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Some Thoughts on Improving Patient Satisfaction Scores

So don't think for a moment that chaplains are simply "supporters." Healthcare chaplaincy is a clinical discipline. Doctors and nurses can heal the body, but healing the spirit takes a very different kind of training.
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Hospitals and health care systems have been directing more attention to whether or not their patients feel satisfied with the care and treatment they receive. If hospitals don't score well on standardized patient surveys that rate the care, they risk losing some Medicare reimbursement. Thus, a satisfied patient experience is becoming a priority of the medical establishment, and with this comes the emergence of the chief patient experience officer -- or PX -- in the executive suite.

I recently had reason to visit the chief patient experience officer of a large metropolitan medical center who was in the midst of a system wide study in an effort to improve patient centered care and eliminate stressors. His office walls were lined with a series of "maps" of a patient's progress through the day and night. It reminded me of a continuous EKG chart measuring heartbeats. Each time a hospital employee, whether nurse, doctor, or housekeeping staff interacted with the patient, it was noted.

However, not once during these intensive surveys in all departments did the patients' spiritual needs come into consideration. And this hospital has a professional health care chaplaincy department! I wondered why those chaplains did not figure into this plan to document patient satisfaction even for the most basic reasons such as requesting a blessing or prayer before surgery, or simply making communication between the patient, the family and the health care staff more congenial. When people are sick, often facing an unknown future, they may not know what to ask for or say to all the people bustling in and out of their hospital room.

Professional health care chaplains are trained to listen to people in their time of crisis, and also to hear what is unsaid. For example, when a patient is afraid, perhaps facing serious or risky surgery, he or she may not want to express that fear in front of a loved one. I know of a man who was facing his third round of chemotherapy and was truly scared. However, he did not want to express his fears to his wife and add to her already high level of anxiety. A health care chaplain visited and let him know that she was there to be present and let him share his fears. The man eventually regained his health and was so inspired by what that chaplain did for him that he began training to become a professional health care chaplain himself.

Sometimes a very religious family won't go along with the treatment recommended for their family member because they believe God will heal him if they have enough faith. Without denying God's existence, a chaplain knows how to reframe it from being God's choice, so that the medical staff can proceed with treatment. Chaplains, trained to be present for persons of any faith or no faith at all, are also cultural liaisons. For example, they know that a Native American family will not talk about death openly, but address it only in the third person. A chaplain knows how to work with them so that treatment and care can progress for their seriously ill family member. When there is family tension in a patient's room because they don't all agree on what the treatment and care should be, the chaplain sits with the family and diffuses the situation, thus relieving the family's spiritual distress.

So don't think for a moment that chaplains are simply "supporters." Healthcare chaplaincy is a clinical discipline. Doctors and nurses can heal the body, but healing the spirit takes a very different kind of training. And while many healthcare organizations are coming to realize that spiritual care matters to the patient's comfort, wellbeing and recovery, that discipline is still largely missing from the decision-making counsels of health care.

While hospitals rush to create more attractive rooms and better food, those things are not always upmost in a patient's mind. As early as 2011, a study of more than 3,000 inpatients at the University of Chicago Medical Center suggested that many more inpatients desire conversations about religion/spirituality than have them. Patients' overall experience with being hospitalized and patient satisfaction might improve by addressing this unmet need. A 2012 nationwide survey concluded that "communication by doctors, nurses and other staff was most important, while the facility accounted for a fifth of patient satisfaction." Likewise, a 2013 survey of more than 670 hospitals and healthcare systems by The Beryl Institute, found that "the one behavioral priority remains communication, which while broad in scope has significant implications for patient experience performance."

Dr. Linda Dubay, the chief quality officer at St. John Providence Health System in Michigan said "Bells and whistles make it a nicer environment for patients but if you are not addressing holistic spiritual care, they're not going to rate it well."

Perhaps more hospitals should look to their professional chaplains for help communicating with patients. It's what they do.