Improving MMCs Patient Satisfaction & Health Care Quality through Spirituality Manchester Medical - Essay Example

Manchester Medical Center Improving MMC’s Patient Satisfaction & Health Care Quality through Spirituality A Strategic Initiative Spring 2009 EXECUTIVE SUMMARY Manchester Medical Center (MMC), an accredited health care provider of Joint Commission Accreditation of Health Care Organizations (JCAHCO), received a ranking of 75th percentile on the category “meeting emotional and spiritual needs of the patients”. This provided the impetus for the CEO to delve into the theories, concepts and practical applications of spirituality and spiritual care in conjunction with health care. There are strategic measures needed to improve the situation. First and foremost, the identification of strengths and weaknesses of the present system is imperative to determine the courses of action to be undertaken. A formulation of a “spiritual care” committee is needed. This committee would review, evaluate, analysis, plan, implement, control and monitor the new health care system which would incorporate spiritual care. Strategies to be developed would always be concurrent with the requirements of JCAHCO, especially in the category of meeting emotional and spiritual needs of the patients. Moreover, MMC should consider that their present and future staff requirements would be oriented to the new program and be qualified to handle various spiritual needs. Training is of utmost importance to ensure that the level of competence and knowledge to updated theories and concepts on spirituality are ingrained in MMC’s workforce. The success of this endeavor would only be possible with the joint efforts of all the staff, from the nurses, physicians, clergy and top management of MMC. INTRODUCTION Health care covers a profound area dealing with the complex integration of an individual’s composition as a total person rather than merely as the sum of various parts. The objective of health care providers is to ensure that the status of an individual’s health is improved. This does not only mean complete physical, mental, and social well being; it also incorporates spiritual well being. Delaune and Ladner (2006) averred that the history of spiritual care dates back to the times of the ancient Babylonians, Egyptians and Greeks. Though the exact date of origination could not be specifically identified, their study revealed that “in many primitive cultures, the role of physician, psychiatrist and priest were combined into one”. As early as people started dealing with pain, the role of spiritual care had already been ingrained in the healing process. With the recent ranking received by Manchester Medical Center (MMC) of 75th percentile for the category “meeting emotional and spiritual needs” from the Joint Commission Accreditation of Health Care Organizations (JCAHCO), it is imperative that drastic and urgent measures be undertaken by MMC to increase the rank. This improvement would be made possible by undertaking the following strategies: 1. Determine the patients’ comments on MMC’s ability to deliver emotional and spiritual care. 2. Pinpoint MMC’s strengths and weaknesses through a feedback mechanism utilizing survey/questionnaire. 3. Form a committee to evaluate and review the results of the survey and make recommendations to address the delivery of emotional and spiritual care of patients. 4. Implement the necessary strategies to improve the status of MMC’s delivery of emotional and spiritual care. 5. Monitor the success of the implemented strategies and its effect on the staff and patients of MMC on a regular basis. LITERATURE REVIEW ON SPIRITUALITY IN HEALTH CARE A. DEFINITION OF TERMS Spirituality is defined by authors Delaune and Ladner (2006) as “multidimensional in that it refers to one’s relationship with one’s self, a sense of connection with others, and a relationship with a higher power or divine source”. On the other hand, spiritual care is viewed by Chaplain Loyal Ward as “recognizing and responding to the multifaceted expression of spirituality we encounter in our patients and their families”. Spiritual care recognizes the need to assess the spiritual belief and values of every patient as a unique individual. It also integrates these beliefs with the present health condition of the patient and their implications to health care. Several researches have been written which explicitly prove that there are positive effects for patients who acknowledge a spiritual power and seek connection to improve their overall condition of health. B. JCAHCO REQUIRMENTS ON SPIRITUAL CARE The JCAHCO has designed criteria for evaluating spiritual care delivery that accredited health providers must meet. In the Joint Commission study (2008), requirements were outlined related to the provision of culturally and linguistically appropriate health care. Several provisions specifically deal with the inclusion of spiritual care; to wit: “EP.20. (LTC only) The information defined by the [organization] to be gathered during the initial assessment(s) also includes the residents psychosocial and spiritual status, including the following: Cultural and ethnic factors which influence care, treatment, and services Current emotional status Social skills Current living situation Family relationships and circumstances Relevant past history of roles Response to stress caused by the illness and required treatment Spiritual orientation, status, and needs The dying residents concerns related to