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Becker’s Healthcare Podcast
Improving the Patient Experience through the Integration of Chaplaincy and Ethics Services with Jason Lesandrin & Kelsey B. White
00:14:06
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- [00:01]
A
This is Kristin Kuchno with the Beckers Healthcare podcast, and I'm thrilled to be joined today by two guests to discuss the role of chaplains within healthcare organizations. Jason Leslandrini, Assistant Vice President of ethics, advanced care planning, spiritual health and Language access services at WellStar Health System, and Kelsey White, Assistant professor and Chaplaincy faculty researcher at Virginia Commonwealth University and Editor in Chief at the Journal of healthcare chaplaincy. Dr. Lesandrini and Dr. White, thank you both for taking the time to be on the podcast today.
- [00:35]
B
Thanks, Kristin.
- [00:36]
C
Thank you for having us.
- [00:38]
A
Dr. White, could you start by sharing an overview of your work with Dr. Lesandrini and walk us through the role of chaplains within healthcare organizations?
- [00:47]
C
Absolutely. So chaplains is probably the colloquial term, but I think there are many places that also call them spiritual care providers. These are the experts that attend to spiritual health in a healthcare organization. They're employed by the healthcare organization. So these aren't volunteers or community clergy, which are very different from professional chaplains. They have graduate degrees and about a year of clinical training after that graduate degree, and then are members of the interdisciplinary team that help attend to the spiritual health of patients, families, and even other staff members. And I'll explain a little bit about what spiritual health means because it's often very vague to many people. People, but this is about how we all make sense out of the world around us. So how we process difficult experiences and connect, connect to others interpersonally and with our own identity. For many, this ends up getting connected back to their religious affiliation or their religious identity, but not always. And so professional chaplains are really trained to care for those across religious traditions and even care for those who may identify as spiritual or humanist or nothing in particular. That's just a little bit about what chaplains do. In terms of my work with Jason, we've been working a lot on how we can improve spiritual care providers integration within health care through partnerships with healthcare executives. What we are really trying to push is how healthcare executives think about these experts. We want to move away from them as this nice addition that we have on the healthcare team and more thinking about them as strategic players in advancing an organization's goals.
- [02:33]
A
Great. Thank you so much for that overview. Dr. Lesandrini, can you expand on how chaplains are being used to address strategic priorities at hospitals and health systems?
- [02:45]
B
Yeah, well, thanks, Kristen. I think it'll be a nice piggyback on what Kelsey was saying. So there are lots of different areas depending on the organization and how they see spiritual care providers integrating into the work that they do on a daily basis. So I'm going to talk about three broad areas and then talk about a unique experience here at wellstar. So when we think about what strategic initiatives that chaplains or spiritual care providers plug into, one of the big ones is workforce well being. As we know across the country, we're seeing a lot of burnout, fatigue, stress, you name it, put whatever word you want, moral distress, moral injury, you want to it. And chaplains have been used in the past and continue to be used in this space to help so things like code blue, response strategies. So having a chaplain or a spiritual care provider who's there during the resuscitation, either to lead, pause after the death, to be present with the clinicians as they're doing their work and or with the family as a support structure for families. The one we do this here at wellstars T for the Soul is another big one. There's a cart. We have times throughout the day where we take this cart throughout the organization and just give staff a brief pause or moment to sort of reconnect or as Kelsey said recenter about who they are and give them an opportunity to sort of take a moment out and then, you know, get back to the, to, to the work. But we, we do that here across our organization. We found it to be super engaging. The other two big areas that we see spiritual care providers engaging with strategic priorities is around patient experience or patient satisfaction. I will give an example of my own organization and Kelsey has told me we need to write this up. We just never did. We, we decided that we thought CHAPL be really good for patients, just to connect with them in the initial phases of their hospital stay. And so in one of our sites, we brought in chaplain into the visit within 48 hours of admission. And it was just a touch point with each patient who came into the organization. It was just there to offer services. And it wasn't a sort of, you know, had to do prayer or anything with them. It was just a sort of support tool that we used. And what we found in the units where we did that versus the units that we did was significantly higher scores of patient experience. And we controlled for, you know, all the other counterfactors or, you know, counterbalancing things that could be happening in the unit. There are lots of other things that people have done out there in the country, like dignity therapy, spiritual legacy interventions, thing called this is my Story. So there's lots of different opportunities where chaplains can engage around patient experience and make meaningful impact for the organization. And then the last is really about access to care. We know that chaplains are an untapped resource in this space and we see it happening in new ways. So for example, one of our sites, we do a tele chaplaincy program where we follow up with patients either who have been diagnosed with any particular disease. It doesn't have to be something dramatic, but just to give a. Lending a sort of supportive ear to patients. And we find that this sort of extends the connection of the organization back to the chaplain. And I think that's what others are doing. I think it also provides sort of support and counseling to a patient as they're going through illness. You know, I. I've said this before. Kelsey's heard this. I'm a broken record. I've never met anyone with better ears than a chaplain. Right. They're just good listening people. And I think organizations could do a lot more to use them. I think the last thing I'll circle back to my own organization is our chaplains are deeply and intimately involved in what we. We have a program where there's an incident that happens in the hospital or in an outpatient clinic or anywhere across our system. It's sort of like a critical response system. And so our chaplains are the people that are called and then respond and go to it. So if there's a death of a member of someone in our organization, or if there's a death of an employee, or if there's something tragic that happened, you know, there were. I'm making this up. There was a fight that happened on the floor. You know, our chaplains are. And other team members come to the. To the floor and to the bedside to be again, a great listening ear to work through what other struggles our team members may be encountering.
