Rick: [00:00:00] Welcome to healthcare nation podcast. I'm your host, Rick Gennada with our producer, Joe Woolworth. Joe, how you doing up there?

Joe: Doing well. How's Florida?

Rick: Good. Good. It's very, it's still hot here. It's still hot. Down here. I'm in studio C, which is down in, in Florida. Not in our new studio B, but can't wait to get back there and see you because it's so much more efficient.

And listen, I miss your face. That's the

Joe: Oh, that's nice

Rick: That that, and look, the other pieces, and I want you to weigh in heavily. We've got our show today. We've got David cow. Who is the vice president for mission integration. I'm going to introduce him formally in a second for dignity health in Northern California.

I've wanted to do a show that really revolved around spirituality and chaplaincy, because that's the way it expresses itself within really, we'll say the healthcare delivery side of the health sector and Joe, this is an area that you have experience in. Do you want to share that with the audience just a little bit?

Joe: Yeah, [00:01:00] sure. My, my degree is in ministry. I spent a couple of decades in various roles and various pastoral type of roles. And now I'm focusing more on ministry. non traditional ministry kind of stuff. Whereas I still have my faith. I'm just not on staff anywhere at a church any longer.

Rick: Yeah, but I think, yeah, I think it's safe to assume though, and I've, seen this with you that look, your spirits in your work every each and every day, the way you treat people, the way clearly it comes through

Joe: This was a fun topic. It was interesting to me because I did spend decades in, a church setting where surrounded by other employees who did this kind of thing full time and entrusted with the spiritual care of people and the idea of talking about it from a chaplaincy standpoint, really simplified a lot of things that I found were very challenging.

So it was a really fun episode for me, particularly thinking. [00:02:00] As some of the churches that I served on, one of the big things that we were doing is trying to educate, or the Christian word for it would be disciple, someone into thinking according to the doctrine that. Is held up by that church and most churches hold up the doctrine of the Bible, et cetera.

And the, challenge being there was a couple of challenges that I think chaplaincy solves efficiently. One, it seems like for some churches, the role of discipleship can be about making it, how do I get people to conform to the pattern? And less about the results of is the spirituality helping this person?

And it's that's not really the metric, but in chaplaincy, that's their only metric. They have to constantly, as we talked about on this episode with David, they have to prove their worth to administration. They have to show efficacy that the, care that they're providing is, helping in a tangible way which I [00:03:00] thought was really beautifully streamlining the process instead of saying like how well do you conform?

It's more about like how is spirituality making your life in health? Better

and Putting the focus. There's is a pretty unique.

Rick: I'll tell you when you, think about this, and clearly I've been in the C suite of a few healthcare organizations for many years. And what I have always thought is. Chaplaincy was an X factor. That's the, that was the term I used. It was just there. And if you were fortunate enough, I'll say blessed enough to have a great chaplaincy program.

And this goes way back to my early years when we had a CPE program within the hospital. Wow. It did so much clearly for the patients we serve, but what I. Quickly recognized was the staff benefited, dare I say, almost as much as the patients did just to have a person that can [00:04:00] go to that level of counseling.

Everything that goes into that really powerful. But one of the things that came up in this episode was also and you just touched upon it. How do you measure that? Because in healthcare, look, sometimes you have finite resources, you got to prioritize what you're doing. There are big ethical issues, very highly charged situations, measuring what you're doing what kind of a clinical return you get.

And dare I even say the, just the return in general, when you have to think about, again, allocating finite resources, right? Your budget, it's important to measure the impact. And I think we

Joe: Measurement is a really, it's a really tough thing. It's a really tough thing spiritually. Like I sat on the sweet suite in a pretty large mega church and we would talk about how do you measure someone's spiritual development? What are the key metrics that you can evaluate? And there's some tangible stuff like in the church world, do they come?

Do they donate? Do, have they done [00:05:00] this thing? Have they checked this box? Have they done that? But there is an acknowledgement that those are pretty weak metrics. It's more like it's measuring symptoms more than causes. If somebody is spiritually healthy this, would be something that they would do, and it doesn't necessarily work the other way.

Like spiritually healthy people are healthy because they've done these things, isn't the same trade it's, it doesn't really translate well. So

Rick: Yeah,

it's almost when we think about patient satisfaction, right? Or staff engagement. If you had that world represented in the metrics, and I think you probably could. Maybe not so much happiness, but sense of contentment, that kind of thing.

Joe: Contentment, contentment may be measurable. I think one of the X factors to your point is, and I think this is an important role in somebody surviving or beating something. Like I think when my dad was going through cancer, the doctor said hope is really important. How do you [00:06:00] measure somebody's level of hope? And it's not really a standardized thing that when the doctor, the oncologist comes in, he's there to deliver results. Their framework is probably not in to make sure I instill some hope. But that is the role of a chaplain which is unique and actually just a really beautiful human caring kind of thing to do is to.

Help somebody bolster their hope for their situation. It's challenging.

Rick: And having, the time to be present with someone when they're going through a

Joe: Yeah

Rick: very rough

Joe: that's a really good point

Rick: That's, I think that's, one of the things

Joe: And I was thinking to it yeah, and I was thinking about that while David was speaking the It's almost there's if you're find yourself in a situation that is life and death a spiritual talk feels a lot more appropriate Then like when you're in [00:07:00] the checkout at the grocery store Have you ever seen that christian person like in the checkout on the grocery store that makes everything about jesus?

And it's oh that could be like as extreme as like I got a flat tire. The devil's really persecuted me It's okay. Maybe you just got flat tire. It

just feels a little bit

Rick: It's a worldview.

Joe: It's a worldview. and it. But it feels it seems like the people that do it really well, and I think about parenting, and not necessarily instilling spiritual values, but even instilling spiritual values, the appropriate time to have those parenting conversations is in the moment when they come up.

