The Science and Art of Compassion in Healthcare
When I suffered a concussion a few years ago the phrase 'being cared for' and variations on that theme were 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 were 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 I 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.
Describing a horrific coach crash in Sweden in 2007 the book where, 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 presents the data and evidence on the impact of compassion in medicine or healthcare delivery. The book’s 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, 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 investigated how long it takes - addressing that very issue of time. It 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’m curious about how the statements were delivered and how you can control for delivery intent and perception, however, the point made is that it doesn’t take as long as we think it does. Personally, a smile is a good start.
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 and generally follow 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 particularly keen to get to was the impact on providers of care. The impact of compassion fatigue and staff burnout are frequent and far too regular conversations and commentaries. So I wanted to know what this book had to offer. Specifically, 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, and 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 suggest 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 stems from relationships and connections - being compassionate for each other.
Lastly, the book reminds you that compassion for yourself is 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. There are colliding perspectives that challenge the thinking and ask good questions.
As the way healthcare is designed and delivered is considered and changed, I hope that compassion is utilised across the spectrum, not limited to what we show to patients.
Understanding and learning the components and behaviours that makeup 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 need to be able to factor that into the design and its sustainability.
