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