health care reform: presentation outline implications for
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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: [email protected]
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