A culture of compassion: How timeless principles of kindness and empathy become powerful tools for confronting today's most pressing healthcare challenges.

The role of compassion in healthcare is receiving increased attention as emerging research demonstrates how compassionate patient care can improve health outcomes and reduce workplace stress and burnout. To date, proposals to encourage empathy, kindness, and compassion in healthcare have focused primarily on training individual care providers. This article argues that increasing the awareness and skills of individuals is necessary but insufficient. Compassionate care becomes an organizational norm only when health leaders create and nurture a "culture of compassion" that actively supports, develops, and recognizes the role of compassion in day-to-day management and practice. The article profiles four organizations that have adopted compassionate healthcare as an explicit organizational priority and implemented practical measures for building and sustaining a culture of compassion. Common principles and practices are identified. These organizations demonstrate how compassion can lead directly to improved outcomes of primary importance to healthcare organizations, including quality and safety, patient experience, employee and physician engagement, and financial performance. They show how compassion can be a powerful yet often underappreciated tool for helping organizations successfully manage current challenges.

Healthcare in Canada: Choices Going Forward.

The overarching purpose of serial Health Care in Canada (HCIC) surveys of the adult Canadian public and a broad spectrum of healthcare professionals over the past two decades has been the development of an evidence-based map to inform strategic and clinical decisions to improve care and outcomes for Canadians. Recent surveys reveal a growing concern that medicare may require complete rebuilding or major strategic repairs. On the other hand, a majority of stakeholders perceive continuing underlying quality in our clinical care and look forward to both system- and patient-centred initiatives to improve future care. Currently, the most strongly supported strategic improvement target among the public and professional caregivers is enhanced availability of less expensive prescription medications. With regard to practical implementation of this strategy, the public's (39%) and healthcare professionals' (39-54%) preference was institution of a nation-wide pharmacare plan, funded by a federal tax. There was also pan-stakeholder concordance around the two least favoured potential strategies: increasing taxes and shifting money from other funded services. In terms of improving clinical care, the public and all professional groups were also concordant in most strongly supporting increases in home and community care services, disease prevention/wellness education and use of non-physician care providers and electronic health records. There was also remarkable concordance regarding who is most responsible for implementing these preferred innovations: research hospitals/health authorities, government funding agencies and pharmaceutical/biotech industries. In summary, contemporary Canadian public and health professionals agree on key strategic and practical priorities to improve future care and outcomes. Moreover, they concur on who should lead their implementation. This public/professional concordance supporting evidence-driven choices and leadership for improving care is not common. It is, however, an opportunity, providing a call to arms for other stakeholders, particularly governments and industry, to recognize the opportunity and their leadership expectations and to act upon them. Things can be better.

Leaders go first: Creating and sustaining a culture of high performance.

The culture of a healthcare organization plays a critically important role in determining whether strategic plans will be executed effectively and organizational goals will be achieved. A culture of high performance serves as a foundation that supports the implementation of healthcare strategies and enables health leaders to evaluate, select, optimize, and sustain a full portfolio of improvement initiatives linked directly to top priorities and mandates. This article argues that a culture of high performance should become an integral part of all strategic planning and, further, that a strong and explicit leadership commitment, beginning with the board and CEO and extending throughout all leadership levels, is required to implement a successful culture transformation. Proven methods for developing a culture of high performance in practice are described, addressing key areas such as alignment, accountability, standard behaviours and practices, leader development, discipline, and consistency.

High reliability in healthcare: creating the culture and mindset for patient safety.

Occurrences of patient harm in healthcare represent a significant burden, with serious implications for patients and families and for the capacity of health systems to manage patient access, flow, and wait times. Interest in the science of high reliability, developed originally in industries such as commercial airlines that have demonstrated exceptional safety records, is an emerging trend in healthcare with the potential to help organizations and systems achieve the ultimate goal of zero patient harm. This article argues that zero patient harm is a fundamental imperative, and that high-reliability science can help to accelerate and sustain progress toward this vital goal. Although the practices used in other industries are not readily transferable to healthcare, and no single proven model for High Reliability Organizations in healthcare is yet available, leading organizations are beginning to demonstrate effective healthcare-specific strategies. Experience from Studer Group's international network of partner organizations is used to illustrate and understand these early efforts. Studer Group's Evidence-Based LeadershipSM framework is applied in diverse healthcare settings to provide a foundation of culture transformation and change management to support high reliability. It offers an approach and resources for moving forward toward the goal of zero patient harm, with concurrent benefits related to the efficient use of our valuable healthcare resources.

La haute fiabilité en soins de santé: la création d'une culture et d'une mentalité favorisant la sécurité des patients.

