Dear Hospital Leader:
For the last several years, we have had an HCA Pastoral Care Steering Committee. This committee has
consisted of a representative group of clinical chaplains from our hospitals.
This excellent group believed that it would be useful to our hospitals to prepare some background information
about pastoral care programs. This document is the result of their work. We want to express our appreciation to
the members of the committee for creating this resource material. There is also a videotape on this subject.
We would encourage the leadership of our hospitals to consider this information from time to time as you
evaluate the manner in which the pastoral care needs of our patients are met.
Sincerely,
Richard M. Bracken.
Chairman and
Chief Executive Officer
Milton Johnson
President and
Chief Operating Officer
Alan R. Yuspeh
Senior Vice President,
Chief Ethics and Compliance Officer
1
Body, Mind, and Spirit: Caring for the Whole Person
The Role of Professional Chaplaincy in HCA Facilities
Healthcare is all about meeting people’s needs: physical, emotional, and spiritual…the three are
inextricably bound to one another. An effective pastoral care program recognizes this and
provides a cadre of clergypersons [to address] the emotional and spiritual needs of the patient,
the patient’s family, and staff….
– James C. Scoggin, Jr., Executive Vice-President,
Methodist Healthcare System, San Antonio, Texas
COMPASSION, KINDNESS, HONESTY, INTEGRITY, FAIRNESS, LOYALTY, RESPECT, DIGNITY
HCA’s core values are most evident in the provision of quality physical, mental, and spiritual care. Our core
values, as reflected in our Code of Conduct, recognize the importance of spiritual care for patients, their
families, and hospital staff.
2
The Role of Professional Chaplaincy in HCA Facilities
This guide and the accompanying video, HCA: A Primer on Pastoral Care, are
designed to help your organization assess pastoral care needs and identify a program
model and resources to meet the needs of patients, families, staff, and the community.
Table of Contents
The Role of Professional Chaplaincy in HCA Facilities ........................................................................................ 3
The Role of the Chaplain in Healthcare .................................................................................................................. 4
Benefits of a Clinical Chaplaincy Pastoral Care Program ...................................................................................... 6
Assessing Pastoral Care Needs ............................................................................................................................... 7
Program Models for Pastoral Care .......................................................................................................................... 8
Level One: Full Service Pastoral Care Program ................................................................................................ 8
Level Two: Departmental Status plus CPE Residency Status ........................................................................... 8
Level Three: Pastoral Care Department Status .................................................................................................. 9
Level Four: Limited Pastoral Care ..................................................................................................................... 9
Level Five: Coordinated Local Clergy ............................................................................................................ 10
Level Six: Random Uncoordinated Local Clergy Visitation ........................................................................... 10
Recruitment of a Clinical Chaplain....................................................................................................................... 11
Conclusion ............................................................................................................................................................ 12
Additional Resources ............................................................................................................................................ 13
3
The Role of the Chaplain in Healthcare
Chaplains work to help others, through words, acts, and relationships, to experience as fully as
possible the reality of God’s presence and love in their lives.
– Lawrence Holst
The clinical or professional chaplain is a religiously affiliated person (ordained or lay) who has theological
training as well as specialized training in healthcare settings. The professional chaplain is usually credentialed
by a national certifying body, and may also be endorsed and ordained by the chaplain’s faith group. Integrated
into the work and life of the institution, the professional chaplain “tends to the soul of the institution.” While
others may serve as chaplains, clinical or professional chaplains offer quality care sensitive to the nuances of the
crisis of illness.
The chaplain’s role is to provide spiritual care for patients, their families, and the staff caught in the crisis of
illness. The chaplain seeks to bring each person’s faith resources to bear in the journey towards healing.
The work of the chaplains within an institution may variously be referred to as pastoral care or services,
spiritual care or services, or chaplaincy services. These terms are used interchangeably in this document. All
refer to the multidimensional task of using spiritual and faith resources in caring for the institution: patients,
their families, staff, and the community. The work of chaplaincy expresses itself in many ways:







Presence
Listening
Counseling
Liaising
Mediating
Advocacy
Proclamation
4
A clinical chaplaincy program includes the following attributes:





Patient Centered
A central task of the chaplain is to ensure that the right spiritual resources reach the right patient at
the right time. Many religious resources are available, but not all resources are appropriate for all
patients. Those who visit patients with a religious purpose (to evangelize or provide sacramental
ministry, for instance) provide potentially valuable religious services that may not be universally
applicable. Clinical chaplains do not impose their beliefs on others; rather, they are trained and
ethically bound to assist the individual patient in the exploration of the depth and potential of her or
his own beliefs and their application to the treatment and healing process.
