I rather enjoy reading what some of the contemporary pundits of professional chaplaincy have to say about the current status of the professional chaplain and state of affairs IN professional chaplaincy as a healthcare discipline.
In a recent posting on a popular forum for professional chaplains, a renowned personality, albeit from the podium of a branded accreditation organization, George Handzo, in a post “Lack of Integration for Chaplaincy is an International Issue” (that links directly to his Handzo Consulting blog article) preaches some disputable notions about the profession and the burden of responsibility attaching to the community of professional chaplains (“we” per Handzo), and ipso facto to the individual professional chaplain.
In this posting I take issue with three of the venerable George’s distillations of statements made in two published texts cited by him (Wendy Cadge, Paging God: Religion in the Halls of Medicine, University Of Chicago Press (2013) ISBN-13: 978-0226922119 and an article by Ian Macritchie appearing in the Scottish Journal of Healthcare Chaplaincy (not more specifically cited by Hanzo)).
While George Handzo is generally more or less on target in most of what he exposes to the professional community of [healthcare] chaplains, and while one cannot discount his allegiances, especially to the ACPE, he sometimes appears to preaching from his cathedra of laurels than from a more praxis-oriented position of insightful compassion for the frontline, in-the-trenches chaplain.
In general, I found his comments to be facially insensitive, almost indifferent to the actual obstacles facing the institutional chaplain, and he fails to note fairly that those obstacles have little to do with the professional chaplain but with the larger picture of institutional models and cultures, not the least to do with how we educate, train, and form the hierarchs running those institutions. Here my responses:
Handzo Point: “1. The responsibility for the lack of full integration and lack of growth of professional chaplaincy in health care rests mostly if not entirely with us as chaplains.”
This is placing an inordinate and unrealistic burden on the shoulders of professional chaplains and does not take into consideration the real fact that developments in both “professional” (viz. interfaith) as opposed to “denominational” chaplaincy, socio-cultural changes, and models of healthcare in the past half-century. Whereas prior to the most recent five decades chaplaincy was generally the purview of the ordained cleric or, in the hands of “religious,” it is now, like spiritual guidance, up for grabs, if you will, for just about anyone discerning a “calling” to serve the suffering. This, compounded by the problem of over-marketing of certification and the suspicion associated with the process. Some of that suspicion granted is pure envy and professional lassitude but some is factually based.
Yet another problem is posed by the fact that the practically inexhaustable availablity of unqualified volunteers being welcomed by ignorant volunteer coordinators with the blessing of indifferent institutional hierarchy is not even broached, despite the fact that it is an insidious affront to professional chaplaincy and its institutional and public image!
The decline in membership, rather active participation, in mainstream faith traditions, the aging of faith communities, the declining availability of qualified and formed clergy and religious, and the various popular theologies espoused by overzealous agendas have fostered, and nurtured, a climate of “apostolic missionary ministries” and programs, volunteer programs are the most culpable, that welcome the half-baked, baggage-laden, “chaplains” and pastoral care associates responding to nebulous “callings” into nursing homes and hospitals. Why? Not because professional chaplains (those with professional degrees, appropriate life experience, necessary acquired skills, and an understanding of the organization and dynamics of their chosen or preferred work environment) have shirked their duty of “evangelizing” hierarchy in institutions that would benefit from the ministrations of professional chaplains and well-organized pastoral care departments, but because the hierarchy is generally inculturated with the focus on institutional efficacy and efficiency in a fiscal, technical and regulatory sense, rather than in a customer-centered wholistic sense.
While I do not disagree that the chaplain, as a professional minister, bears some responsibility to guide and to educate institutional hierarchy, we are also inculcated with the notion of boundaries and avoidance of making and impression of overstepping, trespassing. We are admonished against proselytizing, evangelizing where inappropriate; so, too, we are admonished against proselytizing the important role of chaplaincy in an institution that feels expanding the gift shop has priority over providing the chaplain with a respectable space. This requires an attitude shift not in hierarchies that are focused on corporate business objectives but in the very early stages of education of the individuals who will later become the board members, the vp’s of quality, customer relations, public relations, etc.
Healthcare delivery models have changed. No longer is there the family physician or event the primary care physician at the bedside. The hospitalist model has taken the lead. In some respects this is good for chaplaincy because the chaplain has a finite number of physicians to deal with and a chief hospitalist to recruit to the cause, with whom to communicate, and from whom to gain access to the inner sanctum. Analogous models can be found in other institutions benefitting from the ministry of spiritual support such as jails, long – term care facilities, colleges, etc. Indeed, no amount of theology or scriptural studies, nor human developmental theory, nor spirituality and prayer discipline is of practical value when attempting to communicate and to work in such an environment.