Les préjudices que subissent les patients recevant des soins de santé représentent un fardeau considérable et peuvent avoir de graves répercussions sur les patients et les familles ainsi que sur la capacité des systèmes de santé de gérer l'accès des patients, leurs déplacements dans le système et les temps d'attente. L'intérêt pour la science de la haute fiabilité, mise au point à l'origine dans des secteurs comme l'aviation commerciale, qui ont un bilan exceptionnel en matière de sécurité, est une nouvelle tendance en soins de santé qui pourrait aider les organisations et les systèmes à atteindre le but ultime : zéro préjudice subi par les patients. Cet article fait valoir que zéro préjudice au patient est un impératif fondamental et que la science de la haute fiabilité peut aider à accélérer et à soutenir les progrès vers ce but vital. Bien que les pratiques utilisées dans d'autres secteurs ne soient pas facilement transférables aux soins de santé et qu'il n'existe pas encore un seul modèle éprouvé pour les organisations à haute fiabilité en santé, des organisations de premier plan commencent à faire la démonstration de stratégies efficaces propres aux soins de santé. L'expérience du réseau international d'organisations partenaires du groupe Studer est utilisée pour illustrer et comprendre ces premiers efforts. Le cadre Evidence-Based LeadershipSM (leadership fondé sur les données probantes) du groupe Studer est appliqué dans différents milieux de soins de santé pour transformer la culture et la gestion du changement visant à favoriser une haute fiabilité. Il propose une démarche et des ressources pour progresser vers le but zéro préjudice subi par les patients et tous les avantages liés à l'utilisation efficiente de nos précieuses ressources en soins de santé.

Patient-Centred Care in Canada: Key Components and the Path Forward.

Canadians' health and its care continue to evolve. Chronic diseases affect more than 50% of our aging population, but the majority of public and professional stakeholders retain a sense of care quality. An emergent issue, however, is generating an increasingly wide debate. It is the concept of patient-centred care, including its definition of key components, and efficacy. To advance the evidence base, the 2013-2014 and 2016 Health Care in Canada (HCIC) surveys measured pan-stakeholder levels of support and implementation priorities for frequently proposed components of patient centricity in healthcare. The public's highest rated component was timely access to care, followed by perceived respect and caring in its delivery, with decisions made in partnership among patients and professional providers, and within a basic belief that care should be based on patients' needs versus their ability to pay. Health professionals' levels of support for key components largely overlapped the public's levels of support for key components, with an additional accent on care influenced by an evidence base and expert opinion. In terms of priority to actually implement enhanced patient-centred care options, timely access was universally dominant among all stakeholders. Caring, respectful care, also retained high implementation priority among both the public and professionals, as did care decisions made in partnership, and, among professionals, care driven by research and expert opinion. Low priorities, for both the public and professionals, were the actual measurements of patient-centred care delivery and its impact on outcomes. In summary, there is remarkable concordance among all stakeholders in terms of favoured interventions to enhance patient-centred care, namely, timely access, caring, partnering and communicative delivery of evidence-based care. Unfortunately, the lack of contemporary imperative around the value of measuring and reporting actual use and outcomes of favoured interventions means uncertainty of their efficacy will persist for the foreseeable future. Things can be better.

Searching for Best Direction in Healthcare: Distilling Opportunities, Priorities and Responsibilities.

Canada's health and its care are evolving. Evidence from serial Health Care in Canada surveys of the public and health professionals over the last two decades reveal a persistent sense of care quality, despite an aging population, decreasing levels of good and excellent health, increasing prevalence of chronic illnesses; and sub-optimal access to timely and patient-centred care. Stakeholders are, however, somewhat pessimistic and many sense complete rebuilding, or major changes, may be necessary. To improve access, the primary health concern of all Canadians - increasing medical and nursing school enrolment, and requiring professionals to work in teams - have attracted increasingly high support from both the public and professionals. However, physicians' support lags behind that of nursing, pharmacy and administrative colleagues; and, currently, only a minority of patients and professionals are actively involved in team care programs. Another example in which high levels of support may not necessarily translate into priority implementation of promising interventions is the realm of patient-centred care. The public and all professionals report a very high level of general support for care provided in a caring and respectful manner. However, while the public rank it second in implementation priority, following timely access, the majority of professionals rank it only fourth. By contrast, there is remarkable pan-stakeholder concordance around interventions to improve the overall health system, with the majority of public and professional stakeholders rating the creation of national supply systems as their top priority to expedite the clinical and cost efficiency of new treatments. There is a similar pan-stakeholder concordance around priority of responsibility to drive innovations, the top three being: federal/provincial governments; research hospitals/regional health authorities; and the pharmaceutical industry. In summary, Canadians are at a healthcare crossroads. Population health is decreasing, chronic diseases are increasing and desire for timely access to patient-centred, team-delivered and technology-supported care remain top concerns. Despite some disconnects between theoretical support for, and priority to implement, promising innovations, there is universal support to optimize resources to make things better. And there is concordance around the leadership best suited to lead innovation. Things can be better.

