leadership in any successful organization needs to establish a clear vision for the goals of the organization and articulate that vision in a manner that all employees understand. Accomplishing this sets the stage for our employees knowing where the organization is going and what performance expectations are.??? ?Leadership needs to actively engage employees in pursuit of this vision. Seek out employee's ideas, get feedback, be responsive to implementing their ideas and measure their success. Accomplishing this establishes a culture of teamwork and employee engagement around accomplishing the organization's goals.??? ?Leadership needs to be visible. Actively round in your operations, engage employees in conversation, ask them how they are progressing on their unit's goals, ask them if they deal with any barriers on a daily basis, ask them what they enjoy most about their work day and be responsive to their input.? ?That's how we do it at Sentara Obici Hospital. With our employees' engagement and support, we improved our overall customer service scores by 13 percent and accelerated from last in our region to first in our region in the last year.Steven Johnson, president and CEO of Susquehanna Health (Williamsport, Pa.). We place an enormous priority on the role each person at Susquehanna Health plays in providing excellent medical care to our community. That's why we refer to each other as "service partners." Treating each other with respect is a cornerstone for our employee satisfaction. We include service partners in each step of our annual work climate surveys. We share results with them and involve employees in the development of the action plans to address the opportunities for improvement. This is part of our effective leadership development program to provide capable leadership for our employees.Creating an environment where service partners look forward to coming to work begins even before they arrive at Susquehanna Health — this is keeping true to our faith-based history. A new employee's very first day begins with a comprehensive on-boarding program that includes the CEO and effectively communicates our culture and expectations. From there, we maintain a robust employee reward and recognition program and an employee relations program that responds quickly and effectively to service partner concerns.We incentivize healthy living with an internal wellness program with incentives, such as a Weight Watchers at work program. We have an employee communications committee chaired by one of our sisters to ensure we hear the voice of the service partners. The committee also helps organize community-based social activities for employees and their families. We try to exemplify living balanced lives from senior management throughout the organization. Maintaining a culture where service partners are happy with their jobs is more than providing competitive compensation and benefits. We do all we can to treat service partners with the same dignity and respect we ask them to show our patients. Scott Teffeteller, CEO of Union Hospital (Terre Haute, Ind.). I feel the happiest employees are those that feel they are listened to, involved in processes and changes and who have administrative staff accessible to them. I also believe good communication is the backbone to each of those components. When I became Union Hospital's CEO last year, it was my intent to make communication a top priority. I now have a monthly column in our employee newsletter; administrative staff provides a weekly email update to all staff; we have instituted a better leader-rounding program; and we do a quarterly administrative update for staff and provide it in a video format, too. We've had positive feedback from our employees and believe happy employees provide the best care for our patients.Related Articles on Hospital Employees:Shattering Glass Ceilings: Women in the Hospital C-SuiteFrom Cop to CEO: Q&A With Chris Van Gorder of Scripps Health Tools of Engagement: Improving Workplace Quality ? Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here. of Engagement: Improving Workplace QualityWritten by Graham Barnes, CEO, Concerro, Inc.?| July 20, 2011 There's a crisis today in the healthcare industry; a crisis of spirit. No matter what conclusions are drawn about the pros and cons of healthcare reform, it is having a psychological effect, as shown in a recent study in which 57 percent of all nurse leader participants acknowledged healthcare reform had already had a substantial impact on morale (see graph below)[1] As healthcare reform begins in earnest and the extent of its impact becomes clear, healthcare organizations will need to place renewed focus on the morale of those individuals who are working so hard with so much less. Since labor costs represent nearly 60 percent of a hospital's overall expenses, [2] workforce management plays a major role in achieving the dual goals of cost reduction and improved productivity. As a proven, cost-effective way to attract and retain motivated workers and increase morale, efforts to increase employee