In February 2013, the publication of the Mid Staffordshire NHS Foundation Trust Public Inquiry catalyzed the emergence of a new paradigm for health professionals and health systems: healing requires more than treatment of a disease – it requires person-centered, compassionate care.
Since then, the concept of “compassion” has ricocheted throughout the global health sphere, often with varied meanings in different contexts and languages and is now recognized as an essential component to achieving quality in universal health coverage (UHC).
Compassion has linkages to all levels of the health system, across all stages of the continuum of care. Compassion should be considered as a lever for improving the performance of health systems and efficiency of care delivery as compassion has been linked to better communication between providers and patients and improved health outcomes overall.
The Global Learning Lab for Quality UHC (GLL) recently elevated the discussion on compassion by establishing a learning pod that specifically grapples with how compassion places people at the center of care: both those receiving care and those delivering care.
To kick off the discussions, the GLL held an international webinar on February 14, 2018, sharing examples of how compassion can be integrated into health systems to achieve greater quality. Participants in the webinar followed the journeys of four health practitioners as they shared their experiences integrating compassion (1) at the point of care, (2) at the facility level, (3) within health organizations, and (4) at the national level. Understanding where compassion fits within each of these four levels of a health system is a useful approach for exploring the relationships between people and institutions when promoting compassionate care.
Compassion at the Point of Care
During the GLL’s webinar, Dr. Rana Awdish, author of In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope, urged listeners to think of the role of the provider as a patient’s partner along the path to recovery, working side-by-side with patients rather than as the “voice of medicine” fighting a battle against a patient’s ill body.
She emphasized that “true healing” can only occur in the context of a mutually compassionate relationship. Within a supportive system, caregivers who provide compassionate care may also benefit from this relationship — reciprocally feeling the nourishing benefits of an open, trusting relationship with patients.
Within this approach, compassion is most visible at the point of care. Patients receiving compassionate care are correlated with better control of non-communicable diseases, better adherence to treatment and increased markers of immune responsiveness. The ability to deliver compassionate care is a learnable skill accessible to any provider and has the potential to transform patient experiences and responsiveness to treatment. However, sustaining a culture of compassion requires institutional support, which is explored in the next three levels of the framework.
Compassion Within Health Facilities
For compassionate care to exist, health facilities must purposefully incorporate empathy and compassion into the health care environment. Inadequate support can lead to physician burnout and decreased levels of engagement with the patient and other health workers.
Health facilities are essential for creating an enabling environment for compassion, cultivating a compassionate culture and elevating empathy as a critical priority for providers. Compassion-based care is an empowering perspective that can drive positive behavior change for both patients and frontline health workers.
During the GLL webinar, Dr. Susan Parrish-Sprowl, an adjunct clinical professor at Indiana University, reflected on her experience working in refugee health facilities in Jordan and shared that commitment and ongoing support from leadership is needed to support and sustain a persisting culture of compassion. Dr. Parrish-Sprowl spoke about the benefits of mindfulness practice as a strategy for health workers to shift from potentially harmful reactivity to compassionate responsiveness.
However, she emphasized that for mindfulness to become embedded in regular practice, facilities play a crucial role in instituting systematic support for this type of service delivery. For example, non-clinical staff can play a vital role in providing compassionate care to patients and are often an untapped resource when facility directors are thinking through ways to promote compassionate care. Particularly in resource-constrained and understaffed settings, it is essential to work with all personnel within a facility to innovate comprehensive systems to support a culture of compassion.
Compassion in Health Organizations
Facilities, like providers, are also not operating alone. Frequently as part of a broader health organization, facilities require support to prioritize compassion in health care. Building a culture of compassion across an entire organization requires a deliberate change to make space for meaningful human connection and develop mechanisms to capture data — both quantitative and qualitative — emerging from improving care.
Speaking during the GLL webinar, Shaun Maher, strategic advisor for person-centered care and improvement at NHS Education for Scotland – an education and training organization for health systems employees – shared Scotland’s “What Matters to You?” initiative, a day of reflection and compassion, as an example of prioritizing person-centered interactions at the organizational level.
“What Matters to You” reminds both providers and patients to listen to one another. From this compassionate listening, providers can design treatment options that respond to a patient’s priorities, which increases treatment adherence and improves health outcomes. The success of the initiative is partly attributed to the strong support it receives from health organizational leaders — elevating compassion as a priority for all participating facilities.
To complement the growing emphasis on compassion as a priority throughout health organizations, many are also redefining success. Most current health systems were established over 50 years ago when the culture of health care mainly focused on doctors as all-knowing vessels of medical information.
Within that framework, most data collection focused on the success rate of treatment rather than the total healing and well-being of patients. Shifting to collect both qualitative and quantitative data on patient welfare rather than disease treatment alone can help gain new insights into healing and the benefits of compassion.
Compassion at the National Level
Underpinning the three entry points for quality listed above, prioritization of compassion within the overall national direction on quality plays a pivotal role in ensuring that compassionate care is delivered at all levels of the health system.
An entry for this move is the inclusion of compassion in the national health quality strategy or policy. Incorporating “compassion” as an agenda item in the national health strategy can open the possibilities for compassion to be integrated into medical curricula, the establishment of national-level incentives for compassionate care and the scale-up of effective programs. Dr. Daniel Burssa, chief of staff in the State Minister’s Office at the Federal Ministry of Health in Ethiopia, shared three key insights during the GLL webinar:
- To secure financial and institutional support for increasing compassion, it is essential to build political commitment and clearly reflect the prioritization of compassion in national quality policies.
- To generate buy-in, it is necessary to engage a diverse set of stakeholders, particularly patient groups, religious leaders, professional associations, and medical education associations.
- When compassion is built into the national health strategy, every health care organization and facility director must start creating a culture of compassion, which leads to better implementation at scale.
Building Cultures of Compassion: Add Your Voice
Building a culture of compassion can transform health systems by creating space for quality people-centered care that is more effective and efficient and increases health outcomes and the resilience of health through engagement of all stakeholders.
As Dr. Burssa emphasized, compassion must not be thought of as a luxury, but as a human right that is necessary for survival. The work on this topic is just beginning and will continue to explore the key drivers for compassionate care as it relates to UHC and the global health agenda.
Are you interested in sharing your experiences instituting compassion in each of the four entry points described here? The GLL has announced a compassion call, asking for contributions to the four thematic areas and the linguistic, cultural and professional dimensions that ground this practice. To contribute, please click here. Inputs from the JLN community will feed into a global document on compassion and quality within UHC.
Furthermore, we invite you to join the GLL Learning Pod on compassion or reach out to the JLN Network Coordinator at firstname.lastname@example.org to seek more opportunities to exchange knowledge on compassion, quality and UHC-related topics.
Nana Mensah Abrampah, Melissa Kleine-Bingham, Heather Harmon, WHO Global Learning Laboratory for Quality UHC; Samantha Ferguson, Results for Development