This article was submitted by Ballad Health’s Spiritual Health Services department, describing a project the department spearheaded to enable chaplain Matt Hallam, who is blind, to carry out his full duties, including charting in the electronic medical record system and keeping a log of daily activities. Thanks to a team effort involving people from different departments across the system, a process was developed and a successful solution was created!
As a department leading Ballad Health in spiritual and cultural dimensions of health and well-being, we were faced with one of our greatest challenges. One of our team members/chaplains is blind. That chaplain was able to carry out most all of his duties independently, except for charting in the electronic medical records and maintaining an account of daily activities in a personal care log. This was a gap in our service at one of our facilities and we knew it needed to be addressed.
Breaking down the problem
Let’s break this down into two action items and the barriers facing the completion of those actions:
- Chaplains visit patients and families in the hospital and address the emotional and spiritual components of their health and well-being. Addressing and identifying these components has a direct impact on the recovery process of the patient. Topics impacting these visits include motivation for life, permitted procedures involving the patient’s physical body, end-of-life requests, a sense of faith and calm in the treatment plan, etc. All of these discussions directly impact the care given to the patient. The chaplain’s responsibility is to assure that the care team is aware of the directives, decisions and status of the patient’s well-being. We do this by charting in the patient’s medical record. Thus, it is imperative that the chaplain has access and can provide this information just like the rest of the total caregiving team.
- Chaplains also have the responsibility of being accountable for their work. Unlike other disciplines in the hospital, the work of the chaplain is self-regulating in that there are not enough of them to meet every spiritual distress or request in the hospital. Thus, the chaplains set their own priority of activities. In order to account for their time, the chaplains complete a daily care log. This log measures activity and time spent serving the staff and the community; completing administrative duties; recruiting, orienting, teaching and retaining volunteer chaplains; and other tasks. The electronic medical record measures the activity and time spent serving patients and their families.
These two action items pose a challenge for anyone who is blind – because they require completing the forms using a computer mouse to hunt and click on boxes to enter information. In the past, with our chaplain who is blind, we created workarounds. These workarounds included having other chaplains chart his patient care notes – sometimes completing the care logs or sometimes not completing them. Thus, much work was going undocumented both in the patient records and the departmental records.
Our goal going forward, as the spiritual health and emotional health caregivers, was to create an atmosphere and workplace where everyone could work independently. We realized that being independent in our vocation brings self-actualization and feelings of worth as a contributor to the good of the whole. Thus, we accepted the challenge and began working decisively to create an independent work environment for everyone.
Pulling together a team
We started by identifying all the departments that needed to be involved in this project to produce independence for our chaplain who is blind. Each entity involved then identified a leader or point person from their department. This included:
- Chaplain expert (chaplain who is blind)
- Spiritual Health Services director
- Administrative secretary for Spiritual Health Services
- Ballad Health vice president and chief patient experience officer
- Clinical informatics
- Information technology (IT)
- Vice president
- Epic global representative
- Screen reader organization Freedom Scientific and the program JAWS (Job Access With Speech) representative
Attacking the problem: Part 1
When COVID-19’s first surge started declining, we diligently worked on the process of creating an independent working reality with our fellow chaplain. Our first step was learning what could be done and what could not be done in the present setup. Next, we identified our perfect state or future state. The most common barrier was that the chaplain who is blind could not use a mouse to hunt and click on functions to go to folders, patient charts or files. All functions had to be completed by using the keyboard.
This involved some changes in key strokes both on the Ballad Health IT side as well as identifying the key strokes in JAWS and Epic. Thus, there was a lot of chasing people down to address what program was going to change and make the function keys workable for navigating through Epic by only using the keyboard with the screen reader JAWS.
Communication and dealing with the same individual each time were two important components to the success. The continuity of this project relied upon what was done previously and what were the identified limitations as well as actions of each program going forward. It did not all go as smoothly as we had hoped. There were times we needed directors and vice presidents to support the project and maintain the urgency of completion. With the COVID-19 pandemic as the system’s priority, it was often difficult for leadership to find the time to focus on our project.
All in all, it took about four months to complete the project where the chaplain felt comfortable charting on patients’ medical records without the assistance of others. This was a monumental success contributed to all departments involved.
Attacking the problem: Part 2
Our next hurdle was creating a process where the chaplain could document his daily work in the personal care log. This was more of an internal department remedy. As we worked on this project, we recognized that the chaplain could navigate Excel spreadsheets.
However, our care logs were stored in a shared drive and had multiple folders within folders. The chaplain found it very difficult to navigate through the multiple folders as well as the number of headings and subheadings inside the Excel spreadsheet. He could not determine what heading he was using or filling out. Thus, we had several conversations and changes to the care log Excel spreadsheet. We also made some changes on where the care logs for this chaplain would be stored.
Our solution involved creating a care log that required no sub-headings. We also created an individual month care log so the chaplain would only deal with one file at a time. The result was at the end of the month the chaplain would send to our administrative offices the completed care log for that month and we would send them a new monthly care log. So far, it is working well. There is still room for improvements and we plan to address those as we mature in the process. This, too, was a success.
Our opportunity for innovation was an achievement worthy of notice. This was a win for every organization as we proved to the system and to the other facilities that one person’s obstacle could be another person’s opportunity. The end products were achieved. We have a chaplain who is blind but who is independently charting in the electronic medical record. This chaplain can also submit a monthly care log reporting his daily activity. This is truly an innovation of independence that took a team effort!
A word from Matt Hallam
The chaplain, Matt Hallam, added this comment about his heartfelt gratitude for this project:
“I have been serving as a hospital chaplain in some capacity for 21 years, and this is the first time I have ever been able to chart by myself. I am extremely grateful to my corporate director of spiritual health services, Gary Metcalf, for orchestrating this; for Epic being a leader in making their EMR accessible to a screen reader; and to Ballad Health for being willing to hire people with disabilities and to give them the tools needed to succeed in the workplace. I have experienced a new level of independence, and I cannot thank everyone involved enough.”