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A Message from APC President...



APC President Ronald C. Oliver PhD MBA BCC
 

APC Forum, July 2019, Vol. 21 No. 4

  

Future Trends: Great Opportunities
The
President’s Address
for
The Association of Professional Chaplains
Orlando, Florida – June 22, 2019
 

The Rev. Ronald C. Oliver, PhD, MBA, BCC
President, Association of Professional Chaplains, 2018-2019
System Vice President, Mission & Outreach, Norton Healthcare, Louisville, KY

Watch a recording of the 2019 APC President's Address
 
During the recent decade I’ve become a bicyclist, again.  For many years my staple has been 100 mile rides, centuries as they’re known.  In fact, you are looking at the Louisville Bike Club’s 2012 Tour de Mad Dog New Rider Champion.  One summer my two sons & I cycled 455 miles from our home in Louisville, Kentucky to our family reunion in Amory, Mississippi.  Amory is a little corner of this world I’m glad to be from.
 
The Old Kentucky Home Tour is a wonderful cycling event with hundreds of riders through Kentucky’s country roads.   For years lunch has been at the same place – St. Michaels’s Catholic Church in Fairfield, Kentucky.   One year as I headed to the picnic tables I noticed these rows of Black Walnut trees.  What’s significant is that if you can wait 50 or so years, Black Walnut trees can be immensely valuable – a veneer quality log can be worth as much as $20,000.  A church member told me the story.  Over forty years ago 200 trees were planted by Father Nord with this idea in mind, “One day the church will need money for something important and this will be the provision.”  This priest was a visionary leader.  He acted with creativity to ready his little congregation for circumstances long past the horizon of his life.
 
You are our profession’s leaders.  As Board Certified Chaplains the profession now relies on you and me to ready the profession for its future around values that reflect our calling, our convictions, our competencies, and our craft. 
 
This evening I will describe the 4 trends shown on the screen that I see impacting our profession.  Each trend also brings opportunities that I will speak to.

  1. Big data and artificial intelligence
  2. The new again relationship of religion and science
  3. Business realities and the impact of secularization
  4. Formation and the soul of the profession

 
I’ll conclude by describing 3 essential practices I believe we must embrace to insure that the people and institutions relying on the unique care we provide will have it past the horizons of our lives.
 
These are:

  1. Be about Ultimate Concerns
  2. Be a Professional
  3. Be Proactive

 The first major trend is big data and artificial intelligence or AI as it’s more commonly called.  Hang with me here as I’m about to cover a lot of ground really fast.

  • AI in healthcare was #2 on Cleveland Clinic’s 2019 list of Top 10 medical trends
  • TIME magazine quoted Vladimir Putin saying, “Whoever masters AI will become ‘ruler of the world.’”
  • Isn’t this impressive?  Take a look at how big data drives the “Capacity Command Center” at the Johns Hopkins Hospital. 
  • While being a physician has seemed like a rather secure job, some are suggesting that because of AI, “physicians as we now know them will become obsolete eventually.”
  •  Ophthalmologists, look out!  AI is capable of detecting 53 kinds of sight-threatening retinal diseases in a matter of seconds and with 94% accuracy.  And, guess what, the computer is never late, never takes a vacation, doesn’t gossip, ask for a raise, or step away to go to the bathroom. 
  • AI is teaching physicians how to be more empathic.  Do you feel the irony?  Humans are being taught by a machine how to be more, well, human.  This 2019 book similarly argues that AI “can make healthcare human again.”
  • Then there’s nursing, secure or not?  Just four months ago a webinar examined how “AI and voice technology deliver more human, empathetic care” than human nurses.  Specifically they claim, “Virtual Nurses report lower admission rates, higher satisfaction scores, and better treatment outcomes.”
  • Surely religion is exempt from all of this.  Well, maybe not so much.  According to this March Wall Street Journal story, ‘Religions are now using Robots to Connect with the public.’
  • Robots?  Really?  How about for chaplaincy training?  Does this ‘person’ look human?  She’s not.  She’s an avatar using AI to convey a problem to the chaplain and then actually responds in real time as a person would.  And, get this, she reacts to the words and body language of the counselor.  One of my Chaplains, Major Kerry Wentworth trained with this technology and he tells me that the Air Force has been using it for about 6 months.

