The Empty Chair

Amazon CEO Jeff Bezos likes to include an empty chair at his management meetings to represent the customer, who should always be a presence, uppermost in his team's mind. The empty chair implies that someone is missing from the conversation, from their place at the table. Of course, throughout history, people have been missing from a place at the larger table, such as minorities and women. But it seems to me that today there is a very obvious empty chair in our hospitals and health care systems, one that should be occupied by trained and certified health care chaplains, who care for the patient's spiritual and emotional comfort, talk with families and caregivers and help them navigate the system. These professionals are the "active listeners" trained in all cultural and religious backgrounds, so they actually "hear" what patients need. In other words, they would bring the patient -- the health care customer -- to the table with them.

Healing the body is done by physicians and nurses, but healing the spirit takes a very different kind of training. And while many health care organizations are coming to realize that palliative and spiritual care matters to the patient's comfort, well-being and recovery, that discipline is still largely missing from the decision-making counsels of health care.

Health care had traditionally been managed by executives and physicians until 2002 when registered nurses fought for a place at that table by staging the longest nursing strike in U.S. history at a hospital in Michigan. Since then more health care management includes strong nursing representation at the top of the organization. There are some hospitals with nurses as CEOs. An article in Trustee Magazine asserted that trustees need to remember that day-to-day patient care is the domain of nurses.

The newest kid at the table is the CXO, or Chief Experience Officer. These executives deal with patient complaints and safety. Essentially they are customer service; they measure customer satisfaction. The Cleveland Clinic was one of the first health care systems to establish the position in 2007. "It is estimated that there are currently about 60 U.S. hospital executives with the CXO title, and the number is slowly increasing. Some are from the nursing background, some are physicians. This is progress, but customer service is about efficiency and safety for the physical self, not about treating a patient's spiritual well being. That chair is still empty.

Some Catholic and protestant hospitals have spiritual care professionals on their boards, (although they may not be trained in health care chaplaincy), but in non-denominational systems, such representation is rare. In one large children's health care system with 10 hospitals, a board certified chaplain is vice president of Mission and Spiritual Care. She said the CEO is very supportive of her department, which can influence executive decisions, but there are still great "Aha!" moments. She told me that, in general, people don't understand the role of professional health care chaplains until they experience it such as the father of a young patient who said he would not have thought to seek out the chaplain, but once he did, he was astonished at just how much that person relieved some of his worries and helped him communicate with the others on the health care team.

A chaplain in a New York City hospital told me about a recent conference on spirituality and palliative medicine sponsored by the American Academy of Hospice and Palliative Medicine. Most of the speakers were physicians, except for a few health care chaplains, who were mobbed at the end because attendees clearly understood the need for this kind of guidance in their settings and wanted to hear much more.

New York is one of the states that have a palliative care law, which means that care, which includes spiritual care, must be offered as a treatment option to patients approaching the end of life, so some already have a chance to sit at the table, but chaplains are not taking their seats. Part of the problem may lie with the practitioners themselves. Chaplains are, by nature, not like Jeff Bezos. Nevertheless, they may be missing an opportunity to put their convictions to work for the benefit of the greater good of the patient and the health care system. If they don't take their place at the table, others will. Indeed, according to the job description of the CXO at Cooper University Health Care in New Jersey, that person "provides the vision, leadership and direction for customer-centric approaches to improve the emotional, physical and spiritual experiences of patients and their families."

I'd like to see the CSO, Chief Spiritual Officer in the C Suite of every health care system. This person, a board certified health care chaplain, who understands the needs of all cultures and beliefs should fill the empty chair. Everyone else at that table needs input from this person because total patient care, is bringing not only physical healing, but complete healing -- body, mind, and spirit.

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