here we see a Chaplain being productive…
If you’re a professional chaplain you have probably heard this phrase: “Let’s talk about your productivity.” For anyone the “productivity” talk is uncomfortable. For chaplains this talk is often more uncomfortable because what we “do” and “produce” can be very hard to grasp.
Picture trying to tell someone with no experience or knowledge of what chaplains do what it is that you do, and then consider your “productivity” to be just doing more of that. It’s not fun. Even seasoned chaplains can have a difficult time communicating what exactly it is that they do, and when they can the things that they “do” seem less like things and more like states of being. We provide “positive regard”, “ministry of presence”, and “open expression of feelings”. The request to be more productive can seem perplexing in this context (“ok, so I’ll provide even more spiritual witness I guess”).
I think by nature most chaplains dislike, or are even repulsed by, typical corporate notions of what it means to be productive. For a chaplain, spending time in personal prayer, reading spiritual literature, and self-reflection are necessary parts of of her work day. A two hour long visit with a family might seem like the best use of one’s time for one case, while fifteen minutes for another would seem just as appropriate. So when managers start pulling up productivity reports that simply show numbers – visits per day, average time of each visit, caseloads, time spent in “non-clinical time” – we bristle. I’ve had chaplains tell me that they’ve felt insulted by limiting their performance and outcomes to simple numbers. I tell them I feel the same way, because often I do. It’s very frustrating.
Besides the subjective nature of our job, frustration comes from a lack of common understanding about what is expected for chaplains in terms of productivity, especially in healthcare settings. It often comes down to the ability to manage a particular caseload. In an article in Chaplaincy Today, researchers found that one health organization recommended a chaplain-to-patient ratio in hospitals at 1 chaplain per 50 beds, while another 1:100, and another 1:30. Chaplains working in in-home hospice settings also have caseloads that vary widely, even by the day. A hospice chaplain can have 50 patients, but spread out over several hundred square miles. It can be very hard to see what can reasonably be expected in these situations.
So how does a chaplain survive in a system where, even if we are well liked and respected, our overall productivity is reduced to visit quotas and call sheets?
- Don’t take it personally. I say this first because many of us do. We often feel misunderstood and overworked by managers and others who “don’t get what we do”. It becomes easy to take that hurt and internalize it to make it more about us than it is. I think many chaplains (but not all) tend to fall on the more sensitive side of the emotional spectrum. This makes us sensitive to the needs and feelings of others, but also more likely to feel hurt by others when we don’t feel accepted or understood.
- Accept it. Yes you are more than your numbers, but in terms of performance indicators you are your numbers. You can and should educate others about what you do, but accept that your numbers will most likely tell your story for you. Find ways to quantify what you do and keep track of it as best you can (Excel spreadsheets are great for this).
- Advertise yourself. This one is hard. After all, those of us who are Christian chaplains can rattle off countless verses and quotes about self-denial, putting others ahead of ourselves, and doing things not for “the praise of men”. But I’ve learned over the years that nobody is going to toot your
beancounters love spreadsheets
horn for you. Let your managers know what you are doing, especially if they don’t ask. Are you leading community bible studies at the nursing home? Performing a funeral? Responding to a call after hours? Say something. This isn’t boasting, it’s self-report. It’s also self preservation. A quick email or a weekly report (with that Excel spreadsheet I talked about) can speak volumes on your behalf.
- Maintain your balance. Remember all that self-care stuff I mentioned at the beginning? You still need to do it. However the pressure to perform, especially when under scrutiny, can push all that quickly off the plate in an effort to please. If you feel that you need to work longer to get things done, set a time to turn work off. It is very easy to find work to do, as there is always another call or visit to make. That takes a toll though. If you are having difficulties maintaining balance, talk to someone in your workplace about how they manage their work and life balance. Take a class on time management.
