A Requiem for Compassion in Healthcare?

Not just yet.

As a clinical cardiologist I am deeply inspired by neurosurgeon and compassion advocate James R. Doty, M.D.

I whole-heartedly agree with Dr. Doty’s call for change:

“We don’t just need a compassionate revolution in healthcare...We need a compassionate revolution in the world.”

So here’s the $100 million question: How can we normalize and operationalize compassion throughout our complex and profit-driven organizations in order to transform healthcare? Without a complete roadmap which takes into account both organizational and individual obstacles to compassion at work, any attempt at actualizing the vision of a “culture of compassion” is doomed to fail.

How Do You Change a Culture?

Our U.S. healthcare systems is currently more aptly characterized as a “culture of disconnection.” And yet there is so much promise -- there are many examples of systems moving in the right direction.

The reform process needs to include the following elements which fall into the broad categories of external (organizational, policy-related, etc) and individual (relating to the emotional flexibility, psychological inner resources, and mindset of the individual provider and leader.)

These interventions are not a matter of “either-or.” Our healthcare crisis of disconnection requires a “both-and” mindset.

External (Organizational) Factors:

• Removing the many external obstacles to our natural compassion, including the well-documented drivers of burnout (disempowerment of the provider, widespread workplace distractions and inefficiencies, overwhelming workday and call schedules, insufficient social connection, the burden of excessive clerical/documeation tasks, and eroded sense of purpose and meaning)
• Committing to a workplace culture that protects psychological safety and mutual trust. This must begin at the top with servant leaders who “walk the walk” of empathy and compassion and embody these values in every interaction and communication. These skills can be taught in leadership training and are becoming more commonplace in the business world. Commitment to providing optimal “human experience” must first and foremost apply to those providing care for others, so that they have the inner resources to be fully present and emotiaonlly available for those we care for.

Internal (Psychological) Factors:

• Adequate funding and protected time dedicated to education on practical stress management and healthy coping skills, in order to foster resilience and emotional openness, which are the prerequisites for compassion. We as a culture must destigmatize mental illness and normalize the spectrum of mental health states among the general public and among healthcare providers. Without removal the veil of silence, caregivers avoid seeking help. At the same time, we as providers must give up the deeply programmed mindset “I can do it myself, and I don’t need help, or rest” This cultural shift needs to happen in medical school and residency training programs. We need to feel safe and protected to fully manifest altruistic, generous, and kind behavior towards others.
• Sharing evidence-based techniques (like self-compassion and empathy-enhancing practices) that have been shown to help us strengthen our natural human desire to help others in need. We can leverage the power of evidence-based mental training and visualization techniques and practices shown to enhance the neurological and emotional pathways that drive compassionate behavior. Love and compassion are active mental states and virtues that can be developed. Unless nurtured, they too easily fall victim to our more base tendencies towards self-centeredness and tribalism.

It's Up To You. Really.

So what do you think? Is it possible to create a healthcare system rooted in and imbued with compassion? What are our greatest obstacles? Solutions? 

Please share your thoughts below. We need to figure this out together. For all our sakes.