hope, despair, guilt, or forgiveness. EP.21. (LTC only) In addition, when the bereavement process is a significant factor, the psychosocial assessment includes the social, spiritual, and cultural variables that influence the perceptions and expressions of grief by the resident or family. Standard PC.3.100 (BHC only) The assessment includes the client’s religion and spiritual orientation. The rationale for PC.3.100: A clients spiritual orientation may relate to the substance abuse, dependence, and other addictive behaviors in terms of how the client views himself or herself as an individual of value and worth. Spiritual orientation is not considered synonymous with a clients relationship with an organized religion. EP.1. The clients spiritual orientation and religion are obtained as part of the assessment. EP.7. (LTC only) Services are made available directly or through arrangement to meet the following resident needs for spiritual services. Standard PC.8.70 (HAP, LTC, OME only) Comfort and dignity are optimized during end-of life care. EP.1. To the extent possible, as appropriate to the [patient/resident]’s and family’s needs and the [organization]’s services, interventions address [patient/resident] and family comfort, dignity, and psychosocial, emotional, and spiritual needs, as appropriate, about death and grief.” C. PRESS GANEY’S STANDARDS FOR ASSESSING EMOTIONAL AND SPIRITUAL NEEDS SATISFACTION Press Ganey is the pioneer institution in measuring patient satisfaction in the areas of emotional and spiritual care even before the Institute of Medicine begun assessing spiritual needs. In their report on Patient Satisfaction with Emotional and Spiritual Care, it explicitly identified that this category is measured as one item: “’Degree to which staff addressed emotional/spiritual needs’ as evidence demonstrated congruence in patients’ perceptions of emotional and spiritual needs as well as staff behaviors in caring for these needs.” It is evident here that there are two (2) factors to be considered in assessing the level of effectiveness in this category: patient’s perceptions and staff behaviors. In one of their findings, it is interesting to note that the patients’ demographic variables have no correlation in predicting satisfaction in these areas. In addition, as the pioneer in quality surveys to medical institutions and health providers, Press Ganey could provide a standardized survey to solicit the patients’ response in these areas. According to Guadagnino (2003), “Press Ganey can customize surveys to match the specific services offered by a hospital or clinic, and the firm has a consultant division that keeps abreast of any changes in the medical industry that might warrant survey alterations.” This would ensure that accurate and appropriate questions pertinent to addressing both emotional and spiritual care are designed to assess their effectiveness. D. EFFECTS OF SPIRITUAL CARE ON HEALTH CARE There are vast sources of information from books, medical journals, websites and other medical researches which all attest to the increasing need to incorporate spiritual care into the nursing curricula (Sellers 2001). In fact, during assessment, nurses are suggested to differentiate spiritual well-being and spiritual distress in a client. Sheldon (2000) outlines several spiritual care interventions that nurses are capable of (after proper assessment). These include: providing privacy, if appropriate; conducting life review or faith history; encouraging storytelling of one’s spiritual life; suggesting that the patient keep a journal; reading a Bible story and discussing it as it may apply to the patient; observing relationships with family; offering to pray with a patient/family; referring patients to a spiritual care coordinator or clergy; facilitating spiritual practices or rituals; including patients spirituality / beliefs in plan of care; among others. There are cases where medical illnesses have been diagnosed as terminal in nature but are miraculously cured and are solely attributed to spiritual care and belief. Several testimonies are worth mentioning which strengthen the link between spirituality and health, as briefly summarized below: Hams, et.al. (1995) made a study on heart transplant patients at the University of Pittsburg which revealed the following: “those who participated in religious activities and who said their beliefs were important showed better compliance with follow-up treatments, exhibited improved physical functioning at the 12-month follow-ups, developed higher levels of esteem, and had less anxiety and fewer health worries. Koenig, et.al. (1997) delved into a study of immune system in 1,700 older adults with the hypothesis that religious commitment may improve stress control by having better coping mechanisms, richer social groups, and strength of personal values. The results of the study reveal that those adults attending church were half as likely to have elevated levels of interleukin (IL) – 6. “Increased levels of IL-6 are associated with an increased incidence of disease.” Another study on coping with pain by McNeil, et.al. (1998) presented that “personal prayer is the most commonly used non-drug method for pain management”. This emphasized the utmost importance that patients relegate to prayers as a means to alleviate pain. Hostetler (2002) emphasized the remarkable impact of spirituality in health care. In a conference on “Spirituality and Healing in Medicine”, of which seven hundred professional health