Compassionate Care: Who Have We Become?

April 3, 2015

According to a recent report from the Schwartz Center for Compassionate Healthcare, “Healthcare organizations that show a commitment to compassion enjoy a better bottom line as well as increased patient and caregiver satisfaction.”

Is it really as simple as if we do THIS, we get THAT?

The incentivizing of empathy and compassion is yet another stunning example of how our healthcare system has hijacked patient-centered care.  No, not 100%.  But, when an organization is motivated by economic benefit rather than by a shared humanity and caring for the community it serves, it seems as if we have forgotten why healthcare is a calling; not just a job or a transaction. Who have we become?

The valuation of compassionate care is frustrating. Do we need an ROI to prove that kindness, concern, and genuine engagement with patients is good for business?

In an op-ed in the New York Times, Dhruv Khullar, M.D, a resident at Massachusetts General, shares his experiences  of “efficiency-empathy trade-offs” that are resolved only in bartering the “time to care” for “tasks to do.”  Dr. Khullar writes eloquently about the pressures placed on new residents who cannot or do not prioritize spending time with patients in any meaningful way.

“We hide behind buzzwords like “patient-centeredness” and “shared decision-making” without being able to offer the time that gives these terms true weight,” he writes.

We often read about dying patients requesting a nurse or doctor stay with them for a few moments. The response is “I will be right back.”  And, the patient dies waiting; the nurse or doctor never forgets what they failed to do for one patient.

When I was in the hospital with my own serious crisis several years ago, I remember having dry heaves, panicking because I could barely breathe. The nurse standing outside of my room was apparently oblivious to my situation. Instead, she was checking on her laptop to see when my next meds were scheduled.

There was a disconnect between the nurse and her job to care for me.

HCAHPS scores have given us one more report card that follows the model of teaching to the test.  And, the test, each time, is a human being whose life is at stake, being pitted against an operational manual that doesn’t have “human caring” as part of its instructions.

If you’ve got one of those manuals, here’s what I suggest you do.

1. Use a No One Dies Alone Program

Started at Sacred Heart Medical Center in Eugene, OR, Sondra Clarke, RN, tells her story, which has now become a national movement to ensure that no patient is alone in the hospital at the end of their life.

2.  Create a Nurturing Environment

A physical environment that itself is nurturing is palliative by its very nature. Utilizing The C.A.R.E. Channel is one way to do this. Both patients and families tell us all the time how The C.A.R.E. Channel “held their hands” and comforted a dying parent to his/her last breath.

3.  Establish Comfort Processes

This will allow nurses to be with a patient, as needed, and still take care of their other patients. This could include brief, but frequent “drop ins” that may not each include measuring anything.  It could also include informed CNA’s coming in, speaking to the patient by name, and engaging in personal caring.  I might include informing Spiritual Care as to the needs of patients and families.  Partnering among nurses, so that patients experience their “care team” as more than one person allows for more flexibility.  It will take more than one person, regardless of their role, to authentically care for a patient and families whose personal needs have reached the acuity level of their physical needs.

4.  Be Creative and Flexible

If there is a situation than requires special planning, such as a patient near death or approaching active dying process, then do it, one patient at a time.

Experiencing human intimacy through the sense of caring is the real bottom line benefit of compassionate care.

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