Frederick A. Smith, MD, on establishing a pastoral care department at a large metropolitan hospital

Persuading a Budget-Balancing Administrator to Invest in
Non-Revenue-Producing, Full-Time Clinical Chaplains

Dennis Dowling is a well-known hospital administrator who measures by results, and whose compliments must be earned. So I was moved and gratified when, one year after its inception, he called me on my direct line to thank me for my role in helping to bring Clinical Pastoral Care and its director, The Rev. Jon Overvold, to North Shore University Hospital in Manhasset, New York.

Bringing clinically trained chaplains to North Shore didn't seem like a slam-dunk idea when the directors of social work and volunteer services first identified it as a pressing need in early 2000. When they spoke to Mr. Dowling, he reasserted the hospital's longstanding policy that chaplain services were a responsibility of the religious organizations in the community, and not something the hospital should pay for.

As a physician interested in the interface between religion and medicine, I joined these and other advocates in an ad hoc effort to make the case that the hospital should hire a full-time CPE-trained chaplain. Our written proposal described specific vignettes to illustrate how many in-patients’ spiritual needs could not possibly be met by clergy not prepared for cross/un-traditional spiritual counseling, including:

•Religious people following religious traditions different from the faiths traditionally dominant in our community and hospital;
•Individuals whose anger, doubt, guilt or other experiences put them in ambivalent tension with their faiths of origin;
• and patients indifferent or hostile to "organized religion" who nonetheless wrestle with existential/spiritual issues of meaning, value, relationship, and remorse.

The proposal elicited no immediate response from administration. But about six months later, its advocates were invited to an administration meeting with The HealthCare Chaplaincy representatives. Despite Mr. Dowling’s aversion to out-sourcing, he was impressed enough to ask us to phone numerous hospital administrators in our area, who were almost uniformly enthusiastic about the benefit that The HealthCareChaplaincy’s clinical-chaplain staffing had brought to their organizations.

With self-conscious chutzpah, we proposal writers pushed beyond our initial recommendation for a single chaplain, and requested two. To our surprise, Mr. Dowling decided on budgeting for three positions, including a certified ACPE supervisor to extend the program’s reach.

Pastoral Care at North Shore has come a long way since then. Having concluded two sessions of training CPE interns, our three-member pastoral care department has added to its training program two paid residents and an ACPE-supervisor-in-training for 2004-5, with the full support of hospital administration.

No doubt there are patient-care advocates at other hospitals who, like us, have been only faintly hopeful that they can persuade a budget-balancing administrator to invest in non-revenue-producing, full-time clinical chaplains. What can we recommend to them?

First and foremost, do some gentle and respectful education:

1) Explain the difference between clinically trained chaplains and regular clergy who do not have this training, whether they are in the hospital all the time or not.

2) Demonstrate very specifically how the lack of such clinical chaplains

•leaves a large number of patients in the cold with respect to spiritual care;
•makes it almost impossible to effectively identify and manage spiritual conflict and suffering on the wards;
• forfeits opportunities both to enhance compliance with standard medical care, and to enhance healing that goes beyond mere physical cure;
•and deprives health care workers and administrators of a unique source of comfort and spiritual support when they too suffer from daily losses and threat of burn-out in the hospital.
• (But don’t threaten a citation on the next JCAHO review; such threats tend to get an administrator’s back up.)

Second, be prepared to do the leg work, make the phone calls, and document the experiences of administrators who support clinical pastoral care departments at other institutions.

Third, point out the benefit to the hospital itself in increased appreciation from patients, families and community, and in improved morale for clinicians whom trained chaplains have helped to fill in that too-often-missing wedge (or substrate?) in the circle of healing — the spiritual and existential comfort of faulty mortals who, overtly or covertly, fear the suffering, separation and extinction threatened by physical illness.

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