Rick: Yeah. And you know what I'm saying, worldview, it's just it's, meeting that individual in their place. That's their view of the world. And I think this is, again, I will tell you that particularly when we talked about staff burnout and having someone present and be there. When you're thinking about a clinician stretch to the max and maybe not being able to be with a patient through their entire time, if they're going through a really rough batch or a family member who's losing someone, [00:08:00] it's we could both agree it's the right thing to do but it's even more than that.

It's the thing to do

Joe: Yeah.

Rick: if that makes sense.

Joe: And it's a very challenging, and a lot of respect for chaplains, because there's, you can be right in the wrong way, You can offer hope in the wrong way. You can in your attempts to offer hope, be very trivializing and hurtful and not being aware. I remember one of the first funerals I did was my, for my grandfather and my grandmother, not a very deeply spiritual person at all.

And I had just come out of seminary and I did the whole thing and blah, blah, blah. And we're in that. I'm in the wake after, and I'm just trying to consult my grandma or console my grandmother. And I said, just that really trite thing that a lot of people say, Oh, grandpa's in a better place, a thing.

And that was hurtful to her at the time because she didn't share [00:09:00] that worldview and it was just like heaping on. And was in, from her perspective, it was like, I want him to be in this place. So that was not bringing hope and care to her.

And so I think.

Rick: It was a lot. An unreconcilable loss for her.

Joe: Yeah, and I think that was I thought was a very beautiful part about david brought up is trying to figure out how to take A lot of the spiritual language out of things And just distill it down to the helpful Things he even mentioned like we don't necessarily frame it as prayer.

We might call it guided meditation the helping people understand the benefit of the act of spirituality without feeling that they've got to be on board with joining a dogma or a, particular brand of denomination or branch of spirituality is, a worthy thing to [00:10:00] spend your time trying to do.

Just figuring out how to help people and cut through some of the things that can be. loaded for people that can be triggering for people, especially based on your upbringing and your background. Some people have beautiful things to say about their experiences at church. Some people have awful things to say about their experiences at church, and that can really shade any interpretation of spiritual truth that somebody is trying to share with somebody.

And so it's, a complex thing. And I think chaplains are really they're really going for it. It's

Rick: Yeah. And Joe, let, I, I gotta take take advantage of, of. your place and where you're at right now in time with me and this show I call you, you're my spiritual technologist. Yeah. Yeah. You produce the show, but, and this so many episodes we talk about technology. We talk about the health sector.

That's happening in the markets. What's the next thing around the corner? Think about your background as when you went through [00:11:00] ministry and now you're deeply into technology, not only producing the show, but you have lots of productions out there with your company doing an incredible job. Where do you see things going with respect to chaplaincy in the health sector and technology?

What are some of the what are folks missing? I've always believed you got to have. Perspective from the outside come

Joe: Yeah,

Rick: to charge things up. So let's hear it from you.

Joe: it's a great question. I don't know if I'm going to pull out a crystal ball and give some predictions of where stuff is going, but I'll tell you, I have a very strong opinion on this topic of what is missing. I feel like the last time that the church really the last time the church really came up with a new modality.

For treatment to use some medical terminology was the 70s in Sunday school that was the last time they changed from like a Lecture based sermon where you come and gather and one person speaks and everyone [00:12:00] listens to a different modality Across the board and then Sunday school kind of fell out of fashion and we have no new modality I was I was optimistic with some of my ministry friends that kovat was gonna force the new modality To come into play and be like so how and this is To use some christian terminology if that makes anybody that's in the church or spiritual and comfortable.

It's not changing the message I'm talking about changing the modality

Rick: right?

Joe: Are we being? are we meeting people where they are which is the words that david was using the Are we being effective in? Joining people in their situation as opposed to the lecture based. You should come here feels if you play by our rules, you can join the team and then this could be useful for you.

But if you don't then church is just super boring for people that aren't trying to play by the rules. [00:13:00] It's.

Rick: Think about how hard it is when you're going inside a healthcare institution or within or side by side with someone who's going through a journey of a health crisis. But one of the things I wanted to ask you along really along those lines, particularly with the technology side is what I'm seeing is, yeah, sure, we have the double digit population growth of folks over 65, no doubt and meeting them through some kind of Tele chaplaincy probably would make sense when you think about that population, but it's the younger folks with social media.

And when you think about, and clearly we're talking about the health sector here, but when I look at the apps that are out there for mental health and, they're making such a difference, I think that the statistics

Joe: right.

Rick: and the feedback is just it's certainly more good than, not.

are your thoughts on the social media side and we're going to talk about health and spirituality and what's missing out there or maybe [00:14:00] I'm missing the fact that there is

Joe: Yeah, I think there's. I've seen like two sides of the camp when it comes to the pros and cons of social media. And I think what it breaks down to is a person's individual take on whether they think online connection is real connection or is online connection fake connection. And I think the person who would make the argument that it's fake connection is of the camp that it's that whole.

On Instagram, we give the glossy version of our life that's just we only show the good things and we only talk about the good things and I think the person that would be in the camp that social or online connection is real connection is just more thinking like connection is the thing that's valuable.

Who cares the platform in which it happens. You could see people make the same arguments about the telephone in the past. I can't believe we're not going to have face to face conversations. This is the beginning of the end. And now it's like a phone calls like this [00:15:00] elevated form of communication to text.

It's Oh, you really care? Like you called on the phone. This must be serious. And it doesn't have that connotation anymore. So I think we're still in that. That place where it comes to I think a lot of churches and a lot of people from a spiritual standpoint I think kovid changed that for a lot of people with offering services online We got real good at a church of being like, okay, like we used to be like You can't go to church from your couch with your feet up and be not Engaged with people and blah blah blah and then we couldn't go anywhere and we're like it's better than nothing and so it's we figured out how to do it.

