Research into healthcare outcomes indicates
that when the spiritual needs of patients are met there are further tangible
benefits. These benefits include shorter hospital stays, improved pain
management and better management of cardiovascular needs. It is not surprising
that a recent Deloitte’s report into the economic and social benefits of
hospital chaplaincies in New South Wales, Australia showed that for every
dollar the New South Wales government spends on subsidising hospital
chaplaincies there is close to a seven dollar benefit. That is, given that the
New South Wales government spends $2.5 million each year on subsidising
chaplaincy services provided by Christian churches and other Faith groups, it
would have to spend seven times this amount to achieve the same results if it
did not subsidise chaplaincy.
When I was reading some of this
research I was excited to see the benefits and outcomes of chaplaincy being
measured. But I began to ask myself, “What do they mean by ‘the spiritual needs
of the patients’?” What are ‘spiritual needs’? How are spiritual needs defined?
When pastoral carers and healthcare professionals speak of ‘spiritual needs’,
do they mean the same thing? Are we speaking the same language?
In a similar vein of concern about
what is being measured in the pastoral encounter John Swinton asked the
question, ‘what actually constitutes acceptable evidence, who decides and why?’[1]
While acknowledging the important role of scientific measurement, even in pastoral
encounters, Swinton then says, ‘I want to suggest that science, or at least a
narrow definition of science, is only one dimension of the professional role of
chaplaincy. On its own our current definition of ‘science’ cannot provide an
adequate basis for the theory and practice of chaplaincy.’ This is because, on
its own, the spiritual ‘outcomes’ of the pastoral encounter cannot be measured.
If a pastoral encounter is primarily about relationship, it is only secondary
outcomes such as a feeling of wellbeing, which can be measured scientifically
in a manner that might satisfy those who are seeking to measure the length of
stay in hospital in terms of economic benefit. Swinton further suggests that
pastoral ministry has a place in informing scientific outcomes in that it moves
beyond empirical measurement to speak of the human condition.
The research on the outcomes of
pastoral interventions speaks of things like ‘meaning’, ‘comfort’, ‘hope’ and
‘community’. That is, when a person’s spiritual needs are met they report that
they have a greater sense of meaning, comfort, hope and belonging. Spiritual
Care Australia defines the value of spirituality as something that increases
resilience within a person, helps to positively embrace experiences and
outcomes and to celebrate life. The Mayo Clinic Pastoral Care Services defines
its work as assisting people in using strengths in coping with their medical
condition.
These views seem to place the idea
of spirituality within a holistic view of humanity. Within the health care
context particularly, a person is viewed as having, not only physical and
mental health needs, but also spiritual needs. Within this view of the whole
person, just as solutions can be applied to the fixing of a broken leg, or the
resolution of an eating disorder, so can solutions and resolutions lead to a
person finding meaning, comfort, hope and community. Certainly this is the view
in a large body of literature on pastoral care that speaks of the ‘functions of
pastoral care’. Kate Bradford has addressed this issue in her earlier post on
this site in “Chaplaincy
─ a Ministry ─ not a Function”.
Following on from Kate’s work I want
to ask, “If Chaplaincy or pastoral care is not a function but a ministry, how
then does it fit into the sphere of public healthcare?” In other words, if the
New South Wales government sees the value of subsidising chaplaincy in its
public hospitals as achieving better health outcomes and therefore saving
money, how does a ministry that does not seek to serve these functions fit into
modern health care?
These questions highlight the
dichotomy between Christian ministry and the desire in a modern results driven
economy to have measurable outcomes. Someone has said, “What cannot be measured
has no value.” This statement begs the question about value. In Christian
ministry we are not seeking an economic value. It is well and good for
government to know that its hospital patients feel better and have better, measurable
health outcomes as a result of the ministrations of the chaplains it
subsidises. But Christian ministry, which is not a function, has no measurable
outcomes, at least in a scientific sense. It does not have an immediate economic
value. At its best Christian chaplaincy and pastoral care is an activity where
two human beings, the patient and the chaplain, encounter the true human,
Jesus.
Government may well want to keep
subsidising chaplaincy in its hospitals and prisons because of the measurable
positive but secondary outcomes and the economic benefit they bring. Christian
denominations, while not denying these tangible benefits and the positive
impact they have on society generally, must, never the less, maintain the
primary focus of pastoral care as fellowship with the risen Christ. Government
must recognise that this ministry is an activity Christian chaplains will focus
on. At the same time the Christian chaplain must recognise that in a public
institution he or she is there as a guest. They are not ministering to their
parishioners, those who come to church of their own free will. In public
institutions the chaplain encounters people from every Faith and none, and
therefore must show due respect.
As much as the Christian chaplain’s
role is to listen with the patient to the Christ who is present, their role in
a public institution is not as an evangelist. But as the chaplain listens to
the Christ who is present, the patient also, who experiences the listening of
the chaplain, will also begin to listen to the Christ. They may or may not respond
to this listening but those who do have the opportunity to move into fellowship
with Christ, the giver of life. This is no scientific measurable outcome but health
managers and other professionals must recognise that this is the real work of
pastoral care. When it is done at its best, they may well also see measurable,
secondary positive health outcomes.
Chaplaincy and pastoral care in our
public institutions must be allowed by government to be chaplaincy and pastoral
care. The desire for measurable outcomes must not overtake the real ministry
that is happening. If it does, and begins to shape and dictate what a chaplain
can and cannot do, it will lose the secondary outcomes government and
healthcare professionals are looking for. At the same time chaplaincy must
bring its unique contribution to bare on the professional business of
healthcare. This will hopefully shape healthcare to be more patient focused
than outcome focused. It will remind healthcare professionals that patients are
not economic outcomes. It will focus on the human condition and see science and
pastoral care working together for the full physical, mental and spiritual
health of the patient.
[1]
John Swinton. ‘Reclaiming Mystery and Wonder: Towards a narrative based
perspective on chaplaincy.’ Journal of
Healthcare Chaplaincy. 2002. pp. 223-236
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