A common refrain from many of my health care chaplain colleagues in response to any new study, case report, or consensus document on health care is “why weren’t chaplain’s mentioned?” or the variant, “why wasn’t spiritual care mentioned?” Favorite targets recently are any reports on the recently released Institute of Medicine (IOM) document, Dying in America. Now, granted, if any report on any phase of health care should prominently include a discussion of spiritual care and chaplaincy care it should be a report on how people die and how that process could be improved. However, much of the commentary on these reports in general, and the IOM report in particular, highlight several issues that often characterize these responses.
The implication of some of the chaplain commentary is that because chaplaincy was not mentioned in a given presentation or not mentioned prominently, there must not have been anyone with chaplain experience on the panel (untrue in this case) and there is no real mention of chaplaincy in the report. In fact, if all the mentions of chaplaincy in this report are cut and pasted to a single document, that document is 12 pages long in 12-point type (thanks Brian Hughes). The lesson here is we need to be sure to do our homework before we comment. To be clear, I have been known to shoot from the hip with the best of them, but we chaplains need to recognize that it doesn’t help our credibility to not read and think before we speak. To assume we have been left out yet again is, thankfully, increasingly incorrect. And, in the case of this document, that assumption does a significant disservice to a good number of people on this panel who absolutely believe in spiritual care and chaplaincy care.
The commentary also often belies a lack of understanding of how some of these processes work. In the case of the IOM and other bodies including the National Quality Forum (NQF), the credibility of their reports is based on their strict adherence to a policy of not including anything that is not supported by evidence. In other words, like it or not, these are processes based on science. It is a very simple equation. No evidence = no mention. On the individual level it means no experience or history doing good science in this field = no seat at the table. Again, to comment without a full awareness of this fact suggests that we chaplains don’t do our homework and therefore lack credibility. Fortunately, what constitutes evidence is broader that many of us usually understand which is why there is so much in the IOM report about chaplaincy.
But finally, my irritation with all of this is that virtually every comment I see about issues like this from chaplains stops with the complaining. We all know we are underrepresented at these tables. The commentary almost always stops short of adding “and here is what I plan to do to help make sure this eventually doesn’t happen” or “here’s what I am doing or plan to do to help develop the evidence.” Kristin Baird, a leader in patient experience consulting has often said something like, What have you done this week to improve patient experience? The chaplaincy equivalent is, What have you done this week to develop/disseminate the evidence for the efficacy of chaplaincy? This is something every professional chaplain should be doing in some form. The first step is to know what the evidence is. This is a matter of reading including at minimum the J of Health Care Chaplaincy, the J of Pain and Symptom Management (borrow a copy from your local palliative care doc or RN), PlainViews, and the blogs PalliMed and GeriPal that are free on line. Then we all need to do a much better job of writing. It can be as little as a 2-3 line comment on PalliMed, or an article for PlainViews or a piece for the hospital newsletter which discusses some new study supporting spiritual care. And we need to speak up and educate our teams about what the literature says and what the standards are and support quality improvement and research projects that help extend this evidence.
And while we may not lead research projects, we need to go out of our way to participate in them when we have the opportunity. Recently I heard from two chaplain colleagues who have gone out of their way to write a research protocol testing an online support structure for chaplains and get it approved by their IRB which is no easy task, only to have trouble getting our colleagues to volunteer to participate.
A request to all chaplains. Please from now on refrain from writing anything about chaplains not being included in something. We already know that and the reason why which is that chaplains have not attended sufficiently to developing the evidence and the best practice that support our inclusion. So instead of writing or talking about what is not happening, we all need to spend that time finding ways to develop and disseminate the evidence and integrate it into our practice and tell each other about it in writing. And I would ask everyone to hold me to that standard as well.