engagement will become a lifeline for hospitals, especially as economic conditions improve and competition for top talent increases.Among other employee engagement strategies, scheduling tools that give employees freedom to choose when and where they work are proving to be instrumental in raising quality of life and job satisfaction — both of which are critical to patient care and satisfaction, and ultimately, to improving the bottom line.Becoming a world class employerThe challenge: Many people in today’s workforce are "disengaged." In one study from Gallup [3], only 30 percent of surveyed employees were considered to be "engaged," with 50 percent "disengaged." That’s a lot of people putting forth minimal effort, doing just enough to keep their jobs. Surprisingly, 20 percent of the employees in the same study were actively disengaged. According to the research, actively disengaged workers are the excuse-makers of the organization. They tend to stir things up and blame others for problems. Like disengaged employees, this group is a drain on the bottom line.Gallup found a complete reversal in "world-class" organizations, where 63 percent of employees were engaged, 29 percent were disengaged and only 8 percent were actively disengaged. Not surprisingly, this pattern of disengagement is mirrored within the healthcare industry. According to many studies, nurses are three to four times more likely to be dissatisfied with their jobs than the average U.S. worker (with nurses age 44+ four times more dissatisfied than the national average). Several studies report that most of the variability in job satisfaction is explained by working conditions (see box), with salary/benefits contributing little. [4]Putting quality of life firstQuality of care, safety and patient satisfaction are obvious priorities to the healthcare industry. Despite these imperatives, in troubled times, many hospitals opt to reduce the size of their workforce to save costs. According to an April 2009 study by the American Hospital Association nine out of every ten hospitals in the survey reported they had cut back on expenses to address economic concerns, and nearly 50% reduced staff. [5]Though hospitals experienced unusually low staffing problems during the recent economic downturn, the improving economy and job market will likely increase voluntary turnover rates as the best and brightest nurses leave for greener pastures. Fewer nurses will be competing for the same number of jobs, and hospitals that cannot attract and retain top talent will lose out.No matter what else healthcare reform has in store, one thing is clear: Top-performing hospitals will reap rewards and low performers will suffer penalties. Becoming a top performer in light of an aging workforce, a looming shortage of nurses and stronger competition for both employees and patients will not be easy, nor will traditional strategies be as successful as in the past.Becoming a "destination workplace" is one way hospitals can survive in this rocky environment. Tools that simultaneously improve quality of life, employee engagement and productivity are one proven strategy for becoming a more profitable — and hospitable — hospital.Satisfied staff leads to satisfied patientsUnder new healthcare reform initiatives, reimbursements will be determined, in part, by patient satisfaction scores, which are clearly related to employee satisfaction.Gallup reports a strong link between employee engagement and patient satisfaction: "As organizations improve their engagement levels, there is a positive linear relationship with growth in patient satisfaction and loyalty." [6]Purdue University researchers found a direct link between worker satisfaction and customer satisfaction and between customer satisfaction and financial performance. [7]A March 2011 study by Elizabeth H. Bradley, MD, published in The Annals of Internal Medicine, concurs. Bradley and other researchers visited 11 hospitals, half ranked in the top 5 percent and half in the bottom 5 percent based on mortality rates for heart attacks. After conducting more than 150 comprehensive interviews from all areas and job categories of each hospital, they discovered the culture of the hospital had more impact on mortality rates, including communication and support of staff, than more traditional factors such as patients' income levels, affiliation with a university, number of beds or location.Work/Life schedule flexibility trumps salaryWorkgroup cohesion and equitable assignments make the work environment more productive and collaborative. Hospitals can foster greater staff satisfaction by providing choice, flexibility, and transparency in scheduling. This leads to better quality of life for staff, managers and patients. According to PricewaterhouseCoopers, organizations that pay attention to work/life balance for physicians and nurses will also have a competitive edge in recruiting and retaining the best and the brightest. The same report states that work/life balance is the biggest influencer of how medical students pick a specialty, and that