Before the pandemic we asked 11 healthcare executives and 14 chaplaincy managers across the country how they gather and use data in the work of spiritual care and chaplaincy departments for a pilot study about how healthcare executives think about and value spiritual care. In the evidence-focused context of modern healthcare, we expected to hear how data informs the work chaplains do, what they offer patients and families, where they are staffed, and how departments work regularly to improve the care they provide. Instead, we heard a lot about the data they gather but did not find much evidence that the data informs institutional practices.
What data is gathered
Chaplaincy managers told us they use dashboard measures from the electronic medical record to track the frequency of patient visits, which unit staff are paging chaplains, and what kinds of consults and deaths happen in the hospital. Managers also described gathering information from patient satisfaction surveys or information they gather on their own with survey tools and spreadsheets. Many managers acknowledged that tracking patient interactions does not capture all chaplains do with staff or how they participate in the hospital more broadly. To address this, several managers described the “shadow systems” they have created in order to track what electronic medical records do not, such as teaching, staff support, and how chaplains serve the community. Most spiritual care departments we interviewed are gathering some data.
How data is used — or not
When we asked executives and managers how they use these data, we mostly heard them talk about data symbolically, not practically or functionally. We listened to managers explain why they were not discussing and reflecting on the data they collect with executives or aligning data collection with what executives want to know. In the words of one manager, “no one in higher administration is asking me to use benchmarks to determine if chaplain productivity is satisfactory…we are just busy all the time. Right now, that is not the first thing on the dashboard that I spend time looking at.” This perspective may be best summed up in the words of a manager who told us “In the past we’ve used data for streamlining process but I don’t collect any numbers or data, qualitative or quantitative, for this purpose, at this point. My supervisor and I have talked about that a little bit, but no one wants to discuss it now. It’s seen in some ways that’s sort of just a freedom that chaplains have.”
We heard stories about managers and executives not consistently reviewing data on chaplains in the context of quality improvement. As one executive noted, “the chaplaincy director doesn’t produce reports for our bi-monthly meetings, I don’t really need to know why the chaplain was called or how many times.” Some managers cited the challenges of capturing chaplain impact; another manager mentions that “I do not have productivity standards in my department because you can set productivity at any number you want. Say you say every staff chaplain should see 80 patients/family/staff a week. Well, you can blow through that in probably two shifts, right? Or you could never get through that.”
The future of the profession
Much ink and many dollars have been spent in recent years trying to make healthcare chaplaincy a more research literate profession. Data is not symbolic, however. It needs to be used to improve the skills, work and outcomes of chaplains as well as the ways executives make decisions about spiritual care.
If you are a chaplaincy manager, consider getting on the same page with your supervisor about the institution’s orientation to data on spiritual care. Ask your supervisor important questions: What data would you like to see so we can assess the effectiveness of spiritual care? Are there units in the hospital I can partner with to gather and analyze that data? Ask yourself: Is our department collecting data we are not using to make functional decisions? Is the data we have being using symbolically or practically to make resource decisions? Are we communicating the data we have to our supervisors in ways that make clear how it can help them solve problems? If your supervisor is not asking for this information, ask why?