 

AI is driven by data – Big Data.  Here’s an astounding statistic.  The authors of this Fortune article calculated that, “The amount of data you slough off every day – in liquid biopsies, electrocardiograms, to name just a few – is overwhelming by itself.  Throw in the stuff from medical claims, clinical trials, prescriptions, academic research and more and their yield is something on the order of 750 quadrillion bytes every day – or some 30% of the world’s data production….  It’s the most radical change happening in healthcare.”
 
To put this in some perspective, the first computer I bought in 1986 had, are you ready for this, a 5 megabyte hard drive.  As I was working on the purchase the salesperson tried to up-sell me to a 10 megabyte hard drive to which I vividly remember saying, “What will I EVER need 10 megabytes for?”  To get my head around 750 quadrillion bytes I asked my engineer son how many 5 megabyte hard drives would be needed to hold the data being generated EVERYDAY in the healthcare ecosystem.  Get this, I’d need over 143 million of those old 5 megabyte drives just to hold the daily accumulation of healthcare data.
 
And we’re just beginning, this author assessed, “Artificial intelligence is sort of like the internet.  It’s going to creep into everything.  From what I hear, we’re at the 1 percent stage right now.”  AI is being called the Fourth Industrial Revolution.
 
AI and all this data will impact every venue in which we work.  So wonder with me, “What will we do when a robot can comfort our patients and clients?”  Lest you assume that people can’t bond with something that isn’t human, remember Tom Hanks’ anguish in the movie Castaway when Wilson floated away?  I’m betting that during the next 71 seconds you’ll feel something tender for a volleyball named Wilson……I’m wondering, who did you feel worse for?  Tom or Wilson?
 
Here’s a possible scenario.  Instead of getting a list of new admits, your client list is generated by an AI Command Center that determines the clients most likely to benefit from your visit.  I say “your visit” because the list will be different for a chaplain with different specialties.  Wouldn’t it be great to see just the people that would benefit from being seen by you?  I think so.  Does the administrator agree?  I think so.  And, the administrator has more options.  What if the chaplain’s plan of care is translated into data that assesses the impact of the encounter on length of stay, patient satisfaction, patient compliance, and inevitably, return on investment?  Sound far-fetched?  I don’t think so. 
 
In this I see great opportunity for us.  Klaus Schwab, executive chairman of the World Economic Forum believes that, “[While] we have less need for labor…the question we need to answer is, ‘What is the purpose of life?’  Up until now we defined our purpose of life by production and consumption.  Perhaps now, we move from that narrative to one of sharing and caring.”  Schwab’s words eerily echo those of Dr. Martin Luther King, Jr. who said in a speech one year to the day before his assassination, “…we must undergo a radical revolution of values.  We must readily begin…the shift from a thing-oriented society to a person-oriented society.”  What does this mean for the professional chaplain?  Dear Colleagues, you and I are exceptionally well prepared to help people grapple with these deep questions and consider what living a purposeful life is about.  We do this and we have been doing it forever.
 
A second trend is the incredible change happening between religion and science
 
In the movie Flatliners, five medical students create their own ‘temporary’ death experiences in order to take a sneak peek into their hereafters.  Notice this line from the original release…Philosophy failed.  Religion failed.  Now it’s up to the physical sciences.”
 
Today science is making unexpected inroads to areas long the exclusive purview of religion.  This 2018 article on “The Science of Good and Evil,” says, “For centuries the question of how good and evil originate and manifest in us was a matter of philosophical or religious debate.  But in recent decades researchers have made significant advances toward understanding the science of what drives good and evil.”  Another study carries the bi-line, “The science behind our complicated relationship with the truth.”
 
Here, secularization and science intersect as “In God We Trust” becomes, for some, “In Science We Trust.”
 
Arguably overdue, professional chaplains have embarked on our own research agenda.  I support this focus and believe that it is long overdue.   Let us be careful though that we do not linger too long at an altar strewn with calculators, spreadsheets and mounds of data dripping with statistical significance.  
 