So I think the same thing applies with telehealth and chaplaincy, and you can, increase the effectiveness with the tools. Again, I think it just goes down to if we thought about the way that we applied spiritual principles as modalities we could ditch some of this debate that is esoteric around the right way to do [00:16:00] stuff if we were just like, but what if it was just helpful? What if we just focused on just things that were helpful and if there, maybe there's different degrees of helpful. And like you could make a case that's like the best way to do it is this way Yeah, but you can't always do it the best way So we don't need to throw the baby out with the bath water and say there's only one way to do spiritual care as a chaplain

Rick: Yeah great, points. And the one thing though, I have to weigh in on that too. And I want to hear what you say when you look at even Instagram and I don't know if I'd characterize it as self help, but. Some of the feeds that are coming through that, yeah, they're inspirational.

There's no doubt about them, but they're certainly not chaplains in a real conversation. And how much do they substitute, if I can use that for the real thing. And by the way, what will the real thing even look like in the future? You and I both spoke about the JAMA study that had [00:17:00] AI.

Demonstrating equal to, if not arguably more empathy than physicians.

Joe: Yeah

I would love to see like a correlating study with that on spirituality like from a church standpoint there's so much of Tradition baked into the way that denominations communicate with people and it would be really interesting to see like a fresh take one of the things that I where I work the church that I worked at one of the things we worked hard to do was to not speak to people in Christian ease that thing that if you're not really down with like how do you understand the end times?

I have an eschatological pneumatology about how I believe that it's okay, I don't know. Just help me out. That's not where I'm at. I'm just, I was drunk yesterday and now I'm here in the pew today.

And how do you, how do you communicate to that person and the person that's on a different level?

So I think I would love [00:18:00] to see the role of what AI could possibly do to translate in a way where, language is lost when it comes to issues like vocabulary and and

Rick: Yeah. I think,

Joe: concepts that are difficult to unpack,

you know,

Rick: the common language, the taxonomy that we could relate to, but I think it gets back to our guests and meeting folks where they are. So look, Joe you, are the spiritual technologist, right? That's it, man. You're,

here. that's we know that.

Joe: the heck is that?

Rick: And, we at Healthcare Nation, we take everything into account, including clearly the spiritual side of care, not only in healthcare delivery, but in the health sector.

So look let me, introduce our guest. So David Kal, great episode. David is the Vice President of Mission Integration for Dignity Health in [00:19:00] Northern California. I taught with him over the past year at Union Theological Seminary in New York on really the value of chaplaincy in, in, in the healthcare space and healthcare delivery.

He's got a long history in obviously chaplaincy, but a really incredible journey and story that he's gonna get into in the episode. But one of the things that I think is compelling, From talking to him and his perspective is he gets the high reliability organization side of hospitals, the highly charged environments that are there he we talked about telechaplaincy.

That is, I think, bold and different for someone who comes from that perspective, at least for me, understanding the value of chaplains, that X factor, Joe, that you and I talked about. And how to demonstrate that through some sort of performance metrics. We look, nothing was out of bounds with it. So I think that moving forward at least my prognostication is there's gotta be a place for chaplains [00:20:00] because you can't think about physical and mental health without thinking about spiritual health conversation with David Cowell really brought that home.

So Joe, thank you for your insights. And with that, give a warm welcome to David Cowell. Okay. Welcome again to the healthcare nation podcast with our host here, Rick Chinada and a very special guest, David Cowell. David, my friend, how are you doing today?

David: I am great. Thank you for having me on your show. Rick, Joe, nice to see you both. It's a sunny day here in San Francisco. It's been kind of cloudy for, for weeks on end, but you know, it's great to see the sun.

Rick: Hey, look, we've got all the coast represented today. We've got the East [00:21:00] coast. I'm down in South Florida right now. Joe's at our studio up North and North Carolina. Got you on the West coast. So you said we want to have a national show. I think we've got it. So thank you for doing that, David.

David: Box checked.

Rick: Listen, we got so much to talk about and I just wanted to tee it up and think about, you know, we're going to go down into some foundations. I've always thought of chaplaincy as. Being the X factor really in, in healthcare delivery, getting into places that folks don't really ever recognize with respect to everything from the healing power that you can have with spirituality to the value proposition.

If I can characterize it that way. And also some of what you're seeing is trends. I know you are a wealth of knowledge because of your vast experience, but I want to go back and dial it back really to the beginning, the background and foundation that is all about you and and your journey. So why don't you share [00:22:00] with me and our audience really what got you into health care?

Chaplaincy. What inspired you? What was the drivers? And how does that keep you going and contributing as you do?

David: Well, I will, there's the short, there's the short version and then there's the very long version. Chaplains actually were, are trained to be able to give a spiritual journey at various kinds and various lengths. The show. I'll start with that and then we'll circle back. The short version is that I am a cisgender, white guy queer.

And I am working as Vice President of Mission Integration for Dignity Health in the Bay Area. I have four hospitals that I am connected with here in the Bay Area. But how I got here was a little bit circuitous, I'd say, [00:23:00] actually. I'm a second career chaplain. I was, I was raised in California.

I was born to a loving home with multi generational alcoholism. Multi generational issues around you know, it was a, it could be a violent home at times. And so I had a very early experience of feeling a little bit different, a little bit set apart. I had a very spiritual side to myself, but my dad.

who was raised in Oregon, was very anti religious. He had an experience when he was a young man, being sent by my grandparents to a church service and being excoriated from the pulpit because my grandparents owned the bar. So, that was a very formative experience for me. And so, I was not somebody who grew up in the church.

It was not something that I was... familiar with, particularly I'm [00:24:00] still a little fish out of water because I don't have that deep, you know, genetic, you know, understanding from birth of what churches are like. So I came to it later in life. I Resist. I, I resisted being a minister. I did feel the call to ministry in my twenties but I very much resisted the call to ministry as a, as a queer person, that's a very complicated you know, inter internal dialogue.

