By JULIE MINDA
A set of spiritual care standards is giving chaplains and others in the Daughters of Charity Health System a shared understanding of what the chaplain position requires and what it entails.
Implementing the standards has given chaplains greater visibility and greater respect in their facilities, according to spiritual care leaders involved in developing and using the guidelines.
The standards "can draw out the richness of each (chaplain's) contributions, and you can see the marvelous work that's being done," said Fr. Robert McKay, who uses the standards to generate ideas for how to report on his team's achievements. He is director of spiritual care for O'Connor Hospital of San Jose. It's one of six Daughters hospitals, all of them in California and all of them using or planning to use the standards.
The 10-page "DCHS Spiritual Care Standards" approved by the board of the Los Altos Hills, Calif.-based Daughters system two years ago lays out Vincentian values that undergird the delivery of spiritual care at the system. The document also defines the system's vision for how chaplains will deliver spiritual care, explains the many elements of the chaplain role, establishes the type of educational credentials chaplains must have and explains how chaplains are to be involved in virtually every aspect of their hospitals' operations — from patient and family support, to staff support, to strategic planning.
A companion document the Daughters system introduced this summer, called "Executive Summary: Essential Measures and Indicators for DCHS Spiritual Care Standards," delineates how chaplains can adhere to the standards and provides a tool for determining how well chaplains are implementing the standards.
Daughters facilities — and spiritual care directors especially — use the documents to evaluate the capabilities of their spiritual care departments and the competencies of individual chaplains in those departments, to evaluate job candidates and as a guide when they are explaining their work to others, or reporting on department achievements to leaders.
The documents provide "a clear explanation of how the Daughters envision us working in the hospital, and it's a high level of integration in the everyday operations of the hospital," said Erin Tribble, a staff chaplain at Seton Medical Center of Daly City.
Making standards 'our own'The Daughters system has been testing various ways of defining and measuring spiritual care delivery since the system's 2002 inception, and its facilities had been doing the same prior to their incorporation into the system. Most recently, the system had used a strictly quantitative formula for measuring spiritual care delivery, for instance focusing on the number of pastoral visits chaplains made as a measure of productivity.
Fr. McKay thought such metrics were not a full measure of the contributions of chaplains. He suggested the system stop simply quantitative reporting and look at qualitative reporting as well.
Br. Richard Hirbe, fsp, director of spiritual care and ethics at St. Francis Medical Center of Lynwood, thought the old ways of measuring the delivery of spiritual care were not tailored enough to the Daughters' Vincentian heritage — for example the old standards did not explicitly link chaplains' work to the Vincentian call to serve the sick and the poor in a Christ-like way. The system, Br. Hirbe thought, needed standards that "we could make our own."
About five or six years ago, the system charged a committee of its spiritual care directors with developing standards that would reflect its Vincentian values and set forth clearly the system's expectations of its chaplains. Fr. McKay and Br. Hirbe as well as Sr. Paula Baker, PBVM, vice president of mission services at Gilroy's Saint Louise Regional Hospital, served on the committee alongside Anne Bellan, the system director of mission integration.
Fr. McKay began by studying the writings of Daughters of Charity sisters who had served in leadership roles in the past, to understand how those women translated Vincentian values into spiritual care practices. He also researched how professional chaplain associations and others define chaplaincy. And he relied heavily on CHA resources, including guidelines the association has developed on spiritual care services.
Then, he worked with the committee to draft proposed standards that were vetted with the Daughters of Charity sponsors, system and facility mission leaders and chaplains. The committee incorporated the input and sent the standards to the board before developing the companion piece, essential measures and indicators, through a similar process.
The spiritual care directors and chaplains "were like proud parents" when the companion documents were introduced to the system, said Br. Hirbe. Each DCHS facility is adopting the measures at its own pace and in its own way. Most are using the standards to evaluate their spiritual care departments and chaplains; and many are using the document to educate others — including staff, leadership and board members — about chaplains' work and credentials, according to the committee members who spoke to Catholic Health World.
Layers of responsibilityThe standards document begins with an explanation of the Vincentian values and the charism of the Daughters of Charity who founded the Daughters system. The text explains how chaplains use their spiritual gifts to help patients, families, staff, leaders and community members address their concerns.
The standards set education and credentialing criteria for chaplains.
Chaplains are expected to shape the culture at their facilities, to position themselves as organizational leaders, to be involved in their communities, and to advocate on behalf of the vulnerable. The standards also outline how chaplains are to aid in ethical decision making, including by serving on ethics committees, assisting with ethical consults and helping patients, family members and staff members struggling with ethical issues.
Sr. Patricia Talone, RSM, CHA vice president of mission services, said the Daughters' standards 'represent a living out of the Ethical and Religious Directives' call to provide "appropriate professional preparation' for pastoral care. At the same time, they reflect the distinctive charism that has shaped the system since its inception."
She added that the standards' "emphasis on both the quantitative and qualitative aspects of measuring pastoral care can be a model for other systems as well."
Bellan looks forward to sharing the work with others, especially St. Louis-based Ascension Health, where merger discussions are currently under way with the Daughters system.
Increased understandingBellan said in general in health care, chaplains have not always been well-understood or well-valued, and oftentimes leaders and colleagues do not fully grasp how much education, credentialing and training it takes to be a certified chaplain. Tribble noted that it was common for other staff to think of chaplains as nice people who talk to patients, without recognizing the skills required to give meaningful spiritual care. "Few people appreciate how difficult it is to be present in hard situations, and that we do so much more than that as well — we're involved in consulting on matters at higher levels of the hospital."
She said the standards teach colleagues, administrators and board members about the extent of chaplains' work.
Bellan said, "These standards help develop a better sense of what spiritual care is" and why chaplains' work is so essential.
Copyright © 2012 by the Catholic Health Association of the United StatesFor reprint permission, contact Betty Crosby or call (314) 253-3477.