Chaplaincy by the Numbers
There’s been some discussion lately about this fun little term called quality improvement, or “QI,” for chaplaincy and ethics work in medical settings. Nancy Berlinger defined QI according to Baily as a “systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of health care in particular settings.” (p.31) Martha Jacobs says chaplains’ “affinities are with the patient and family” and that we are “called to care for the sick and the suffering; this is where we all want to be; this is our vocation.” (p. 15-16) Martin Smith points out that both chaplains “should be attentive listeners who are able to communicate interest, respect, support, and empathy.” (p. 28, all sources from the Hastings Center Report No. 38)
Now ask yourself, how often in life do you find an empathetic listener with an affinity for the suffering who also enjoys “systematic, data-guided” research? Not very many, I would wager. In fact, I think it’s likely most chaplains would resent the insistence that they participate in such activities as it takes time away from being with the people whom they have chosen to serve. It is not surprising then, that the study by George Fitchett (highlighted by Berlinger) found chaplains “are frequently skeptical about QI.” (p. 32)
Personally, I’m skeptical of anything with a two-letter acronym. It sounds like someone is trying to sell me something. (What was so hard about saying “quality improvement” anyway?) I’m not saying it shouldn’t be done. But asking chaplains to do it is like asking a dog to walk on two legs. It’s possible, but is it really that worthwhile? How far do you think even the most talented canine will get?
Chaplains and ethicists have an integral role to play in patient-centered care, one of the six areas of QI in health care that Berlinger mentions. (p. 30) It is our duty, as chaplains and ethicists, to make truly patient-centered care a reality, to make what “ought” to be what “is.” However, in order to accomplish this, I believe it is vital to allow chaplains to do what chaplains do best. If quality improvement is to be carried out, let it be done collaboratively, where chaplains are part of a team that involves other members whose affinity is for “systematic, data-guided” research rather than empathetic listening. If someone with both qualities exists, that’s great, and those skills should be put to maximum use. However, I don’t think an across the board insistence that chaplains (and ethicists) lead quality improvement research is wise. Let chaplains be chaplains.
The question then becomes, what can chaplains do as chaplains to improve our field if not “quality improvement?” Well one thing that the above authors all acknowledge is that chaplains are exceptionally good at paying attention. I believe that chaplains are exceptionally good at generating qualitative data, but that analysis and theorizing should be done in collaboration with other individuals. For example, chaplains are trained in writing verbatims and reflections. These can be compiled and analyzed. Chaplains can even be trained in ways to make the information they provide more useful, for example, by consistently reflecting on a certain topic over a long period of time and different situations. The researcher doing the analysis will gradually come to understand the work of the chaplain. It would be good if she had some experience with it herself, but I have found that this is often not necessary for qualitative data analysis. This researcher can then present the results of the “systematic, data-guided” analysis. In partnership with the chaplains (or ethicists or other care professionals), trends can be discussed, theories offered, and solutions formulated. The critical piece to making such work successful is that it be a fully equal partnership in which both chaplain and researcher has a valuable role to play.
I believe teaching a chaplain to do data analysis is like teaching a dog to walk. While teaching a researcher or statistician to empathize with the suffering is like asking a fish to breath air. Both are possible, but neither advisable, nor long sustainable. Expecting one person, or every member of a group of practitioners, to fulfill both roles is unlikely to lead to the type of positive changes these QI advocates deem essential. I think it far more feasible and productive to help people do what they are naturally inclined to do best, but as that they do it in relationship rather than isolation.
There is wisdom in calling for chaplains to do this work themselves because, one assumes, they will have the best insights and understanding to offer. Yet it is often the case that one cannot see the mountain you are heading for from within the forest. Wrapped up in the daily reality and sheer urgency of the suffering and dying, chaplains may have trouble tearing themselves away long enough to sit in front of a computer screen full of numbers and statistical analyses. We shouldn’t make them try.