Understanding and Developing Spiritual Care Leadership

George Fitchett, DMin, PhD

Department of Religion, Health & Human Values, Rush University Medical Center

Leaders play an important role in teams and organizations. They help set direction, strategic goals, for teams and organizations. They also help teams work together productively to achieve those goals. In recent years researchers have begun to examine the importance of leadership in building effective spiritual care programs. Wendy Cadge (2012) conducted an important early study examined chaplaincy programs in 17 leading hospitals in the U.S; 16 were on the U.S. News and World Report Honor Roll at the time, the 17^th hospital was an affiliate of one of them. Based on her interviews with chaplaincy managers and staff chaplains, Wendy described three broad types of chaplaincy departments: professional, transitional, and traditional. In the professional departments (4 of the 17, 24%), chaplains were well-integrated in their institutions. They were salaried employees, followed protocols to routinely respond to specific situations (e.g., code blue), were members of the interdisciplinary care team, part of many hospital committees, and saw care for patients and families as their first priority. Transitional departments (3 of the 17, 18%) were in the process of becoming professional. Wendy found that most of the departments (10 of the 17, 59%) were tradition. In these departments, the chaplains were not well integrated, “less physically present” she wrote (p. 117), in their institutions. They were less often integrated into interdisciplinary teams and were involved in fewer protocols where spiritual care was expected. Among the factors associated with the chaplaincy departments’ type, Wendy underscored the importance of the spiritual care program’s leader. She wrote, “Professional and transitional departments have…grown and became integrated into their hospitals through the efforts of directors who became familiar with the language and priorities of the health-care system” (p. 119-120). These managers then developed strategies to build their departments.

Ten years after Wendy’s research, Lex Tartaglia and colleagues (2022) report on a study that in part replicates Wendy’s work. This team conducted zoom interviews with the spiritual care managers of the 20 U.S. News and World Report Best Hospitals from 2020-2021. Lex summarized key findings from the study in a blog in last month’s Transforming Chaplaincy newsletter.  Care at the time of death and at the end-of-life was expected in all the departments. Two-thirds of the departments had routine spiritual care in one or more outpatient clinic. All the managers said that care for healthcare staff was a very important part of the services they provide.

In their report, Lex and colleagues reflected on these spiritual care programs in light of Wendy’s typology. Their conclusion was that “most spiritual care departments in the study share characteristics of the ‘professional’ typology” (p. 13-24). The change in the proportion of “professional” type departments from 24% to “most” in ten years is noteworthy. It suggests important progress in the quality and integration of spiritual care services in these leading hospitals. However, in light of the differences between the two studies, in the hospitals that were included as well as their methods, we should exercise some caution about this conclusion.

The past month saw the publication of another important study about spiritual care leadership. This was the report by Beth Muehlhausen and colleagues (2022) about leadership of spiritual care programs in the early days of the Covid-19 pandemic. The team conducted interviews with 20 managers of spiritual care programs; 7 were managers of a hospitals’ spiritual care department, 9 were spiritual care managers for a health care system or hospitals in a specific region. The interviews were conducted in the spring of 2020, in the early months of the Covid-19 pandemic.

The analysis of the interviews found 3 main stories: how chaplaincy changed in the pandemic, the leadership the managers provided for their departments and organizations during the pandemic, and the impact of the pandemic on the managers personal lives. In describing the changes in their work during the pandemic many of the managers reported high levels of interdisciplinary collaboration. This included collaborating with clinical teams to provide information and support for families that were unable to visit their loved ones and collaborating with wellness programs to provide support for healthcare colleagues. The managers reported high levels of improvisation; the increased use of telechaplaincy was a notable example. Creativity in care at the time of death was another. “One department created a ritual for dying patients that included a card sent to families so loved ones would know, ‘caregivers were present, hands were held, soothing sounds in the room were playing, words of comfort or prayers were spoken’” (p. 5). Some managers reported there were times in these early weeks of responding to the pandemic when decisions needed to be made quickly. They found themselves having less time to help their teams reach consensus and needing to be more assertive.

This project didn’t ask directly about the spiritual care managers’ level of integration in their organizations. The evidence from the interviews suggested, “There was variation in the degree to which spiritual care leaders were asked to collaborate in organizational decisions” (p.8). Some managers reported being included in the daily huddles of senior leaders. In contrast, one leader was only contacted by her administrator when she was asked to furlough some of her staff. The team noted, “It is unclear what factors, including institutional culture or leaders’ skills, led to leaders and spiritual care being more fully integrated into their organizations,” (p. 8) and further research about this should be conducted.