working conditions and schedules are the greatest influences onoverall job satisfaction among nurses, with salary only third place. [8]It's clear that physicians and nurses want to drive the terms of their employment, and hospitals that provide scheduling options and integration of flexible work arrangements into their staffing models will thrive. Many hospitals in this brave new world of healthcare are stepping up to the challenge and are experimenting with new ways of engaging their workforce by implementing practices that heighten job autonomy and ownership. One workforce management practice that improves quality of life (and the bottom line) is open shift management, which can be used as a standalone tool or integrated with scheduling solutions.Best practice: Open shift managementMain Line Health, a five-facility healthcare system in suburban Philadelphia, is one of many healthcare institutions that have implemented an open shift workforce management solution to improve employee engagement and quality of life.Using an online "Software as a Service" solution, nurses can view a complete listing of available shifts that match their qualifications and synch them up with their own availability dates and the preferences of their families. If they want to pick up extra shifts in other Main Line facilities in nearby communities, that's possible too, with manager pre-approval. Staff members are categorized by competencies to ensure the most qualified clinician with the most appropriate expertise is assigned to a given shift. By heightening awareness of staffing needs, nurses are given the opportunity to work on new units where they are qualified, which helps them gain valuable experience and encourages them to expand their education and accreditation to further their careers. Providing career development support and opportunities to advance their skill sets through unit cross-training increases quality of life, boosts retention, and maximizes human resource management for the hospital. Open shift management has vastly changed the nursing landscape at Mainline Health from a mindnumbing exercise of phone calls and manual scheduling to a process that encourages a closer partnership with nurses and gives them freedom to manage their own time and the flexibility to schedule work around family and personal life. When management can more intelligently and more appropriately schedule a nurse or technician to be in the right place at the right time, they’re setting themselves up for greater success and ensuring that all standards of care are appropriately maintained.These new processes have produced financial benefits as well. Conservative estimates indicate that each of Main Line's 85 nursing and medical staff managers individually save an average of five to six hours a week on scheduling minutia, which roughly translates into an annual savings of more than 22,900 hours of nurse manager time or approximately $1.97 million per year in reduced management labor and outbound scheduling calls that don’t have to be made.Strategic benefits of open shift managementEmployees can view schedules, request desired shifts and monitor their hours from any Web browser at home, at work or on the go.Incentives and bonus pay are more cost-efficiently managed and focused on those areaswhere the greatest needs exist.The professional resource pool can be cross-trained and shared among multi-facility locations to meet the requirements of a variable patient census.Shift managers are easily able to balance and redeploy employees in nursing, respiratory, radiology, laboratory and therapies through a convenient, easy-to-use Internet-based dashboard.Required skills for specialized shifts are more readily available to improve and maintain safety and QI standards while reducing premium labor costs.Many of the outbound telephone calls for shift scheduling of employees, contractors and agencies are no longer necessary, since a majority of the open shifts are filled automatically.Managers save five to six hours per week on staffing and scheduling tasks, and this produces a potential savings of millions of dollars per year for a typical hospital in reduced management labor and lower outbound telephone costs.Premium labor expenses from overtime, contractors and outside staffing agencies can be cut significantly to save millions of dollars per year for the average hospital.With online open shift selection, a hospital can evolve into more of a world class "employer of choice" for nurses and clinicians, due in part to the flextime, work life freedom and greater variety of interesting assignments.Concerro offers healthcare management systems and services that improve both quality of life and your bottom line. With online scheduling, open shift management, and emergency preparedness solutions, you can effectively manage and communicate with your staff. Join more than 500 hospitals that rely on Concerro’s award-winning solutions and services. Learn more at .Footnotes:________________________1 Results from HealthLeaders Media Industry Survey 2011, Nurse Leaders.2 American Hospital Association, Cost of Caring, 2010 report.3 Gallup Consulting, “Employee Engagement: What’s Your Engagement Ratio,” 2010.4 Robert wood Johnson Foundation. “Multiple Factors Affect Job Satisfaction of Hospital RNs.” Feb 2007.5 American Hospital Association, “The Economic Crisis: The Toll on the Patients and Communities HospitalsServe,” 2009.6 John Commins, “When Average Isn’t Good Enough,” HealthLeaders, April 2011.7 Purdue University at pdf/employee_engagement_study.pdf8 PricewaterhouseCoopers Health Research Institute report, “What works: Healing the healthcare staffingshortage,” 2007.? Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here. programs Workplace culture Organizational communication Trust & respect ?Press Ganey Pulse Report 2010Effects of Higher Employee Engagement Levels on Employees Effects of Higher Employee Engagement & Satisfaction on Patients Effects of Higher Employee Engagement/Satisfaction on Financial Performance ? Improves employee productivity ? Improves relationships with management ? Reduces job stress ? Increases employee satisfaction ? Increases retention & turnover ?? Improved care quality ? Increased patient satisfaction ? Increased patient loyalty ?? Lower employee recruitment/retention and training costs ? Higher patient loyalty to organization ? Possibly lower costs related to the delivery of patient care (because of shorter patient stays) ?Increasing Employee Loyalty & Retention and Motivating Involvement & Effort Hospital’s "Best Practices" Ways to Improve ? Recognition of employee milestones/accomplishments ?? Better communication of goals, decisions, and between departments ? Family-like atmosphere among long-term employees (good co-worker relationships) ? Financial bonds including salary/pay and benefits ?? Empowerment/Involvement in decision making ? Continue to improve work relationships, especially between supervisors and their departments and between physicians and nurses ?Table 5: Significant Patient Satisfaction Differences Across the Employee Satisfaction Groups Employment Referral Likelihood: I Would Recommend Employment Here Lowest Group Mean Highest Group Mean Sig Likelihood of Recommending Hospital Overall Rating of Care Given Summed Overall Rating Score Across Questions Patient Satisfied With Patient Care in My Unit Satisfaction With Other Departments’ Service Quality 78.2 80.0 76.8 4.9 4.0 82.5 83.4 78.6 4.8 4.5 .05 .06 .05 ns .01 Summed Overall Satisfaction With Job Lowest Group Mean Highest Group Mean Sig Likelihood Recommending Hospital Overall Rating of Care Given Summed Overall Score Across Sections Patient Satisfied With Patient Care in My Unit Satisfaction With Other Departments’ Service Quality 79.3 80.5 76.3 4.6 4.1 82.4 83.7 79.1 4.8 4.5 .09 .065 .07 ns .01 The primary contribution of this study is the finding that hospital departments that have higher levels of employee satisfaction provide better experiences for patients. Patients in departments with more satisfied employees are more likely, by a margin of four scale points out of 100, to say they would recommend the hospital to others. What’s more, those same patients rate the quality of the care they received as higher (by three points out of 100). ?, listening, coaching, participation and feedback are also priorities among nurses. Organizations are encouraged to establish teams of nurses, physicians and other employees who touch patient care to improve processes and develop plans to improve outcomes. These teams should also determine where supplies are stored, which equipment to purchase and how to create the optimal environment in which to provide excellent patient care. Allowing employees to be more involved in the decision-making process, or even to own the decision-making process, is difficult for senior leaders at fast-paced organizations. However, employees want to be more involved, and leaders must learn to use internal assets and challenge employees to share best practices in the organization and to search for those outside the organization. This also requires senior leaders and managers to give up control. To be successful in a complex organization such as a hospital, leaders must realize they cannot control everything and that involving staff in decisions improves the outcomes, adoption and sustainability of processes, programs and improvements. Survey item Based on responses of 85,495 employees from 305 hospitals received between Jan. 1 2009 and Dec. 31, 2009 National nursing division employee perspectives priority index Rank 213 Mean 5 Hospital Pulse Report: Employee and Nurse | ? 