Sparking Social Connection and Community With Indiana University Health

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Tom Haederle
In 2023, the Surgeon General issued an 80 plus page report that shocked and dismayed many people. It found that loneliness - social isolation - is epidemic in American society and carries very real physical as well as mental costs. The report compared the effect of loneliness on health to smoking 15 cigarettes a day. With locations all over the state of Indiana,

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Tom Haederle
Indiana University Health was among the first large health systems to recognize and act on the healing effects of social connection and community.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. "We are made to be in community." That philosophy is the guiding force behind Indiana University Health's Congregational Care Network created to address loneliness and social isolation. In this podcast, hosted by Jordan Steiger, senior program manager of Clinical Affairs and Workforce with the AHA,

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Tom Haederle
Jay Foster, vice president of Spiritual Care with Indiana University Health, and Shadreck Kamwendo Director of Congregational Care Network, talk about the difference the program is making in the lives of area residents. Let's join the discussion.

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Jordan Steiger
So I'd like to start the conversation just by learning a little bit more about IU Health and really what the role of a chaplain is at IU health or in a hospital system, just in case there's a listener out there that doesn't really know. So Jay can you tell us what a chaplain does in your organization?

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Jay Foster
Hey, Jordan, thanks so much for having us. And I like to think of it that there's things that chaplains do and things we try to be. And I'll start with the second one. It turns out that spirituality is really important in how people understand and cope with their illness. When folks are in the hospital, some people find that their faith is the most important thing to them, however

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Jay Foster
they define that faith. Others find themselves questioning that. And so chaplains try to be someone who can walk with a person of whatever faith, religious tradition or not they may or may not identify with. But to accompany them on that health journey. Some of the things we do, some of them are kind of obvious, maybe. We get called to most deaths to be with loved ones of family members who are breathing.

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Jay Foster
We get called the most traumas when loved ones show up and are understandably distressed. Some are maybe a little less obvious. We do things like advance care planning. We help with ethics consultation, work with persons who are having difficulty adjusting to their illness and help them identify their spiritual, emotional resources for coping with their illness better. And then finally, we provide a lot of support for our team members because we're embedded with team members.

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Jay Foster
They find that they can have a level of trust, and sometimes we can help that team member get to the right door for more help. Maybe we can walk them to if they need to work with a therapist, if they need work with someone in H.R. or someone on our legal team, we can help them get to the right door.

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Jordan Steiger
It's a really important role within the hospital system and the care team. And you know, what I'm hearing you say is that you are really that emotional guidance. You are there to help people walk through this, this experience. And we know that some of the experiences that our patients and families can have with health care can be a little bit isolating and a little lonely.

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Jordan Steiger
And we know that people are lonely in the community across the country. So, Shadreck I was wondering if you could tell us a little bit more about the issue of loneliness and social isolation, and then also tell us why hospital leaders should care about it.

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Shadreck Kamwendo
Yeah, that's a great question there. I think social isolation and loneliness has been found to be associated with hospital increase and hospital readmissions. Jay and I and others always talk about that. You know, patients come here to get treatment and they go home to get well and if they don't have those tools or things to make them well like community, they'll come right back to the hospitals.

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Shadreck Kamwendo
So it is in the interest of all health care systems, hospital leaders. We are made to be in community. And for us to do better is to have everything and the community around us who wishes us well to get better.

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Jay Foster
Thanks, Shadrack, for for making that point. I'd love to amplify just a bit. Two things. When we were trying to figure out where we as a spiritual care department would focus our work, we chose to focus on social isolation and loneliness because it's something that chaplains know how to do well, as you were saying, Jordan, But it's also something that congregations excel with and that's providing care for the sick and the shut-in.

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Jay Foster
But the second thing and this was this is now much more well-known in our community, but as the surgeon general pointed out in recent studies, this is an epidemic in our country, isolation and loneliness. And it had it's a biological condition. I mean, it has actual impact on our spiritual and physical health. He compared it to smoking about 15 cigarettes a day.

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Jordan Steiger
So really, you know, affects physical, mental, sociological, all of those outcomes. It's an important thing that we should all be focusing on. And I know at IU Health you have created a program that really has focused on reducing loneliness and social isolation in your community. And that's why we're here to talk today about your congregational care network. So Shadrack, I'd love for you to tell me a little bit more about the program, how it got started, how you fund it.

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Jordan Steiger
Just anything you want to share.

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Shadreck Kamwendo
Yeah, I'd love to do that. Our ill health care system. One of our goals is to make Indiana healthier, a healthier state. And one of the things that they see IU health system established in 2018 was a community impact investment grant. So when we thought about starting this program, loneliness and social isolation is one of the things that we'll focus with the partnership with the chaplaincy.

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Shadreck Kamwendo
So we got funding from the IU Health Foundation through this grant, a community investment grant to start this program to study it here in Marion County, in the Indianapolis area, to find eight congregations and two congregations in Monroe County, Bloomington area. So we got started and Jay and others thought, how are we going to train the congregations? Who is going to be journeying with our neighbors?

