Rev. Jon Overvold on the importance of demonstrating how chaplains make a difference

Hospital Consumer Assessment of Healthcare Providers
and Systems Survey

The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is a new standardized survey tool developed by the Center for Medicare and Medicaid Services (CMS) that focuses on the patient’s experience of care. The survey questions were carefully developed so that despite the differences among hospitals it is still possible to accurately measure and compare the patient’s satisfaction with their care. These scores will be publicly reported in March of 2008 and, in the future, these scores, combined with the Core Measures of Quality, will be tied to reimbursement rates thus affecting the hospital’s bottom line.

As professionals who work in health care settings, chaplains need to be aware of the dynamic impact HCAHPS will have on our institutions. Of the 27 questions in this survey none specifically ask about spiritual care. However administrators will be carefully monitoring two key questions: one question asks for the patient’s overall rating of the hospital (1-10) and the other asks if the patient would recommend this hospital to family and friends. We are given a wonderful opportunity to demonstrate the contributions that chaplains make in improving patient satisfaction. Conversely, if we fail to make that case within our hospitals, at a time when so much is riding on patient satisfaction, we will have contributed to our own marginalization and the perception that spiritual care is irrelevant.

Because chaplains contribute significantly to the patient’s experience of care, it is essential that chaplains participate in the development and implementation of the hospital’s efforts to improve the satisfaction of its patients. In a study published in Joint Commission Journal on Quality and Safety,[1] researchers Clarke, Drain and Malone found a “strong relationship between ‘the degree to which staff addressed emotional/spiritual needs’ and overall patient satisfaction.” This study includes an extensive literature review, which explores “whether patient’s emotional and spiritual needs are important, whether hospitals are effective in addressing these needs, and what strategies should guide improvement.” The study is invaluable to chaplains for the bibliography alone. The other component of this study includes original research on data collected by Press Ganey in 2001, which had findings that confirmed results of the earlier studies sited in the literature review.

Clark, Drain and Malone make the following recommendations to improve patient satisfaction by addressing spiritual needs:

1) Provide basic emotional and spiritual care resources, such as, sacred texts and religious materials, support groups, a chapel of meditation area, special diets;
2) Chaplaincy/Pastoral Care Team which can provide an in-depth spiritual care experience that results in improved satisfaction;
3) Multidisciplinary Emotional and Spiritual QI Team;
4) Standardized assessment tools to elicit spiritual needs and the meeting of those needs.

Especially significant are their recommendations to the pastoral care teams. They write: “A chaplain/pastoral care team can coordinate the elements of an emotional and spiritual infrastructure across disparate organizational boundaries. An isolated chaplain/pastoral care team exclusively responsible for patients’ emotional and spiritual needs will be unlikely to influence organization-wide behaviors and processes needed to address patients’ emotional and spiritual needs.” Evidently, chaplains need to insert themselves in places where they can systemically influence the spiritual dimensions of care. Why? Because we know it will have a greater impact on improving the patient’s experience of care.

In summary, HCAHPS gives chaplains an opportunity to demonstrate how spiritual care of patients contributes positively to the whole healthcare team’s care of the patient. On a basic level chaplains should be monitoring the routine services like availability of religious resources and the systems that provide special foods or sacramental services. Another important practice is regular review of the written comments by patients. This is available from your patient satisfaction vendor and can be very revealing of patient’s perceptions of pastoral care. Chaplains who can articulate how the goals of pastoral care are aligned with the institution’s goals will have a far better chance to influence the systems and infrastructure of an institution than those that cannot.

Reference/Footnotes

www.hcahpsonline.org

[1] Clark, P.A., Drain, M, Malone, M.P.(2003). “Addressing patients’ emotional and spiritual needs.” Joint Commission Journal of Quality and Safety, 29, (12), 659-670.

Gerteis, M., Edgeman-Levitan, S., Daley, J., Delbanco, T. L., (Eds.), Through the Patient’s Eyes: Understanding and Promoting Patient Centered Care. San Francisco, CA: John Wiley and Sons, 1993.

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