I get fidgety when people speak about compassion in healthcare. Don’t get me wrong, I believe it is as real and as vital a part of the healing process as the surgeon’s knife or the well-targeted dose of chemotherapy. My quandary is that personal compassion is a central issue and an irrelevance both at the same time. Let me explain.
What is a hospital ward or an old people’s nursing home if the staff have little personal compassion for their patients? The vital spirit is missing. They have lost sight of their purpose and forgotten why they started in their profession. The health service is all about treating, caring and healing. Compassion is central to that identity and reason for being. So compassion is perhaps the central issue. But is it enough?
What about a cancer ward, a diabetes clinic, or an ambulance crew with dedicated, caring, and compassionate staff, but where the work environment is poorly-equipped, badly-organised and buried in a sea of bureaucracy? What good is the touch of a hand or the pause at the bedside, if the ‘system’ doesn’t seem to care? This is my source of unease and frustration.
Compassion in health professionals is intangible. It is a feeling, a spirit, a personal value or an ethic we expect of them. But it’s not enough. The organisational system they work in also has to be compassionate; otherwise the patient’s experience of compassion is incomplete.
The best available research shows that one in ten patients admitted to hospitals in the UK will fall victim to an unintentional error. This is unacceptable. Think of the outcry if a supermarket, a car manufacturer or an airline was harming people on this scale. It isn’t simply because of careless staff. It’s the ‘system’ that doesn’t work and that isn’t compassionate. If the socio-technical ‘whole-system’ is mis-aligned with the organisation’s purpose, it is highly likely to appear uncompassionate to patients, and indeed to the staff working in it despite their best efforts.
Where should we start with compassion? Should we start by encouraging healthcare leaders to be role-models and recognise compassionate behaviours in others? Or should we start by equipping those leaders to create local work environments where the ‘whole system’ works effectively and efficiently to deliver appropriate, safe healthcare?
It’s not a question of either/or. We need both.
Can a healthy work environment be designed? We think it can. Think of architecture. Remember Sick Building Syndrome? A lot of research has gone into modern hospital design to create environments that are geared to healing and, for example, avoidance of infection. It’s no different when designing work systems and organisations. We believe that there are lots of organisations with ‘Sick System Syndrome’. It’s just rarely diagnosed.
We see several basic characteristics in the design of an organisation environment and systems where compassion can flourish. Here are a few examples.
Take Roger’s experience of the 3 different team leaders in his previous blog. Think of job design. Did the first staff nurse follow him from A&E to the CDU because she wanted to or because her job was designed that way? Or was the job designed to satisfy Agenda for Change grading criteria?
Think of performance appraisal. Is compassion recognised and rewarded in the performance appraisal system for staff? If it is recognised, how does it compare with skills and competence in the appraisal of professional staff? Where is compassion in the Knowledge & Skills Framework?
Think of communications training. The night shift argument happened because the patient didn’t want to frighten his family by having to stay overnight in hospital. In fact he didn’t want them to know he had been unwell at all. A difficult situation for staff, but a simple conversation about handling communication with his next of kin could have averted a public argument.
Think of how teams are organised and led. Think of what performance measures are in place for the ward or unit. Think about whether the ward team has the tools to plan, deliver and evaluate their own performance. And so much more besides.
We often talk about leaders walking the talk. The challenge we pose here is whether the organisation systems are aligned with its values. Do your systems walk the same talk as you? Or do you have Sick System Syndrome where you work?
The good news is that it is treatable! Simon Thane