care givers attended, three (3) important published results were revealed: “1. Open-heart surgery patients are twelve times more likely to survive if they depend on their social support and religious faith. (Koenig 1999) 2. The mortality rate for people who are frequent attendees of religious services is almost twenty-five percent lower than for people who attend on a less regular basis. Surprisingly, for women the figure is nearly thirty-five percent. (Koenig 2000) 3. People who attend religious services at least once a week have stronger immune systems. (Strawbridge 1997)” All these findings attest to the fact that spirituality plays an important facet in the healing process of an individual. Because of this, more research studies are still being conducted to validate other medical breakthroughs which are attributed to spiritual care. STRATEGIC PLAN After discussing the major issues and concepts that surround spiritual care in relation to health care, Manchester Medical Center (MMC) should implement strategic measures to improve their efficiency in providing spiritual care to their patients. The goals of this strategic spiritual care plan are as follows: 1. To identify the strengths and weaknesses of the present healthcare practice scrutinizing the spiritual care component. 2. To form a “spiritual care” committee. 3. To evaluate and review the results of the survey from the patients’ response on the effectiveness of MMC in providing emotional and spiritual care. 4. To give suggestions and recommendations based on the results of the survey. 5. To present the recommendations to the CEO for review. 6. To implement approved strategies and plans to be incorporated in MMC’s health care policies. 7. To conduct another set of survey to solicit patients’ response on the newly implemented policies on spiritual care. 8. To monitor the implemented plan and gauge its effect on the staff’s performance and patients’ satisfaction. IMPLEMENTATION A. FORMULATION OF SURVEY-QUESTIONNAIRE As indicated, this survey-questionnaire would be designed to solicit the responses of patients in the effectiveness of the current practice being implemented by MMC regarding spiritual care. As previously noted, the assistance of the Press Ganey could be sought to secure the appropriate structure of the questionnaire and ensure that accurate questions are designed to solicit patients’ response on the effectiveness of MMC’s delivery of emotional and spiritual care. Questionnaires would be distributed by the nurses to the patients upon advice from their attending physicians that they are eligible for discharge from the hospital. By then, ample time would have been already given to the patients for evaluating the level of spiritual care administered to them during their hospital confinement. These questionnaires would be collected by the head nurse on duty at the nurse’s station together with the rest of the documents needed for clearance and gate pass required prior to discharge. These would be forwarded to the customer relations department who has the responsibility to collate the forms, tally the results and forward the results to the newly organized ‘spiritual care’ committee. B. CREATION OF A SPIRITUAL CARE COMMITTEE The Spiritual Care Committee would be formed with the purpose of reviewing and evaluating the results of the survey. They would determine the strengths and weaknesses of the present system and thereby initiate measures to correct the deviations. These measures would be presented to the CEO for review and approval. The members of the committee are as follows: all unit managers from all nursing units; the head of the department of nursing; the head of the customer relations department; the head of training and human resources department; and a pastor or priest of MMC. STRATEGIC TIME FRAME DETAILS PROPOSED TIME DATE Survey – Questionnaire formulation, 4 weeks Feb. 2009 dissemination and collection Collation and tallying of data and results 2 weeks Mar. 1 – 15, 2009 Formulation of a Committee 1 week Mar. 15, 2009 (announce members and agenda) Second Committee Meeting 1 week Mar. 22, 2009 (evaluate results, strategic planning) Presentation of Plans to Top Mgt./CEO 1 week Mar. 31, 2009 Review by Top Management 1 week April 7, 2009 Approval of Plans & Information Dissemination 1 week April 15, 2009 Implementation of Strategies 6 months April – Oct. 2009 1. Dissemination to Staff 2. Training of involved staff Monitoring 4 weeks Oct. – Nov. 2009 * Survey-Questionnaire Nov. 15, 2009 SPECIFIC COURSES OF ACTION FOR IMPROVEMENT Assuming that the results of the questionnaire have been reviewed and evaluated, and given the initial JCAHCO ranking received by MMC, it can be deduced that MMC had shortfalls in the following areas: 1. recording spiritual values and beliefs of patients; 2. assessing the patients’ needs for spiritual care; 3. empathizing and communicating with patients and relatives in terms of spiritual care; 4. offering assistance through the availability of pastors and/or priests who are competent and equipped to address spiritual needs; 5. monitoring and following-up if patients’ needs for spiritual care have been properly addressed. The recommended actions to improve the spiritual care condition of MMC should be prepared after taking into consideration the requirements outlined by JCAHCO in the areas of spiritual care delivery. In their research on addressing patients’ emotional and spiritual needs, Clark, et.al. have suggested the following areas of