The bottom line here is to first of all to access the decision-makers of the institution, to speak their languages (sometimes also their institutional dialects), and to make the impression of understanding the culture and the concerns (especially the institutional strategic mission and how chaplaincy plays an integral role in that mission) of hierarchy.
Handzo Point: 2. To the extent that our status in health care is due to the lack of understanding by others of our capabilities and possible contributions, we need to bear full responsibility for that situation.”
Vide supra (the above is included here in its entirety by reference).
The status of the professional healthcare of the professional chaplain is that of a healthcare provider. Period. Again, I beg to disagree with the venerable George on the point that we (I am assuming George is referring to the community of professional chaplains) “bear the full responsibility for lack of understanding by others of our capabilities and possible contributions.” That statement is not wholly true and if not wholly true, is false.
Neither the individual chaplain nor the various corporate entities that claim to advocate for the individual chaplain can claim to bear full responsibility for the general, regional, and local understandings of attitudes towards the capabilities and contributions of chaplaincy. First of all, the statement is overly broad and overreaching in its scope. Acceptance of chaplaincy in general differs widely from locale to locale, from institution to institution. To homogenize this understanding to positively affect the overall acceptance and admittance of the role, competency and contribution of chaplaincy would be an almost impossible task. It would have to start at a national level, preferably in the form of recommendations, regulations, and legislation. This is, in fact, in the making when one considers more recent HIPA and JCAHO statements and provisions, and while I may rightly be accused of strong criticism of the various chaplain accreditation organizations, I do admit that they may have a role in a sort of lobbying activity to nudge legislators and key bureaucrats and other influential pundits of healthcare.
Again, I must make a point that chaplaincy can be advocated and promoted only early in the formation of the hierarchs or, in the alternative, with an organized authoritative presence in places where the hierarchs convene to discuss their agendas such as at conferences and congresses. If recognized authorities in chaplaincy–not branded accreditation schemes or representatives of such agendized operations–are admitted a place at the head table or on the discussion panel, then we may gain certain ingress to the minds of those hierarchs, and through those sacred spaces, to their institutions as bona fide healthcare providers.
Handzo Point: “3. We have failed to make the case about how we ’help address larger institutional issues’ or how dispensing with chaplaincy would be a ‘great loss to healthcare outcomes.’”
Again, I must take issue with this statement, and again, vide supra.
I take umbrage that venerable George uses the corporate “we,” or in the alternative that the “we” is intended generally to embrace the community of professional chaplains. Here, too, we cannot go where we are barred access or where we are not expressly invited. It’s a long haul to move beyond the first level caregivers (nurses, techs, support staff, even physicians) to get to the boardroom. Nor do most “chaplains” have the credentials with which to impress hierarchs that what the chaplain has to say carries reliable business weight.
Take, for example, the hospital: How many chaplains can say that they have an adequate knowledge of the structure and organization of the hospital? Or of the myriad regulations that affect the hospital? Is the hospital a too complex example? Take, then, a prison, if you will. What does the generalist chaplain know about prisons? About the regulations affecting prisons and their operation? So, absent specific, specialist training in specific and particular institutions, how does the chaplain addresss “larger institutional issues?” Without such training, knowledge, experience how does the chaplain address “larger institutional issues?” Does the professional chaplain have to have a degree in theology, in pastoral care, in business administration, public administration, and social work to do that? Or, in the alternative, does s / he forge inter – or multi – disciplinary networks or support resources to do that? Does the professional chaplain need to be the epitome renaissance person or just know how to finagle and kibutz?As to the suggestion that “dispensing with chaplaincy ‘would be a great loss'” I must comment that to experience loss you must first attach value to the thing lost. And so we make full circle.
But what is pristinely clear to me is the fact that, like efficacious chaplaincy itself, the response, if not the answer, lies in an early access to the core decision makers…
The basic question to be answered, far from heaping the burdens of responsibility on the community of professional chaplains, as George Handzo appears to be willing to do, we must ask ourselves: At which point and how do we inculcate the much touted holistic healthcare model (spirit, mind, body) in the hearts and minds of the seculars who call the shots? It’s a very complex question and, since chaplaincy is such a variegated ministry and the cultures in which the ministry is done are so myriad, I personally doubt that there is really one answer. But what is pristinely clear to me is the fact that, like efficacious chaplaincy itself, the response, if not the answer, lies in an early access to the core decision makers, effective formation of the decision makers, comprehensive education, training, and formation of professional chaplains (after an appropriate period of reflection and ongoing discernment), frequent, open, and affordable continuing formation for chaplains, and express support from mainstream denominations of the ministry of chaplaincy based on a spiritual rather than a traditional model.
If I commit the offense of overgeneralization by making the statement that in the past chaplaincy has been its own arch-enemy, I humbly apologize. But chaplaincy must advocate itself as a professional healthcare discipline both internally and ad extra.