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Shadreck Kamwendo
So we chose a pathway training called Companionship Training that we provide to their congregations that are part of our program. This is a four-hour training. We talk about hospitality, just active listening, just being present is a deliberate admission of being present. And they ask for us to the connectors who are part of this program is to just to make phone calls about an hour a week for about 12 weeks.

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Shadreck Kamwendo
And in that, you get to learn a little bit about what's going on in just being a friend and showing some love and saying, hey, we're not always about the disease that you have or a diagnosis you have. You are a human person, you're a neighbor, and we want to support you through this process.

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Jordan Steiger
Wonderful. And I know just from speaking to both of you and learning more about your work, that the outcomes from this program have been unbelievably great for your workforce, for your patients, and for the volunteers that are part of the congregations in your community. So Jay, could you tell us a little bit more about how this has positively impacted your workforce at IU health?

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Jay Foster
Maybe the main way is that it provides our team members with a sense of purpose. We are a values based organization and one of our core values is is connecting to purpose and spirituality. We actually find that the more persons are connected with their with their purpose, their North Star, the healthier they are. So that works well for our team members that we're helping patients connect with a higher sense of purpose.

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Jay Foster
One of our hospital presidents said to me recently, said Jay, I just love this program. And here's the reason why: hospitals really aren't set up to be wellness communities. Now, we could argue that one way or the other, but that was his perspective. He said, But the community is where folks need to focus in order to really work on their wellness.

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Jay Foster
But what you've managed to do here, not me, Jay, but you the CC and team - is help build that bridge way so that we identify a patient. One of our physicians connects with a patient that they love and they see that this person is lonely or isolated. Connects him with the chaplain. The chaplain connects them with a congregation in their neighborhood.

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Jay Foster
And over that 12 week period that Shadreck was talking about, that individual find some companionship and hopefully gets really strongly connected with a broader sense of community and ultimately with something bigger than their than their illness. It's like, okay, I'm not just my illness, I'm all these other things. And how can I actualize that even while I'm coping with this particular illness?

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Jordan Steiger
I love that you are connecting this back to purpose. And I think, you know, health care providers and people that work in health care really are drawn to that sense of purpose in their work. And so having this avenue, I think, is a really smart, beneficial program, I think, for your workforce. But let's talk about patients, because that's really what this program is about.

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Jordan Steiger
So, Shadreck, tell us about some of the positive outcomes that patients have seen.

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Shadreck Kamwendo
Yeah, So most of our patients is their stories that we we tend to hear coming from the our connectors, you know, in the companions, the relationship that are being formed. I'll give you an example. We had a companion that was being followed by a congregation and we were delivering food on her porch, you know, raw food on her porch, and she confided to her connector and say, you know, you're providing me food, but my stove does not work.

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Shadreck Kamwendo
So the congregation was able to get the men from the church on a Saturday morning, went and got her a new stove. And she was able to get that nutritious food that we have. We wouldn't have known some of the struggles that are going on into her household. So that program, supported by their own neighbors, makes a difference.

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Shadreck Kamwendo
Another example was a companion that we met here at the hospital that had moved from St. Louis because she has been widowed for several years and she came to live here in Indianapolis with her daughter. But she said I had and haven't made friendship with anybody. Can this program connect me to a friend? And we said yes. She said, Because of all the friends I have on my daughters friends, I live my life, 50 years of life in Saint Louis, and I'm in the new city.

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Shadreck Kamwendo
So I needed support and care. And now she has friends that will go to farmer's market with her. And that makes a difference. That's the wellness we are talking about. And we have other companions in our program. They have all the resources. They just want somebody to talk to. You can only watch TV for so long.

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Shadreck Kamwendo
So as I said earlier, we go home to get well. And those are the things that will make you go well, because if you don't have those things, you're going to return back to the hospital. So we have seen a lot of positivity coming from the companions, the patients that I, you know, program. But also let me add the transformation that is taking place for those connectors.

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Shadreck Kamwendo
The volunteers now, they are starting to learn what's happening in their neighborhood, that they have friends that are food insecure, they have friends that have transportation problems to get to the appointment. And how are we going to come alongside making sure that they get to the right care at the right time in order to be well?

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Jordan Steiger
I think you bring up some great points, you know, individual outcomes that are improved, community outcomes that are improved. None of that would have happened without IU health stepping in to make some of those connections. So I think that's a really good lesson for others listening and that hospitals really can serve as that social connector in communities. Jay, I was wondering if you could talk a little bit about how your partnership with local congregations has strengthened the services you're able to provide to patients?

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Jordan Steiger
Because I don't know if all of our, you know, member hospitals and health systems would think maybe to go to a congregation for this kind of program.

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Jay Foster
So a couple of ways. The first is a recognition that many of these congregations have been in their neighborhoods for decades, sometimes hundreds of years. They are trusted sources of information, of wellness in many communities where people go to to to learn about all of their needs, including their health care and social needs. And so an operating philosophy of ours is to really partner with congregations and let them teach us: How do we provide better care for your neighbors, help us help you do that, rather than coming in and saying, let us tell you what we as a health system can do for you or can't do for you.