- Claim your boundaries. Your professional and personal boundaries need to be maintained not only so you can do your job well but so that you won’t go crazy doing it. If your boundaries are cracking due to pressure from a manager that you think is honestly expecting too much from you, reclaim them. Talk to your manager directly about what you can and cannot do. Back yourself up with your own numbers and data about what you do. Seek to find common ground without giving too much of your own. If boundaries continue to be broken though, it may be time to move on unless you are prepared to wait out the storm.
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Thanks for brining up the topic and for your reflections. Recently hospital administration where I work has become interested in “touches”; i.e. contacts where the person is using the top of their license in such as way that the person served would be positively impacted. They have found that the number of contacts is less indicative of good service. We are coming up with ways for a clinician to have a client scan a code that takes them to an online survey so they can weigh in anonymously about their experience. In counseling Scott Miller found that outcomes improved when clients filled out surveys at the end of the counseling visit to give feedback on such indicators as how well the clinician listened and whether their core concerns were addressed. i wonder if chaplains can use some of these changes. Could we come up with ways to have smart phones as a tool to provide feedback loops where the person served could speak and the person serving could get some real time feedback. We know that people do not improve without real time feedback. Surgeons improve; family physicians often do not because the feedback is not immediate. There have often been times when the person who was serving would go away without much awareness of how much impact they had, good or bad.
That’s a really good idea. Feedback is sorely lacking, and often long past the visit was made. Providing a business card with a QR code to scan which links to a survey would be a great feedback tool not only for chaplains but all staff!
The hospital where I work has a patient survey that is sent out and the entire hospital is rated by their department based upon the responses of the patients who answer the survey anonymously.
The counseling feedback survey from http://www.talkingcure.com is not anonymous. It serves as a feedback tool for the clinician and has proven to improve outcomes. This may be a separate process from an anonymous data gathering tool. Most hospitals send out satisfaction surveys to patients and families. I am looking for something more precise to the clinicians with which I work who are out in the community.
The hospital where I work we utilize excel spreadsheets and record visitations on a weekly basis. The categories are total patient visits, palliative care patients, traumas, deaths, call/pages, and unit rounds.
At my job we utilize excel sheets, the fields consists of total patient visits, and time spent. The categories are broken down into Palliative Care patients, rounds, traumas, death, pages, calls/requests, etc. A weekly report is printed out against all of the total admits for the week and our visitations are broken down by each floor/department.
Great posting! I think most chaplains have been faced with this issue. In my residency I was and it turned out to be a great source for a reflection paper – “Stickers (patient labels) for Jesus!”
Thanks!
Fred
I think a lot of the problem here is that we (and many of our administrators) confuse interventions with outcomes. So, being present is an intervention. Even a visit could be considered an intervention. Neither are an outcome or a product. Interestingly, our colleagues from other disciplines understand what we produce often better than we do . If you ask them what chaplains do, they often say things like “they help patients be calmer” or “they help patients work through complex health care decisions”. Especially in the era of value added care, these are the products we need to be measuring and reporting. We will likely still have to report numbers of visits as well but they should not be the focus of our productivity reporting.
Very good point George regarding interventions vs outcomes. Good thing to keep in mind. I agree that our colleagues can sometimes recognize our outcomes better than we do, however that doesn’t always communicate well either. I’ve had nurses introduce chaplains to families as “just extra support”. Another good measure of outcomes are family reviews post death, but those can be skewed as well due to small sample sizes and return rates, as well as by the fact that people usually only return surveys if they are very satisfied or very upset. At least that’s been my experience.
Perhaps the most universal issue I have encountered in my Chaplain ministry is that other disciplines are frequently unaware of the scope of practice of Chaplains. For this reason, I quickly learned to document my encounters through the lens of interventions and outcomes. Interventions provide a framework for identifying the specific actions of Chaplains. Meanwhile, outcomes provide a metric for the level of interventions offered after an initial assessment or visit. Thus, assessing a visit in terms of interventions and outcomes provides a framework for helping others to understand why we might spend 15 minutes with patient and 2 hours with another patient.
This is a very important observation and recommendation. It also helps with care planning in that documentation that addresses interventions and outcomes directly as well.