The Healing Healthcare Initiative: Guiding leaders to heal a traumatized workforce.

The COVID-19 pandemic amplified burnout and moral distress among healthcare professionals and accentuated the systemic gaps and limitations of current approaches to workforce well-being. The Schwartz Center for Compassionate Healthcare launched the Healing Healthcare Initiative (HHI) in response to these compounded challenges. Aligned with national recommendations, the HHI framework comprises six key principles and eight implementation domains that foster compassionate and trauma-informed organizational cultures. C-suite level executive teams from six diverse healthcare organizations were selected to participate in the year-long pilot. Organizational and executive team surveys identified siloed well-being efforts and gaps in knowledge and awareness that undermine meaningful progress. The HHI pilot offers executive teams a space for reflection and open conversations, fostering trust within the team, and reinforcing the commitment to employee well-being. The program supports leadership teams in creating a strategy to implement the HHI framework that engages frontline workers in co-designing organizational solutions for a thriving workforce.

Intensivists' perceptions of what is missing in their compassionate care during interactions in the intensive care unit.

BACKGROUND: We proposed that the behaviors that demonstrate compassionate care in the intensive care unit (ICU) can be self-assessed and improved among ICU clinicians. Literature showing views of intensivists about their own compassionate care attitudes is missing. METHODS: This was an observational, prospective, cross-sectional study. We surveyed clinicians who are members of professional societies of intensive care using the modified Schwartz Center Compassionate Care Scale® (SCCCS) about their self-reported compassionate care. A modified SCCCS instrument was disseminated via an email sent to the members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine between March and June 2021. RESULTS: Three hundred twenty-three clinicians completed the survey from a cohort of 1000 members who responded (32.3% response rate). The majority (54%) of respondents were male physicians of 49 (+ - 10 SD) years of age and 19 (12 + - SD) years in practice. The mean SCCCS was 88.5 (out of 100) with an average score of 8 for each question (out of 10), showing a high self-assessed physician rating of their compassionate care in the ICU. There was a positive association with age and years in practice with a higher score, especially for women ages 30-50 years (P = 0.03). Years in practice was also independently associated with greater compassion scores (p < 0.001). Lower scores were given to behaviors that reflect understanding perspectives of families and patients and showing caring and sensitivity. In contrast, the top scores were given to behaviors that included conducting family discussions and showing respect. CONCLUSION: Physicians in the ICU self-score high in compassionate care, especially if they are more experienced, female, and older. Self-identified areas that need improvement are the humanistic qualities requiring sensitivity, such as cognitive empathy, which involves perspective-taking, reflective listening, asking open-ended questions, and understanding the patient's context and worldview. These can be addressed in further clinical and ICU quality improvement initiatives.

Do Physicians Have Collective, Not Just Individual, Obligations to Respond to the Opioid Crisis?

Evidence-based clinical guidelines could mitigate variations in care for some patients. However, patient and clinician distress can arise when guidelines are misapplied or mandated by processes that are not evidence based, fail to integrate physician expertise and patient preference, or fail to motivate informed, shared decision making. Physicians can choose to collectively advocate at national, state, and local levels for policy changes.

Beyond Convenience: Patients' Perceptions of Physician Interactional Skills and Compassion via Telemedicine.

OBJECTIVES: To understand the interpersonal and communication behaviors that are perceived positively by patients in a video encounter and whether patient-centered relationships can be established virtually. PATIENTS AND METHODS: A qualitative analysis of patient visit feedback was performed to build consensus around exemplary interpersonal and communication practices during a virtual urgent care visit. Voluntarily submitted patient comments associated with a 5-star review after a visit were randomly selected from more than 49,000 comments in an 11-month period, from January 1, 2016, through November 30, 2016. Researchers used a consensus-based, widely used health care communications framework as a sensitizing scaffold to develop a preliminary set of codes. RESULTS: More than 30% of the comments coded were classified as Building Rapport. The next most frequently assigned code was Shares Information/Provides Guidance. Among codable comments, the third most frequently assigned code was Elicits Information. Provided Treatment accounted for only 2% of comments. CONCLUSION: These results suggest that patients who are satisfied with telemedicine encounters appreciate their relational experiences with the clinician and overall user experience, including access and convenience. Highly satisfied patients who interacted with providers on this platform commented on key aspects of medical communication, particularly skills that demonstrate patient-centered relationship building. This supports the notion that clinician-patient relationships can be established in a video-first model, without a previous in-person encounter, and that positive ratings do not seem to be focused solely on prescription receipt.