And. Being somebody who also what came out in the early 80s, you know, as AIDS was becoming so prevalent in most in our urban areas in particular it really was it was something that I resisted doing for a long time. When I was 27, I was seeing, I was with somebody, I had a partner, and [00:25:00] that, his name is John.

John had a case of pneumocystis pneumonia. We had always assumed, of course, that he was HIV positive. But he was in the hospital one day and he was dead three days later. That was a very transformative experience for me and it set me on a spiritual journey that was sort of unbound.

I became sort of fearful, shifted from being sort of fearful of seeking a spiritual life to someone who was a real seeker. My seeking went to... There were a lot of New Age folks in New York City at the time, that's where I was living, a lot of New Age folks, so I explored that a little bit and then began to think about structure.

I found myself at Riverside Church really the social justice [00:26:00] aspects of things appealed to me intellectually I felt a sense of being at home. To say, to a certain extent and that eventually ended up leading me to seminary. I wasn't the Union Seminary was an incredible experience. I learned so much, did not get ordained until 10 years later.

And in the interim, I was still resistant to the call to ministry. So when I moved back to California, I realized that it was time I was 41 years old, I figured it was time for me to really accept what I was called to do at least to some degree. So I entered a clinical pastoral education programs, kind of picking up where I had left off with my ministry.

Rick: Yeah. And let me just, let me, let me ask you one question along those lines. Cause I, [00:27:00] you know, the, the, I guess the notion of conflict, right. And, and if you were thinking about conflict, let's just say with respect to your sexuality, that would be one thing, but I think what I'm hearing here too, is, is almost the conflict of, of denying this, the strong spiritual calling that was developing over time.

And unfolding perhaps culminating in, you know, the loss of your partner, probably other environmental things that were happening in a very electrified time during the HIV AIDS crisis when it was emerging. You know, when, when you think about that, David, you know, what, what, what are your thoughts on, on that, the conflict?

And what do you think with, I mean, clearly you were being, you weren't just being called. It sounds like you were being pulled into the ministry.

David: I was, yeah, it was more of a poll as opposed to, and it was mutual, right? It was, there was definitely something in me that was searching for meaning and finding a way I had to, [00:28:00] my call I think was to serve in a positive way. I knew that I had certain kinds of gifts and that those gifts could serve a greater purpose.

And so The idea of being able to, to use those gifts in a way was balanced with institutional understanding of the institutions that were around me in, in the crucible of the AIDS. Epidemic, right? Churches were not a very comfortable place for, for, for gay people at that point. And so I had to actually make the the split between institutional church and spirituality not having had kind of the, the upbringing in church or having much of a spiritual foundation to some degree.

But it, you're right, [00:29:00] it was, it was this experience of losing somebody being able to transform that into a spiritual moment and connecting the grief process to a healing process really. And I mean, that's what it is. We had consciously feeling the grief, moving through it and having it transform your life so that you're something at the end of it, although, as we know, grief is ongoing.

But I did feel like once I entered, once I entered the seminary, that was, it was a step forward.

Rick: Yeah. And let me ask him along those lines. I mean, you know, finding a spiritual home. So, you had the spiritual sense, clearly, again, that notion inside of you, that, that call, that pull, that sense and, and even in your seeking to find a home then, in the, at [00:30:00] seminary, what, what did that do for you, and how did you then, guess, focus that into the healthcare space?

David: Well, I, it's interesting. I had never, when I was in seminary, I didn't really have a sense of healthcare at all really. I was more focused on getting through all my classes, staying in relationship with, with, with my classmates and my teacher, learning as much as I could so that I would have some tools.

At that time, we're talking early 90s now. At that time, really seminaries were a different place. They were looking at kind of specific context like they were trying to graduate people into. You know, Ph. D. Programs or they were trying to graduate people into churches themselves. The, you know, my, my internship was at the Riverside Church in the education department, for example, [00:31:00] gave me a sense of a place to give me a sense of how things run from that perspective.

We weren't talking a lot about. about CPE. We weren't talking a lot about healthcare chaplaincy, healthcare ministries at all. It wasn't until I started talking to folks about CPE that I really got a better understanding of what that could be.

Rick: Yeah. And how did you cross that bridge into thinking of ministry in a more traditional sense? And by the way, you know, Riverside Venerable Institution, really fantastic. How did you make that, that, that walk? Was it through volunteering or you said healthcare is perhaps a microcosm of the world?

Because I think not everyone is cut out for hospital chaplaincy. It's a very different environment. I'm not saying there's not. clearly analogies to, you know, the real world because it is the real world. [00:32:00] It's just a very charged environment. And there's other nuances with it when you get into clinical ethics and some of the other, let's just say challenges that you see within a healthcare, you know, situation.

David: Relational. It was interesting. I think once I decided that the call needed to be acted upon, I'd already moved back to California. It turned out that one of my friends from seminary was a CPE supervisor in the Bay Area Center for Clinical Pastoral Education and I reached out to her, Amy.

And I said, let's have lunch. I want to check in. I want to see how you're doing. And I wanted to talk about, you know, where we were with our lives. So she listened to me and we listened to her well and we connected and she felt like CPE was a good place for me to be in order to develop my own [00:33:00] awareness, to harness my own inner gifts that I could share with others.

I mean, that's clinical pastoral education is about that, getting awareness and understanding how. You, your, your, your heart works, your, your brain works, your, you know, where your soul is has a gift and then being able to use those gifts in the most effective way. So, she referred me to another person who ended up being my CPE supervisor at Sequoia Hospital in Redwood City.

It was amazing. I knew the first day. Once I walked in to... Sequoia Hospital that first day, and I started learning. I knew that this was actually what I had been looking for all along. It

Rick: Yeah, that,

David: just.

