Outcomes

by Marshall Scott

I’ve been thinking a lot about outcomes. For a chaplain, outcomes are an ongoing concern. Actually, for just about everyone in healthcare outcomes are a concern. We measure our success – and to a greater and greater extent, we’re going to be reimbursed – according to the outcomes.

However, it won’t surprise anyone that for chaplains outcomes are difficult. Just how do chaplains establish outcomes? By in large, for our colleagues in healthcare outcomes are pretty clear. Blood pressure goes up or it goes down. The infection responds to the antibiotic or it doesn’t. The patient’s pain is better or it isn’t. But for chaplains, the problem is different. Indeed, it’s a matter of great discussion among chaplains.

Indeed, chaplains have among themselves a real difference of opinion. What are the spiritual outcomes that are most important? A sense of peace. A sense of gratitude. The capacity to love. The capacity for generosity. Relationships reconciled with others, with self, with God. Arguably these are important for a sense of wellbeing, and for physical and behavioral health. Those relationships are known, and even studied. At the same time, they’re not easy to document, and not always easy even to describe.

There are outcomes that we can describe and document. We can enumerate how many folks we visit, and how many visits include prayer. We can identify who we spoke to (patient, family, etc) and perhaps some of the topics discussed. Those, though, are really process measures, and not outcomes per se (granted that whether appropriate things happened is an outcome in and of itself, and is certainly relevant). We can document whether coping seems improved, or anxiety is less. These are outcomes, of course, but still hard to describe, and sometimes to relate specifically to spiritual values. As I have said often enough, it seems the outcomes we feel important aren’t amenable to measurement, while the outcomes we can measure don’t seem so important.

As I was thinking about this, I also found myself thinking about Lent. As we prepare for Lent, many of us, I think, find ourselves having thoughts that are similar. I sometimes think there is this progression of questions: “What shall I do this year?”; followed by, “Well, what have I done before?”; and ending with, “When I did that, what came of it, really?” Certainly, we worry about motivation, but motivation is integrally related to results and consequences. There is the recurring story that would be apocryphal, if it weren’t for the fact that not only has it happened, it happens somewhere every year (and probably in any number of places). That is the young person who commits to giving up dessert in Lent, who hears the response, “It isn’t really Lenten abstinence if your real purpose is just to look better in your bathing suit this summer.” The young person clearly had a result in mind for abstinence during Lent. It just wasn’t a result that was actually about Lent.

What are the results of Lenten discipline? If I do give up desserts or take up a regular exercise program, there may well be results that are good for me. If I give up caffeine, there will certainly results, but I don’t think they’ll be good for me – or, for that matter, anyone around me. That’s not to say that giving up desserts or caffeine, or taking up regular exercise can’t be part of Lenten discipline. It’s just that the reason for choosing, and the results sought in choosing, can’t simply be what’s good for me, or what makes me uncomfortable. Those may or not be reasonable consequences, but as ends in themselves they’re lousy, and certainly not Lenten.

On the other hand, what are the consequences of reading Scripture more, or praying more, or taking more time in silence? My experience is that they help my relationship with God. However, just what that looks like can sometimes be hard to demonstrate. I feel closer – but, how is that lived out? Am I kinder or more patient? Does prayer come easier, or can I stay silent longer? If there is a difference, would anyone besides me notice?

You can see why this would feel to me like my quandary as a chaplain. Arguably, for Lent, too, the important results are hard to measure, and the measurable results don’t seem as important.

I do want to have results, and I also want those results to be about my relationship with God. I want to experience them both day to day during Lent, and also to have them reshape my life. So, I seek something that augments something that’s already part of my discipline. I want to challenge myself. I want to choose something important enough to me that if I miss it during the day I’ll notice and remember to ask forgiveness at night. I want to choose something attainable, so that if I do miss it during the day I’ll know it’s my own failing and not a physical or emotional wall. And especially I want to choose something that in its very nature turns me to God. It may not turn me entirely away from myself – for, after all, what is good for my relationship with God is good for me – but it’s clearly not about me.

I know that I’m “preaching to the choir” about this. So, I don’t think readers will be too skeptical if I say that, following these principles, I have over the years seen results. Sometimes those results have been temporary. Sometimes those results have become permanent. Most of the time, those results have been things God and I have been clear on, that would be less obvious to others – although I do think perhaps others might note that I listen a little better, and better root my reflections in my faith. Whether anyone else sees them, I am aware of them in my closet, when I know I am not alone. They aren’t necessarily the most measurable results; but I’m more than convicted that they are most important.

The Rev. Marshall Scott is a hospital chaplain in the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an Associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

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One Comment
  1. One of the blessings of our relationship with God is that “outcomes” are less important. The only outcome that really matters, salvation, is assured by God’s grace. So maybe a focus on inputs is actually a better one in cases like these.

    I remember a presentation given at an NAES conference several years back where school chaplains were asking the same questions. They ultimately chose inputs as their measure, trusting the outputs to God.

    Art Callaham [added by ed.]

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