By Gary Gunderson
And Other Duties as Assigned: Walking the Path of a Chaplain Manager Inside and Outside the Walls,
By Rev. Graylin Carlton, Rev. Dianne Horton, Rev. Dr. Adam Ridenhour, and Rev. Dr. Emily Viverette, with Melanie Raskin
What is excellent spiritual presence in and around health care today?
A century ago, faith-based hospitals were small, the science relatively primitive, and patients stayed a long time. At Baptist hospital, the CEO was a pastor and was expected to go around most days to see and pray with the patients.
Those days—and that simple science—are long in the past. Now among the many thousands of hyper-specialized staff there are usually a sprinkling of people called chaplains. In most hospitals they’re called for complex patient or staff needs inside the hospital. These chaplain managers are more likely to be called when an unusually complex patient needs to find their way home, back to a different life even more complex and difficult than that inside the hospital.
A new book describes this breakthrough role that has been developed and matured with business models, job descriptions, and all the HR accoutrement so that it can be adapted into many other institutions. Heroic, brilliant, spirited and tenacious, the authors are literally testifying about how this has happened; they built this bridge by walking it every day.
To be sure, I had a minor role as executives do in these creative breakthroughs. I had seen in Memphis the extraordinary things that are possible when a hospital goes against the norm and builds webs of trust with hundreds of community churches, mosques, and temples. Those relationships moved data and patient outcomes otherwise impossible for the hospital to imagine.
When TC and I came to North Carolina we had a chance to adapt that learning into a radically different religious, political and cultural ecology. This new environment opened up space for an expanded model of chaplaincy to emerge, particularly in our more rural areas. But nobody knew what to do with all the new freedom. These authors did the creative work and now tell the story so that others can do so in many other settings.
This small group of chaplains followed clinical medical science out the door and into the community. It is common for chaplains to get credit for spiritual gifts. Although comfortable and skilled in the most challenging of bedside roles, these chaplains are also comfortable on the rural landscape of seemingly scarce resources. Here you find spiritual capacities unlocking the difficult complexity of psycho-spiritual determinants of health at community scale. They work with a broader menu of science relevant to patient outcomes. Sometimes as practical as transportation to follow-up cancer appointments, or food, or or or or or or. They are trusted with unusual freedom and a tiny bit of flexible resources that science demands.
Why does this matter? For too long chaplains have served in a narrowly defined and often misunderstood role at the very end of life in the most extreme circumstances inside the hospitals able to fund them. The misunderstood role means institutions do not know the true value that their chaplains may hold. This leaves most rural medical centers without access to clinically educated chaplains and the added resources they bring to the table.
This book maps a chaplain manager role in more rural facilities that is relevant to all the patients who do not die (maybe only 5% do in most hospitals). But most patients must navigate a different phase of their life. Spirit—and the practitioners of spirit—are hugely relevant to that difficult journey. This cannot be left to brave pioneers; it needs all the job descriptions and competencies of any other defined role in the modern health care environment.
This is, of course, worthy of individual praise. But this book is not for that. It is for others to find their own way into the broader new role that science demands in any hospital anywhere. In this book they have mapped the competencies and cracked open the role to help a new generation of chaplains become more relevant both outside and inside the walls.
The webs of partnership these new chaplains weave is the not-secret-sauce of their success. They support new capacities in their other colleagues inside the hospital. Most importantly, they build sustained webs of trust with the wild diversity of faith outside the walls. A high art that is! But it means they are not always where you expect a traditional chaplain to be. They are protected by job descriptions built on a different model of where value is created, and success is defined.
Read the book if you are one of the chaplains yearning for another way. Or one of the administrators with nobody to deal with the complex patients who keep rebounding because of the failure to take the next steps of their journey seriously and with nobody who has the complex competencies to make something better happen. Or if you are thinking there may be a whole different world in which your spirit, energy, and sweat might be expressed.
- Join us for a Zoom meeting with the authors to hear about the inspiration behind the book and ask questions. The meeting, at 1 p.m. ET October 21, 2025, is co-sponsored by the Chaplaincy Innovation Lab, Wake Forest University School of Divinity, and Hold.Health. Register here.
- Read more about the book here: https://hold.health/shop/uncategorized/chaplain-manager-and-other-duties-as-assigned/
- Buy the book here: https://www.amazon.com/Other-Duties-Assigned-Walking-Chaplain/dp/1732422273
- Or here: https://www.barnesandnoble.com/w/and-other-duties-as-assigned-graylin-carlton/1148195800?ean=9781732422278
