At Western Maryland Health System intentional effort to define and improve our patient experience and culture have been in place during the entire 5 years I have been an employee.  The structure and format of the staff that have the responsibility to implement changes and monitor the level of engagement and culture have changed several times during these five years.

Under each configuration I have found that Pastoral Care can be an effective partner in helping identify patient needs and support initiatives to improve the total patient experience.  These changes tell me there is more than one way to accomplish this work.  I have also learned that without coaching employees on the power of patient experience it is easy for that focus to slip from the fore front of our minds as we encounter patients.

At our most recent meeting our team was divided into groups of 5 – 8 people and the theme was a baseball diamond.  Each table had a different part of health care they were looking at from the lens of patient experience.  Each team was able to identify steps we either are taking or could adopt to help with this area of patient experience.

I liked the theme of the baseball diamond because is stressed we are in constant movement as we round the bases with each patient.  Just as a baseball runner is very aware of the people on the field as he or she is running the bases while the ball is in play.

I chose this graphic of the globe and a stethoscope intentionally because the image states our mission in images not words.  We are to care for the medical needs of the world (or the portion of the world that seeks help at our institution).  Showing patients we care for them is the first step in treating their illness even before we know their diagnosis.  If people don’t feel that they are valued as individuals they will not place much trust in the medical interventions we provide.  Caring creates trust.  I invite you to create trust with those you encounter by first showing them you care for them as an individual.

One of the ministries that offered to families who have experienced a recent death is our Bereavement Support Group.  The group meets monthly and the individuals who attend it changes over time as some people cease coming and new people start to attend.  People attend as long as they feel the group is helping them cope with the death they have faced.  I am not the leader of the group and don’t attend the sessions.  I do hear from attendees who tell me how much they benefit from the group.

Several components that those who attend the group share in common are what give the group the power to be effective as they meet.  They include:

• A chance for everyone to talk and the permission for anyone who chooses to be silent to do so without pressure to speak.
• A chance for members to benefit from hearing from others who have walked the path they are now walking. Knowing that your thoughts and emotions are normal for the situation can be a great comfort.
• The structure of the group is also informal. As a result fellowship that follows is as much a comfort to those who attend as the content of group session.

I am glad that this group exists and thankful for all the good things that each participant brings to the group.

Today I want to place focus on how the illness of one member of a family affect the other members of the family.  Illness doesn’t just change the life of the patient – it changes the lives of everyone in the household.  These are a sampling of the comments I receive that describe how family member’s lives are changed by illness:

• Our daily routine is changed and we don’t have time for activities we enjoy.
• Waiting with the patient at the hospital is more exhausting than we thought it would be.
• I did not realize how much the patient did around the house until I had to do those chores.
• Caring for the patient while being an act of love is also very tiring.

Family members tell me some of the most appreciated actions of friends and extended family members are those actions that bring comfort and relief to the members of the household who have made significant adjustments to their routines to meet the needs of the patient.  While it is always important to remember the needs of the patient, it is equally important to remember the needs of other members of the household.

Today we remember one of the most unexpected tragedies in modern history.  The Alfred P. Murrah Federal Building was destroyed, lives were lost, and people were injured.  The picture posted is not of the destruction 20 years ago, rather it is a picture of the memorial that has been placed where the Murrah building was previously located.

I have been to Museum and walked along the rows of chairs, one for each person killed that day.  It is a somber experience to be there.  The way that people all over nation responded to help care for the injured and then to plan and erect a fitting memorial is a testimony to the fabric of this land we call The United States of America.  Even when tragedy strikes, we don’t let that tragedy keep us from moving forward dedicated to the hope of a better tomorrow.  I encourage you to pray for the survivors and the families of those who died that day.  Even 20 years after the fact, they need our prayers!

I intentionally chose the image of the light bulbs with only 1 bulb lit and the others dark.  For me it provides a visual of how we feel when we experience a change that we have not chosen, but because it has happened we now have to decide how we will respond to the change.

I attended a workshop this week on the changes in life cycles for churches.  The point of the workshop is that once a congregation reaches the point of decline, the decline will continue until something is done turn the direction of the church.

As I reflected on the workshop the next day between patient visits I realized that when patients face sudden change in their health status they encounter challenges similar to those that congregations experience when they start to decline.

Let me share one of the types of change a patient can face and two different ways they can respond to the change.  Let’s call this patient “Bob” to personalize the experience.  Bob has just learned that his diabetes has decreased the blood circulation to his leg.  Infection has developed that antibiotics can’t eliminate.  Left untreated the infection will circulate through the rest of his body and he will die.  The physician has just defined the change.  The choices of how to move ahead will the result of collaboration between Bob, his family, and the medical staff that are caring for him.

I have listed below 5 Facets of Change that we have to deal with as me move forward.  I will use Bob’s situation to show how we integrate these facets into addressing the change.  In Bob’s case the change is the declining circulation in his leg and inability of pharmaceuticals to eliminate the infection that has developed.

Five facets of change to be dealt with once you define the change:

• Communicate the change
• Manage the change
• Deal with the change
• Relate to the change
• Lead the change

The first facet has already taken place.  The physician has communicated the change to Bob and his family.  They have been explained the best option for extending his life is amputation of his leg.  The other option is to decline the surgery and prepare for his death to happen much more quickly than he would like to happen.

Bob and his family discuss what his life would look like if he had the amputation.  He could be fitted with a prosthetic leg and be able to continue to enjoy most of the things he finds pleasurable in living.  Bob also struggles with the reality that he does not want to have a prosthetic leg; he wants the leg “God gave him at birth”.   This is the facet of managing the change.  Bob and his family look at the result of both having the surgery and not having the surgery.  Both options before him are not ideal, but he has to choose one.  If he makes no choice the infection will move through his body and he will die anyway.  If he makes a choice he retains some control in the process.  If he lets nature take its course he declines to make a decision.

