The Rev. Russell Myers on Surveys and Outcome-based Pastoral Care

Surveys and Outcome-based Pastoral Care: The Neither/Nor Approach

The week before the APC annual meeting I received a report entitled Patient Satisfaction Survey results for Spiritual Care. The score for “Percent of patients who answered excellent to the question, ‘inpatient care met spiritual and emotional needs,’” was reported to be “low.” This was not the Press-Ganey survey; there was only one item including both spiritual and emotional care.

Observations: (1) These numbers would mean more if they compared expectations to experiences; (2) patients who receive support from their own faith community may have lower expectations of the hospital in terms of spiritual support, and therefore would enter a low score for that question; and (3) since chaplains only have contact with 10% - 20% of inpatients, there's no way we could meet the spiritual/emotional needs of all patients.

In Dallas I attended the pre-conference workshops called Outcome-Oriented Pastoral Care Giving. Relative to the satisfaction surveys, I sensed two opposing messages. Outcome-oriented pastoral care suggests a deeper relationship with patients (qualitative), while the emphasis on improving scores (quantitative) encourages a brief interaction centered around a "we care about your emotional and spiritual needs" message.

During the seminar, satisfaction surveys were discussed. A chaplain said Hospital 1 in his health system continued to work as he always had, and Hospital 2 utilized brief "we care" visits to every patient. Survey scores for Hospital 1 were unchanged, while the scores for Hospital 2 went up. Focusing on survey scores, the quantitative model looks better, even though we as chaplains would like to have the option of providing more qualitative spiritual care.

Throughout the APC conference I talked with other chaplains about the surveys. One chaplain’s administrator wants him to start seeing all new admits, about 100 per day. Another hospital’s surveys have been revised, removing the word "spiritual” from the question. They recognized that all hospital staff contribute to "emotional" support, whereas not all patients need or receive spiritual support.

One option might be to move from either/or to both/and. Rather than either quality or quantity, perhaps we could do both. Volunteers could visit all new admits, then chaplains could follow up on a referral basis, offering more in-depth care.

With this quantitative/qualitative debate in mind, I went to the plenary session to hear David Augsburger, speaking on the topic, “Who Knows but One Culture, Knows No Culture!” He discussed how (1) western culture tends to look at problem-solving as either A or B = the solution, (2) eastern culture tends toward both A and B = the solution, but (3) the southern hemisphere cultures view the issue as belonging to the community, and the solution is neither A nor B.

After returning from Dallas, I talked about this with a physician colleague. He said responsibility for spiritual/emotional support of patients belongs to all staff and attending physicians. He suggested taking it to the leadership team, where chaplains could meet with some of the nurses. Together we — the hospital community — might come up with a way for nurses to express our hospital's concern for patients’ spiritual and emotional well being. Perhaps they would do the quantitative part, and chaplains would do the qualitative part.

As he spoke I realized that this is what David Augsburger was describing as “the neither/nor approach.” The solution will emerge from the community, and it will be neither of the two options I’ve considered.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.