My pause is this:  For some there is a hope that research will provide an utterly irrefutable rationale for our work. I do not share that hope, at least not to that extent.  While we have data that makes the case that employing a professional chaplain makes economic, patient satisfaction, employee engagement sense, I wonder if anyone has studied whether or not this data convinces an employer that they should hire or keep a chaplain?  In the face of convincing data, how likely is that administrator to say, “I believe in your data, but, frankly, I just don’t believe in you.”  My concern is not about chaplain effectiveness in the aggregate, but how compelling is an argument about effectiveness if the chaplain has not demonstrated competence and achieved meaningful team-level integration?
 
So, what does this mean for the professional chaplain?  When our research informs our practice and our practice positively impacts those in our spheres of influence, something very relevant and enduring occurs.  Where appropriate, integrating faith and science dimensionalizes our ministry.  Dear Colleagues, I believe that “All Truth is One” and some of our most interesting and necessary work will be helping others find comfort in the unsettling paradoxes found where theology and science intersect.
 
Trend three, “Let’s talk business.”  Particularly for those of us in healthcare, take note of this: In a 2018 survey of hospital CEOs, “Financial Challenges” was their #1 concern.
 
I became so concerned about the business argument chaplaincy faces that I went back to school in 2016 to earn a MBA.  I did the MBA because I became convinced that in order to remain relevant, our profession must grow in its capacity to interface faith and the realities of business.  And, I believe, the responsibility for this integration lies with the leaders of our profession.
 
We have to look for ways to connect our expertise with our business opportunities.  Among many possible examples, professional chaplains are extraordinarily well prepared to address provider burnout.  According to this 2015 Mayo report of nearly 7000 physicians, 54% reported symptoms of burnout, 33% excessive fatigue, and 6½% reported recent suicidal ideation.  Four hundred physicians complete suicide every year.  What that means is that roughly three average sized medical school graduating classes are needed every year just to replace the physicians who killed themselves that year.   This is a crisis of grave professional concern.
 
Our efforts here will, however, face challenges.  Notice that the Experience Innovation Network does not include “Spiritual” as a domain in their definitions of “Burnout” and “Well-Being.” Additionally, only 2% of medical residents say that spirituality is a resource they use to cope with stress.  The lessening role of religion, and to some degree spirituality, is an obvious indicator of the impact of secularization. 
 
You’re likely familiar with the data quantifying how fewer and fewer in the US say that religion is very important to them.  Here are a few data snapshots.   Christmas continues a long trend toward secularism.  While the exact number is hard to pin down, it’s widely estimated that thousands of churches and other faith communities close every year.  According to a 2017 Pew study, 25% of U.S. adults now consider themselves spiritual but not religious.  In Canada and Europe all these trends are occurring, but are more accelerated.  For example, in the Netherlands only 14% of its population believe in a personal God and for the first time in history agnostics and atheists there represent the majority of the population.
 
While we are well prepared to care for those for whom religion and spirituality hold little sway, there’s a growing facet of this demographic we are not yet well prepared for:  Colleagues, meet your next supervisors, the “Nones.”  Soon today’s “Nones” will be running the institutions that employ us.  We can expect that this generation of leaders will be unfamiliar with religious language and practices and may even lack the intra-psychic infrastructure that even a modest practice of spirituality instills.  They are more comfortable with privatized spirituality than group religious experiences and they value the leading emanating from their personal inner space far more than authorities and dogma.
 
Bottom line: We cannot assume the “Nones” will understand us and what we value.  For example, I expect they may not grasp what “presence” is and they most certainly won’t appreciate what “presence” means to us.  Dear Colleagues, if we are going to be around we will have to get great at aligning our work with our organization’s strategic plans, financial goals and operational tactics.  We must translate the insights from our research into return on investment metrics.  Remember Murphy’s Golden Rule, “Whoever has the gold, makes the rules.” You and I may not like that rule, but it is the rule that drives business politics.
 
