Wednesday, February 08, 2006

Quality and Pastoral Care

I work in a health care system, and like all corporate entities these days' the system is very self-conscious about mission, vision, and values. We hold up values that we think make us stand out. It's not enough to point out that we give excellent care; everyone in the industry says they give excellent care (and almost everyone is really trying as best they know how). So, we try to highlight those values we think make us stand out from the competition.

In our system, three values stand out: that we are faith-based, locally owned, and committed to quality. Over time, I will certainly speak about all three. Today the one most on my mind is our commitment to quality.

That is true in no small part because, even as I began this reflection, I was sitting in a leadership meeting, the central topic of which was a detailed description of the criteria of the Baldrige National Quality Award. The fact that I could write this during the presentation was a measure of how often I had heard this presented before, and not of how I valued it. In health care we need to be committed to quality, and the Baldrige criteria are arguably the best available. We want to do our best, and do it consistently, from the bedside to the boardroom to the boiler room. That will bring the best care to everyone: patients, families, and staff and associates.

And what is the chaplain's role in all of that? In one sense the answers are pretty clear. Chaplains can participate in interdisciplinary teams and in institution-wide efforts at quality management and performance improvement. I have even written on resources for chaplains to think about the process of performance improvement [“Performance Improvement: Theological Reflections”, Chaplaincy Today, Vol. 16, Number 1 (Summer, 2000)]

From a different perspective, this is a matter of great discussion among chaplains. You see, we are not agreed on what constitutes quality in pastoral care. It is part of the difficulty we have had in determining how we should account for our work and our time. Elements of quality in pastoral care include at least being present to the right people, making the right intervention, committing the right amount of time, and coming as close as possible to the desired effect. However, each of these dynamics is unique to the situation. Do we care for the person in the center of the situation, or to the person with the most dynamic response to the situation? What is an appropriate intervention, in light of the situation and the persons served? Prayer? Scripture? Counseling? Silent presence? What is the right amount of time? A long visit? A series of short visits? And hardest of all, what is the desired effect? And how would we measure it?

Chaplains in particular, and clergy in general, are all somewhere in the midst of those questions – arguably, “all over the map” is an understatement. Those questions are integral to the spiritual care we provide. We all recognize the questions as important, even as we wrestle with the answers, not only to set standards for the profession, but to make the individual, daily decisions about how best to minister.

Which moves us back, I think, to a commitment to professional self-consciousness, self-supervision, and improvement. I think there are a number of ways that we can think about the process from our religious heritage. However, in practice it’s simple enough: I need to be attentive to what I do. I need to evaluate whether I am meeting the standards I think appropriate to the best of my ability. I need to stay educated and to try new behaviors to try to meet those standards. And then I need to be attentive again to whether those changes improve my ministry.

And so I’m quite comfortable with the focus in health care on quality and performance improvement. I can see how it is good for patients, families, and staff, because over time it can improve the work of all of those who care for them. And I can see how that is as true of me as it is of any other professional in the business.

3 comments:

Bill said...

At the hospital where I work, we have been in pursuit of the Baldrige Award for quite a while. We began a journey to service excellence in the late 1990s. It's interesting to me that our Press, Ganey scores have gone up astronomically, but one hears among the administrative staff the speculation that "it's all about awards." Culture changes can be so incredibly difficult to bring about. But I guess Jesus could tell us a lot about that. ;-)
I've sent the link to your post to a couple of folks here who will be interested. Thank you.

Marshall said...

That, of course, is always an issue. Before I came to the health system I serve now, I served in a large system in the rust belt. There was a lot of lip service given there to Total Quality Management (TQM). Unfortunately, it was only lip service; and it created a situation I described as "war in heaven." Some administrators were committed to the program, and others were not. So, when important decisions needed to be made, some wanted to work through data and others wanted to use intuition. Because there was no clear leadership from the top, there was no clear message to those in the middle, much less those in the trenches. "For want of a vision the people perish."

My current system is consistent throughout management: we're trying to work from data and from best practices. It will help us care better and support better care. It can also win us awards; but the best management strategy in the world will not win an award if the people at the bedside aren't clear on the goal of doing our job better, which for us means caring for people better.

Bill said...

Hey! I like the addition of the picture. Suddenly you've become human! It's interesting what having a face to see does to a relationship. "The Lord make his face to shine on you."

As a wide digression, you look a lot like a younger version of the former Archdeacon of the Diocese of Southern Ohio, who was introduced at our parish one Sunday morning as "the Archbishop of the Diocese."