2010 by Press Ganey Associates, Inc. Connections BetweenPatient Satisfaction and Employee Partnership Happier employees mean happier patients. Press Ganey data show a strong correlation between employees’ overall partnership with their hospital and the satisfaction of patients at those facilities. The correlation coefficient between these two variables is strong and positive indicating that as one variable increases (i.e., patient satisfaction) there is a positive increase in another variable (i.e., employee partnership). While correlation studies do not prove that improvements in one variable cause improvements in another variable, these findings are consistent with the assumptions inherent in the Service Profit Chain model. The Service Profit Chain model is a schema which lays out the assumed impact internal environments have on external environments and, ultimately, customer satisfaction/organizational performance. The model assumes that a positive internal work environment (i.e., good coordination of work, leaders really listening to employees) positively impacts employees’ satisfaction and engagement with their employer (i.e., hospital). Satisfied and engaged employees will then be less likely to voluntarily leave the hospital and seek employment elsewhere, yielding a highly experienced and productive workforce. An effective workforce is assumed to produce high quality outcomes which in turn positively impact patients’ satisfaction with their hospital experience. 70.0 75.0 80.0 85.0 90.0 95.055.0 60.0 65.0 70.0 75.0 80.0 85.0 Inpatient overall satisfaction score Employee overall partnership score Relationship between patient satisfaction and employee partnership Data include responses of 169,002 employees and 305,757 patients at 185 facilities received between Jan. 1, 2009 and Dec. 31, 2009. R = .53 11 ? it comes to faith and the workplace, even the ?little things,? like subtle shifts in language, can make a big difference, the audience was assured.Rabbi Shira Stern, treasurer of the National Association of Jewish Chaplains, told the predominantly Christian audience that something as simple as use of the word ?we? can be critically important.?We are all brothers and sisters,? she said, hastening to add, ?But we are not all brothers and sisters in Christ.? Careless use of ?we? can then create barriers, warned Stern. ?When we say ?we,' we need to include all of us.?Giving Jewish employees flexibility about celebrating religious holidays, for example, is extremely important, or making sure that kosher food is available. For Muslims, setting aside time and space for them to pray during the workday is important, as is accommodating Muslims fasting during the holy month of Ramadan.?It is unbelievably affirming when we know that our bosses recognize our needs,? said Stern. ?Sweat the small stuff. The small stuff counts. Big time.?Use of religious symbols and imagery is also important to consider. If an employer provides space for employees to worship or pray, for example, faith-specific symbols such as crosses may have to be covered or removed at times when non-Christians are using the space.?It will feel like you are giving up things,? said George Handzo '73 M.Div., a chaplain and clinical director of Healthcare Chaplaincy, Inc. who moderated the panel. ?There are things you will not be able to do.?The gathering?? Workplace Chaplaincy: Hot Issues and Best Practices? ?was a first-of-a-kind event, according to David Miller, executive director of the Yale Center for Faith and Culture, the YDS-affiliated center that organized the conference. Never before, Miller said, has there been a national conference of this scope focused on chaplains in business settings.The primary sponsor of the three-day conference was Tyson Foods of Springdale, Arkansas, one of the largest corporate users of workplace chaplains. Support also came from several organizations that provide workplace chaplains: Marketplace Chaplains USA, Inc.; Corporate Chaplains of America; and Chaplains Associates, Inc. A number of topics were covered, including subjects like ?Thorny Legal Issues of Workplace Chaplaincy,? ?Chaplains in the Newsroom,? and ?What Makes for the Most Effective Workplace Chaplaincies??There was also some heartfelt testimony by people in the world of business who have tried chaplaincy programs and are committed to the idea?from top executives at large corporations such as Tyson Foods to businesspersons at much smaller operations, like Tim Embry, CEO of American LubeFast, a Georgia-based chain of 70 oil change and auto maintenance shops in the South that employs about 500 persons.At an annual cost of $60,000, LubeFast has chaplains in each of its markets who visit the company's shops once every two weeks and minister to men and women who spend most of their day under the chassis of automobiles.Embry reported that since he implemented the chaplaincy program through Marketplace Ministries, based in Dallas, TX, his employee turnover rate and product shrinkage (losses due to theft) declined dramatically.He described the chaplaincy program as ?an employee assistance plan on steroids? and recommended that other business leaders involve their companies. Said Embry, ?Do it. You will be rewarded.?Chaplains in the workplace are part of the broader ?faith at work? movement that seeks to bridge the so-called ?Sunday-Monday gap? that often separates worship life from the workaday world, including life in the world of business. At YDS, the Yale Center for Faith & Culture has a major initiative exploring this