More Than a Prayer: How Chaplaincy Services Shape and Improve Patient Experience

 More Than a Prayer: How Chaplaincy Services Shape and Improve Patient Experience

By John E. Delzell Jr., MD, MSPH, MBA, FAAFP

As physicians and educators, we often talk about the patient experience as if it's only tied to clinical outcomes, nursing care, timely communication, or the cleanliness of the hospital. But a recent study in the Journal of Healthcare Management challenges us to widen that lens. White and colleagues (1) examined a less discussed—yet profoundly impactful—hospital service: the chaplaincy department. Their research poses a simple but powerful question: Does having a chaplaincy department improve hospital patient experience scores? The answer is a strong yes, and the implications are far-reaching for how we think about team-based care and holistic healing.

Study at a Glance

This was a large, multi-year observational study using American Hospital Association (AHA) data and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The researchers looked at a sample of 1,215 hospitals between 2016 and 2019, using rigorous multivariate regression modeling to adjust for variables like hospital size, ownership, status as a teaching hospital, and patient demographics.

The key variable of interest? Whether a hospital had a chaplaincy department according to their answer on the AHA Annual survey. The dependent variables were from the HCAHPS report in patient experience domains, specifically global hospital rating of 9 or 10 and the percentage of patients who would definitely recommend the hospital. These variables roll up many of the things that patients (and families) care about and include those related to communication, emotional support, and nursing care. These are the types of things patients remember after discharge, even when they forget the name of their antibiotic.

What Did They Find

Hospitals with chaplaincy departments consistently scored higher across the two primary outcome measures. The differences were small but statistically significant. In bivariate analysis, the hospitals who had a chaplaincy department had 1.6% more patients that were likely to give a top box score of a 9 or 10 (t = –5.04, P < 0.001) than those without a chaplaincy department. 3.1% more respondents would definitely recommend a hospital with a chaplaincy department than those without one (t = –8.91, P < 0.001). When the multiple variable regression model was applied, the results were still statistically significant. Hospitals who had a chaplaincy department had 1.5% (standard error [SE] = 0.58, P < 0.05) more patients giving a top box ranking than hospitals without a chaplaincy department. And 2.2% (SE=0.66, P <0.001) more patients that would definitely recommend the hospital.

They also found that chaplaincy presence was associated with a more significant impact in nonprofit and teaching hospitals, where patient acuity and complexity tend to be higher. This nuance adds an important layer to the conversation: chaplaincy services may be especially beneficial in the very environments where patients are most vulnerable.

Why Does It Matter

This study adds quantitative muscle to what many of us have long known anecdotally—that spiritual care is more than a “nice to have” in the hospital setting. It’s part of the fabric of compassionate, patient-centered care. In a former role, I had the privilege of having administrative oversight for our chaplaincy program, the VC &Mary Puckett Center for Spiritual Care (https://www.nghs.com/spiritual-care). The Center includes hospital chaplain services, pastoral care education for chaplain interns and chaplain residents, a live therapeutic music program, and a center for clinical bioethics. A busy and amazing group.  

As someone who has spent years in academic medicine and hospital leadership, I’ve seen how easily chaplains can be overlooked during strategic planning or budget decisions. They often operate in the background, providing emotional and spiritual care, facilitating difficult family conversations, or simply sitting with a patient in silence when nothing else seems to help. But this research tells us that those seemingly quiet contributions reverberate in powerful ways. Chaplains may not prescribe medications or write orders, but their presence has measurable effects on how patients feel about their care. And in a healthcare environment increasingly focused on value-based metrics, that matters.

Implications for Medical Education

One area where I think this research really resonates is in how we prepare students and residents to think about interprofessional care. We train them in evidence-based medicine, population health, and systems-based practice. But how often do we talk about spiritual care as an evidenced-based part of the clinical care team?

This study opens the door to that conversation. If chaplaincy departments contribute to a better patient experience—and therefore better outcomes, clinically and financially—then students and residents should be taught how to collaborate with chaplains just like they learn to work with pharmacists or nurses or case managers. Incorporating chaplain shadowing, discussions of spiritual assessments, and interprofessional simulations into our curricula could make a real difference. It’s not just about preparing future physicians to treat disease—it’s about preparing them to treat people.