- [07:44]
A
Definitely really interesting how impactful chaplains have been in patient experience. But I also want to talk a little bit more about how they can support workforce well being. Dr. White, can you highlight any key initiatives or examples that demonstrate this work in action?
- [08:01]
C
Yeah, absolutely. I think Jason gave a great example of T for the Soul as a way that chaplain's really providing one on one care or formal interventions that are designed to reduce distress in real time. We know that from literature that spiritual care providers are spending between 20 and 30% of their time caring for staff who are struggling with either aspects of their job or their own personal lives. When I worked as an outpatient chaplain, I actually spent close to 50% of my time caring for staff who were in the midst of personal crises. Health emergencies, finding out news about a loved one across the country, all sorts of things that would come up that would warrant some additional support. Besides that one on one care, as I said, Jason talked about tea for the soul. They actually have found that that intervention in some places they call it a chai cart or qi cart. I apologize. Whenever it circulates, it not only provides clinicians with a moment of respite and helping them connect to things that inspire them and recenter with their sense of purpose and calling, they also have found that it increases staff sense of support from leadership even without leadership involved, which is really amazing. I think another great example in a way I describe these interventions or these approaches is that chaplains will be integrated into a process or a routine process that a hospital experiences to be able to shift some of the emotional burden away from staff and sometimes it's even practical burden. So in many places when someone dies, a chaplain may go in and actually be the one that navigates the post mortem needs. Right. Another example is, is when there's code in a hospital and how a chaplain can either come in as a family facilitator to help facilitate, whether it be the emotional needs of the family or if a hospital decides that the family can actually watch the resuscitation events to be there to provide support and also physically help keep that family from interfering with the clinical processes. Here at VCU we have something called a family communication coordinator which is a. We actually have two and a half FTEs for this and this is really good for hospitals that deal a lot with organ transplantation. But it's a person that navigates between the family, the clinical team and the organ procurement organization to really minimize role ambiguity, to minimize stress and to ensure that the family, that relationship of trust that's already been established by the clinical team is maintained. Those are just some examples and there are many more. But again it's back to chaplains either providing that one on one support or being integrated in processes in a way that can relieve some of the burden and the stress that clinicians face.
- [11:23]
A
Definitely. Thank you so much for sharing those examples. Dr. Lesandrini, what advice or lessons learned would you offer to organizations looking to implement similar programs?
- [11:37]
B
Yeah, so it's a, it's a great question and I think there's actually an easy answer and it sounds kind of ridiculous but. But it's true is healthcare leaders should ask chaplains or spiritual care providers to be present in, in their team meetings, in their process planning. Back to what Kelsey was saying about it's not about spiritual care providers being an add on to some project. It's about being integrated in to that project. And so, you know, we, we all in healthcare want a seat at the table. That's what everybody wants. And I would say, you know, the best thing I think a healthcare leader could do to sort of really change the way, you know, these three themes that we've talked about today can be impacted is to give the chaplain, spiritual care provider, a seat at the table in the, in the midst of the process, not at the end of the process, but really thinking about them at the beginning of it and how they can bring something to it. I think the other thing that I'll just say is, and then chaplains need to step up to the table when it, when they're given that seat. They need to speak up and say things that, where they know they can provide impact, you know, and I think we've talked about these here, but, you know, patient experience is a big one. I think there are lots of leaders across this country who are really focused on, you know, doubling down. How do we make sure that our patients experience the care and compassion that we provide in organizations? And man, what better way to ensure that they're experiencing care and compassion than the focus on the people who are expertly trained in providing care and compassion? I think, you know, spiritual care providers are in the top echelon of that bucket. There are a number of others, of course, in healthcare who are too, and that should be their focus. But I really think there's a unique opportunity for folks to do that. And I think the number one lesson is really to just give them the opportunity to be at that table to do it.
- [13:44]
A
Definitely. That's a great point. Well, thank you both for joining the podcast today. It's been a pleasure getting to know more about this important work in healthcare, and I look forward to connecting again in the future.
- [13:57]
B
Thanks, Kristen.
- [13:58]
C
Thank you, Kristen.