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Jay Foster
So we begin from that that point of view of appreciative inquiry. Second, you know, we talk a lot and health care about physician extenders or provider extenders. And so in that way and this model, the chaplain is up and the outpatient clinic is an extension for that provider. And the congregation is an extension of that chaplain.

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Jay Foster
And here's the way that works. Quick story. We had a patient was just loved by her physician and they had a great relationship, just loved by their social worker, growing relationship with their chaplain. But it was their connector who they said, you know what? My oldest son has moved back in with me and my expenses are going up, so I've cut back on my medications.

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Jay Foster
So it works both ways. The connector then reached back upstream to be able to say to to that physician ultimately and that social worker, hey, here's the problem. And they were able to come in and make adjustments so that her medication wasn't compromised and her budget stayed on track. The other thing is, is it more of a relational level?

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Jay Foster
Our system, like all systems or like many health care systems, struggles to be a trusted source of information in the community. As we build these person to person relationships with clergy and the congregation of all faiths, they know they can pick up the phone and call Shadrach or their connector or their chaplain and have somebody on the other end to listen.

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Jay Foster
So the pathway works both ways. The physician is a extender for that congregation. The other thing I would come back and amplify from your earlier question, if I could, I'm surprised that my friend Shadrech didn't jump all over this. Shadrach is like the only non-chaplain on our team. He's got to put up with a bunch of us.

00;16;04;09 - 00;16;36;04
Jay Foster
He's a population health MBA guy, but thanks to Shadrech, we've developed some really strong utilization metrics that he's built a Power BI dashboard with our population health team. This has now been vetted through our pretty rigorous statistician and we're comfortable saying that we've been able to see a 4% reduction in hospital readmissions for CCN patients compared to our control group.

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Jay Foster
And we've seen remarkable reductions in ED utilization and a complimentary rise in family medicine and other appointments. That's just the thing you want to see after an intervention like this. We've also provided pre and post inventories of a validated instrument called the care field, Loneliness Scale. We use the abbreviated version. This demonstrated statistically significant improvements in a person's sense of feeling connected and less lonely.

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Jay Foster
I feel like someone's on my side. I feel like I know who I can call if I get in trouble.

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Jordan Steiger
Absolutely. And I was going to ask about any data that you had to share. And so that is a perfect explanation. And I think, you know, across the country, we see, you know, hospitals and health systems struggling with things like ED utilization with readmissions. So I think that's something that resonates and it's, I think, incredible that you've been able to reduce some of that utilization because we know people seek those services or go to the hospital because they don't have other places to go.

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Jordan Steiger
It's not necessarily that they're needing care all the time, sometimes, but not all the time. So as we start to wrap up our conversation, Shadreck, if you and Jay have inspired anybody out there to think about how they could maybe adapt your program to their community or their hospital or health system, what kind of advice would you give them?

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Shadreck Kamwendo
I think the choice of working with chaplaincy was really profound because they have a little superpower of being gentle and bring trust to their room. And if hospitals can, making sure that the chaplains are at the table as they develop some of these programs, because usually they will have a little bit of time to sit in their room with the patient and the really deeply at least seen what's going on.

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Shadreck Kamwendo
So that's what we have done here into making sure that the chaplains are at the core of all the strategies of how we can help our communities. So they bring that that power. So I would encourage different health care systems and making sure that they are really bringing their chaplains to the table as they develop new programs to figure out how they can help to communicate, but also to encourage patients to be part of them.

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Jordan Steiger
I think that's great advice. The chaplaincy and social work and all of those those professions I think are so powerful when they are used in the right way. So I think that's great advice and something to consider. Jay, as we close out anything you'd like to add?

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Jay Foster
So one thought, we focus an awful lot on social isolation and loneliness, and that is absolutely the primary intervention is that we give an hour of time or more during this intensive 12 week period to try to help people find community. But if I spent an hour listening to you, I'm going to learn all kinds of things. I'm going to learn that there's food insecurity.

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Jay Foster
I'm going to learn that that there is domestic violence. I'm going to learn that there's substance misuse. And so what we've really worked hard on is to provide training and encouragement for our connectors and resources to know how to help people get to the right door and then stay connected with them after they've made it to the right door.

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Jay Foster
So if they get to a behavioral health therapist, they get to the kind of food and security concerns that they need, but then they stay connected because the ultimate intervention is around providing that love and friendship as there is our coping with your illness.

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Jordan Steiger
I think that's a great place to conclude and thank you both for your time today and for sharing your story with other members of the American Hospital Association membership. I think this is a program and an approach that could be used in a lot of different communities and kind of adapted to that community need. Jay, as you mentioned, you know, taking that that approach of like letting the community tell you what they need from, from that, I think that's a huge takeaway.

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Jordan Steiger
So thank you so much. We will make sure to link some information about the Congregational Care network so people can learn about it if they're interested. And again, thank you so much.