By JULIE MINDA
Traditionally, many ministry chaplains have focused the bulk of their time and energy on hospitalized patients.
But, people receiving outpatient care have spiritual care needs too; so Mercy health system of Chesterfield, Mo., is challenging its chaplains to extend their reach beyond the hospital walls and into Mercy's clinic system.
"The clinic environment is fertile ground for spiritual care services," said Deaconess Kandi Mount, a chaplain with Mercy's Bella Vista Medical Center, a family practice and internal medicine clinic in Bella Vista, Ark. "The clinic is where a patient hears the cancer diagnosis — the clinic is where they walk out dazed and confused. By the time they get to the hospital, they generally already know the bad news," she said.
New territory
Mount is among the chaplains at facilities throughout Mercy's four-state system taking part in a demonstration project to determine how they can extend their own ministries into Mercy clinics in ways that meet the needs of patients and staff. Participants are developing and field testing a variety of approaches to build relationships with the staff of Mercy clinics, and sensitize staff to the spiritual needs of patients.
The hope is that clinic staff will come to see chaplains as a vital resource for helping patients and that staff will gain the skills and confidence to initiate conversations about spiritual matters, to be emotionally present for the patient, or to make referrals. "Our vision is that someday you will be able to walk into any Mercy clinic and see that spiritual care is as embedded there as is the laboratory," Mount said.
During an Innovation Forum session at the Catholic Health Assembly in Philadelphia in June, three Mercy colleagues will describe how the demonstration project is going and explain what Mercy has learned from it. Presenting "A New Model of Pastoral Care: Expanding into the Clinic Setting" will be Julie Jones, Mercy executive director of mission and ministry; Dorothy Sandoval, director, pastoral services, Mercy's central communities, and Dr. Raymond Weick, physician leader, Mercy Clinic, and family medicine physician in Grover, Mo.
Distinct clinic cultures
Mercy's pastoral care leaders began looking at extending chaplain services into the clinics about two years ago, as a way of supporting the system's broader strategy of investing in the clinical and operational aspects of Mercy's outpatient sites — that's where the majority of patients encounter Mercy. Mercy's network of about 450 physician practices is called Mercy Clinic. The chaplaincy demonstration project is rolling out concurrently with a formation program that is teaching staff at Mercy Clinic locations about Mercy's mission, vision, values and heritage. For now, about four or five Mercy chaplains are involved in the demonstration project, but in time, Mercy hopes to involve most of its chaplains in working with all the clinics near them that are open to this type of partnership.
When chaplains at Mercy hospitals first began venturing into these clinics to make staff aware of the chaplaincy resources available to patients, they found that while the employees generally were enthusiastic about extending these services to patients, that initial introduction did not lead to increased use of chaplain services by patients, said Jones. That's when Mercy decided on the approach being used in the demonstration project — allowing chaplains to take the time to get to know the operations and culture of individual clinics and then to work with the staff to figure out the best way to provide chaplain services there.
Taking this measured approach to building relationships is important, according to chaplain Mount, because "each clinic is as different as a snowflake." Each has its own culture, its own idiosyncrasies, its own rhythm, she said.
Engaging clinic staff
Through regular rounding with clinic staff or calls or videoconferences with those in remote locations, chaplains have engaged clinic staff in the ground floor development of methods to extend spiritual care to clinic patients, which include:
Making presentations to clinic staff on how to detect that a patient may need spiritual services. The chaplains are encouraging staff to actively listen to their patients, to pray with them and to refer individuals to Mercy chaplains.
Working with clinic staff to develop brochures and flyers explaining chaplain services, which are placed in waiting rooms and treatment rooms.
Enlisting an outpatient cancer services nurse navigator to send a patient referral to a chaplain for each patient newly diagnosed with cancer.
Developing 10-minute training modules on spiritual care topics for clinic staff. These resources are posted on the intranet for chaplains to access.
Jones said demonstration project leaders hold regular calls and meetings with the chaplains to talk through the various approaches and to learn what is working and what isn't. Chaplains borrow and tailor each other's best practices.
Sandoval, a demonstration project leader, said that one measure of comparative success is the number of chaplain referrals generated by each approach.