Back to the future: Patient experience and the link to quality, safety, and financial performance.

Improving patient experience has emerged as an important healthcare policy priority across Canada. Tools and systems for monitoring patient experience metrics are becoming increasingly refined and standardized, and the trend toward greater accountability for improvements that are sustainable and affordable is well underway. For many healthcare professionals, this represents a renewed focus on core patient needs and priorities, following decades during which structural and technological changes have dominated healthcare agendas. Improving patient experience in our contemporary healthcare environment presents major challenges-and opportunities-for Canadian health leaders. The experience of Studer Group partner organizations in Canada is relevant and instructive in this context. These organizations have adopted a model known as Evidence-Based Leadership (EBL) that enables and supports the alignment of all activities and behaviours toward specific organizational goals, including measurable patient experience improvements. This article reviews case studies of organizations that have adopted EBL. These organizations are demonstrating rapid progress in patient experience indicators while simultaneously making gains in critical areas such as clinical outcomes, safety, physician and staff engagement, and financial performance. Emerging evidence concerning the factors and processes that underlie these improvements is also discussed.

Retour vers le futur: l'expérience des patients et le lien avec la qualité, la sécurité et le rendement financier.

Au Canada, l'amélioration de l'expérience des patients est devenue une priorité des politiques de santé. Le perfectionnement et la normalisation des outils et systèmes pour surveiller les mesures de l'expérience des patients augmentent, tandis que la tendance vers une plus grande reddition de compte sur des améliorations durables et abordables se confirme. Pour de nombreux professionnels de la santé, ce phénomène fait foi d'un intérêt renouvelé pour les besoins et priorités fondamentaux des patients, après des décennies où les changements structurels et technologiques ont dominé les programmes de santé. Pour les leaders en santé canadiens, l'amélioration de l'expérience des patients comporte actuellement de grands défis et de belles possibilités. À cet égard, l'expérience des organisations partenaires du groupe Studer au Canada est à la fois pertinente et instructive. Ces organisations ont adopté un modèle, du nom de Evidence-Based Leadership (EBL, ou leadership fondé sur des données probantes), qui favorise et soutient l'harmonisation de l'ensemble des activités et des comportements, conformément à des objectifs organisationnels précis, y compris des améliorations mesurables de l'expérience des patients. Le présent article expose des études de cas d'organisations qui ont adopté l'EBL. Ces organisations ont réalisé des progrès rapides en matière d'indicateurs de l'expérience des patients, ainsi que dans des secteurs essentiels comme les résultats cliniques, la sécurité et le rendement financier. Les données émergentes sur les facteurs et processus qui sous-tendent ces améliorations sont également abordées.

The power of engagement: creating the culture that gets your staff aligned and invested.

The Canadian government officially recognizes the value of staff engagement in providing better healthcare. Evidence demonstrates that engagement is connected to improved financial outcomes as well as better patient safety and clinical outcomes. There is a need for health leaders to create organizational cultures that simultaneously result in higher rates of employee and physician engagement, better clinical care, and lower costs. This article highlights the research and experience gained on the benefits of engagement, explores Studer Group's approach to improving both engagement and quality, and shares the results achieved by the firm's Canadian partners. In addition, it describes some of the "building blocks" that, together, create the necessary cultures of engagement inside organizations.

Partnership and measurement: the promise, practice and theory of a successful health social networking strategy.

Patient health management (PHM) was launched as a promising paradigm to close care gaps, the inequities between usual and best care, for whole patient populations. PHM's core premise was that interventions of multidisciplinary, community-oriented partnerships that used repeated measurement and feedback of provider practices, clinical and economic outcomes and general communication of relevant health knowledge to all stakeholders would continuously make things better. This article reviews the evolution of PHM from its genesis in a series of casual hospital-based networks to its maturation in a province-wide, community-focused, clustered-lattice social network that facilitated the improved clinical and cost-efficient care and outcomes of whole patient populations. The factors underlying PHM's clinical and cost efficacy, specifically its patient-centric social networking structures and integral measurement and knowledge translation processes, offer continuing promise to optimally manage the care of our increasingly aged patient populations, with their high burden of chronic diseases and disproportionately large care gaps. In an era when patients are demanding and leading change, and governments are struggling fiscally, PHM's clinical efficacy and cost-efficiency are especially resonant. Things can be better.

