1. Spiritual Care in Clinic Offices (Outpatient) CHE Spiritual Care Champions October 16, 2013

2. Introductions Chaplain Ellis Robinson, BCC Chaplain Susan Stucco, BCC Julie Jones, Exec. Director, Mission & Ministry

3. Overview Context for our work with Mercy Clinic Assumptions Evolution Working within clinic environment Getting and responding to referrals Changing role of chaplain

4. Backdrop for Presentation Evolution in Role of Chaplain Changes in Health Care New ways of providing Spiritual Care

5. 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.

6. 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 6

7. 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

8. Assumptions in Planning Pastoral Services resources shared across the ministry Use new technology to connect chaplains with patients in clinics

9. “We are walking on a bridge we are building.”

10. 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

11. 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

12. Processes and Tools Defined approach Developed training for chaplains about approach Refine education chaplains brought to clinics Developed promotional materials Surveyed clinics Tracked referrals

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Group work in clinic setting Debriefing/support with clinics when there is some critical event Chaplains have supported some chronic disease management groups

24. 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

25. Chaplain’s Perspectives Energizing Changing traditional role

26. Questions and comments