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