Case study to improve our work
I’m committed to improving my practice as a chaplain.
I don’t want to mess things up, for myself, my colleagues, or my organization. There are legal and moral constraints that I want to navigate well. There are ways to move the organization with graciousness.
I want to be as helpful as possible to the patients and families we serve. Being in the hospital is unfamiliar, disorienting, and scary. If I can bring clarity, calmness, and confidence to our work, some of that scariness can be removed.
That scariness was the situation I faced in the middle of a busy shift one Saturday.
A nurse paged a chaplain. When I arrived, a patient’s friend was waiting for me. The patient’s friend said the patient wanted to sign a document. The patient needed help. The patient’s friend was overwhelmed. So I stepped up to help.
I asked for advice from our experts in that document. I talked with the patient. I helped the patient fill out her part and then I filled out my part. I completed the steps we always complete, charted what we always chart. And I finished my shift.
A couple days later, my boss texted me at home to see if I could talk. When he called, three of us had a conversation about the document. Some people close to the situation were complaining about it, and the other chaplain in our phone call had borne the intensity of that conversation.
I reviewed what I had done. The actions I had taken were appropriate for the situation. As far as our institution was concerned, there was nothing to change.
But that didn’t stop the complaining. The tension continued for a week or two. Finally, there was a resolution that was consistent with our procedures. And the patient left the hospital.
But the story didn’t leave my head. I reviewed it over and over. What could I have done differently? What could I have done more effectively? I wasn’t blaming myself, exactly, but I also was sure that the situation could have been handled better. So I decided to stop thinking about the situation as something to worry about and started to think about it as a case study.
“Case study” is a process which can be used to identify lessons from situations that have occurred. Rather than looking for blame, a case looks for lessons, for ways of working that are effective and ways that can be refined.
I’ve learned one way of using cases through a resource consulting group that I am part of. We meet monthly to review a case in order to learn how to do our practice of consulting more effectively. Our method has a writing step and then a conversation step. In the writing step, the person presenting the case writes out a description of what happened, step by step. You can summarize the conversations, but you are often helped by including the whole conversation or email or letter. You can include a bit of what you were thinking at the time, but you can’t include conclusions or blame or evaluation. (“I did this. I thought this” is fine. “I had a stupid idea, it was my fault” are not.)
After you write it out, you give the case to a group of peers for discussion.
In the first stage of discussion, they can ask clarifying questions about what you have written. It’s a way of making sure that all the relevant facts have been surfaced. In the next stage, they talk among themselves about what happened, about alternate steps they have taken or seen in similar situations, about what makes the situation so complicated or simple. After this discussion, you can respond to their comments. And finally, everyone completes this sentence about learning: “I have learned that when X happens, I could do Y, and I could expect that Z would be the result.”
I didn’t have a group of people in the shower with me the morning I started to walk through my hospital situation as a case, but I did follow the process.
I described in my head the situation as it occurred, from the very first conversation I had with the friend. Because I was describing it in a linear fashion, driven by the timeline, not by the results, I saw some parts of the situation I hadn’t previously noticed. Worry mode involves self-deception, by forgetting the good things that may have happened and magnifying the bad. I understood why I had responded the way I did at the beginning.
I realized that in this moment, organization expectations, compassion expectations, and situational ambiguity converged. I realized that my action was consistent with, not in violation of, my training. And that the training created the tension.
Once the situation was out of my worry framework into a case description framework, I took the lessons learned step.
“If I find myself asked to complete that process again, I will ask two or three specific questions beyond my past training. And I can expect that as I take those questions into account, the situation will unfold in a similar, but better explained, way.”
If you are in an environment where you or others want to learn how to do your work more effectively, consider developing cases. You can expect to work with greater clarity and confidence.