area of inquiry ? the Ethics and Spirituality in the Workplace program, the mission of which is ? to help people integrate the claims of their faith with the demands of their work.?David Miller, executive director of the Center for Faith & Culture, described what he called the ?compartmentalizing? of faith and work by a majority of people in a speech earlier this year. ?This schizophrenic alternative seeks to honor each area but finds no way to integrate them,? Miller said. ?Businesspeople and others in he world of work often live a bifurcated life in which faith and work, the spiritual and the material, Sunday and Monday are unrelated. This is one of the great tragedies of the modern church.?After the conference, Miller said, ? At its core, a faith-friendly policy is about honoring employee's desire to live integrated lives, where they do not have to hide their spiritual side, and respecting the many faith traditions represented in companies today. Being a faith-friendly employer is another way of helping employees overcome what many refer to as the ?Sunday-Monday gap.'?Miller identified five issues that surfaced repeatedly during the conference that he believes merit further study and discussion:Inappropriate proselytizing, possible religious-based harassment and consequent disruption to business. Creating internal chaplaincy programs versus use of third-party chaplaincy resources. Possible friction between local religious bodies and chaplains who might be viewed as being in competition with those bodies. Difficulties associated with measuring the success of chaplaincy programs in terms of typical cost/benefit assessments. Pluses and minuses of creating a chaplaincy accreditation process. Miller said the conference achieved its primary goals, including providing a forum for exchange of ideas and generating enthusiasm for continued development of chaplaincy programs. ?Yet the conference also raised as many questions as it answered, as it pointed to the wide spectrum of views and approaches to workplace chaplaincy,? noted Miller. ?This will be a fertile area for further study and theological reflection.? ? Roles for Chaplains on Patient Medical TeamsSource: Wall Street JournalView larger with caption Kimberli Lile, left, helped Ms. Hynes deal with some of her fears during treatment for cancer.December 6, 2011Bigger Roles for Chaplains on Patient Medical Teams Wall Street JournalThe Informed PatientBy: Laura Landro / laura.landro@ December 6, 2011Doctors and nurses were preparing Kathleen Hynes for a stem-cell transplant at Long Island's North Shore University Hospital last June when she asked them to page another member of the medical team—hospital chaplain Kimberli Lile.Ms. Hynes, a 53-year old cancer patient, wanted the chaplain to bless the cells before they were administered intravenously.Hospital chaplains have long been a source of comfort and succor for patients facing daunting illness.Chaplains are seeking bigger roles in hospitals and in some cases joining the medical-care team, as new research shows positive spiritual guidance and discussion can help improve a patient's medical outcome.Some hospitals are giving patients questionnaires upon admittance to identify who may benefit most from chaplain referrals.Chaplains, of course, may still pray with patients regardless of denomination, help families make difficult end-of-life decisions or simply offer a sympathetic ear.As interest rises in the links between religion, spirituality and health, there is a new push to establish chaplaincy in the medical mainstream and apply more rigorous scientific research. The Association of Professional Chaplains, which certifies health-care chaplains, issued its first standards for practice in 2009, including the requirement that chaplains document their work in patient medical records and stay abreast of new research.Medical schools are adding courses on spirituality and health, and training residents to consider patients' spiritual needs. Some two-thirds of U.S. hospitals provide chaplaincy services; others rely on local clergy and lay volunteers.Studies indicate as many as 40% of patients with serious illnesses like cancer struggle with spiritual concerns, which can harm emotional and physical well-being, says George Fitchett, research director in the Department of Religion, Health and Human Values at Rush University Medical Center Chicago.Patients who have negative thoughts—say, questioning God's care for them—are more likely to develop worse health outcomes than patients who show positive spiritual coping, such as turning to religion for solace.Chaplains "are patients' greatest advocates," says Harold Koenig, director of Duke University's Center for Spirituality, Theology and Health. They should work closely with other medical professionals, he says, and help them understand how spiritual beliefs influence patients' treatment decisions and response.Studies indicate that chaplain visits can result in less patient anxiety, shorter hospital stays and higher satisfaction. Still, a review in the Journal of Health