improvement: “Fully meeting patients’ emotional and spiritual needs involve a foundational infrastructure, which may include the provision of basic resources, persons to meet religious needs, an emotional and spiritual care quality improvement (QI) team, customized interventions, and a standardized elicitation of patients’ emotional and spiritual needs. Response to patients’ concerns/complaints, inclusion of patients in treatment decisions, and staff sensitivity to the inconvenience that health problems and hospitalization can cause can all serve as foci for improvement in emotional and spiritual care.” With these concepts in mind, the Spiritual Care Committee of Manchester Medical Center would have to suggest the following programs: 1. Restructuring of the patients’ medical information data to include spiritual values and beliefs. Data on spiritual beliefs and values of an individual and his/her family is a relevant initial factor to assess the patient’s spiritual needs. Religion should actually be specified. Several diagnostic and therapeutic procedures, food preferences, drugs prescribed and alternative healing methods depend largely on the religious beliefs and practices an individual has. 2. Training of nursing personnel as well as attending physicians and the clergy is needed for them to be more attentive to the emotional and spiritual needs of the patients. Training is necessary to enforce the provision of spiritual care. Delaune and Ladner (2006) presented as appropriate a checklist for nurses (which can also be appreciated by doctors and other personnel who would attend to the spiritual needs of the patients) in providing spiritual care, as detailed below: Listen actively and take the client’s concerns seriously. Demonstrate an interested, emphatic response to the clients’ comments. Respect the clients’ beliefs. Provide privacy for the client to perform religious practices or rituals. Make referrals to clergy when appropriate or when clients ask. MMC, with the assistance of the training department, should provide continuous update, seminars, and assessment tools to ensure that the nursing staff, doctors, and the clergy, are competent enough to address diverse spiritual needs of their patients. The supply of the in-house clergy should be reviewed against the demand. Should additional clergies be needed, MMC should be prepared to contact external sources and make sure that these clergies are oriented and immersed on the requirements of the job. 3. Offering basic emotional and spiritual resources to support patients’ and families’ spiritual beliefs and practices which include books, multimedia, and support groups. There are a variety of religious and/or spiritual resources which can be offered to provide spiritual support. These resources provide valuable assistance in keeping the patients’ minds focused on more pleasant subjects aside from their illness. Aside from spiritual and inspirational books, videos and social support groups provide inner strength and revitalize power to hasten the healing process of the patients. MMC can suggest the nurses to offer scripture readings, invite fellow church members who could dialog with the patients, attend a religious service, and engage in meditation and prayers. 4. Conducting regular reviews. Although the time frame for actual monitoring of the newly implemented strategies is projected six months from the actual time of implementation, the spiritual care committee should conduct regular reviews and monitoring on the progress and success of the program. The members should personally visit patients and conduct impromptu interviews to evaluate the effectiveness of the plan. In addition, regular staff meetings should be scheduled to: solicit feedbacks on the part of the nurses, elicit support from doctors and clergy and to find out their reactions, notate any difficulties encountered, and provide MMC’s with an overall assessment including a compilation of employees’ suggestions for improvement. Any innovative idea which has been proven to be effective in the implementation phase should be incorporated in the spiritual care system. 5. Ensuring availability of spiritual care facilities and discretionary funds to support spiritual care activities. This would mean assessing the present facilities and funding requirements that MMC have: availability of a chapel, or a private place for spiritual activities and meditation; funds to support spiritual programs, honoraria for the clergy, purchase of spiritual books, video, and other support activities, as required. 6. Conducting another set of survey through a follow-up questionnaire after the six- month period. The purpose of this second survey is to find out the strengths and weaknesses of the new system and therefore, apply appropriate action, as required. The immediate response to this phase is an important strategy to ensure corrective action. EXPECTED RESULTS After carefully evaluating which areas need improvement in MMC’s spiritual care, as collected from the patients’ survey, these specific weaknesses would definitely be used to address the issue. As a result, it is expected that upon implementation, with proper training and dissemination to the staff, there would be a remarkable improvement in the delivery of spiritual care in MMC. MMC can expect an increase of at least fifty percent in its initial percentile rating by JACHCO. It is also expected that initially, the staff and even the clergy might be overwhelmed by the magnanimity of the