Does Organizational Compassion Matter? A Cross-sectional Survey of Nurses.

OBJECTIVE: To examine factors that influence nurses' perceptions of organizational compassion and their engagement with the organization. BACKGROUND: Despite agreement about the importance of compassionate healthcare, it is difficult for employees to consistently act compassionately when organizational leaders, managers, and systems of care fail to support compassion as a value. METHODS: The study used a cross-sectional design, and quantitative and qualitative data were collected through an online survey of nurses. RESULTS: Higher individual compassion and team compassion were associated with higher perceived organizational compassion, and higher organizational compassion was associated with greater engagement with the hospital. In contrast, high turnover rates and inadequate staffing were associated with lower perceived organizational compassion and lower engagement with one's organization. CONCLUSIONS: Adequate staffing, resource allocation, and practices that contribute to the sense that one is a supported member of a caring team focused on addressing patients' needs build the capacity for compassion within an organization.

Can Organizational Leaders Sustain Compassionate, Patient-Centered Care and Mitigate Burnout?

EXECUTIVE SUMMARY: Organizational leaders are recognizing the urgent need to mitigate clinician burnout. They face difficult choices, knowing that burnout threatens the quality and safety of care and the sustainability of their organizations. Creating cultures and system improvements that support the workforce and diminish burnout are vital leadership skills. The motivation to heal draws many health professionals to their chosen work. Further, research suggests that compassion creates a sense of personal reward and professional satisfaction. Although many organizations stress compassion in mission and vision statements, their strategies to enhance well-being largely ignore compassion as a source of joy and connection to purpose.Passage of the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009 and the Affordable Care Act in 2010 ushered in a new era in healthcare. Little is known about how changes in the healthcare delivery system related to these legislative milestones have influenced health professionals' capacity to offer compassionate care. Further, advances such as artificial intelligence and virtual care modalities brought more attention to the elements that form the clinician-patient relationship.This study analyzed the views of U.S. healthcare providers on the status of compassionate healthcare compared with 2010. Postulating that compassion is inversely correlated with burnout, we studied this relationship and contributing factors. Our review of evidence-based initiatives suggests that leaders must define the organizational conditions and implement processes that support professionals' innate compassion and contribute to their well-being rather than address burnout later through remedial strategies.

Correction: Measuring compassionate healthcare with the 12-item Schwartz Center Compassionate Care Scale.

[This corrects the article DOI: 10.1371/journal.pone.0220911.].

Measuring compassionate healthcare with the 12-item Schwartz Center Compassionate Care Scale.

BACKGROUND: Patients and clinicians endorse the importance of compassionate healthcare but patients report gaps between its perceived importance and its demonstration. Empathy and compassion have been associated with quality of life and significant health outcomes but these characteristics are not optimally measured or used for performance and organizational improvement. OBJECTIVE: To address these gaps, we conducted a study with the objective of evaluating the properties of the 12-item Schwartz Center Compassionate Care Scale® using psychometric analysis and cognitive debriefing. METHODS: Non-hospitalized patients with multiple chronic conditions were sampled using an on-line platform. Classical test theory and Rasch measurement theory were used to evaluate psychometric properties of the scale. Structured questions elicited cognitive responses regarding clarity of each item. RESULTS: Classical test theory analysis confirmed that the 12-item Schwartz Center Compassionate Care Scale is a unidimensional scale with excellent internal consistency and test-retest reliability. Patients' ratings of compassionate behaviors using the Schwartz Center Compassionate Care Scale correlated significantly with a related instrument designed to measure empathy, demonstrating convergent validity. Rasch measurement theory showed that reducing the number of response options on 3 items in the scale would improve respondents' discrimination between responses on these items. Although person-item threshold distribution analysis showed that patients may wish to rate compassionate care at levels both higher and lower than the scale permits, items could be ordered on an interval scale from low to high levels of compassionate care. CONCLUSIONS: The current 12-item Schwartz Center Compassionate Care Scale demonstrates excellent psychometric properties by Classical Test Theory and Rasch measurement theory. The 12-item Schwartz Center Compassionate Care Scale adds questions related to understanding and discussing emotional, contextual issues and the needs of the patient and family. Easily completed on-line, it could be used for work-place based assessment and feedback to clinicians and performance or quality improvement.

Should a Physician Offer Recommendations Based on Experience but Contrary to Current Practice Guidelines?