Bob seeks many sources of comfort and assistance in making this decision.  He hears from physicians, family members, friends, and also asks the chaplain to visit.  Bob feels overwhelmed at all the information and differing opinions he has received.  The physicians feel the surgery is the best option.  His family is divided, some feel the surgery is must while others can see how Bob can justifiably decide between surgery and letting the illness proceed without surgical intervention.  As a chaplain I engage Bob in a discussion about his beliefs and how his faith is influencing how he feels.  Bob admits his core belief is that at his age he does not want to deal with the surgery and recovery process.  He has lived a good life, and dying from an infection is no better or worse than dying from any other illness.  He will miss his family and knows they will miss him.  He knows if he decides against surgery he will be pressured by some to change his decision.  He feels he is in God’s hands and that God has given him a good life.  He is ready to move toward the change from earthly life to eternal life.  In this process Bob has decided how he will deal with the change.

Bob realizes now the hardest part of the change process is about to commence.  He is going to have to share his decision and experience the reaction of people whom he loves to what he has decided.  This is the process of relating to the change.  He will undoubtedly be asked why he is declining surgery by many people.

The final facet of change is how he will lead the change.  This will involve the process of saying good-bye to many people.  It will involve deciding what measures of comfort care he is willing to receive and the setting in which he will receive them.  Arranging for people to care for him as he gets weaker will have to addressed.  The hardest part of leading the change will be dealing with resistance and complexities of taking care of all the steps in this process.  For anyone in his situation it is a process he has never been involved in before and because it is new there are moments where fear will creep in.

I could have just as easily written this scenario with Bob making the choice to have the surgery.  While the outcome would be the different the facets in facing the change would be same.  I used this example to hopefully stimulate a discussion about the significant changes my readers face and how effectively they use the 5 facets of change to aid them in the process of responding to change.  I know this blog article is significantly longer than most of my articles.  I thank you for bearing with me and reading this entire post.

The church that hosted the workshop now has to decide how they will handle the 5 facets of change as they prepare for their future.  My prayer for them is that they will find a path that leads them to renewal and a new phase of dynamic ministry.

Today I attended a funeral visitation for a friend whose son had died. Deaths of child are some of the most difficult deaths for people to experience. In this example the family had done everything to care for their child impeccably through his whole life. The have the peace that they know there was nothing more they could do for him. They are also strong in their faith and believe he is in Heaven even as they a grieving his death.

At the visitation there was nothing profound that anyone said that brought comfort. The family indicated most comforting thing was the number of people who took time from their schedule to come to the funeral home, stand in line, and then offer heart-felt expressions of love and support to the members of the family. Anyone who attended the visitation probably wished they at a more enjoyable activity. What they may not realize is the gift of their presence at that precise moment was a gift of grace and love to the grieving family. I am glad to see so many people chose to make time to give that gift to the family as they grieve their loss.

Yesterday and today I tried to make a follow-up visit to a patient who was originally seen by one of our On-Call Chaplains.  Each time I went to see her our Patient Transport staff was in her room preparing to take her for a test.  Since I know the patient believes in the power of prayer I asked the staff to allow me a few minutes to pray.  The patient appreciated the prayer but the whole visit lasted less than 2 minutes each day.  I am really hoping that on Thursday I will be able to have a visit with a long enough length of time that it can be meaningful for the patient.

This is one of the surprising dynamics of hospital chaplaincy.  Even though the patient is an in-patient and in our building 24 hours a day, getting a chance to see the patient can be a challenge when the patient is having diagnostics or surgeries that have them outside of their room.  I know that is aware of my diligence in trying to have a quality visit and until we can have a longer visit this will have to suffice.

This week is Volunteer Appreciation Week.  Our local newspaper published a picture of a volunteer who plays the piano in our hospital lobby every Friday.  I am not able to post that image because it is not downloadable from the publication’s web page.  So I have used a stock image for this post.

Volunteers make a huge difference in every area of the hospital.  Even though people generally feel chaplains are in place for patients and visitors, we are also in place to provide spiritual care for employees and volunteers.  In addition we have volunteers at our hospital that provide spiritual care for patients in these roles:

• Volunteer On-Call Chaplains
• Volunteer Prayer Partners
• Volunteers who call churches to notify them of members who are in the hospital.
• Eucharistic Ministers who provide the Sacrament to Roman Catholic patients.
• Volunteers who help with various pastoral care mailings.

As a chaplain I am thankful for the times that volunteers help me and I am also glad for the times when I can provide direct spiritual care to volunteers when it is requested.  The next time you encounter a hospital volunteer take a moment to thank them for sharing their time.  It is guaranteed to put a smile on their face!

Today in church I was told about a cartoon of one of my favorite characters “Dennis the Menace”.  In the panel Dennis and his Mom were leaving church and greeting the pastor at the front door.  Dennis asked the Pastor, “Are you sure Moses only had 10 Commandments?”  The pastor replied, “Yes”.  Then Dennis replied, “So why then does my Mom need 100 rules for me?”

Dennis appropriately noticed that human beings were not able to behave as God wants us to with the 10 Commandments and so other laws have been developed.  Even though Dennis represents children, Dennis in this comic strip is also representing adults because adults also have demonstrated the need to have more than 10 Commandments to guide our behavior.

So my challenge today is to be as astute as Dennis when it comes to monitoring my behavior.  I know I will mess up, that is what human beings do.  But I know when I mess up, I can ask God to forgive me, and I know that God will.  That is the good news by which we are all saved!