Care Chaplaincy concludes that many studies haven't been rigorous enough to test effectiveness and define the best practices of chaplains' care."Every dimension of health care has to be accountable," says Walter Smith, a Jesuit priest and president of the nonprofit Health Care Chaplaincy in New York, which conducted the review and provides chaplains to area hospitals."Creating a strong research foundation of what chaplains do in the clinical setting will mark the coming of age of health-care chaplaincy as a profession," he says.With a $3 million grant from the John Templeton Foundation—whose late founder was an investor interested in the intersection of scientific research and spirituality—the Health Care Chaplaincy will oversee six national research projects on professional chaplains' role in health and palliative care, Dr. Smith says.A study published online in July in the Journal of General Internal Medicine found that among 3,000 patients hospitalized over a three-year period at the University of Chicago Medical Center, 41% wanted a discussion of religious and spiritual concerns, yet only half of that group reported having one.Patients who had a spiritual discussion reported being more satisfied with their overall care, whether or not they said they had desired it.Patients may hesitate to ask for a chaplain's services out of concern that chaplains will proselytize—even though in many cases they don't use explicit theological language and "are there to be companionable and offer support," says Wendy Cadge, associate professor at Brandeis University.Doctors, she adds, may feel uncomfortable asking patients about spiritual needs, or that it is inappropriate to do so.That's where tools such as spiritual history-taking can help, says Christina Puchalski, director of the George Washington Institute for Spirituality and Health, in Washington D.C., who developed a screening questionnaire.Ann Berger, chief of pain and palliative care at the National Institutes of Health's Clinical Center in Bethesda, Md., says it is "an easy way to ask these questions of patients and teach spiritual assessment to health-care providers." Chaplains visit referrals from such questionnaires and often make rounds to chat informally with patients.At North Shore University Hospital, Ms. Hynes met Rev. Lile, a Health Care Chaplaincy employee, when the chaplain stopped by her room.Ms. Hynes, a Catholic, had turned to her faith to help her cope with the 2008 death of her husband and the loss of her teaching job. After she was diagnosed with mantle cell lymphoma, a rare and often aggressive cancer, Rev. Lile helped Ms. Hynes face some of her fears, she recalls. "She gave me a beautiful prayer, and we sat and talked for an hour. She was so receptive and interested in what I was going through." The two spoke often during Ms. Hynes's hospital stay, laughing over the notion that Rev. Lile, trained as a Lutheran minister, would be blessing Catholic holy water that Ms. Hynes's son brought to the hospital for the stem-cell transplant.After the transplant, Ms. Hynes wrote to Rev. Lile to express her thanks: "I feel so blessed to have your encouraging influence during this turning point in my life. . . . The beautiful prayer and blessing is a memory I will always carry with me."Checking on Spirit After a TransplantAs a nearly 20-year survivor of a bone-marrow transplant at the Fred Hutchinson Cancer Research Center, in Seattle, I get an annual questionnaire in the mail about my physical and psychological well-being. This year, it asked about my experience of "Spiritual/Religious/Existential Struggle."Stephen King, manager of chaplaincy at the Seattle Cancer Care Alliance, which includes Fred Hutchinson, says the aim is to learn more about how the aftermath of a transplant affects not just the body but the soul. It is part of a medical effort to understand the links between health and spirituality. Of all the medical treatments that cause extreme pain and deadly risk in pursuit of a cure, few are more daunting than a bone-marrow or stem-cell transplant to treat leukemia, lymphoma and other diseases. Patients get high doses of chemotherapy and radiation to kill cancer cells; then healthy cells are administered intravenously in hopes of building a strong new immune system. Even when it works, patients can suffer terrible side effects, dangerous infections and long-term physical limitations.On the encouraging side, studies have shown that many transplant patients experience enhanced appreciation for life, re-ordered priorities, increased empathy and higher self-esteem. Yet they also often report lower spiritual well-being. "Negative religious coping"—feeling angry, unloved or abandoned by God, or doubting one's beliefs—has been associated with anxiety, depression and poorer social and emotional well-being.Experts say attending to one's spirituality—be it with yoga, prayer, meditation, music or putting others first—may help turn spiritual struggle into an opportunity for growth. ................
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