plans; however, like any innovative venture – this is a normal situation. Once the personnel, management, and spiritual care professionals are accustomed to the requirements of the duties, and to the prospective positive effects it would accord to patient care, the benefits would far outweigh any apprehensions or costs associated with these strategies. CONCLUSION Health care providers all over the world are already aware that patients need a holistic approach to assess and address their health needs. According to Ray (2006), “holism incorporates a mind-body-spirit perspective to assist clients in achieving the best possible condition in order to restore health”. As appropriately summed by Press Ganey, by answering the following questions, MMC would be able to gauge their effectiveness in meeting emotional and spiritual needs of their patients: “1. Do we have effective customer service behavioral standards in place that address privacy, respectful communication, kindness, etc.? 2. Do we systematically and frequently elicit and meet patients’ emotional and spiritual needs with screening questions like “How are you feeling?” “We care about your emotional and spiritual well-being. Do you have any needs or request that I can help with? 3. Are we conducting Emotional or Spiritual Assessments or taking Spiritual or Faith Histories in order to understand patients’ preferences and assess needs? Are we connecting with patients? Are we reassessing or reconnecting patients on at least a daily basis? Are we understanding and reaching all patients? 4. Do we have an effective service recovery process? Have we trained all staff in service recovery? Do we have a service recovery or general discretionary fund? 5. Do we know how to communicate empathically to demonstrate to patients that you understand and empathize? Does everyone know how to communicate in ways that calm and soothe angry or upset patients? 6. Do we have a chapel or meditative place? Do patients know about it? Do we tell them when services are? Do we offer to take patients to the Chapel? Do we have and do patients know about religious programming on our T.V.? 7. What do staff know about your patient population’s culture, spiritual beliefs and related emotions? What are your organizational learning needs? By setting up the necessary facilities, allocating the needed funds, preparing and training staff requirements, soliciting the responses of the patients, regularly reviewing and monitoring the success of the program, Manchester Medical Center is definitely on its way to efficiently and effectively address the emotional and spiritual needs of its clientele. Although medical and technological breakthroughs provide the therapeutic and diagnostic help, one can never discount that there are individuals who acknowledge the contribution of spiritual care. The ever changing organizational climate coupled with the fast pace in technological advancement provide a challenge to health care providers to realize and emphasize the importance of spirituality in patient care. References Clark, P.A. & Drain, M. & Malone, M.P. Addressing Patient’s Emotional and Spiritual Needs. Joint Commission Journal on Quality and Safety. Retrieved on January 30, 2009 from http://www.pressganey.com/files/addressing_es_needs.pdf Delaune, S.C. and Ladner, P.K., 2006, Fundamentals of Nursing: Standards and Practice, 3rd Edition, Delmar Learning, Singapore. Guadagnino, C. 2003. Role of patient satisfaction. Physician’s News Digest. Retrieved on February 3, 2009 from http://www.physiciansnews.com/cover/1203.html Hams, R.C., et.al. Medical Compliance: Study of Heart Transplant Patients at University Of Pittsburg. Journal of Religion and Health. 1995. 34(1) 17 – 32. Hostetler, Jep. 2002. Humor, Spirituality and Well-Being. Perspectives on Science and Christian Faith. Volume 54, Number 2. Koenig, H.G. et.al. 1997. Immune System Functioning: Study of 1,700 older adults. International Journal of Psychiatry in Medicine. 27(3) 233- 250. Koenig, H.G. 2000 “Psychoneuroimmunology and the Faith Factor,” Journal of Gender Specific Medicine 3, no. 5: 37–44 Koenig, H.G. 1999. The Healing Power of Faith: Science Explores Medicine’s Last Great Frontier, New York: Simon & Schuster. McNeil, J.A. et.al. Coping: Pain Questionnaire by American Pain Society to Hospitalized Patients. Journal of Pain and Symptom Management. 1998. 16(1) 29-40. Press Ganey Knowledge Summary: Patient Satisfaction with Emotional and Spiritual Care. Retrieved on February 3, 2009 from http://www.pressganey.com/files/rose_esn.pdf Ray, R. 2004. The faith connection. Nurse Week. A Nursing Spectrum Publication. 11(9) 17 – 20. Sellers, S. 2001. The Spiritual care meanings of adults residing in the Midwest. Nursing Science Quarterly, 14(3), 239 – 248. Sheldon, J. E. (2000). Spirituality as a part of nursing. Journal of Hospice and Palliative Nursing, 2(3), 101-108. Strawbridge,W.J. et al. 1997. “Frequent Attendance at Religions Services and Mortality over 28 Years,” American Journal of Public Health 87: 957–61. The Joint Commission 2008 Requirements Related to the Provision of Culturally and Linguistically Appropriate Health Care, April 2008, retrieved on January 31, 2009 from http://www.jointcommission.org/NR/rdonlyres/6941959E-D4BE-48D7-A2F8-A4834E84B263/0/JC_Standards_D... · Cached page · PDF file Ward, L. “Spiritual Care Defined”. Spirituality: Faith and Healthcare presented by Chaplain Dana Britton retrieved on January 31, 2009 from www.wdbydana.com/Spirituality.ppt Read More