Budget vs. Benefit

Of course, none of this comes without cost. Many hospitals, especially smaller, for profit, and rural hospitals, have cut back on “non-essential” services like a chaplaincy department. (2) But this research challenges that decision. If chaplaincy services drive improvements in HCAHPS scores, then investment in these programs may actually support hospital finances through higher reimbursement rates tied to value-based purchasing. Hospital leaders and CFOs may want to reframe how they see chaplaincy—less as a soft service and more as a strategic investment. This is especially true in teaching hospitals, where patients often face extended stays, complex illnesses, and existential crises that stretch beyond the reach of medicine.

A Broader View of Healing

In the end, this study reminds us that healing isn’t confined to the body. The hospital is not just a place of procedures and prescriptions; it’s also a place of fear, hope, grief, and meaning. Chaplains walk with patients through all of that, often in moments when medical interventions have nothing left to offer. So, the next time you see a chaplain walking the halls—or hear their name mentioned during a family meeting—take a moment to recognize the vital role they play. And maybe even ask yourself: Are we doing enough to support this essential part of our care team?

Because healing doesn’t happen in isolation. It happens in community. And chaplains, it turns out, are part of the reason patients feel seen, heard, and cared for.

 

(1) White KB, McClelland LE, Jennings JAC, Karimi S, Fitchett G. The Impact of Chaplaincy Departments on Hospital Patient Experience Scores. Journal of Healthcare Management 2025; 70 (3): 220-234. DOI: 10.1097/JHM-D-24-00143

(2) White KB, Lee SYD, Jennings JAC, Karimi S, Johnson CE, Fitchett G. Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective. Health Care Management Review 2023: 48 (4): 342-351. DOI: 10.1097/HMR.0000000000000382

Expanding the Pipeline: how do we get more physicians into underserved areas?

 

Expanding the Pipeline: how do we get more physicians into underserved areas?

John E Delzell Jr MD MSPH MBA FAAFP

In the face of ongoing primary‑care workforce shortages, it is important to identify ways to expand the number of physicians who choose practice in health professions shortage areas. This also means that more graduates will need to choose primary care specialties as many rural and underserved communities cannot easily support subspecialty practice. Several recent articles enrich this discussion and illustrate some of the challenges and successes.

Targeted Admissions Strategy

A study by Evans and colleagues (1) from 2020 looked at the medical school admissions process by surveying all 185 US Allopathic and Osteopathic medical schools. Their premise was that there is an inherent social mission of all medical schools to meet the health needs of the public. I am not sure that all medical schools would agree with that statement, but it led to the authors questioning how each school targeted applicants. Specifically, the school’s admission strategy.

The authors had an impressive 72% response rate. Schools were grouped by their targeting strategy-69% used a rural targeting strategy and 67% used an urban-underserved targeting strategy. The strategies used characteristics such as graduation from rural high school, growing up in rural community, growing up in an underserved area, and stated interest in practicing in an underserved area. Interestingly, only 20% of the schools reserved admission slots for students with these characteristics.

Holistic Review for Admissions

Ballejos and colleagues (2) in an article published in 2025 looked at data from a single medical school (the University of New Mexico School of Medicine) over a period of eight years from 2006 to 2013. In this study, the authors looked at all the students matriculating each year and used practice data to identify their post-residency practice location. They were trying to identify objective attributes that might predict in-state practice location. The admissions committee at UNM SOM uses a holistic review to consider objective data (MCAT, GPA), personal attributes (gender, ethnicity), goals (practice plans), and experiences (graduating from rural high school). This is done, at least in part, to assess whether a given applicant is likely to practice in New Mexico and advance the school’s mission.

They performed univariate and multiple regression analyses to compare the graduates. The authors used in-state versus out-of-state practice location identified by NPI number and medical licensure data. They found that only 41.7% of graduates during that time period practiced in New Mexico. Older students and those who graduated from an urban high school were more likely to practice in-state after training. Importantly, most of the variables that they looked at were not significant and the three that were significant only explained 6.4% of the variance.

Not much help to inform the Admissions process.

Admissions impact on Primary Care choice?