These changes could feel alarming, and in some circles I’m sure they are.  For professional chaplains, though, I see opportunity as our training and expertise makes the land of the “Nones” and the concerns of provider burnout fertile soil for our expertise.  A professional chaplain understands that people all seem to want, wonder and worry about mostly the same things.  As the Dali Lama said, “Everyone wants a joyful life.”  We understand that burnout is more existential than circumstantial.  Systemic burnout is not fixed with recreation and frou-frou, but with connection to meaning and purpose.  In this study the authors identify workplaces that provide meaning as the “best places to work” for millennials.  Professional chaplains have insights that create meaning.  Undeniably, meaning-making is where professional chaplains are uniquely competent and capable.
 
Trend four:  Because I so deeply believe in what people long for, because I am concerned that that people suffer, because I connect with what people hope for and because I am convinced the professional chaplain is uniquely positioned to help them, this fourth trend is of significant concern to me.  The profession is now well into an ontological challenge that pivots on this question: “What is the role of formation in the process of becoming a professional chaplain?” … “What is the role of formation in the process of becoming a professional chaplain?”
 
Speaking to this question, ACPE Board Chair Dr. Amy Greene wrote, “There is an important difference between training and formation. Formation is what happens in the intensive give-and-take of the person’s interaction with their own beliefs, attitudes and prejudices when confronted with all the variety of the human experience of suffering….  When caring for persons in life’s most pressing situations, the integration of self and learned skills is necessary in order to be effective and, even more importantly, to do no harm. One cannot be effective by applying facts or techniques gained by rote memorization or checking off a list of courses completed.  Spiritual care is an art, not just a skillset.”
 
APC Board member Dr. Mark LaRocca–Pitts wrote what may currently be the definitive essay on this perspective.  Mark says, “Beginning with the early pioneers in healthcare chaplaincy…a philosophical as well as a pedagogical difference has existed between the doer of chaplaincy care and the doing of chaplaincy care…, or … the difference between ‘the integration and transformation of the chaplain as a person versus the acquisition of knowledge and skills the chaplain needs.’”
 
One of the first texts of the profession is, The Art of Ministering to the Sick by Cabot and Dicks.  Ministry is much more than tools and techniques.  Ministry is art informed by research, conveyed by tools, and expressed by technique.  Once we separate tools and techniques from the art, the profession is doomed. 
 
Unfortunately, this misplaced emphasis on knowledge and skills is well-underway.  A group unrelated to us or any of our Strategic Partners, stated in their marketing literature, “The central feature of [our] … certification process is to, as objectively as possible, assess whether the candidate has the knowledge and clinical skills to deliver evidence-based quality process, structure, and outcomes for spiritual care."  Their assertion is that anyone demonstrating the ability to retain the knowledge and enact the skills can be one of their BCCs. 
 
In fact, that’s exactly what’s marketed: “[We now offer] a path for social workers, nurses, and other health care professionals interested in becoming a Board Certified Chaplain (BCC).  If you are interested in adding BCC to [the] list of your credentials, this program may be of interest to you.  It is designed specifically for the working professional.  It is very flexible and convenient, and it takes approximately one year to complete.  You do not need a Masters [sic] of Divinity or religious endorsement to be board certified as a chaplain.”  Is this not problematic?  ‘Houston, do we have a problem?’
 
Last year in my role as president-elect I attended the conference of an association unrelated to any of our Strategic Partners.  A plenary speaker, a physician, praised his chaplain who told him, “I never discuss theology with the dying.  I listen for the affect.”  Uh-oh, ‘Houston, we have a problem.’  While I agree that listening for affect is important, I reject that a chaplain “never discusses theology with the dying.”  If a chaplain only focuses on “affect,” what’s their uniqueness?  What do we bring to the patient or client that is any different than anyone else listening for affect? 