If we fail to communicate or document “outcomes” might it not be the shortcoming of the CPE programs themselves and not of the product they churn out as “chaplains”?
Handzo continues his editorializing by noting the problem of outcomes in chaplaincy. According to Handzo, “We often still resist the idea that outcomes are something chaplains should have. We don’t have commonly understood sets of outcomes, we don’t train our students to work toward outcomes, and we often don’t document outcomes so other members of the health care team know what we do.” Again that ubiquitous, corporate “we,” that contributes only to the ambiguity of what Handzo is writing. Who is this “we?” It certainly cannot be the in – the – trenches professional chaplain, or can it, George? It also seems a bit misleading to hear an apostle of the CPE movement, a board member of the consulting firm Healthcare Chaplaincy and a past president of the Association of Professional Chaplains (APC), would make such a statement, especially in view of the reasonable prestige that Rev. Handzo allegedly has in the chaplaincy movement. If “we” have not established “commonly understood sets of outcomes,” and we “don’t train our student to work toward outcomes,” “and we often don’t document outcomes,” that is, we do not communicate to other members of the inter – or multi – disciplinary team members, whose fault is that? Might it not be the shortcoming of the CPE programs themselves and not of the product they churn out as “chaplains.”
Handzo is describing a lack of community, a lack of consensus, a lack of fraternity among professional chaplains – – could this be attributable to the plethora of competing “advocacy” or “standards” or “certifying” organizations and competing “outcomes”
Handzo continues, “I am convinced that one of our greatest barriers is our own infighting and the time we waste debating internally whether professional chaplains should have outcomes, demonstrate value, and have measurable outcomes. I find myself increasingly disinterested in engaging those questions.” I am appalled that a leader in the chaplaincy movement and a leader in the CPE movement should be “disinterested” (I am somewhat at a loss what Handzo intends to mean by “disinterested.” Does he mean “indifferent?” “Impartial?” “Dispassionate?”) in engaging such questions! It would seem that Handzo is describing a lack of community, a lack of consensus, a lack of fraternity among professional chaplains – – could this be attributable to the plethora of competing “advocacy” or “standards” or “certifying” organizations and competing “outcomes.” I’m also having some difficulty with the notion of “outcomes” in spiritual support, and wonder where that one came from. Handzo conspicuously avoids any further elaboration of what are the outcomes to which we should aspire, or how we demonstrate value and to whom. I have not problem demonstrating value to the suffering nor demonstrating value to my contributions to staff education, institutional image, community outreach, service retention, etc. but my point is: How many readers understand these to be values to be demonstrated?
My further point is that Handzo fails to define his terms like “demonstrate value.” Measurable outcomes poses another problem. From the administrative, management point of view I can appreciate the the board or the corporate director for quality might be so limited as to grasp only PowerPoint depictions of measureable outcomes, metrics, etc. If that’s what Handzo is meaning, does that really fall on the lap of the in-the-trenches chaplain? True, the professional chaplain very frequently wears the administrative, managerial hat, too, of director of “pastoral care” (Ugghhhh!) but does the in – the – trenches provider have the time, energy, inclination to start recording “measurable outcomes?” I think not, especially when the professional chaplain, if the institution even has a professional chaplain, has the burden of impossible numbers of patients and the responsibility to triage who gets the visit and who doesn’t. There seems to be a serious disconnect between Handzo’s statement and the real world.
There are many saints that are locked out because of the rigor of artificial and ambiguous certification agendas; likewise, many individuals with more temporal than spiritual / apostolic aspirations gain access to sensitive precincts and cause much damage…
Regrettably, Handzo’s concluding statement: “I continue to rejoice that this is a large and growing group both in the US and abroad that I hope and trust will continue to make a difference in how spirituality is integrated into health care” does not lend much lucidity to what he attempts to share with us. In fact, it reveals a deplorable lack of sensitivity to the complexity of chaplaincy, especially when considering chaplaincy in terms of international models. Which group? The wannabe’s or the professionals? The branded certificated or the natural vocations? The international organizations’ membership censuses or the invisible ministers of spiritual support to the suffering. I’m not quite clear what Rev. Handzo’s point is, really.
There are many saints that are locked out because of the rigor of artificial and ambiguous certification agendas; likewise, many individuals with more temporal than spiritual / apostolic aspirations gain access to sensitive precincts and cause much damage. As impractical, even impossible as it may sound, we must self-police, inter-form, and inform each other as co-disciples, and then corporately police, form, and inform our target institutions. We can do this only if we are humbly authentic and emptied of self-interest and attachments. In other words, we much attain chaplaincy “sunyata” before we can attain chaplaincy “nirvana.”