Staff Trained for the Clinical Setting
In addition to schooling in theology and pastoral care, a chaplain usually receives specialized,
supervised training in a clinical setting. This training may consist of additional graduate studies or
Clinical Pastoral Education (CPE). Certification is provided by either the National Association of
Catholic Chaplains (NACC) or the Association of Professional Chaplains (APC).
Integration with the Culture of the Facility
The professional chaplain integrates the work of spiritual care into the life of the institution. As a
part of the healthcare team, the chaplain strives to fulfill the mission of the hospital, and
demonstrates the facility’s commitment to holistic care to the larger community.
Distinct from Congregational Clergy
When considering the mix of congregational, retired clergy, or professional chaplains to use in a
pastoral care program, understanding their differences is vital. Most congregational clergy generally
visit their own members in hospitals, but clinical chaplains have additional training and experience
in healthcare and institutional ministry. The clinical chaplain is dedicated to the values of patientdirected, ecumenical, and interfaith ministry. Clinical chaplains are committed to respect patients’
rights and privacy, and are trained in the increasingly important areas of cross-cultural sensitivities
and biomedical ethics. Congregational clergy can place only secondary importance on time given to
a hospital, hospice, or nursing home by virtue of their primary focus on congregational ministry.
Retired clergy may contribute valuable experience and skill in a healthcare setting, but they often
lack training in the nuances and demands of the clinical setting.
Accountable to their Faith Group
Many denominations and faith groups offer endorsement for those members trained in professional
chaplaincy. Endorsement ensures that the facility chaplain is qualified to minister by the standards
of the chaplain’s faith tradition and is accountable to that faith group.
5
Benefits of a Clinical Chaplaincy Pastoral Care Program
HCA’s core commitment to create a culture of compassion, kindness, integrity, fairness, loyalty, respect, and
dignity must always be the primary motivating factor in decisions to offer professional chaplaincy care to
patients, families, and staff in any institution. However, the realities of finite resources and budgetary concerns
cannot be ignored. In an environment of strict fiscal management, it is important to understand how clinical
chaplaincy can positively affect the bottom line. Clinical chaplaincy programs can:






Increase patient and family satisfaction
Positively impact end-of-life decisions
Reduce litigation
Enhance conflict resolution
Increase staff retention
Increase staff efficiency
The above claims may seem bold, but all are documented through conventional research. Healthcare litigation
often results from poor service and/or poor communication. A clinical chaplain is a trained listener,
communicator, and crisis intervener. A chaplain can use these skills, enhanced by an attitude of compassionate
care, to facilitate constructive expression of the patient’s or family’s emotions and provide opportunities for
conflict resolution that don’t require litigation. The revenue saved by avoiding just two lawsuits per year can
underwrite an entire chaplaincy program.
The chaplain is called upon to help families make decisions concerning initiation or termination of life support
systems. The intent of the facility and the chaplain is not to dictate a particular decision but rather to help
families make informed decisions within the context of a caring healthcare environment. One frequent
byproduct of this pastoral care is reduced ventilator days.
Chaplains provide important services to patients, families, and staff during critical decision-making times
through advance directives counseling and ethics consultation. A chaplain can be a trusted guide through
unfamiliar and painful situations, producing better outcomes for all concerned.
Nurse retention is a national problem. Estimated recruiting costs vary between $10,000 and $25,000 per nurse.
Providing pastoral care to nurses, in coordination with employee assistance programs, may significantly reduce
burnout leading to resignations. Through pastoral counseling, the chaplain is in a unique position to hear the
frustrations of staff and make recommendations to management without violating confidentiality. Most
chaplains are skilled conflict mediators. Resolving conflict early can reduce turnover. A sufficiently staffed
clinical chaplaincy program has a positive effect on a facility’s morale and productivity.
The chaplain is a liaison between the hospital, local clergy, and congregations to facilitate clergy contact with
congregants in the healthcare setting. A chaplain can serve as an interpreter of the hospital culture to clergy and
congregants as well as an interpreter of religious cultures to the staff.
