Es­tab­lish­ing a strong cul­ture of com­pas­sion im­proves qual­ity of care, bot­tom line

Modern Healthcare - - COMMENT - By Julie Rosen In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at modernhealth­ Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@modernhealth­

Kay Red­field Jami­son, a psy­chol­o­gist who of­ten writes about her own strug­gles with bipo­lar dis­or­der, once wrote in a New York Times op-ed that when she is asked about the most im­por­tant fac­tor in treat­ing bipo­lar dis­or­der, her an­swer is com­pe­tence. “Em­pa­thy is im­por­tant,” she wrote, “but com­pe­tence is es­sen­tial.”

Jami­son is cer­tainly not set­ting up an ei­ther/or con­struct. But in my trav­els as ex­ec­u­tive direc­tor of an or­ga­ni­za­tion whose mission is to pro­mote com­pas­sion­ate care, I some­times hear a false di­chotomy that goes some­thing like this: Would you rather be cared for by a top­notch sur­geon with a poor bed­side man­ner or a car­ing and com­pas­sion­ate sur­geon with ad­e­quate, but not ex­tra­or­di­nary, sur­gi­cal skills? Com­pas­sion or com­pe­tence? You can, and should, have both.

Com­pas­sion is the foun­da­tion of good med­i­cal care. It ad­dresses the emo­tional and psy­choso­cial as­pects of the pa­tient ex­pe­ri­ence and the pa­tient’s in­nate need for hu­man con­nec­tions and re­la­tion­ships. It is rec­og­niz­ing the con­cerns, dis­tress and suf­fer­ing of pa­tients and their fam­i­lies and tak­ing ac­tion to re­lieve them. It is based on ac­tive lis­ten­ing, re­spect, em­pa­thy, strong com­mu­ni­ca­tion and in­ter­per­sonal skills, and knowl­edge and un­der­stand­ing of the pa­tient’s life con­text and pref­er­ences. At its core, it means treat­ing pa­tients as peo­ple, not just ill­nesses.

Our or­ga­ni­za­tion re­cently com­mis­sioned a study into what makes health­care or­ga­ni­za­tions com­pas­sion­ate. Build­ing Com­pas­sion into the Bot­tom Line re­ports on the con­clu­sions of a months-long in­quiry into how some hos­pi­tals have cre­ated en­vi­ron­ments that reap the many doc­u­mented benefits of com­pas­sion­ate care: higher pa­tient and em­ployee sat­is­fac­tion, lower staff turnover, shorter lengths of stay and fewer read­mis­sions and costly pro­ce­dures. What’s im­por­tant to note is that th­ese hos­pi­tals are also known for de­liv­er­ing high-qual­ity health­care.

Not sur­pris­ingly, the hos­pi­tals in­ter­viewed have a lot in com­mon. For ex­am­ple, they in­volve pa­tients and fam­i­lies in care-im­prove­ment ac­tiv­i­ties; hire and train staff with a fo­cus on their abil­ity to be com­pas­sion­ate; have a cul­ture of ex­per­i­men­ta­tion; have com­pas­sion­ate-care cham­pi­ons, of­ten in the mid­dle of the or­ga­ni­za­tion, as well as units that model com­pas­sion and share their suc­cess with oth­ers; they em­pha­size con­ti­nu­ity of care and team­work; and they use pa­tient ex­pe­ri­ence data to drive im­prove­ment.

Th­ese are hos­pi­tals that re­ward physi­cians who spend more time at the bed­side, screen job ap­pli­cants for com­pas­sion­ate char­ac­ter traits and em­ploy “cul­tural nav­i­ga­tors” to bridge com­mu­ni­ca­tion and cul­tural gaps. At th­ese or­ga­ni­za­tions, pa­tients’ per­sonal sto­ries and val­ues are as crit­i­cal to the med­i­cal record as their lab val­ues, care­givers write hand­writ­ten con­do­lence notes to mourn­ing fam­i­lies, and pa­tients and fam­i­lies are in­cluded in shift-to-shift re­port­ing so they are bet­ter in­formed and can ask ques­tions.

Many of the best prac­tices we un­earthed were based on a con­vic­tion that em­ployee ex­pe­ri­ence drives pa­tient ex­pe­ri­ence and sup­port­ing care­givers is es­sen­tial to pre­serv­ing their com­pas­sion. Un­for­tu­nately, car­ing for care­givers in to­day’s high-stress health­care en­vi­ron­ment does not ap­pear to be a high pri­or­ity for many hos­pi­tal CEOs. Ac­cord­ing to a 2014 Amer­i­can Col­lege of Health­care Ex­ec­u­tives sur­vey of 388 hos­pi­tal CEOs, fi­nan­cial chal­lenges, health­care re­form im­ple­men­ta­tion, gov­ern­ment man­dates and pa­tient safety and qual­ity lead the list of toprank­ing con­cerns. Pa­tient sat­is­fac­tion ranks sixth, and care­giver sat­is­fac­tion does not ap­pear on the list at all. Yet we know that care­giver burnout—now at epi­demic lev­els in the U.S. health­care sys­tem—is as­so­ci­ated with lower pa­tient sat­is­fac­tion, poorer health out­comes, and quite pos­si­bly in­creased costs.

Among the care­giver sup­port ac­tiv­i­ties we learned about through our in­ter­views were mind­ful­ness train­ing pro­grams and weekly well­ness con­fer­ences; on-site ther­apy and classes in mu­sic, art and dance; bi­monthly break­fasts with the CEO; and emer­gency depart­ment sup­port groups held on a ro­tat­ing ba­sis at physi­cians’ homes. But just as im­por­tant are ef­forts to re­lieve care­givers of some of the ad­min­is­tra­tive tasks that de­plete them and pre­vent them from do­ing what they went into health­care to do in the first place: care for pa­tients and fam­i­lies.

Build­ing a cul­ture of com­pas­sion doesn’t in­volve large cap­i­tal in­vest­ments, just the com­mit­ment of health­care se­nior ex­ec­u­tives and well­re­spected cham­pi­ons, com­bined with a will­ing­ness to ex­per­i­ment and be open to new ideas. Yet the re­turn on in­vest­ment, across mul­ti­ple di­men­sions, can be re­mark­able.

Julie Rosen is ex­ec­u­tive direc­tor of the Schwartz Cen­ter for Com­pas­sion­ate Health­care. More than 450 health­care or­ga­ni­za­tions in the U.S., Canada and the U.K. have adopted the Bos­ton­based not-for-profit’s pro­grams to ad­vance com­pas­sion­ate care.

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