Rev. Martin G. Montonye, D.Min., on utilizing our skills in a new way

An Emerging Role for Professional Chaplains: Training Healthcare Teams

The real work of altering the cultural dynamics in modern healthcare takes place in interdisciplinary meetings where chaplains model and coach staff on how to work together as a team to improve communication and reduce medical errors.

During the last decade, when it comes to formally integrating teamwork principles into all areas of the healthcare system, agencies such as the Institute of Medicine (IOM) and the Joint Commission (formerly JCAHO) have realized the wisdom behind Alfred North Whitehead’s use of the phrase corruptio optimi, perrima: Inert ideas (ones received without being challenged or tested) are not only useless; they are, above all things, harmful.[1] While many clinicians express competence in functioning as a member of a team, in reality they could be more competent. Communication skills and teamwork concepts are not a regular part of healthcare professional training programs.[2] As a result, modern heathcare professionals import inert ideas regarding communication and teamwork into their practice with devastating results: Poor communication and lack of teamwork skills are identified as the most common cause of preventable medical errors.[3]

In 1999, the IOM report on patient safety, To Err is Human, estimated that between 45,000 to 98,000 Americans die annually from preventable errors, at a cost of about $29 billion a year. In 2003, JCAHO National Safety Goal Requirements began with a strong focus on communication—with three of the seven goals related to communication, including improving “communication among healthcare team[s].” In response, healthcare institutions across the country initiated numerous patient safety initiatives. Unfortunately, according to some researchers, the effect of these initiatives related to the ultimate criterion—a decrease in the number of accidents—is difficult to measure and has yet to be established.[4] However, relying on other data, such as a measured increase in knowledge and skills in team work, institutions that have implemented team training programs are achieving impressive results.

One program currently gaining popularity is TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety.[5] Developed by the Department of Defense and Agency for Healthcare Research and Quality, TeamSTEPPS draws upon the experience of military aviation training, combat and other high-risk teams. Convinced that many of the lessons learned by TeamSTEPPS are transferable to the heathcare industry, over two hundred hospitals have now begun to use these materials to improve the communication and team skills of their healthcare professionals.

Barriers to implementing successful team training programs can be attributed to organizational and professional culture. Most healthcare organizations remain hierarchical, physician-dominated, multidisciplinary (an old industrial model) and, according to Stephen Small, “tribal.” “Care is given by a variety of specialists and disciplines working closely under stressful conditions, yet training of the various “tribes” occurs in isolation that reinforces individual cultures and norms.”[6] Other barriers to team performance and error rates include complacency, defensiveness, conflict and hidden agendas.[7] Another is the reliance on training materials as “how to” recipes and instructors who lack insight and experience working with human dynamics.

As the first generation of team training programs conclude and training for the next decade begins, professional chaplains will need to decide if participating in their organization’s team training program is consistent with their understanding of their professional role. If patients are entitled to the best quality of care, served by professionals trained to the extent possible by modern means, then chaplains should make all efforts to expose healthcare professionals with the ingredients of high functioning team work and communication skills.

Professional chaplains are trained with the necessary skill set to assist healthcare organizations establish team training programs. At the conclusion of a chaplain’s training program by the Association of Clinical Pastoral Education (ACPE), graduates are able to:

• attend to diverse people, taking into consideration multiple elements of cultural and ethnic differences, social conditions and systems;
• assess the strengths and needs of those served using an understanding of the behavioral sciences;
• demonstrate a range of skills including listening/attending, empathic reflection, conflict resolution/confrontation, crisis management;
• practice accurate professional communication;
• establish collaboration and dialogue with peers, authorities and other professionals.[8]

Some questions worth pondering:

• What is the role of the chaplain in changing the cultural of organizations?
• What core competencies in clinical education/ministry are transferable to facilitating team formation?
• Are there theological arguments for team training programs?
• How do pastoral educators intentionally instruct students in group/team facilitation?

Footnotes:

[1] Whitehead, Alfred N. The Aims of Education and Other Essays. New York: Penguin Books: 1949. (1).

[2] Musson, Helmreich. “Team Training and Resource Management in Health Care: Current Issues and Future Directions.” Harvard Health Policy Review. 2004; 5(1): (25-35).

[3] Joint Commission on Accreditation of Healthcare Organizations. “Sentinel Event Alert.” Joint Commission on Accreditation of Healthcare Organizations, Issue 30, 2004. Oakbrook, Ill.

[4] Baker, David P., et al. “Teamwork as an Essential Component of High-Reliability Organizations.” Health Research and Educational Trust. DOI: 10.1111/j.1475-6773.2006.00566.x.(1585).

[5] TeamSTEPPS™: Strategies and Tools to Enhance Performance and Patient Safety. November 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/teamstepps.

[6] Small, Stephen D. “Virtual Mentor.” Ethics Journal of the American Medical Association. 2005; 6 (3).

[7] TeamSTEPPS Pocket Guide.

[8] Association of Clinical Pastoral Education. Standards of the Association for Clinical Pastoral Education, Inc. 2005. Association for Clinical Pastoral Education, Inc. 1549 Clairmont Road, Suite 103, Decatur, Georgia 30033, www.acpe.edu (12-13).

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