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Health Care Reform:Implications for Spiritual Care

Rev. BJ Larson MDiv MAOLACPE Supervisor

Fairview Health Services, Minneapolis, MNSpiritual Health Services (SHS) Director

System SHS Strategic Lead

APC SymposiumRochester, MN

Thursday, March 6, 2014

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Health Care Reform Context

Complexity Theory Perspectives

Spirituality & Health Best Practices

Leadership Lessons

Further Conversation & Dialogue

Presentation Outline

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Meet the Triple Aim: effective, efficient & exceptional patient and family experience

Demonstrate value-added spiritual care

Innovate new approaches & expand to new settings for spiritual care

Non-revenue generating & vital to whole person/population health

Health Care Reform Context

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Complexity/Self-Organizing Insights:

“Leadership in a permanent crisis requires you to create a culture of courageous conversations” (Heifeitz, Grashow, and Linsky, 2009)

“Effective managers are adept at working both the ‘streets’ andthe ‘alleys’ ” (Davis, et. al., 1992)

“Interaction is our primary mode of engaging and working through change....It is only interactions between diverse entities that gives rise to the potential for transformation .…while threatening identity and current power relations.”

(The Paradox of Control in Organizations by Streatfield, 2001)

Leading well means staying open to emergence, working with uncertainty, vulnerability, multidimensionality, interconnections and self-organizing relationships

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A Relational Perspective

“Remaining inspired in the midst of permanent white water requires both a clear mission and purpose, and inclusiveness –that is the ability to keep members of the organization in touch with each other – including communicating with feeling the leader’s deep conviction of the importance of staying together and supporting each other.”

( Peter Vaill, p. 188)

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Engaging Resiliency

“Resiliency is the capacity of a system, enterprise, or a person to maintain its core purpose and integrity in the face of dramatically changed circumstances”

(Zolli & Healy, 2012)

“…resilient people and companies face reality with staunchness, make meaning out of hardship, and improvise solutions from thin air. Others do not. This is the nature of resilience and we will never completely understand it.”

(Coutu, 2002)

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Fairview Spiritual Health Services Strategic Plan & Process

Meet together regularly

Clarify direction

Collaborate with partners

Coordinate implementation

Convene work groups

Evidence-based best practice

Act, reflect & innovate

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Spiritual Health: Grounded Practice

Model authentic engagement Partner with patients, families and staff Engage humanity in yourself and in others Learn through vulnerability and not knowing Connect with your sources of spiritual renewal Steward time, energy & creativity

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Relationality Meaning and Purpose

“Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and

purpose and the way they experience their connectedness to the moment, to self, to others, to

nature, and to the significant or sacred.”A Consensus Definition of Spirituality

(Christina Puchalski, et al, 2009)

Spiritual Health: Definition

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Defines health in the broadest possible terms, including:

Physical

Intellectual

Emotional

Relational

Environmental

Energetic

Spiritual

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Spirit

Body Mind

HEALTH

Spiritual Health: Holistic Approach

Acute and Primary/Preventive care

Individual chaplain creativity and consistent best practices as a discipline

Oriented to process and the present, while fostering the potential for desired outcomes

Giving space to the voices of others, while also claiming our own authority

Doing what we have done well, while proactively shaping our future role

Spiritual Health: Approach to Reform

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Spiritual Health: HistoryNursing conducts history for emotional/spiritual needs:

Faith – Do you have a connection with a faith community, religion or denominational group?

Influence – What cultural, spiritual, religious practices or values are important to you as a part of your healthcare hospitalization?

Influence – Are you experiencing a significant loss/life change?

Community – In support of your spiritual health, is there someone we may contact for you?

Address – What can we do to support you in using your emotional/spiritual resources during this time?

Adapted from Christina Puchalski, MD

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Spiritual Health: Screen/History Continuum

As a result of spiritual screen/history continuum, nursing/care team partners support/empower patients’ connection with available resources:

Social support – family and friends Faith community Healing practices, e.g., prayer, meditation, nature Support group Therapist/Advisor

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Spiritual Health: Team Member ReferralsBased on spiritual screen/history continuum, nursing/care team refers in chaplain/spiritual health specialist:

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When serious illness is life-limiting and/or life-threatening (new diagnosis, chronic illness, end of life)

When illness entails life disruption and transition

When emotional issues (sadness, depression, anxiety, denial, anger, hopelessness, helplessness, etc.) are impeding treatment/healing or the making of recommended lifestyle changes.

When stress is a factor in healing

In the context of loss, grief, and significant life transition

When there is emotional/spiritual distress related to issues of meaning, purpose, connectedness

Spiritual Health: Chaplain Specialist Skills

Deep, reflective listening –engagement with people regarding difficult issues

A “safe place” for conversation about feelings, meaning, and suffering

Loss and grief education and support

End-of-life care

Short-term holistic counseling

Medical/ethical decision-making support

Instruction in mindfulness/awareness practices, including meditation, centering prayer, and other healing modalities

Mind-body connection and stress management skills training, including mindful breathing, imagery, body scan/progressive muscle relaxation

Individualized meditation and prayer

Rituals consistent with each person’s beliefs and circumstances

Process facilitation and engagement within family/group dynamics

Critical situations support

Advance care planning

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Spirituality & Health: Current Challenges

Educate and equip nursing and other care team members to screen for spiritual health

Empower nursing and other care team members to respond appropriately to patients initial emotional/spiritual expressions of health

Assess patient’s emotional and spiritual needs, intervene appropriately and impact outcomes

Claim contribution of chaplains and CPE educators in best practice outcomes as reflected in written documentation and verbal communication with members of the interdisciplinary team

Leverage and conduct new research regarding necessity and effectiveness of spiritual health care

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Spirituality & Health: Impact on Health Outcomes

Strong relationship between the “degree to which staff address emotional/spiritual needs” and overall patient satisfaction”

(TJC article entitled: “Addressing Patients’ Emotional and Spiritual Needs”)

“Patient spiritual and existential well-being correlates with improved quality of life, reduced fear of death, less aggressive end-of-life treatments, happiness, reduced pain, and increased ability to cope with loss.”