This organization lobbied APC and most of our Strategic Partners to endorse a petition they wrote to lobby the United States Congress.  The centerpiece of the petition stated:

Clinically trained professional chaplains working as members of the interdisciplinary health care team:

  • Facilitate communication across patient, family, and staff
  • Provide valued support to friends and family of the patient
  • Facilitate goals of care discussions for patients that can influence care choices, treatment compliance, and patient quality of life
  • Help alleviate staff stress and burn-out
  • Liaison with community religious leaders

‘Yes, Houston, we do have a problem.’  Are you as startled as I am by what is missing?  Words like theology, religious ritual, integration, meaning, suffering, worldview, purpose…neither the word “spiritual” nor any synonym for it is mentioned in this version of what a professional chaplain is and does.  Alarmingly, replace “professional chaplains” in their header with “social workers,” “patient advocates,” “well-trained lay volunteers,” and “almost anyone else” and their so-called critical functions still apply.
We are at an ontological inflection point.  The profession is bifurcating here.  Those of us who believe the served are best served by the professional chaplain who is both formed and informed must be concerned for our mission, clear about our methods, committed to excellence, and convinced that formation is an indispensable requirement for the preparation of the professional chaplain. 
Allow me to illustrate the point this way.  I’ve worked in healthcare for 30 plus years.  I’ve seen what nurses do and I bet if I put on scrubs, hung a stethoscope around my neck, I could pass as a nurse for a while.  I can deliver meds, clean up messes, answer basic questions, and, perhaps, even do CPR.  So, rough numbers, I could probably do about 75% of what a staff nurse does.  The key question is, “What would I not be able to do?  What’s in the 25% zone?”  I wouldn’t notice that the patient’s color is a little off or that the numbers on the monitor are out of sync or that the drugs I’m about to administer may kill the patient.  Just because I can do nursing stuff doesn’t make me a nurse. 
The parallel is this:  In my view, any organization that requires less education, less clinical training, less accountability and less rigor are producing providers for, at most, the 75% zone.  By contrast, we certify professional chaplains who can handle both the 75% and the most critical 25%.
So then, caveat emptor – buyer beware.  This marketing targets two types of buyers.  First, there are the employers that accept at face value that the profession’s core words: “chaplain,” “CPE,” “evidenced-based,” “board certified,” “M.Div.” and others mean the same thing to everyone.  Quite simply, they do not.
 
The second buyers are providers who choose the skills-based path for their own training.  I do not fault these consumers and do not believe them to be poorly intended care-givers.  But this path is not the same as professional preparation.  Again caveat emptor.
Remember Dear Colleagues, if it were easy, everyone would do it.  We have chosen our path not because it is ‘flexible and convenient,’ but because those served deserve the care only a professional chaplain can provide. Those in desperate need, need someone who can do more than lip sync words of care and faith.
So, among others, these are four trends our profession must address:

  1. Big data and AI invites us to help others define and live into a purposeful life
  2. The ever new again relationship of religion and science should inform our practice and invites us to interpret and promote the complementary relationship of faith and science in a fashion that settles, and enlivens, troubled souls.
  3. Business realities can push us to help our employers focus on life’s ultimate concerns and we can use that focus to address provider burnout.  And,
  4. The ontological bifurcation being forced into the marketplace invites us to assert the rationale and methods for the formation of the professional chaplain.

 
In the face of these trends I agree with Edward Deming who famously said, “It is not necessary to change.  Survival is not mandatory.”  While these challenges, and others, are significant and even interesting, they are not insurmountable.  Those that came before us, met their challenges and delivered the profession to us.  We will meet the challenges of our day.
 
During the Civil War, Abraham Lincoln was known to slip into New York Avenue Presbyterian Church on Wednesday nights to hear the preaching of the Rev. Phineas D. Gurley.  One evening, as Lincoln and a companion left the church to return to the White House, the companion asked, “What did you think of tonight’s sermon?”
 
                Lincoln answered, “It was brilliantly conceived, relevant, and well presented.”
                “So it was a great sermon,” the companion said.
                “No, it failed,” Lincoln replied.  “It failed because Dr. Gurley did not ask anything great of us.”
 
I came here tonight to ask three things of you.
 