Rick: yeah. And, and, you know, I don't think you'd have that. That sense of, of [00:34:00] let's just say resonance with an institution if it wasn't for your background and your journey and what you just kind of described with respect to the, the challenges and the, and the opportunities that come with that kind of background and how you can apply it.

Let me fast forward now into what you're doing. I mean, let's, let's we'll get real here. You've got a pretty big job when you think about you're obviously in the C suite. Mission is a big part, probably the number one part of your job. Multiple institutions, hospitals that are reporting up to you. And it's a big responsibility.

If you think about your journey, everything that, that really makes you effective at what you do, and you think about what you have to deliver for those you serve in many ways, you might pragmatically say, Hey, it's the value proposition. Tell me about how that all comes together for you and what for you is the value proposition for chaplaincy in a health care setting and [00:35:00] I'll start with the health care, meaning the bedside setting.

I think it's much, much more applicable, but let's just start with that. And not only clearly informed by your own background, your own, as I've said before, you know, kind of walk that you've gone through, but what you instill in your staff and what you expect so that if I could say it, You get a clinical return on investment as well as let's just say a spiritual return on investment.

David: Well, yeah. And, you know, it's, it's, it's one, one visit at a time, really. You know, my first, my first gig as a chaplain, I was it was, I worked in hospice. And so I did adult and pediatric hospice for about 10 years before coming back to the hospital system. And those were formative years for me. I, the, the first few years of, of.

Post CPE are really, you get, you go so much deeper, so much deeper into your [00:36:00] practice and you really cement those things. So my understanding of how we serve patients now in the hospital setting is really formed there. I think there's a, there's a piece of me that the idea of a, of a, of a value press proposition because, because it's, you know, it's hard for us to think that way,

um,

Rick: doesn't, it doesn't sound reconcilable with let's just say the soul, right?

David: Right, right. But but on the other hand, chaplaincy departments across the country, across the world have to justify their existence. We have to, we have to show that we are making an impact that just with patient care and skill, the skills that we offer you know, assessing it. Providing [00:37:00] responding to documenting, evaluating, providing information to the team about spiritual distress, about somebody's existential state in order to further the plan of care.

in order to match it with the plan of care. It's a, it's a particular skill and it's a particular insight that we offer that really speaks to the idea of whole person care. We really want to think about the entire person when they come to us because they're mostly, unless it's a birth center or something, they're mostly coming to us at their most vulnerable time.

They want to get the best care possible and they also want their, their culture and their values to be respected, whatever those might be. So in order to advance the care of each individual that have, that trust us [00:38:00] with their care we have the opportunity to look at the whole person. It's the bio, psycho, social, spiritual model. People are, are multifaceted and they have relationships and they have values and they have a culture that's specific to them and what we're not running a factory.

What we're running is a hospital that is to serve the unique needs of each person and the individual. Now the

Rick: Yeah, and I was gonna, I was gonna mention along those lines and just, you know, thinking about my own clinical background, I think rare was the occurrence when There wasn't some element of spirituality in caring for an individual, even if it was a procedure and you knew that this person had a lot on their mind and perhaps they were praying, perhaps they were in deep [00:39:00] thought or wishing for a good outcome.

I think the support you can give at those times is really, it's just so powerful and both the power of just being present with an individual as well as, you know, if you Speak to them or pray with them. And I, I mentioned the X factor earlier and perhaps I shouldn't have connected that to the, to the value proposition, but I think there's, there's a there there, you know, when you think about the value of chaplaincies.

And I have to say the value piece because, you know, I've been in the C suite for many years and, and when you're in a tight, let's just say fiscal position and you're prioritizing things. You look at everything and sometimes chaplaincy is out there and do you outsource chaplaincy? Do you have itinerant chaplains?

Do you bring it in house? This is a real conversation. In fact, you and I, when we're teaching recently at, at Union Theological Seminary, that was a topic that came up and it's a real [00:40:00] I think it's a real challenge, particularly in today's economy and what What healthcare institutions are dealing with when you think about that and and the role you have and the mission that you have to really succeed at, it's got to be a pretty heavy load to carry when you're trying to do a lot for many, many constituents that aren't just say, physically suffering, but you know, they've got that spiritual as well as, of course, we know the mental health issues.

David: So that's very true. The other piece that chaplains provide is relationship with staff, which is really essential. No one else really has the time to check in on staff on a regular basis, on a daily basis, to develop a relationship wherein You know, we know about the kids and we [00:41:00] know about the family and we know about the trips and we know that we know the losses and we share those losses with the people that we're working with and chaplains.

Spend roughly a third of their times doing things you know, doing things with staff can't put, it's not, it's not billable. It's not charitable. It's not, it's none of the things. It's almost invisible unless of course the chaplain's creating problems on the unit, which has happened rarely. But it does happen.

But mostly. Chaplains are the ones who are kind of, I, I call it sort of the carriers of the ethos. That's the, the practice of all of the gifts that we have for the greater good for, for taking care of our patients, taking care of those family members, those loved ones who are also there. And that is prayer at times.[00:42:00]

I'm in California, probably less than where you would be, Rick or Joe. I mean, we don't necessarily pray as much. We do guided meditation. We do dignity therapy, life review, also known as life review. We try to frame things for people so that it highlights their own strengths. In the situation where they may feel completely vulnerable, completely out of place, have few choices, but in to empower people to make choices, to feel better, to do, you know, to do what they need to do in order to move past whatever, whatever issue that they're having to deal with.

Rick: Yeah. And David, you know, I want to go back to something you said because well, first a comment, I do think there are times when let's just say C suite leadership, they don't have the opportunity to walk the walk and there looks like there's a disconnect between, let's just say the mission [00:43:00] of the organization and some of the tough decisions, sometimes unpopular decisions that have to be.