Raleigh and colleagues (3) undertook a narrative synthesis to systematically evaluate existing literature on how various medical school admissions practices, including prematriculation programs, are associated with graduates eventually entering primary care specialties. The purpose of their study was to review literature that describes admissions practices and try to determine the impact on the number and percentage of graduates entering primary care. The performed a comprehensive search of English-language peer-reviewed research with outcomes related to primary care choice and identified 34 qualifying articles — mainly single-institution, observational studies. They used narrative synthesis as their evaluation method for two reasons: it allowed them to evaluate and summarize data from a wide variety of methodologies, and it allowed them to provide a narrative description of the identified studies.

The authors found that pre-matriculation programs were consistently associated with higher rates of graduates entering primary care compared to peers. Other predictive factors included self-identified interest in primary care, rural background, and being older at matriculation. They found that not very many schools explicitly prioritize primary care in their admissions criteria. The authors did note that some of the studies looked at primary care in rural environments, and those results were consistent with the overall group of studies.

Raleigh et al. argue that medical schools should consider pre-matriculation programs targeting students already oriented toward primary care. They also emphasize active recruitment of applicants expressing a primary care commitment and call for more rigorous prospective research. These results suggest that structured prematriculation programs can influence specialty choice outcomes, beyond self-selection effects. The program’s design elements — mentorship, academic support, and clear pathways — likely contributed to success.

There are some great programs out there that target students who come from rural and underserved areas, get them into medical school, and then encourage them to pursue practice in underserved areas typically in primary care. Let’s look at a couple of these programs…

University of Missouri—Columbia: Bryant Scholars Pre-Admissions Program

The Bryant Scholars Program (4) guarantees medical school admission to qualified rural students committed to primary care and rural practice. Students must be from Missouri and from a rural county. The program targets rural and under‑resourced applicants, offering tailored support and conditional admission pathways. Students are committed to the MU Rural Scholars Program after matriculation into the medical school.

University of Kansas School of Medicine: Scholars in Health

The Scholars in Health program (5) has two tracks for students interested in underserved practice areas-Rural and Urban. This is an early‑admit conditional acceptance program targeting students who come from rural and underserved backgrounds and intend to return to practice in those areas after graduation. The program offers academic and career mentoring, with guaranteed admission contingent on performance milestones.

Florida State University College of Medicine: Bridge to Clinical Medicine

The Bridge Program (6) is designed to expand the pool of successful medical school applicants who come from rural and urban underserved areas. FSU COM’s Bridge Program is a 12‑month Master’s in Biomedical Sciences for applicants selected from those not initially admitted to FSU COM. Completion with a B or higher and meeting professionalism standards leads to direct consideration for admission.

Common Threads and Best Practices

Across MU’s Bryant Scholars, KU SOM’s Scholars in Health, and FSU COM’s Bridge Program:
1. Targeted recruitment of students from rural and underrepresented backgrounds
2. Conditional admission or master’s bridging with performance thresholds.
3. Integrated academic and clinical exposure.
4. Ongoing mentorship and professionalism assessment.

Prematriculation programs like MU’s Bryant Scholars, KU SOM’s Scholars in Health, and FSU COM’s Bridge Program embody the strategies highlighted in the literature as high impact. They identify likely applicants, reduce barriers, support readiness, foster diversity, and strengthen the rural and underserved practice pipeline. Expanding these models nationally offers a promising route to a more effective, equitable physician workforce.

References

(1)   Evans DV, Jopson AD, Andrilla CA, Longenecker RL, Patterson DG. Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission. Fam Med. 2020;52(7):474-482. https://doi.org/10.22454/FamMed.2020.470334.

(2)   Ballejos MP, Riera J, Williams R, Sapién RE. Objective Admissions Data and In-State Practice: What Can We Really Predict? Fam Med. 2025;57(6):435-438. https://doi.org/10.22454/FamMed.2025.503525.

(3)   Raleigh MF, Seehusen DA, Phillips JP, Prunuske J, Morley CP, Polverento ME, Kovar-Gough I, Wendling AL. Influences of Medical School Admissions Practices on Primary Care Career Choice. Fam Med. 2022; 54 (7): 536-541. https://doi.org/10.22454/FamMed.2022.260434. 

(4)   https://medicine.missouri.edu/offices-programs/admissions/bryant-pre-admissions-program

(5)   https://www.kumc.edu/school-of-medicine/academics/premedical-programs/scholars-in-health.html

(6)   https://med.fsu.edu/outreach/masters-bridge-program