A year of conducting the demonstration projects has taught Mercy that providing chaplaincy services in clinics is very different from doing so in a hospital setting. For instance, in the hospital, inpatients are available in their rooms for lengthy periods of time, and so they are accessible to chaplains; in the clinics, patients stay only long enough for their wait time and appointment, so scheduling time with chaplains is important. Also, there's a different feel to relationships that develop in the hospital environment, where patients present on an episodic basis and usually in the midst of a health crisis. In the clinic setting, patients may come in on a regular basis and often are seen for routine exams and screenings, according to Mount. The continuity of a patient's involvement with a clinic is more conducive to the chaplain's ability to build a relationship with an amenable patient, she said.
Boosting staff skills
Mount provides chaplain services at the Bella Vista clinic. Her situation is unique among Mercy chaplains in that she staffs that clinic 20 hours a week, rather than simply rounding there on an occasional basis like most chaplains in the demonstration project. She is available on a referral basis when she is not in the clinic or when the clinic is closed, if patients have deeper spiritual needs than staff members are prepared to address. Or, the patient can schedule time with another chaplain; one is available remotely via an iPad application.
Mount said she began the relationship with the clinic by simply being present and learning what the staff does day to day. She built on those established routines. For instance, during regular morning meetings, Mount occasionally presents 10-minute training sessions on spiritual care topics requested by the staff.
"I supported what already existed" instead of coming in with an agenda, explained Mount. She added that she "realized right away a big part of my role is to empower the staff … so they don't feel they lack the skills" when faced with a patient in distress.
Mount said she's seeing a change in the clinic's culture, with staff becoming more attuned to patients' spiritual needs. One nurse told Mount that she used information from a training session on spiritual distress to comfort a patient grieving his wife's death.
"The patient left the appointment feeling better, and the nurse felt good," Mount said.
Mount said she is "so very blessed to witness this ground-changing time in the ministry — to witness this change in the culture of the clinics.
"It's a subtle but powerful thing to see the staff grow and become this dynamic, spiritual care team," she said. "And, they really enjoy it."
Relationship dynamics differ from hospital to clinic
Since the hospital setting is vastly different from that of the clinic, this affects how chaplains navigate their relationships with patients in each setting.
That is according to Deaconess Kandi Mount, a chaplain with Mercy's Bella Vista Medical Center in Bella Vista, Ark., who is one of the chaplains taking part in Mercy health system's demonstration project to expand pastoral care into clinics.
She said since acute care patients normally enter the hospital on an episodic basis, they do not develop the ongoing relationships with clinicians that are common in the clinic environment. Unlike in the hospital, in the clinics, staff often will see patients on a regular basis for checkups, lab work and other appointments. "There is a very natural feel in relating to patients that share pictures of their vacations, and news of their grandchildren," Mount said, adding that clinic staff and patients often run into each other in the community, and recognize each other immediately.
"A clinic family embraces their patients as family," Mount said.
Likewise, chaplains working in clinics benefit because they have multiple opportunities to meet with patients either informally or formally in a preset appointment. Repeat sessions serve to build trust and familiarity between spiritual counselors and patients.
Mount said that the background information she receives on each patient is different in the clinic environment, as compared with the details available in the hospital. While she has access to patient charts in both settings, and while the same privacy rules apply in both settings, the patient record often is more thorough in the hospital. There, she has more extensive details on the patient's illness, how many days they've been hospitalized and their religious preference. In the clinic, the chaplain will know the name of the patient's provider but sometimes little else.
In fact, Mount said, in the clinic environment, the patient's "health issues may or may not be discussed (with the chaplain). Many times, the patient will share primarily their spiritual needs without ever touching on their physical condition, not realizing they are holistically linked." The chaplain, however, may draw out that connection in time through counseling.
Mount noted, "What is most interesting is that clinic care patient needs are very subtle, quiet and usually hidden behind a cordial smile, or greeting. So there is a softness in demeanor as we work to discover the words that go unspoken, and tell of" deeper concerns."
Despite the differences in working with clinic patients and hospital patients, Mount said that in most cases, the basic spiritual condition is the same for all troubled souls. She said, when it comes to the core concerns people have, "all of humanity does carry the same crosses."