Made, let's just say at the executive level, I've always thought that chaplaincy served such a really incredibly important role and making sure that there was alignment with that mission and for the long term vision of the institution with the folks that are out there at the front lines so that they feel connected.

They understand their place within that mission and they can see themselves in a future vision. I've thought that connection just, it should never be, you know taken for granted because it's so powerful. I want to, to expand on that and think now, at least in this environment, from, from what I'm aware of with burnout, clinician burnout, the stresses that are out there, the post COVID world, and actually what went down during COVID with respect to clinicians and, and let's just say a lack of trust, whether it came to [00:44:00] available PPE or not.

There's a, it's a, it's a loaded proposition. There's no doubt. How have you seen your role and your staff's role change vis a vis, you know, the the Even with turnover. I will, I will think about that. Of course, burnout big, but the turnover of staff, what, what are your thoughts on

David: Well, the turnover, turnover is so destabilizing to a culture if it's at the high level. Sometimes it's for the better. Obviously, we all need to do what we need to do with our lives. And so people make choices. But it, when we're, we're seeing a fairly high level of turnover at this point. A lot of people retiring, making that choice, which is lovely for them.

They'll think about it in my head someday, someday but they're making choices about what, how they want to spend the rest of their life. I mean, obviously COVID was a, was a huge moment in [00:45:00] moving people to, to making different choices about what they wanted to do. You mentioned something that I, I, one of the things that I think that really kind of emerged out of COVID was this idea of moral distress.

I, I think about it a lot more now and I also think about it as not being something that we should refrain from talking about. We should talk about it in parallel to grief in, in the sense that you can feel a more moral distress in the moment and it can make you feel better. But it doesn't necessarily have to stay.

And again, we, we go back to resilience whether you're resilient enough to move through it. The PPE, you know, people were having difficulty with PPE. We had a lot of conversations about [00:46:00] scarce resources. So there was a lot of work done during, during COVID around how we would How we would allocate ventilators and how we would allocate pharmaceuticals that might have a healing impact.

So,

Rick: the triage, the triaging and ethical components, I'm sure, came up, right? You must have been front and center with that.

David: A lot of discussion from an ethical framework about how we best do that. And we, you know, where I work I work for Dignity Health, which is part of Common Spirit. We have a very strong ethics system leadership and we got a lot of help to kind of navigate that, which was great. But we also had to engage with groups of people who needed for physicians, for example, who needed to be part of the committee, just in case we had to [00:47:00] decide who was going to go on a ventilator and who was not going to get that ventilator.

That's the kind of moral, this is. It's very antithetical to our mindset in American healthcare and, you know, we don't like having to, to think about scarcity and healthcare, but the reality is we're all subject to that. Perhaps some hospitals, rural hospitals, other hospitals, more so than others. But we all have to think about you know, the choices we make.

And again, it goes to, you know. Every time chaplaincy is up for budget renewal, we have to have that discussion as well. In terms of moral, moral distress I think it's an additional layer of what we're dealing with right now in healthcare. Moral distress is, is simply a disconnect a cognitive [00:48:00] dissonance for what we think is the right thing to do but are unable to do in the moment.

For whatever reason, whether it's institutional, resourcing, whatever that is. And it's something that we are faced with at this point on a daily basis in our hospitals.

Rick: Yeah, you know, I maybe I'll pivot a little bit on that because I think when you fast forward you know, if we could, you know, have a looking glass and look into the future. First, there's a lot of global issues, and you brought up the point. You know, even in the United States, look, healthcare is unevenly distributed, access to chaplains are unevenly distributed, and even, not necessarily the access, but having that point of view reflected in the calculus that goes into, say, an ethical decision.

That certainly is something that if you don't have that in, but it's missing in the equation and the output is, is I would think missing a key [00:49:00] ingredient, particularly when you're dealing with these again, highly charged, moral, ethical decisions that we're seeing more and more of, but let me connect that to what's happening right now.

We were going to talk about trends and where things are going. You know, I do think the pandemic so much yeah. Came out of I hate to say the positive side, but came out of technology as being a bridge or a facilitator to at least stay in contact, communicate, monitor patients, really an important component of that.

We see that building on. You know, even care models as we, as we look to the future at the same time, we've got this emerging retail consumer based. Healthcare, you know, platform that I wouldn't say it's slowly jumping up. It's pretty fast, right? Walmart's getting into things and Amazon, you see the big players that are very much, I think strategically positioning themselves to at the [00:50:00] very least be strong influencers, if not.

Actual delivers of care in some way. And I, I also think the demographics are with them. I'm putting that out there with a, with a trend piece, because how does chaplaincy fit in there? Even when you think about leveraging technology and tell a chaplaincy. Or meeting the needs of a group of constituents.

Let's just say consumers who have their hand on the lever of where they're going to go for care if they're a patient. And, you know, some of these avenues like telehealth, where there is not access to a chaplain or even new models of care where chaplaincy isn't necessarily baked in, forgive my grammar, to the, to the resources that you can have.

Available all sitting on top of world where there is, you know scarcer resources. The economy is a little, you know shaky at this time, and you've got clinician, [00:51:00] you know, burnout as well as shortages happening. So that was a lot to throw out there. But let's let's start with the technology side.

What's going to happen with that?

David: well, I, it's funny, I, I was thinking over the last couple days about just kind of the, the global picture. There's a, there's definitely a sense of uneasiness. And I imagine that it's, it's unique to each one of us and we are all uneasy about what the future will bring, not just in healthcare, but, you know, the state of democracy and, and, you know, the way we communicate with people with different viewpoints and what's truth and all of that, all of those things, right?

Within that, chaplaincy provides an opportunity to, to really drill down on what's important for somebody. Thank you. [00:52:00] I have no idea, like, what, what A. I. is going to do to chaplaincy. I mean, that's, I mean, that's a very compelling question. How is that even possible? But I, I would imagine that there will be at some point some worker in that area.

