Pastoral Care and Risk Management

In 2001, the Association for Professional Chaplains honored me with their Distinguished Service Award for my work in expanding the impact of professional chaplaincy and programs of pastoral care/ ministry in specialized healthcare settings. This was (and remains for me) a huge honor. Yet, since that time, a little over twenty years ago, programs of pastoral care, Clinical Pastoral Education, and chaplaincy are struggling for a concrete place in healthcare. Sadly, instead of watching these programs expand, I’ve seen contraction. Even more sad, I’ve watched geometric increases in management positions in risk management, etc., often while chaplaincy positions were eliminated.

Entering the “way back machine”, the core of my work which was recognized by the Association of Professional Chaplains, was that chaplaincy and programs of pastoral care make good business sense. The clear revenue picture isn’t present – I get it.  The payback however, expressed as ROI via reduced risk, reduced litigation, improved employee retention, and patient satisfaction is enormous.  One needs to however, understand and live, the work of chaplains in a healthcare setting to understand how the benefits are manifested.

I have literally sat in exceptionally contentious family meetings, dealing with issues of death and dying, where years of anger, hostility, sometimes abuse, come forward.  The patient gets lost. Staff get frustrated and no common ground appears visible.  In this midst, a professionally trained chaplain enters and when introduced, the dialogue begins to change.  The issues remain but in short order, a sense of calm and a sense of order begins to emanate. The anger drops as the chaplain listens differently, redirects conversations, asks probative questions, and turns the focus to core beliefs and values.  Ultimately, almost all important, life altering decisions have as their basis, a person’s core beliefs and values.  Even for folk not identifiably religious or denominationally, spiritual tradition faithful, a series of beliefs and values can be found and from there, a decision framework can be built.

What we know about litigation risks, patient and staff, is that the desire to litigate is often born in a search for an answer.  Something less desirable happened or questions posed, were not answered or the answers were obtuse.  Healthcare of course, is not an exact science and bad things happen for no particular reason, even with adequate protections in place.  For example, and I know this one well as my firm via my wife’s practice, handles complex litigation matters for defense counsel; old people fall. Save physical restraints, prohibited by law, old people will fall and sustain injury, sometimes that same leading to death or being associated with death. Falls beget lots of litigation in post-acute care yet, when the organization is heavily invested in pastoral care and the approach of the care team is “transdisciplinary” and the care coordinated, litigation risk can be minimized.  I know, I’ve seen it in action.

Healthcare phraseology loves the words, multi-disciplinary or interdisciplinary.  Pastoral care and care coordination done right (see yesterday’s post on care coordination here: is transdisciplinary. Transdisciplinary process and teams occur when roles are shared beyond traditional boundaries (removing the silo effect) and people collaborate among themselves beyond their specific discipline and restrictions.  The patient becomes the center and his/her values and beliefs are the focal point for decisions and plans.  Incorporating the patient’s key stakeholders into this process is where pastoral care has power and risks are reduced.  Bad outcomes, if they occur, are no longer viewed as something to litigate as all along, the patient had clear value, the team was collaborating in the patient’s best interest, familial stakeholders were present, and the need to find flaw and extract some sort of retribution, diminished.  Is it a perfect process?  Of course not. Is it a process that better handles the ambiguities and the imperfections of healthcare outcomes, especially among the oldest with comorbidities and fragility?  I believe it is and again, I’ve seen it work.

Among the defined dimensions of human care, spiritual care is a specific dimension.  Providers need to address the physical, the emotional, the psychological, the social, and the spiritual dimension of human existence if care is to be complete.  Staff have the same needs in many regards.  As direct witness to suffering, grief and loss, the meaning of their work is often only reconciled spiritually.  Their own feelings manifest in the milieu with the patient, the family and each other and they too, require care.  An excellent White Paper, funded by Bristol-Myers Squibb covers the role of Chaplaincy in healthcare. Its link is here:

The role pastoral care plays in risk management is evident in literature as well but, the words risk management specifically, are not always present.  Managing risk is about reducing negative outcomes or for patients and staff, dissatisfaction with what has occurred or is occurring.  For example, in the journal Supportive Care in Cancer, an article titled, “Unmet spiritual needs impact emotional and spiritual well-being in advanced cancer patients”, the authors noted: When spiritual needs are not met, patients are at risk of depression and reduced sense of spiritual meaning and peace. Spiritual care should be matched to cancer patients’ needs. The risk management that is evident is the reduction of depression and an increase in a sense of peace.  Reductions in frustration, sense of loss, anger, etc., all are reductions in risk and without question, lessened frustration begets better outcomes for patients and their loved ones and lower levels of litigation risk.