Research has affirmed the efficacy of personal faith in healing. A chaplain is the staff member who can most
directly bring this force to bear for the patient, which often results in better protocol compliance and outcomes.
Clinical chaplaincy has a positive impact on the bottom line. It expands the quality of service to patients and
families. It provides support for hospital staff. It is a vital resource to the leadership team, physicians, staff,
patients, and families. Clinical chaplaincy is an integral part of healthcare for the twenty-first century.
6
Assessing Pastoral Care Needs
Each healthcare setting has its own unique culture that will determine the manner in which spiritual care can
best be offered in that facility. General guidelines may help determine appropriate levels of staffing,
competencies, and programmatic expectations for individual facilities.
Recommended Ratios
The Association of Professional Chaplains, a national certifying body, recommends a chaplain/bed ratio of 1:50.
The American Hospital Association has historically recommended a chaplain/bed ratio of 1:100. The level of
acuity, crisis related work (emergency department, critical care), and the number of specialty programs
(oncology, cardiac, neonatal, etc.) are also important factors to consider when establishing appropriate ratios for
individual spiritual care programs.
Joint Commission on Accreditation of Hospital Organizations (JCAHO)
Hospitals place great importance on the results of JCAHO surveys. Currently, JCAHO does not require
hospitals to employ clinical chaplains, but JCAHO has provided standards for spiritual care (JCAHO R.I.1.3.5):
 Recognition of the spiritual needs and rights of the person is reflected in the policies, procedures,
and the administration’s ability to articulate those needs and rights.
 The pastoral services department has a personnel/bed ratio sufficient to meet and implement the
goals and objectives of the pastoral care department.
 A formal arrangement is documented when operational needs require pastoral personnel from
outside the facility.
 Members of the pastoral services staff are professionally trained and maintain or upgrade their skills
consistent with other healthcare professionals.
 Staff demonstrate the ability to minister with persons of diverse cultural and religious backgrounds.
 The pastoral services director is certified by a national professional chaplaincy organization and has
a graduate theological degree and four units of CPE.
 Pastoral services have identified comprehensive resources available for pastoral counseling, spiritual
direction, and other specific pastoral services.
 The pastoral services staff documents their interventions in the record of the patient.
7
Program Models for Pastoral Care
Pastoral care exists in a variety of forms within a large healthcare organization such as HCA. Some forms
comply with the intent of JCAHO, while others fall short. The Pastoral Care Steering Committee reviewed the
various forms of pastoral care and developed the following Models of Pastoral Care as a tool to for improving
the quality of pastoral care throughout the corporation. Six organizational structures are delineated below.
They range from Level Six, which is the least structured to Level One, which models a fully integrated spiritual
care program.
Level One: Full Service Pastoral Care Program
This is the highest level of pastoral care which enhances Level Two service by including a number of additional
responsibilities such as a Pastoral Counseling Center, an Ethicist, an Employee Assistance Program with trained
and licensed providers, a research component, etc. Level One pastoral care programs can generate some
revenues. The staff is certified and licensed to perform its various types of ministries. The Director may serve
at a vice-president level.
Strengths: As with Level Two, the entire hospital is covered with a pro-active approach to patient care.
Chaplains and CPE Residents are usually assigned to units and other places of ministry. There is 24/7/365 oncall coverage in the hospital. There is a strong voice for spiritual care in the institution, and the chaplaincy’s
work is interdisciplinary. Various members of the staff serve on hospital-wide committees. The staff has
access to medical records and documents spiritual assessments and pastoral interventions. Trained chaplains
provide religiously and culturally sensitive care as well as expertise in end-of-life and other sensitive ethical
issues. Quality of pastoral care is assured through continuing education, quality monitoring, benchmarking, etc.
The department has strong community ties. The program provides for more intensive staff education programs.
Pastoral resources are available to the staff. This level can generate some revenue. This model provides
additional resources to the institution, the staff, and the community through programs delineated above.
Weaknesses: Institutional responsibilities outside of patient and family visitation may dilute pastoral coverage.
Level Two: Departmental Status plus CPE Residency Status
The Pastoral Care Department includes total spiritual care for the patients, families, and staff with the addition
of graduate education of local clergy and seminary students in a Clinical Pastoral Education Program or CPE.
Services are provided through both full-time staff and clergy in training. The staff consists of Certified
Chaplains and CPE Supervisors who work as a team in the accredited program. The Director may serve at a
vice-president level.
