Keeping the Care in Healthcare

Growing out of some personal and family experiences in recent years, I’ve been reflecting on the caring part of healthcare. This reflection occurs alongside my continued thinking about systems and trends such as healthcare payment reform. We have made and will continue to make important strides in healthcare technology and in clinical best practices. That we are seeing strong reform initiatives that may favorably shift the cost, outcome, and quality curves in our healthcare delivery systems should come as no surprise. But I also very strongly believe that whatever healthcare technology, clinical practice advances, and delivery system design improvements we achieve, we should never lose sight of the central importance and power of human interaction and compassionate healthcare. 

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”
Leo Buscaglia

Serious illness, disability, or traumatic events can create anxiety and profound feelings of vulnerability. It isn’t always immediately clear what’s wrong with us (or a family member), how serious it is or may become, how long it will last, or what we are going to need to make it better — if that’s even possible. If an illness is chronic or progressive, strong feelings of depression and loss may also arise.

Competent and Compassionate Healthcare

Think back to your own healthcare experiences. If you are anything like me you want to feel that the care you are receiving is competent care. That the people I’ve called upon to “diagnose and fix me,” who are taking my history, scanning me, drawing my blood, manipulating my body, inserting tubes, injecting things into me, putting wrist bands on me, putting me in an ambulance, or whatever else, are people who know what they are doing and that they are clearly communicating with each other.

But for me, close on the heels of competent healthcare is compassionate healthcare – a sense that the people caring for me are attuned to my sense of anxiety and vulnerability as a patient in a circumstance I’d rather not be in. 

“A kind gesture can reach a wound that only compassion can heal.”
Steve Maraboli

Many years ago, I was involved in a September 11th disaster recovery program that served tens of thousands of people. We managed mental health benefit programs that included a national call center and benefit eligibility teams. There were lots of technical requirements, competencies, and procedures to master. One of the first things we did when we put the team together was to invoke a principle that would guide our interaction with victims who reached out to us.

The principle was simply this: every person who reached out to us for help would feel that they had been “listened to, cared about, and understood.”

One of the most gratifying parts of that work is that our team passionately embraced this principle and that, beyond the tangible mental health benefits we provided, we also provided the intangible benefit of conveying that we cared about their well-being and recovery.

I also got firsthand affirmation of the value of this principle in the days after Hurricane Katrina when I volunteered at a disaster call center in Louisiana. We couldn’t immediately fix the many problems of the callers. But, we could listen and convey that we understood and cared about the people who reached out to us. That alone made some difference. The value of delivering compassionate healthcare belongs in all facets of human services.

Measuring Caring

There are parts of our healthcare system that have very formally embraced the concept of patient satisfaction as a critical quality metric (such as the HCAHPS Patients’ Prospective of Care Survey). To create a compassionate healthcare system, we must continue advance such work. This, however, goes beyond having certain protocols and procedures in place. A key underpinning of patient satisfaction measures is a caring attitude on the part of the staff.

The Beryl Patient Institute is an important contributor in this area. The Beryl Institute serves as a global community dedicated to improving the patient experience through collaboration and shared knowledge. They define patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Their work has spawned some very inspiring videos of healthcare staff declaring that “I am the patient experience.”

Demonstrating Compassionate Healthcare

Let me offer my own simple checklist of some healthcare provider behavior that can help convey a compassionate attitude. I hope you’ll offer your own thoughts on things that work, while still maintaining professional boundaries. In no special order:

• Place a premium on listening.
• Focus your attention on the person you are with – don’t give into the temptation to multi-task.
• Know that genuine warmth matters.
• Explain what you are doing and why.
• Take the time to stop and answer questions, and don’t just power through your procedures.
• Find out if the person has questions – don’t just assume they will ask if they do.
• If they are anxious or fearful, acknowledge these feelings and offer reassurance.
• Be conscious that privacy and dignity matter.
• Check on your own reactions – if you are feeling impatient or irritated, manage these feelings.
• This is an interaction of two human beings in unequal positions. Reinforce that their welfare matters and let them know ways they can collaborate in their care.

I’d be remiss and naïve if I didn’t acknowledge that there can be a cost to caring. This can be particularly true for professionals working with victims of trauma who can develop what was once called compassion fatigue but is now more commonly referred to as secondary traumatic stress (STS). We must find a good work-life balance to do the work we do over an extended period, even if we do not work with trauma victims. It’s been observed that “if your compassion does not include yourself, it is incomplete.” While we strive to provide compassionate healthcare, it’s also important to keep that in mind.