(Puchalski—2006 The Cancer Journal, and Sulmasy—2006 JAMA)

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Spiritual Health: A Faith Perspective(ELCA Social Statement, 2003)

Personal & communal responsibility

Bearing the burdens of the vulnerable

Seeking wholeness-body, mind & spirit, including healthy structures

Addressing suffering caused by the disruption of relationships with God, with our neighbors, and with ourselves

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Spiritual Health: Areas of Influence

Community Health Needs Assessment & Resulting Impact

Diversity awareness & education

Faith community health partnerships

Palliative care team advancement

CPE and CPE-like curriculum development

Resiliency & healing capacity of caregivers

Ambulatory, population health-based and senior care related expansion

Health care directive & goals of care conversation

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Spirituality & Health: Leadership Lessons

Develop the leader & administrator in you

Model and support self-care & compassion

Minister to the organization & leaders

Recognize anxiety in the system & in you

Offer ideas and be part of the change process

Stay grounded in what is of ultimate value

Know your Achilles’ heel and core beliefs

Know your organization’s drivers and working values

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References & Resources:ACPE, APC, HealthCare Chaplaincy & NACC webinars & publications

Bellman, G. & Ryan, K. (2009). Extraordinary Groups: How Ordinary Teams Achieve Amazing Results. San Francisco: Jossey-Bass.

Bruch, H. & Menges, J. (April 2010), The Acceleration Trap, Harvard Business Review (HBR).

Coutu, D. L. (2002). How resilience works. HBR, 80(5), 46-51. Retrieved http://search.ebscohost.com/login.aspx?direct=true&db=keh&AN=6623319&site=ehost-live

Fitchett, G., & Risk, J. L. (2009). Screening for spiritual struggle. The Journal of Pastoral Care & Counseling: JPCC, 63(1-2), 4. PMID: 20196352 (no DOI found) http://www.ncbi.nlm.nih.gov/pubmed/20196352

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References & Resources:Galchutt P. Top Ten Articles for Chaplaincy in Health Care. PlainViews. 2013; (10) 23.

Groysberg, B. & Slind, M. (June 2012), Leadership is a Conversation, HBR.

Handzo, G. (2011). The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm. Excerpted from Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook, Rabbi Stephen B. Roberts, editor.

Hastings Center Report. (2008). Can We Measure Good Chaplaincy? A New Professional Identity is Tied to Quality Improvement, 38 (6)

Health Professions Education and Relationship-Centered Care: A Report of the Pew-Fetzer Task Force on Advance Psychosocial Health Education, August 1994

Heifetz, H., Grashow, A. & Linsky, M. (July-Aug 2009), Leadership in a (Permanent Crisis), HBR.

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References & Resources:Hotz, K. & Matthews, M. (2012). Dust & Breath: Faith, Health and Why the Church

Should Care About Both. Grand Rapids, MI: William B. Eerdmans Publishing.

Institute for Patient-and Family-centered Care: www.ipfcc.org

Kahn, William A. (2005). Holding Fast: The Struggle to Create Resilient CaregivingOrganizations. New York: Brunner-Routledge.

Koenig, H. (2008). Medicine, Religion and Health: Where Science and Spirituality Meet. West Conshohocken, PA: Templeton Foundation Press

Mitchell, B., Parker, V., Giles, M. & Boyle, B. (2014). The ABC of Health Care Team Dynamics: Understanding Complex Affective, Behavioral, and Cognitive Dynamics in Interprofessional Teams. Health Care Management Review, 39(1), 1-9.

Sexton, B. “Enhancing Caregiver Resilience: Burnout & Quality Improvement Full Course.” Duke Medicine Conference, 2014.

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References & Resources: Suchman, A., Sluyter, D., and Williamson, P.R., (2011). Leading Change in

Healthcare: Transforming Organizations Using Complexity, Positive Psychology, and Relationship-Centered Care. London: Radcliffe Publishing

Uhi-Bien, M., Marion, R., eds. (2008). Complexity Leadership, Part 1: Conceptual Foundations. Charlotte, NC: Information Age Publishing.

Vaill, Peter B. (1996). Learning as a Way of Being: Strategies for Survival in a World of Permanent White Water. San Francisco: Jossey-Bass Inc.

VanderCreek, L. & Burton, L. , eds. (2001) Professional Chaplaincy, Its Role and Importance in Healthcare, ISBN 0970907400

Williams, J., Meltzer, D, Arora, V., Chung, G. & Curlin, F. (2011)Attention to Inpatients’ Religious and Spiritual Concerns: Predictors and Association with Patient Satisfaction, J Gen Intern Med, 26(2011):1265-71, DOI: 10.1007/s11606-011-1781-y

Zolli, A & Healy, A. (2012). Resilience: Why things Bounce Back. New York: Free Press.

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Further Conversation & Dialogue

Contact me for more discussion: elarson1@fairview.org

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