And so we'll see what A. I. can bring. Telechaplaincy is really interesting. It's, it's definitely something that. was a product accelerated product of COVID. And it's being used not as much in hospital settings right now as with home health and hospices and palliative, community palliative care programs.

I talked to my friend Jessica, Jessica. Jennifer the other day about what she's doing. She's she works in community palliative care. She's a chaplain. One of the things that she found she was a [00:53:00] little resistant to telechaplaincy as it was beginning. She loves it because it offers her The opportunity to give choices to patients.

She can do now, she can do an in-person visit. She can do a a Zoom visit. She can also do a phone call. And I think one of the things that was sort of underlying this generational shift and the expectations of healthcare is that people want choices. With chaplaincy, we are the one discipline that people don't have to talk to.

And I think that's a really, a really interesting choice. That's like, yeah, that's CPE, like day one of CPE. You have to get used to that thing. You're learning about being a chaplain and you're gung ho. You want to, you want to go in and you want to talk to people. You want to, you want to make meaning with people. But you also have to realize that [00:54:00] if you walk in the door and introduce yourself and they ask you to leave, you need to leave.

Rick: Mm

David: And so we are, we are, we're giving people choice in that respect, right? Most people are very polite. And even if they're not, you know, don't want to talk to the chaplain, they'll, some niceties will come along, but it's really nice to know that people still have choice.

And I think that's, For, for whatever reason, kind of an interesting leading edge is we understand that people have choices when we're talking about doing goals of care conversations, when we're talking family meetings with, with, you know, interdisciplinary we're trying to help people again, align their values and their beliefs with whatever choices they're going to be making in the future.

I think. Care settings choices. It's going to be very very that's a trend. That's going to be what people want That's why we're seeing all of these minute clinics and everything else [00:55:00] But also, you know choices within the health care the the patient experience itself

Rick: hmm. Yeah. You know, David, I just, I was kind of picking up on that, you know, I was thinking of changing models of care, partly due to, let's just say clinician shortage. And even if you looked at nursing at the, at the bedside, you know, and I would say I encourage this. Over my career. I've I've leveraged this before.

I don't think in any way it was marginalizing any particular team member, but I knew the less time we could spend with the patient at the bedside because of whether it's nurse patient ratios or you're doing a procedure, you're called away that chaplaincy. And I'm not saying fill a gap in that, but come in from their own perspective and add something to the relationship with the patient that was additive, it was accretive to the care.

And in some ways, I think distributed that, [00:56:00] that care load in a much more equal way because not everyone was addressing Areas of that individual, the patient's needs and have chaplain come in there. It just, it just, it level set things differently. I'm saying this because I think that is again, with the changes we're seeing more ambulatory care, more moving out of the hospital, more telehealth, the dynamics certainly will change outside the hospital, but within the four walls, I would think that need would even increase.

Are you seeing that in your own practice within dignity that. a more of a willingness to engage chaplains in, say the care process than it was perhaps 10 years ago.

David: we are. We are a Catholic health care organization. And so we have a deep, we have a deep history of supporting chaplains in our, in our care settings. Just that's just sort of the general, you know, [00:57:00] underlying culture. I would say that There are a variety of, there are a variety of, of factors that go into it, not least of which is the skill of the chaplain, his or her or their spouse, right?

If, if they are very good at building rapport and have provided enough support in difficult situations, relationships, bills, nurses are great, but there are they can be tough. It could take some time to build relationships with nurses and other clinicians, physicians. So there's, so there's that piece.

There's also just the culture of the hospital themselves itself is the, is the culture of the hospital a place where it's more collaborative as opposed to less collaborative? What [00:58:00] is the value of interprofessional relationship? Is that a respected when you're talking about family meetings, does everybody get involved?

In family meetings, so there are very so, so practice and culture kind of intersect there.

Rick: You know, along those lines and, and kind of a follow up to that, if you were a perfect world, when you think about where things are going and as you do your strategic plan and your budgeting, what are some of the things that you are? Having to let go of, but some of the things that you're fighting for and what are you changing with respect to the model of chaplaincy moving forward?

And I'm recognizing that you're within a faith based organization, but there's got to be lesson learned from, from your perspective that could be applied to other organizations that aren't necessarily aligned. You know, I was chaplaincy.

We're spiritual care and they served a lot of [00:59:00] purposes, including, you know, just relations functions and, and, and as you described for the staff, it was just an incredible source of comfort, I think, to have the service, but what are you seeing as you move to the future that maybe we should change this or, or let it go, going to fight for this and I need this in the new world.

David: Well, we have two clinical pastoral education programs here with two of our hospitals. So we, ironically, I actually, I have, I serve four hospitals. Two of them are community hospitals are not Catholic and two are Catholic. And so it's a really, it's a really interesting. kind of fun mix for me. I was able to, to work across all four in different ways, but also collaboratively, which is really, really nice.

But the, our, our two community hospitals are where we now have our, our CPE [01:00:00] programs, like clinical pastoral education programs. There's a lot of change, and this is not implemented by me, I, this is the Association for Clinical Pastoral Education. They're changing the way they are teaching the curriculum for CPE that the expectations, the objectives, and the outcomes for CPE.

So that kind of thing is happening already. My professional association. So the association of professional chaplains is adding research as a requirement for our annual education requirements. So those things are, those things are happening sort of underneath. It's really interesting to see how we're moving into more of the health outcome research.

Like mindset at least at the professional chaplaincy level. [01:01:00] So my hope is that we continue to educate strong candidates for chaplaincy. I think there is a. Challenge the challenge that I'm seeing for chaplaincy is that we need to find people who want to enter the profession from the start and living in a kind of highly polarized religiously polarized time that we're in.