Strengths: The entire hospital is covered with a pro-active approach to patient care. Chaplains and CPE
Residents are usually assigned to units and other places of ministry. There is 24/7/365 on-call coverage in the
hospital. There is a strong voice for spiritual care in the institution, and the chaplaincy’s work is
interdisciplinary. Various members of the staff serve on hospital-wide committees. The chaplaincy staff has
access to medical records and documents spiritual assessments and pastoral interventions. Trained chaplains
provide religiously and culturally sensitive care as well as expertise in end-of-life and other sensitive ethical
issues. Quality of pastoral care is assured through continuing education, quality monitoring, benchmarking, etc.
The department has strong community ties based on training of local clergy. Program provides for more
intensive staff education programs. Pastoral resources are available to the staff. This level can generate some
revenue.
Weaknesses: Institutional responsibilities outside patient and family visitation may dilute pastoral coverage.
8
Level Three: Pastoral Care Department Status
Pastoral care has full departmental status with a full time Director and optimally other staff members. The
Director has an advanced degree in theology, clinical training, and is certified or eligible for certification. The
Director usually reports to senior management. Clergy and volunteers may assist based on the needs of the
institution. On-call coverage may be contracted out to cover 24/7/365.
Strengths: Pastoral care may be pro-active to specific units rather than a model based on crises, referrals, and
requests. A spiritual care perspective is included in the leadership team and the chaplaincy has a voice in the
institution. Community relations are strengthened by recognition of the institution’s commitment to quality
pastoral care. Trained chaplains provide religiously and culturally sensitive care as well as expertise in end-oflife and other ethical issues. Staff members have access to medical records and documentation. Level Three
may provide staff education.
Weaknesses: Hospital coverage is partial, based on triage of documented needs. The quality of on-call
coverage varies. Institutional needs for pastoral perspective in administrative tasks may dilute patient coverage.
Level Four: Limited Pastoral Care
The institution employs a part-time or full-time staff chaplain. The education and credentials vary, from a bible
college degree and church experience to an advanced theological degree and certification. The chaplain keeps
specified hours in-house and may be available for limited on-call. The chaplain may coordinate a community
clergy or volunteer program to augment services (community clergy may be offered a stipend). The chaplain
may serve on institutional committees, such as ethics. The position usually reports to another service, such as
nursing, social work, or volunteers. (Although this is the usual reporting structure, having the chaplain report to
a vice-president level can enhance the voice of the spiritual perspective within the institution.)
Strengths: A chaplain is on staff and knows the institution and employees. The chaplain provides a contact
person for local clergy and helps build community relationships. This model also provides for access to
medical records and documentation.
Weaknesses: Spiritual care is based on limited resources of potentially varying quality and the staff is forced to
use a triage method of prioritizing pastoral contacts. Volunteer clergy provide inconsistent pastoral care and
quality may become a problem. Interdisciplinary integration may be limited due to resource constraints. A
spiritual care perspective is absent from the leadership team. The availability of pastoral care perspectives is
limited in other areas of the institution, such as the ethics committee and staff education initiatives. Pastoral
services are part of an institutional department (social work, volunteer services), which has limited knowledge
of the role of pastoral care and for whom it is a secondary priority.
9
Level Five: Coordinated Local Clergy
Local clergy provide volunteer pastoral services to the hospital. The hospital coordinates these efforts through
another department such as social services, volunteer services, or nursing. The institution may provide some
education for clergy in the form of in-services. A structure is in place to organize a scheduled rotation for
clergy involved in the program. Some stipend may be offered. The use of this model is usually confined to
small community hospitals.
Strengths: These programs provide an administrative center for limited coordination of volunteer pastoral
services.
Weaknesses: No trained chaplain available. Intentional pastoral care is limited to traumas and crisis referrals.
The quality of services provided is unknown, except that local clergy responded, and may vary widely. There is
no interdisciplinary teamwork, no voice in the institution, no ministry to staff, no representation in ethics, no
medical record documentation or standardized spiritual assessment process, and no guarantee of training in
cultural and religious sensitivities. Delivery of pastoral care is subsumed under an institutional department
(volunteer services, social work, nursing) with limited knowledge of the role of pastoral care and for whom it is
a secondary priority. Additional demands are placed on local clergy with full-time parish responsibilities.
Level Six: Random Uncoordinated Local Clergy Visitation
Local clergy visit their parishioners. The hospital may call clergy during a crisis.
