Acute Care Settings

Pastoral Care Standard Work and Staffing Tool

Development

View the Pastoral Care Staffing brochure

A subcommittee of CHA's Pastoral Care Advisory Committee studied, dialogued and worked together in transparency for a year to develop an initial proposal regarding standard work and staffing for pastoral care departments. The intention was to link chaplain staffing numbers to the essential services of a pastoral care department based on a common metric inclusive all locations of care. The group revisited the model after a six month comment and trial period with membership and is pleased to sharing the following

A listing of 15 essential services of a pastoral care department
A four-tiered standard of staffing based on annual adjusted patient days
A calculation tool to help determine staffing level at a facility.

An Important New Tool for Ensuring Effective Pastoral Care
"In an age of limited resources, it remains essential for Catholic health care to assure care of the whole person. In an effort to be who we say we are, this model will assure staffing that is effective and meaningful in addressing the spiritual distress of patients, families and associates. The model will eliminate the 'guessing' in what is adequate staffing and will help to articulate the importance of Spiritual Care staffing that can speak to both leaders and local spiritual care teams."

Mary M. Heintzkill, MTS, BCC
Director of Spiritual Care and Mission Integration
Ascension

Essential Services

Effective professional staffing of a pastoral care department can be assessed based on the ability of that department to consistently provide the following essential services:

Emergency and Crisis Care

Provide care and facilitate family interactions for Level 1 and 2 Trauma and Code Blue/cardiac/respiratory arrest activations during scheduled hours.
Triage patient/family pastoral support in critical care areas.
Facilitate initial grief and bereavement support at time of death.
Provide support to parents experiencing perinatal loss.

Referrals and Sacramental Needs

Collaborate with interdisciplinary team to respond to referrals for high-risk spiritual distress.
Facilitate provisions of sacraments for Catholic patients upon request.
Facilitation of end-of-life rituals.
Facilitate anticipatory grieving for palliative care patients.
Respond to referral requests from surgical and other patients.
Provide spiritual assessments, interventions and documentation for palliative care patients.
Provide spiritual assessments, interventions and documentation for other patients upon referral.

Education and Staff Support

Facilitate multidisciplinary team education for accurate spiritual screening.
Provide resilience support for staff following critical incidents.
Identify ethics concerns and make appropriate response/referrals.
Facilitate education for co-workers on how to provide basic spiritual support appropriate to their role.

While the committee surveyed spiritual care providers and leaders at all levels of the organization and came to consensus on these 15 areas, it must be allowed for and understood that some ministries provide high value, unique or targeted pastoral services not included in the above. Those ministries may substitute such services for any of the above that they deem to be of less priority in their local context.

Standards of Staffing Levels

Staffing levels are to be based on Productive Hours/Adjusted Patient Days (PH/APD) and assessed per the staff's ability to consistently provide the essential services.

Assumptions
Multiple assumptions were necessarily made given the diversity of care settings, facility sizes and other factors.

Only professional chaplains' productive time is counted. This includes the portion of a working manager's time spent in direct care but excludes support staff or ancillary support staff.

The tool assumes the following formula for Adjusted Patient Days. Yours may differ. However, the numbers in the formula are typically accessible for you to recalculate based on this formula.

(Total Gross Patient Charges /
Total Gross Inpatient Charges)

X Total Inpatient Days

= Adjusted Patient Days

Member Privacy – While your data will be saved for your convenience on the calculator with your login, CHA will not collect, retain, access or share your data.

For the purposed of counting full time employees, the productive allotment for full time Clinical Pastoral Education (CPE) residents is to be counted as 50% of their FTE. (Example: 1.0 FTE CPE resident = 0.5 FTE productive allotment)
Productive hours are standardized at 0.85 of paid hours.
The baseline is assumed to be a medium-sized acute facility which provides clinical chaplaincy coverage 8 hours a day, 7 days a week with arrangements for on-call emergency coverage in the remaining 16 hours of each day. For some smaller facilities, (less than 35,000 annual APDs) effective emergency coverage will require minimum FTE staffing beyond the formula guideline (Productive Hours/Adjusted Patient Day).

Staffing Standard

Given the preceding assumptions, staffing standard is described in four levels:

COMPREHENSIVE PH/APD over .12
Services are offered consistently within the walls of the facility.
Services are offered broadly outside of acute care (virtual, ambulatory and other settings).

Spiritual Care Centers of Excellence. At the comprehensive level teams are able to consistently provide both basic and advanced services through a consistent systemic approach within populations and communities, including programmatic staff support, research, and the development of innovative service delivery, policy and administrative leadership. In addition to providing the 15 essential services within the cost center, wellness and resilience services are consistently offered to associates as a proactive measure against caregiver burnout and compassion fatigue. Comprehensively staffed teams make meaningful use of technology to meet the spiritual needs of patients in various settings. These teams are fully responsive, embedded, and innovative.

ESTABLISHED PH/APD between .09 and .119
Services are offered consistently within the walls of the facility.
Services may be offered broadly outside of acute care (virtual, ambulatory and other settings).

Departments with established staffing levels provide consistent effective responses within a systemic approach including episodic staff support, within acute and related ambulatory settings. Consistently able to provide the 15 essential services within the cost center in addition to other advanced chaplaincy services for patients and families. Established departments are able to provide some but not all of the following: spiritual wellness, staff care, resilience, advanced well-being support of staff, innovation and research. Established teams area able to meet some needs in ambulatory and virtual care settings associated with the cost center and can serve as extenders in formation and ethics.

BUILDING PH/APD between .06 and.089
Services are offered consistently within the walls of the facility.
Services are rarely offered broadly outside of acute care (virtual, ambulatory and other settings).

Teams at the building level of staffing are able to consistently respond to care events and demonstrate the beginning of a systemic approach to services, within the acute setting. With careful triage, these teams are able to consistently perform the 15 essentials services within the walls of the host facility in response to need. Some support may be extended in the ambulatory setting in crisis or emergency.

CRITICALLY LOW below 0.059 PH/APD
Services are inconsistently offered within the walls of the facility.

Critically staffed teams are unable to meet the minimum standards of professional spiritual care. In addition to not consistently providing the 15 essential services, this level of staffing does not provide chaplain availability consistent with the size, scope and complexity of most facilities. Further, understaffed departments experience regular gaps in chaplain coverage due to flexing off to make short term productivity goals or failure to cover when chaplains are on PTO.

For a more complete description of professional spiritual care services, please review the document, The Impact of Professional Spiritual Care.

Online Assessment Tool

This online calculator will help you assess and compare staffing levels at multiple facilities across your ministry. You will need two pieces of information for each facility:

The paid FTE total for professional chaplains, as described above
Reminder: Full-time CPE residents are counted at 0.5

The annual Adjusted Patient Days total for the facility as per the formula given.

The Online Assessment Tool requires you to be logged in.

FAQs

How was the Pastoral Care Standard Work and Staffing Model developed?
Why was the tool developed?
Why are these 15 Essential Services?
Not all of the 15 Essential Services apply to my facility; can I still use the calculator tool?
What are "Annual Adjusted Patient Days" and how do I find that number?

See responses and additional Q and As

Catholic health care is committed to the dignity of each human being as whole person made in the image and likeness of God. This commitment requires that we provide quality spiritual care to those we serve. This proposal on standard work and staffing are offered as a tool in the conversation around how to adequately provide for the spiritual needs of our patients and their families in times of suffering and illness.

For more information about CHA's work in pastoral and spiritual care or questions about this proposal, please contact Dennis Gonzales, Ph.D., Senior Director, Mission Innovation & Integration.

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