Spiritual Care in Clinic Offices (Outpatient)

CHE Spiritual Care Champions

October 16, 2013

Introductions

Chaplain Ellis Robinson, BCC

Chaplain Susan Stucco, BCC

Julie Jones, Exec. Director, Mission & Ministry

Overview

• Context for our work with Mercy Clinic• Assumptions • Evolution • Working within clinic environment • Getting and responding to referrals • Changing role of chaplain

Backdrop for Presentation

Why has Mercy’s Pastoral Services extended to clinic setting?

• 96% of patient encounters are outside of hospital

• Pastoral Services Strategic Goals are aligned with Mercy’s

• Pastoral Services VISION: Everywhere and every way Mercy serves, attention to spiritual needs will be evident.

About Mercy Clinic

• 1,900 integrated physicians practicing in 300 locations

• Physician led, professionally managed

• Primary care doctor and specialists are linked by electronic health record

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Assumptions in Planning

• Redesign priorities and expectations of where and how chaplains spend time

• Cannot just export what exists in hospitals

• Try new things and learn from them

Assumptions in Planning • Pastoral Services resources shared

across the ministry

• Use new technology to connect chaplains with patients in clinics

“We are walking on a bridge we are building.”

Evolution

• FY2011 – Began “assigning” a few chaplains to a few clinics

• FY2012 – Conducted pilots to learn more, focusing on identifying needs and referrals

• FY 2013 – Compiled Learning and Tools

• FY2014 (current year) - Expanding and Refining

Learn Culture and Rhythm of Clinic

• Fast paced, lots of movement

• Build on what is present • Clinical staff already recognize spiritual needs

and provide some spiritual care

• What is present in this clinic

• Physicians and providers in clinic often have deep and long-term relationship with patients

Processes and Tools

• Defined approach

• Developed training for chaplains about approach

• Refine education chaplains brought to clinics

• Developed promotional materials

• Surveyed clinics

• Tracked referrals

Getting in the door…

• Introduction important to get welcomed • Part of formation efforts in clinic setting

• Make relevant to their work/patient care • Clarify Chaplain’s purpose for being there• Staff support • Patient care • Education/training

• Recognizing needs• Make referrals

Lessons Learned: Start with Education

• Work within schedule of clinics

• Education focused on

• How to recognizing spiritual needs

• What staff is doing to address basic spiritual needs

• How to refer to chaplain

Lessons Learned: Getting Referrals

• Infrastructure/processes for doing so • How does staff refer to chaplain who is not in office? • May need to build over time

• Build trust and skill of staff for referrals • Affirming good referrals and following up on them

• Utilizing communication tools that exists with this group

• Newsletters• Gathering

What are we getting referrals for?

• Coping • With illness, new diagnosis• Fetal demise

• Prayer/meditation • Fear/anxiety • Be available for patient getting bad news

(specialists) • Continuity of care – from office to direct

admit to hospital

After referral…patient care

• Various ways of providing this • Face-to-face• Phone• Follow-up with appointment• E-mail after initial phone call

• Follow-up with staff who made referral to reinforce and build their confidence in making referral

Emerging distinct components

• Screening • Identify need• Create referral

• Referrals for risk of and/or actual spiritual distress

• Formal or Informal Assessment • Response to a Referral • Documentation (EHR) • Creates basis for plan of care

• Interventions • Patient outcomes

Different needs from different specialties

• Survey revealed different needs based on acuity – risk for and actual spiritual distress• Convenient Care• Oncology• Cardiology• Women’s health

Spiritual care interventions/needs

• Chaplains use same skills that they used/developed in hospital to meet needs • Calming presence• Compassionate, active listening to help

• Patient find their own resources• Assist patients in identifying next steps

• Crisis intervention/support• Encourage getting support in places available • Make referrals to other disciplines

Distinct spiritual care interventions/ needs

• Goal of Physician: Prevention

Clinical staff recognize patients that have “spiritual crisis” that is leading to health care crisis…what can they do to prevent?

• Part of “team” for patient care in distinct way once illness is present • Consistency • Over time, not just acute episode for hours or days

Unique challenges or barriers for spiritual care

• Physician understanding of role of spiritual care and chaplain

• Distance between chaplain and clinic locations

• May not be “space” for private consultation • Patient needs sporadic, episodic • Electronic medical record for clinic was

distinct from inpatient…needed to learn

Group work in clinic setting

• Debriefing/support with clinics when there is some critical event

• Chaplains have supported some chronic disease management groups

Special competencies required of chaplains

• Passionate about ministry to patients and this new place• Great communication• Professional-confidence in being expert in spiritual care • Empowering/teaching• Flexible with new ways of serving and using technology • Ability to evolve chaplain identity • Innovative• Part of research • Proactive, self-starter and independent yet team oriented• Comfortable with layers of accountability- multiple teams

Chaplain’s Perspectives

• Energizing

• Changing traditional role

Questions and comments