First, be an expert on the ultimate concerns of human experience.  Ultimate concerns are our zone of unique and undisputed expertise.  For most of us that means being a theologian.  Secularization has not made theology obsolete.  Our place is with people trying to understand life and suffering in light of ultimate concerns.  I believe Michelangelo got it right when he placed in the very center of the Sistine Chapel the hope we have to connect with the Ultimate.  Dr. Wayne E Oates, author of more than fifty books on pastoral care and who I was honored to grade for in seminary and then have on my Ph.D. committee wrote, “Pastoral Counseling is the sweaty participation with persons in their life-and-death struggle for moral integrity in relation to God.”  Peter Berger wrote in The Sacred Canopy, “It is not happiness that theodicy primarily provides, but meaning.  And it is probable…that, in situations of acute suffering, the need for meaning is a strong or even stronger than the need for happiness.”  I have found that in every meaningful chaplain conversation I have with someone in crisis, the, “Why?!” question comes up.  This is Ground Zero and it is Holy Ground.  You and I are not in the happiness business, but something much more existential and resilient.  We are in the meaning business.  In this very sweaty place our unique formation and competence shines brightest. 
 
Second, be a great professional.  For most of us being a professional is not about business plans and balance sheets, but about being proactive and producing results where we are.  Here’s the fundamental business question you need to be able to answer with a “Yes” every day:  “Did it get better because I accomplished something relevant?”  What a professional does is solve.  What a professional does not do is whine.  We must stay above the line.  I remind you, criticism requires no talent.  Kathleen Reardon wrote, ‘We are 75% responsible for the way others consider us.’  If so, doesn’t it make sense to concentrate most intently on that 75%?  Own it, live it, shape it, and when necessary change it.
 
Additionally, a professional is a life-long learner.  In 2010 Col. Herman Keizer, Jr. addressed our Association when he received the Distinguished Service Award.  He said, “Competency is a moral imperative.”  I ask you, consider our fifty hour annual continuing education requirement as the bare and absolute minimum.  Your and my BCC represents the starting line, not the finish line. The competence gap between where we will be in relation to our professional peers will grow unless you and I are committed to rigorous, relevant, life-long learning. 
 
Third, take initiative.  Get involved.  Take the right risks.  Embrace the very first habit in David Covey’s 7 Habits of Highly Effective People:Be Proactive” .  .  .  Shape the future.  Address worthy challenges.  Embrace that you are “response-able.”  Don’t drown in the shallow end.
 
The Strategic Partners are going deep with this question: “What do we need to be and do to ensure the vitality of our great profession?”  Since February 2018 we have been working toward an answer – APC began our work in early 2017.  Here’s what we know:  Quite simply, the profession needs us to work together.  We’re doing more and more together and we’re getting better at it as we get closer together.  I promise you that amazing days are ahead.  I promise, you will be kept fully informed.  I promise you that you will have a voice in the process. I hope you sense the magnitude of this moment and support the direction we’re heading.
 
So, in conclusion:
 
In seminary I needed a dozen or so different jobs, many at the same time, to pay the bills.  No doubt many of you relate.  One of the more interesting jobs was the years I did marketing for a volunteer fire department. I was interviewing a volunteer who told me about the very first time he responded to a fire just after completing his training.  They pulled up to a home that was fully involved – fire was coming through the roof and out of every window; it was a real mess.  He told me that he remembers saying to himself, “Someone should call the fire department….”  Then the sobering moment, he realized, “Uh-oh, I am the fire department!”
 
You and the nearly 6,000 members of our beloved Association of Professional Chaplains have been called.  We have been trained, we have been tested, we have been examined, and we are proven.  We have been formed for this very moment.  Together we will ensure that those served by our profession, those whose hearts are heavy with guilt and grief, those who look to the heavens and ask, “Why?,” those whose lives have been pulled down and apart by abuse and addiction, those who are marginalized and minimized, those left out and left behind, those who stand at the altar for both reconciliation and celebration – it is for these dear ones that we have paid the price so we can bring relief from the burden desperation imposes. 
 
My Dearest Colleagues, I have never been as confident and as honored as I am right now to be doing all of this with you.  Thank you so very, very much.

 


Rev. Ronald C. Oliver PhD MBA BCC is a system vice president, Mission and Outreach, of Norton Healthcare, Louisville, KY. He serves as President of the APC Board and may be contacted at president@professionalchaplains.org.