Strengths: This represents a “model” with no intentionality and should be avoided.
Weaknesses: There is no attempt to coordinate services designed to meet the pastoral needs of patients and
their families. This “model’ by its lack of design can create frustrations on the part of patients, families, the
hospital staff, the local clergy, and the community. Spiritual concerns appear to be a low institutional priority.
There is no interdisciplinary teamwork, no pastoral voice in the institution, no ministry to staff, no pastoral
representation in ethics, no medical record documentation or standardized spiritual assessment process, and no
guarantee of training in cultural and religious sensitivities. This model does not meet JCAHO standards.
10
Recruitment of a Clinical Chaplain
Qualifications: The level of pastoral care services offered by a facility will inform the credentials of the person
or persons employed. Below are the levels of credentialing preferred to help ensure quality of care:
 Full-time chaplain
o Clinically trained at an accredited institution
o Holds advanced seminary/divinity school degree in theological studies
o Certified by national cognate group or eligible for certification
o Endorsed by faith group (if applicable) and/or ordained (if applicable)
 Part-time chaplain
o Clinically trained preferably at an accredited institution
o Holds advanced seminary/divinity degree or is actively pursuing degree
Recruitment: Finding the right pastoral care staff for your institution is an important commitment. Several
avenues are available to find qualified staff to fit your needs. Regional seminaries or divinity schools may
provide a list of qualified graduates. The professional journals published by the cognate groups for clinical
chaplaincy will usually post positions in print and online. The principal groups and web addresses are listed
below:
 Association of Clinical Pastoral Education (ACPE) www.acpe.edu
 Association of Professional Chaplains (APC) www.professionalchaplains.org
 National Association of Catholic Chaplains (NACC) www.nacc.org
 National Association of Jewish Chaplains (NAJC) www.najc.org
 College of Pastoral Supervision and Psychotherapy (CPSP) www.cpsp.org
11
Conclusion
Some say that religion and science are opposed; so they are, but only in the same sense as that in
which the thumb and forefinger are opposed--as between the two, one can grasp everything.
– Sir William Bragg, 1925
The goal of every HCA facility is clear: to provide the best healthcare possible to our patients, their families,
our staff, and our community. With a firm commitment to providing quality spiritual care, we can move
towards accomplishing this goal. Without adequate attention to spiritual care, our patients, their families, our
staff, our institution, and our communities suffer. Science and spirit, medicine and faith are inextricably linked
in the quest to care for the whole person.
We hope this guide will assist you in defining optimal pastoral care for your facility. We encourage you to
contact members of the HCA Pastoral Care Steering Committee for further information and assistance.
12
Additional Resources
Video: HCA: A Primer on Pastoral Care. Four HCA chaplains discuss:
 The role of the chaplaincy in healthcare facilities
 Training of clinical chaplaincy staff
 Benefits of pastoral care programs
 Varying models of pastoral care programs
 The daily routine of pastoral care staff
 Creating “sacred” space in a facility for patients, families and staff
Carey, Raymond G. “Chaplaincy, Component of Total Patient Care?” Journal of the American Hospital
Association, 47(14), 166-72.
Cobb, M. and Robshaw, V., eds. The Spiritual Challenge of Healthcare. New York: Churchill Livingston,
1998.
Henry, L.G. and Henry, J.D. Reclaiming Soul in Healthcare. Chicago: Health Forum, 1999.
Holst, Lawrence E., ed. Hospital Ministry: The Role of the Chaplain Today. New York: Crossroads Publishing
Company, 1990.
Koening, Harold. G. The Healing Power of Faith. New York: Simon and Shuster, 1999.
Mitroff, Ian and E. Denton. A Spiritual Audit of Corporate America: A Hard Look at Spirituality, Religion, and
Values in the Workplace. San Francisco: Jossey-Bass Publishers, 1999.
Summers, Thomas A. My Story in Four Decades of Clinical Pastoral Education. Columbia, South Carolina:
Edisto Press, 2000.
VandeCreek, Larry and Lyon, M. “The General Hospital Chaplain’s Ministry: Analysis of Productivity,
Quality, and Cost.” The Caregiver Journal. 11(2), 3-13.
VandeCreek, Larry, Thomas, J., Jessen, A., Gibbons, J., and Strasser, S. “Patient and Family Perceptions of
Hospital Chaplains.” Hospital and Health Services Administration, 36(3), 455-467.
13