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 top-notch 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 top-ranking 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 well-respected champions, combined with a willingness to experiment and be open to new ideas. Yet the return on investment, across multiple dimensions, can be remarkable.