I think that there are some, there is some resistance for some folks who would make incredible chaplains sort of hesitate. I mean, it was my own journey, right? And so I guess I'm seeing it writ large. We really are trying to identify people earlier in the seminary settings, for example, [01:02:00] that might actually be more.

suited to healthcare chaplaincy as opposed to being in a parish, for example. So those are the kinds of people, people who have real insight into group dynamics, people who have a real sense of what grief can be and who are really committed to, you know, helping people. move through very emotional spaces, whatever those might be.

We still, it's still, you know, a very we have competencies, we have skills, but you know, we just need people who can navigate those spaces. And so that's a, that that's beyond my control, except for what I can do locally here. But what I'm looking for in terms of budgeting and things like that.[01:03:00]

I, I pray every year that my budget, you know, doesn't get cut, right? We, we don't lose FTEs. We don't we don't decide that instead of, you know, one and a half, two FTEs, we really could get by with a 8. It doesn't necessarily happen where I am, but I know that it does happen other places. Part of, I would say, you know, there may be a justice issue in terms of, you know, chaplains are very highly educated people.

Not only do we have a master's degree or an equivalent in Dharma teaching and, and other things, depending on what your religious tradition is and where your ecclesiastical home is. We we're highly educated. We have certification, we have co and, and in that we have. Competencies that we need to accomplish in order to become certified as [01:04:00] board certified.

It's really, it's a time where. You know, would be great if we could expand chaplaincy, if we could do if we could find a way to make compensation a little bit more equal across the board. Compensation is

Rick: You know, let me, I just want to go back to something you said that I think is really important. The, the measuring piece, the measurement that you look at, do you have, is there a formal balanced scorecard that Or I'm sure there is, or KPIs that look at the impact factor of chaplaincy at dignity.

David: Not in the sense that you're talking about. I think it tends to be a more of a subjective, more subjective. I mentioned the research that's happening. I mean, there's a, there was a 2012 piece [01:05:00] of

Rick: And

David: research.

Rick: way, I think that the research that is fantastic. I think

David: Yeah.

Rick: research in that space, you know, it needs to, you know, it just, it just supports, fortifies, you know, the value.

David: Yep. You know, I am George Fitch. It really has led this sort of evidence based you know, practice for chaplaincy. And so he's really, he's really done a lot of work at rush. And so there's a there's a 2012 I think this needs to be updated because it's kind of old now but there was a 2012 paper where we found that in palliative care, those who got.

Chaplain visited, were engaged in chaplain visits, were able to discharge home and have a better death [01:06:00] than people in the control group. And they measured this and looked at it and it was because again, the idea that in the conversation about end of life, people's values and culture were at the fore of the conversation.

And they were. Deeply engaged, not just the the complicated medical issues that they were, they were dealing with, but again, working with, with a group of people and considering the whole person. And that's the thing. I don't want us to lose in technology. I love technology. I think technology is amazing.

There's so much creativity that's happening right now and it's, it's just kind of mind blowing and whatever happens is going to be, it's just going to explode and transform and shake the paradigm in great ways. I'm hopeful. I'm a hopeful person. But [01:07:00] in, in that we really need to understand that people are unique. People have unique needs that their stories need to be respected. And that their values and what they choose need to be respected. I mean, we all have the stories of the, you know, 95 year old who's still a, you know, a full code, right? And for whatever reason, they don't, we can't get them to, you know, to DNR, whatever.

And, well, we have to accept people's choices, whether we agree with them or not.

Rick: yeah, meeting them. I've always thought meeting them where they are. I mean, it makes it, it makes it so much easier, you know, David, as we, as we close up the show here I always ask the guests just a couple of final thoughts. One is usually, you know, in a perfect world where, what would you like to do? [01:08:00] How would you like to see chaplaincy?

Evolve. that's my interpretation of what you do vis a vis what I usually ask folks. Where do you want to go with chaplaincy? What's the perfect world for you, David Cowell, if you could substitute and translate your vision for chaplaincy within the health sector.

David: within the health sector. Well, because I people ask me this question. I always think of counselor Troy from Star Trek, right? She was an M. empathic. She was, she was a counselor, right? She was there. She was engaging with the, with the moment. Right. And you know, she's a little bit of a hero of mine. So I always think of counselor Troy as the future in healthcare.

It's not that much different, really. We want to, you know, the chaplains are a valuable member of your team. They provide a, an insight chaplain sometimes is the only one who's getting the right [01:09:00] story, you know, the, you know, the problem patient we call them, you know, I hate this phrase, but noncompliant.

They're really uncooperative. They're awful. They yell at, they yell at staff when they walk in and the one person that they don't yell at and they actually can build a bond with is the chaplain for whatever reason, right? It just happens to be that, that role or that person or that the gifts or whatever that is.

So that person might tell you what's really going on, so, and that's so valuable for the team. And so for us to look to the future in a way where we, we value the relationship with our chaplains. We hold them accountable because we, we want them to be part of the team in a way that's useful to the whole.

And we resource them properly so that [01:10:00] they are not seeing, trying to see 75 patients in a day. And that's just not sustainable for anybody.

Rick: Yeah,

David: Kaplan's the time to do the work of building relationship, right? That is the, that's

Rick: I was going to say, you don't want to see burnout amongst your chaplains either. And I loved your analogy for counselor Troy that, you know, it's something when you think about it and how essential for the mission and, and the vision for the future to have a trusted person that you could talk to.

That's the way I leverage chaplains throughout my career. And I will say this I'm glad you're in the role there, my friend. So. Thank you so much, David, for being on the show. We really appreciated your insights, your perspective, keep doing what you're doing and keep the vision going. And, you know, we, we look to having you back on the show in the future here and where you're up to.[01:11:00]

David: I would love that. Thank you so much, Rick, Joe. This has been a pleasure.