Chaplain Richard Lopez on pastoral care as a budget line item

Office Space: Profit or Presence

“Now before this, Eliashib the priest, having authority over the storerooms of the house of our God, was allied with Tobiah. And he had prepared for him a large room, where previously they had stored the grain offerings, the frankincense, the articles, the tithes of grain, the new wine and oil, which were commanded to be given to the Levites and singers and gatekeepers, and the offerings for the priests.” Nehemiah 13:4-5

We have finally done it! We have caught the eye of the accountant’s consultants, forged our place in the professional world and everyone sees it…including those who have the difficult task of balancing the yearly budget. We have spent decades tidying up our standards for accreditation. We’ve journeyed to the highest heights of hospital administration. JCAHO has finally agreed to our appeal for recognition as a legitimate, professional element in the hospital. We’ve arrived! We have more abbreviations behind our names, higher salaries and an office area of our own. And yet, has our climb up the mountain range of professional recognition really helped us? In the pursuit to have our 15 minutes of fame in the clinical arena we suddenly find ourselves as line-items in the industry. As we make our way forward in this battle of medicine and budgeting, we have quite of variety of our own fruit to taste in front of us.

The hospital industry is looking ahead. It doesn’t look good. Costs for malpractice insurance are rising exponentially, equipment and medication are costly and expenses for employee health benefits are unacceptably high. Hospital administrators are looking at every detail, searching for areas where employees must bear the burden of “making adjustments” to help hospitals stay barely in the profit margin. Finally, after all the pressure to accept recommendations from expensive hospital consultants, the final formula for budgeting has been reduced to this: office space and profit margin. Each square foot of the hospital must produce a certain percentage of profit in order to survive the next budget cut. Where we used to fasten core values like Respect, Excellence, Justice and Compassion to patient satisfaction and good hospital business, Stewardship and profitable Office Space has become the ultimate bottom line for ensuring the future survival of the hospital.

How does this management philosophy for balancing the books affect the spiritual care department? Accountants must place a price not on the work of the chaplain, but on the profit margin of the space the chaplain occupies. Sacred elements of our work like Ministry of Presence, Grief Support and Prayer are not discernable factors on the balance sheet. Rather, our office space is measured in comparison to other departments of the hospital. The news is not good: our office space may receive a thank you card now and then or even a package of chocolates, but rarely can an accountant’s audit detect any beneficial revenue for the hospital’s bottom line. Lately patient satisfaction has been casually ignored for managing costs in the business of medicine and for the accountant’s objective; in this light, chaplaincy should not even be on the map. While our difficult climb up academia has won us our “clinical” office space, our distinguished presence is tragically on the chopping block. What’s next for us in this desperate industry?

For the sake of our presence in the industry, our striving to validate our goal for supreme accreditation must end. With the undercurrents of budget-balancing and the writing on the wall, we must change our focus to reevaluate our goals for survival – and we are in survival mode. We are suffering the consequences of accrediting ourselves right out of a job. Enjoying our professional recognition and erecting lofty clinical standards affords the right for administrators to place a price on the spiritual elements of our service. Today we try to legitimize our position in the clinical arena by developing patient tracking forms and satisfaction cards, but in the end gauging profit margins with spiritual qualities are two elements that will never meet.

Directors of Spiritual Care Departments must overcome the implementing of trendy deficit-reducing strategies by educating hospital administrators about what exactly they’re paying for: Chaplains provide Presence, not Profit, and with Presence come mission and core values. This is a necessary component of our worthwhile visibility in the hospital, continuous service and patient satisfaction regardless of the bottom line. We are their anchors to ensure that a permanent place for patient satisfaction is safe in the scope of eager accountants. Profitable office space for the chaplain is faithfully budgeting in Presence (i.e., staff). Nehemiah was very clear, when office space philosophy needed a shake-up, regarding business and necessity:

“And it grieved me bitterly; therefore I threw all the household goods of Tobiah out of the room. Then I commanded them to cleanse the rooms; and I brought back into them the articles of the house of God, with the grain offering and the frankincense.” Nehemiah 13:8-9

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