Systematized nomenclature of medicine clinical terms (SNOMED CT) to represent computed tomography procedures.

OBJECTIVE: To evaluate the ability of systematized nomenclature of medicine clinical terms (SNOMED CT) to represent computed tomography procedures in computed tomography dictionaries used in the Canadian province of Newfoundland and Labrador. METHODS: This study was conducted in two stages. In the first stage computed tomography dictionaries were collected and consolidated to one master list. The duplicated procedure names were deleted from the list. In the second stage the unique data items from the master list were matched with the SNOMED CT concepts. Sensitivity, specificity, and positive and negative predictive values of SNOMED CT were investigated. RESULTS: After eliminating 680 duplicate procedures from the total of 833, the study sample consisted of 153 data items. For pre-coordination, SNOMED CT had sensitivity of 56% and for post-coordination SNOMED CT had sensitivity of 98%. CONCLUSION: Our results suggest that SNOMED CT is a valid nomenclature for representing computed tomography procedures.

Concordance, compliance and adherence in healthcare: closing gaps and improving outcomes.

The gap between best care and usual care is large for many important diseases. In particular, poor adherence remains a significant, inadequately addressed, cause of the care gap. About half of all patients with chronic diseases stop refilling prescriptions by one year. Several effective interventions are available and adaptations of clinical trials practices offer promise for further improvement. Poor adherence is a remedial problem in healthcare quality and its improvement and accountability offer shared opportunities for providers and patients. There is a large gap between best care, defined as the optimal use of proven efficacious therapies in whole populations at risk from any disease, and usual care, the actual level of efficacious care being provided (Montague et al. 1997). This gap in patient care has four main causes: diseases may not be diagnosed, efficacious therapies may not be prescribed, access to therapy may be restricted or patients may not adhere to prescriptions. Irrespective of causation, the ultimate result of care gaps is the same--less than optimal clinical outcomes and associated lost opportunities for improved quality of life and productivity. Systematic approaches to improving prescribing practices are increasing, and there is much debate around improving patients' access to care. Poor diagnosis is judged to be relatively uncommon, leaving decayed adherence as the major under-addressed cause of care gaps and a major opportunity for improvement. This paper reviews the scope and causation of sub-optimal adherence, evaluates improvement strategies and explores a best-practice benchmark.

Improving cardiovascular outcomes in Nova Scotia (ICONS): a successful public-private partnership in primary healthcare.

Broadly defined, disease, or health management, is a focused application of resources to improve patient outcomes; its premise: things can be better. In particular, the gap between what best care could be, and what usual care is, can be reduced and, consequently, care and outcomes can be improved. This paper reviews the evolution of the partnership/measurement paradigm of disease management and considers its value in sustaining Canadian healthcare. Lessons from ICONS (Improving Cardiovascular Outcomes in Nova Scotia), a major public-private health partnership of physicians, nurses, pharmacists, patients and their advocacy groups, government and industry, are highlighted. Launched in 1997, ICONS' proof-of-concept phase ended in 2002. Due to its positive impact on the cardiovascular health of the population and its integrated and accountable administrative processes, ICONS became an operational program of the Nova Scotia Department of Health. This successful community-based partnership represents a major achievement in organizational behaviour in the arena of primary healthcare. It supports optimal care as evidence-based and seamless, recognizing the patient as the nucleus. It should be considered for other disease states and constituencies where the goals are closing care gaps and delivering the best health to the most people at the best cost.

Undocumented patient information: an impediment to quality of care.

PURPOSE: Poor documentation in medical records might reduce the quality of care and undermine analyses based on retrospective chart reviews. We assessed the documentation of cardiac risk factors and cardiac history in the records of patients hospitalized with myocardial infarction or heart failure. METHODS: We performed a retrospective cohort study involving direct chart audit of all consecutive hospitalizations for myocardial infarction (n = 2,109) or heart failure (n = 3,392) in Nova Scotia, Canada, from October 15, 1997, to October 14, 1998. The main outcome measures were the documentation rates for prespecified clinical items, including cardiac risk factors and history of myocardial infarction or heart failure, which were recognized as indicators of the quality of care for the conditions under study. RESULTS: Information was not documented in a high proportion of cases, ranging from 9% (smoking) to 58% (previous history of heart failure) in charts from patients hospitalized for myocardial infarction, and from 19% (smoking) to 69% (hyperlipidemia) in charts from heart failure hospitalizations. Lack of documentation was more common in women and the elderly. CONCLUSION: Documentation of important clinical information is poor even in the hospital charts of patients with severe conditions. This quality-of-care issue has implications for health services and outcomes research, including the development of report cards.