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.