Monday, July 11, 2016

Laying the Foundation for Excellent Spiritual Care

In the dynamic and ever-changing world of hospice, it is vital for the hospice chaplain to understand the issues that dominate the healthcare world.  Hospice has moved from a movement to an industry.  The founding of hospice came as a response to human suffering by Dame Cicely Saunders in London, England, in 1967.   From then until 2008, hospice enjoyed an environment of a movement mentality.  As Medicare turned its attention to evaluating and assessing the work of organized hospice agencies things began to change.   Reimbursement rates began to be tied to certain indicators.  Quality improvement based upon outcomes began popping up across the country.  Some hospices underwent cataclysmic changes in care given to long-term patients.   Many hospices downsized because funding sources dried up.  Expectations were put forth and accountability was monitored for every discipline, including spiritual care providers.  Into this sometimes chaotic milieu Outcome Oriented Chaplaincy found its place.

The principles upon which OOC is founded are as follows:

  1. Accountability—This is the foundational principle of OOC.  Hospice Chaplains are no longer volunteers, but highly educated and experienced spiritual caregivers.  Many are Board Certified.  Others have a minimum of 3 units of Clinical Pastoral Education.  Hospice Chaplains are professionals in every sense of the word.  As such, these professional Chaplains are held accountable for their work.  A Clinical Team Manager should be able to look at a Chaplains Spiritual Plan of Care, read his or her Clinical Notes, and discuss patient care issues and come away from each experience with a sense that this Chaplain is providing excellent spiritual support for that patient.  Formulating a Spiritual Plan of Care in collaboration with the patient and family, writing a Clinical Note with all of its components, and verbally expressing the needs of the patients in an IDT setting or private meeting with a CM or other IDT members are all part of the accountability process.
  2. Best practice—This principle focuses on the persons a hospice Chaplain serves.  “Best practice refers to a technique, method, or process that is more effective at delivering a particular outcome or a better outcome than another technique, method, or process.  Best practices are demonstrated by becoming more efficient or more effective.  They reflect a means of exceeding the minimal standard of practice.” (Association of Professional Chaplains, Standards of Practice for Professional Chaplains in Hospice and Palliative Care)
  3. Collaboration—This principle focuses on how a Hospice Chaplain interacts with other healthcare professionals.  Included in this pool of professionals are: The Inter-disciplinary Team, healthcare professionals in hospitals and other facilities, and those in the community at large.  This principle underscores the value and broad frame of reference the Hospice Chaplain brings to the healthcare environment.  Further, as part of the Clinical Note, it is expected the Chaplain will document any interaction with other IDT members or healthcare professionals who interact with the patient. 


Ed Reese said...

Richard - quick question. Does this hold true in non-profit hospices as well, or are they immune since they receive no medicare funding or oversight. Just curious - I initially thought all non-profits were in Europe, but in reading the hospice times I've noticed there are non-profit hospices all over the US. Thanks.

Richard Behers said...

Hi Ed: Thanks for the question. Yes, all hospices receive Medicare funding. I like your wording, "immune". Cornerstone Hospice is a not for profit hospice. We have over 1,200 patients in 7 counties the Central Florida area. We employ 18 Chaplains that serve patients in their homes, facilities, hospice houses and units at Orlando Regional Medical Center, and nursing facilities. We are held to the highest of accountability by Medicare just like other healthcare providers.