Another recent study by Csaba Szilagyi and colleagues (2022) reports on research about what the Covid-19 pandemic has taught us about crucial elements of spiritual care leadership. The study used an international expert panel of ten chaplaincy leaders and researchers who had been involved in research about spiritual care during the pandemic. The members of the panel shared their views about leadership in a virtual focus group in May 2021.

From the focus group discussion, the team identified six themes “as significant in shaping the integration of chaplains and the value (or perceived value) of chaplains’ contributions during the COVID-19 response” (p. 4). The themes were: professional confidence, engaging and trust-building with executives and managers, decision-making, innovation and creativity, building integrative and trusting connections with colleagues, and promoting cultural competencies. There seems to be an important similarity between Wendy’s observation about department managers’ integration in their organizations, Beth and colleagues’ report about integration, and the theme of “integrative and trusting connections with colleagues” in this project. Wendy’s observation about department directors’ efforts to become “familiar with the language and priorities of the health-care system” seems to be an example of the theme of “engaging and trust-building with executives and managers” in this report.

The study by Csaba and colleagues introduces professional confidence as an important factor in spiritual care leadership; this is a theme we have not seen in prior research. The report notes that chaplains are used to functioning in a crisis, so it is not surprising that chaplain leaders were confident and effective in the context of the pandemic. Interestingly, the report also notes the role of spiritual care research in fostering professional confidence. “Panelists discussed the importance of research education, understanding the evidence base for chaplaincy outcomes, and research-informed practice as these may have prepared chaplains ‘to be more articulate and confident about the care [they were] providing’” (p. 4). The investigators write, “Chaplain leaders’ ability to function with self-assurance and with an assured standing among other health care professionals may be related to the broader issue of professionalism in chaplaincy” (p. 4). We don’t read a lot about professionalism in research about spiritual care. J.N. (Niels) den Toom (2022) recently completed a PhD dissertation about the impact on their professionalism of Dutch chaplains’ participation in a large, national case study project. In the future I hope we can hear more about his research.

As rich and informative as they are, with a few exceptions – the discussion of “understanding the evidence base for chaplaincy outcomes” in the work by Csaba and colleagues – these studies don’t shed much light on how people learn to become effective spiritual care leaders. Most often, people who have demonstrated they are effective spiritual care providers are promoted to be spiritual care leaders, even though the skills required for the two jobs are not identical. In some organizations there is training for new managers but often it focuses on local institutional policies and mission. Many new managers learn the job by trial and error, sometimes with the help of an experienced colleague/mentor. It is easy to see how these approaches leads to wide variation in the skills and abilities of spiritual care program managers. When managers struggle to master their new role, spiritual care for patients, families and healthcare staff can easily suffer. To address this problem Transforming Chaplaincy, in conjunction with the Department of Health Systems Management at Rush University, has created the Certificate in Spiritual Care Management and Leadership. You will find more information about the Certificate in this month’s announcement and on our website. If you are an experienced, new, or aspiring spiritual care manager we invite you to join us in strengthening your knowledge, skills, and network, to better serve the patients, families, and staff in your organization.  

References

Cadge, W. (2012). Paging God: Religion in the Halls of Medicine, Chicago; London: The University of Chicago Press.

den Toom, J.N. (2022). The Chaplain-Researcher: The Perceived Impact of Participation in a Dutch Research Project on Chaplains’ Professionalism. PhD Dissertation, Protestant Theological University, Groningen, The Netherlands.

Muehlhausen BL, Desjardins CM, Chappelle C, Schwartzman G, Tata-Mbeng B, Fitchett G. Managing Spiritual Care Departments During the COVID-19 Pandemic: A Qualitative Study. J Pastoral Care Counsel. 2022 Oct 11:15423050221122029. doi:10.1177/15423050221122029. Epub ahead of print. OPEN ACCESS

Szilagyi C, Vandenhoeck A, Best MC, Desjardins CM, Drummond DA, Fitchett G,- Harrison S, Haythorn T, Holmes C, Muthert H, Nuzum D, Verhoef JHA, Willander E. Chaplain Leadership During COVID-19: An International Expert Panel. J Pastoral Care Counsel. 2022 Mar;76(1):56-65. doi: 10.1177/15423050211067724.

Tartaglia A, Corson T, White KB, Charlescraft A, Jackson-Jordan E, Johnson T, Fitchett G. Chaplain Staffing and Scope of Service: Benchmarking Spiritual Care Departments. J Health Care Chaplain. 2022 Sep 14:1-18. doi:10.1080/08854726.2022.2121579. Epub ahead of print.