Science and Art
When I suffered a concussion a few years ago the phrase 'being cared for' and variations on that theme where frequent. I remember writing in my journal at the time, that if I heard 'it's because we care' one more time, I was going to punch someone and I'm generally a very peaceful person, my frustration and disconnect was real. So why was it that I didn't feel cared for when people were doing genuinely caring acts. I'd spent years talking about the 'high quality care' we strive to deliver for patients so why was now not feeling it.
On reflecting I realised that care is something that is received not given. We can try all we want to give care - the translation to something that someone feels is another step. This experience is similar to the findings recounted in Compassionmics and in the TEDx talk by author Stephen Trzeciak. The given example and start of the book is about a horrific coach crash in Sweden in 2007. Despite the impact and the devastation at the scene 56 people survived. 5 years later they were asked what they remembered, firstly it was the pain at the time of the impact. Secondly it was the lack of compassion from the healthcare delivery staff.
The book Compassionomicas is a systematic review that present for you the data and evidence on this impact of compassion in medicine or healthcare delivery. The books focus is on the impact for patients, for patient care and for providers of patient care. The author a self confessed data nerd takes huge detail in presenting the evidence from randomised control trials and other studies that have looked at the measurement of compassion. There is a lot of evidence and trial data presented in the book. It flows and is well designed and is an easy read. This is a teaser trailer for picking up the book yourself.
It's important to note that compassion is qualified and defined as something beyond sympathy and empathy - in that compassion requires action. It stresses the vulnerability of being on the receiving end of healthcare. It also describes how simple the actions that translate into compassion can be and how little time they can take.
Keen to understand what the action behaviour looks like beyond the data, I looked for those specifics - what was actually done. It was feeling known as a person, it was as simple as talking and getting to know the person in front of you. I think we feel challenged today with the time that we presume that is going to take. The evidence cited in the book from the US states that 56% of physicians do not believe they have the time for compassion.
A study to look at the time challenge specifically found it can take less than a minute - 40 seconds. The trial used a statement that stressed the sense of being there with the patient, the freedom to ask questions and the acknowledgement of how hard the situation was. I can't recall now how this was relayed in terms of authentic delivery and will dig back in that again now I'm recounting the example. It is the how as well as the what that makes a difference for me.
The book presents evidence on the cost implications, that compassionate care leads to fewer investigations and referrals and lower charges. The evidence here was all based on the US healthcare system, so you get to choose to extrapolate those to a different system or not.
Compassionate care improves patient self care, so patients have better outcomes because they take care of themselves, take medications due and generally following advice. The authors also argue that a lack of compassion is a threat to patient safety, depersonalising care misses elements when assessing a patient and also increases the chance of medical error.
What I was really keen to get to was the impact on providers of care. The talk of compassion fatigue and a focus on staff wellbeing and what that actually means in practice to the numbers of healthcare providers experiencing burnout. I wanted to know what was going to make a difference. The TED talk is a good place to hear the personal story - part of the variety of evidence presented - from Stephen Trzeciak himself, when he faced burnout. The usual path is to escape - get away, take a break, self soothe in a way to rebuild yourself. He took a different action. Acknowledging the evidence that when you care and are compassionate towards others it has a beneficial impact on you, the giver of the compassion, he leaned into compassion. He believed that the antidote for burnout was at the point of care - so get closer to it rather than escaping from it. He cared more not less and the fog that had been his life lifted.
The data and evidence suggests the same and it extends to our workplaces. Compassionate cultures are associated with lower emotional exhaustion. Patients perceive and feel this compassionate culture, creating a win win. A compassionate culture stemmed from the relationships and connections - being compassionate for each other. Lastly the book reminds you that compassion for yourself if a required ingredient. Pointing to the work of Kristin Neef as well as others; be gentle with yourself first if you wish to be gentle with others.
Stephen Trzeciak seeks to answer the question - does compassion matter? He concludes that it makes a difference even when it can't make a difference - those tragic moments when we can't change the outcome. Compassion matters for patients, for patient care and for those who care for patients.
The Compassionomics website has a page of media links, including a book review and a podcast. It's worth checking out the podcast for the commentary and feedback. I like to find those that aren't impressed or as sold on an idea as they challenge thinking and ask good questions.
As the way healthcare is designed and delivered are considered and changed, my hope is that compassion is utilised across the spectrum, not only limited to what we show to patients. Understanding and learning the components and behaviours that make up compassion will allow us the opportunity to design a system that promotes multiple benefits for economies, patients and those working in that system. If the antidote to burnout is to be at the point of care, the system and leadership of those areas needs to be able to factor that into the design and it’s sustainability.
