An Agenda For Improving Compassionate Care: A Survey Shows About Half Of Patients Say Such Care Is Missing

Schwartz Center for Compassionate Healthcare, Boston, Massachusetts, USA.
Health Affairs (Impact Factor: 4.97). 09/2011; 30(9):1772-8. DOI: 10.1377/hlthaff.2011.0539
Source: PubMed


As the US health care system undergoes restructuring and pressure to reduce costs intensifies, patients worry that they will receive less compassionate care. So do health care providers. Our survey of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is "very important" to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care. Given strong evidence that such care improves health outcomes and patients' care experiences, we recommend that national quality standards include measures of compassionate care; that such care be a priority for comparative effectiveness research to determine which aspects have the most influence on patients' care experiences, health outcomes, and perceptions of health-related quality of life; and that payers reward the provision of such care. We also recommend the development of systematic approaches to help health care professionals improve the skills required for compassionate care.

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    • "Effective communication is therefore increasingly a critical component to the delivery of quality care. It can also build trust, improve clinical outcomes, and decrease litigation [1] [2] [3] [4] [5]. "
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    ABSTRACT: Objective To assess the educational value of improvisational actors in difficult conversation simulations to teach communication and relational skills to interprofessional learners. Methods Surveys of 192 interprofessional health care professionals, and 33 teaching faculty, and semi-structured interviews of 10 actors. Descriptive statistics, Fisher's Exact Test and Chi-Square Test were used for quantitative analyses, and the Crabtree and Miller approach was used for qualitative analyses. Results 191/192 (99.5%) interprofessional learners (L), and 31/33 (94%) teaching faculty (F) responded to surveys. All 10/10 actors completed interviews. Nearly all participants found the actors realistic (98%L, 96%F), and valuable to the learning (97%L, 100%F). Most felt that role-play with another clinician would not have been as valuable as learning with actors (80%L, 97%F). There were no statistically significant differences in perceived value between learners who participated in the simulations (47%) versus those who observed (53%), or between doctors, nurses, or psychosocial professionals. Qualitative assessment yielded five actor value themes: Realism, Actor Feedback, Layperson Perspective, Depth of Emotion, and Role of Improvisation in Education. Actors independently identified similar themes as goals of their work. Conclusions The value attributed to actors was nearly universal among interprofessional learners and faculty, and independent of enactment participation versus observation. Authenticity, feedback from actors, patient/family perspectives, emotion, and improvisation were key educational elements.
    Patient Education and Counseling 09/2014; 96(3). DOI:10.1016/j.pec.2014.07.001 · 2.20 Impact Factor
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    • "This study finds that patient perceptions of care quality are associated with a set of concrete organizational practices—compassion practices. Researchers have recently called for reinvigorating compassion in care delivery (e.g., Lown, Rosen, and Marttila 2011), but, aside from suggestive case studies (Dutton et al. 2006; Lilius et al. 2011), previous research lacks an empirical foundation for whether compassion practices are associated with important organizational outcomes. We find that when a hospital explicitly rewards compassionate acts by its staff and supports its staff during tough times, it is associated with patients more highly rating the care experience and being more likely to recommend the hospital. "
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    ABSTRACT: Objective To examine the benefits of compassion practices on two indicators of patient perceptions of care quality—the Hospital Consumer Assessment of Healthcare Providers and systems (HCAHPS) overall hospital rating and likelihood of recommending.Study SettingTwo hundred sixty-nine nonfederal acute care U.S. hospitals.Study DesignCross-sectional study.Data CollectionSurveys collected from top-level hospital executives. Publicly reported HCAHPS data from October 2012 release.Principal FindingsCompassion practices, a measure of the extent to which a hospital rewards compassionate acts and compassionately supports its employees (e.g., compassionate employee awards, pastoral care for employees), is significantly and positively associated with hospital ratings and likelihood of recommending.Conclusions Our findings illustrate the benefits for patients of specific and actionable organizational practices that provide and reinforce compassion.
    Health Services Research 05/2014; 49(5). DOI:10.1111/1475-6773.12186 · 2.78 Impact Factor
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    • "10.1016/j.ijnurstu.2013.01.008 4. contextualized knowledge of the patient and family both individually and as members of a network of relationships. Adapted from Lown et al. (2011). The relational processes and practices that support compassion require the development of skilled interpersonal relationships (Cash, 2007; Congressi, 2006; Crigger et al., 2006; Dewar et al., 2010; Jull, 2001; Kanov et al., 2004; Kim and Flaskerud, 2007; Macleod and McPherson, 2007; Milner, 2003; Peters, 2005, 2006; Schantz, 2007; Schultz et al., 2007; Torjuul et al., 2007; Von Dietze and Orb, 2000; Youngson, 2008). "
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    ABSTRACT: AIM: This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments. BACKGROUND: Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover. APPROACH AND METHODS: The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts. FINDINGS: The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'. CONCLUSIONS AND IMPLICATIONS: The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and accorded status. Staff require appropriate support, facilitation and strong leadership if these practices are to flourish.
    International journal of nursing studies 02/2013; 50(9). DOI:10.1016/j.ijnurstu.2013.01.008 · 2.90 Impact Factor
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