This case of a patient whose physician refuses to prescribe statins for high cholesterol raises ethical issues about a physician's decision to offer clinical recommendations contrary to current practice guidelines. Our response summarizes social forces that have led to the rise of evidence-based medicine, the development of clinical guidelines, and the evolution of the roles of physicians and patients in decision making. We conclude that there are times when a physician can justifiably make a recommendation to a patient that contravenes a current clinical guideline. In making such a recommendation, we suggest that a physician should communicate a rationale for deviating from clinical guidelines and respect a patient's autonomy. We consider the need for and limitations of clinical guidelines, numerous factors influencing shared decision making, and key ethical principles of nonmaleficence and respect for patient autonomy.

Utilizing compassion and collaboration to reduce violence in healthcare settings.

Violence in healthcare settings is a global problem and violent acts are more likely to occur in emergency departments (EDs). Significant barriers to reporting workplace violence persist among healthcare workers. This, and lack of shared definitions and metrics, increase the difficulty of assessing its prevalence, understanding its causes, and comparing the impact of interventions to reduce its frequency. While risk factors for violence in EDs have been articulated, less is known about how the perspectives of patients and accompanying persons, and their interactions with ED staff may contribute to violence.We discuss the nature and social context of ED violence and some approaches used to address this problem in the U.S. We argue that perpetrators of violence as well as healthcare staff who experience ED violence suffer when it occurs. While securing safety is paramount, compassionate practices to address this suffering and the social context from which it emerges should be developed and provided for all involved. Collaboration among stakeholders, including patients and family members, may lead to effective approaches to address this problem.

Mission Critical: Nursing Leadership Support for Compassion to Sustain Staff Well-being.

Compassion, the foundation of Nursing, is a source of both healing for those who suffer and of purpose and meaning for those who seek to heal others. Increasingly, however, the fast pace and volume of care and documentation requirements diminish time with patients and families and hinder the enactment of compassion. These issues and other aspects of the work environment decrease the satisfaction and well-being of professional caregivers and are contributing to a rising tide of burnout. Research suggests that employee engagement emerges from their satisfaction and well-being; however, it is difficult for an individual to engage when she or he feels depleted and unsupported. Nursing leaders and managers can play a significant role in support of compassionate practices for staff and improvement of the work environment and staff well-being. Compassion practices that recognize employees for the caring they show to patients and each other, and that provide the support needed to sustain their caring and compassion, are associated with significantly better patient ratings of their care experiences in hospitals and ambulatory settings. This article describes an example of a compassion practice, Schwartz Rounds®, a program that has been implemented internationally to enhance staff caring and compassion, teamwork, and psychological well-being. Schwartz Rounds have been included as a component of organizational initiatives to enhance staff well-being and patient experience, and as an individual program. Nurse leaders and managers who wish to engage their staff can do so by supporting their compassion and well-being.

A social neuroscience-informed model for teaching and practising compassion in health care.

CONTEXT: Empathy and compassion are important catalysts for the healing process, but some research suggests their decline during training and practice. Compassion involves recognition, understanding, emotional resonance and empathic concern for another's concerns, distress, pain and suffering, coupled with their acknowledgement, and motivation and relational action to ameliorate these conditions. COMPASSION, ALTRUISM AND REWARD: Neuroscientists have identified neural networks that generate shared representations of directly experienced and observed feelings, sensations and actions. When shared representations evoke empathic concern or compassion for another's painful situation, humans experience altruistic motivation to help. The resulting behaviours are associated with activation of areas in the brain associated with affiliation and reward. COMPASSION MODULATORS: Activation of these neural networks is sensitive to multiple inter- and intrapersonal influences. These include the ability to focus one's attention, the ability to receive and accurately interpret input about distress, the perspective one adopts in order to understand another's experience, self-other boundary awareness, the degree to which one values another's welfare, the ability to recognise and regulate one's own emotions, the ability to attend to one's own wellbeing through self-care and self-compassion, effective communication skills, reflection and meta-cognition. CONCLUSIONS: Current research suggests that compassion can be modulated through education and training and is associated with positive emotions, a sense of affiliation, reward and prosocial behaviours. A compassion process model and framework with examples of educational goals, interventions and resources for curriculum development are described. However, education must be aligned with changes in clinical practice to sustain compassionate care.

Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care.

Measuring the Impact of Longitudinal Faculty Development: A Study of Academic Achievement.

PURPOSE: Although faculty development programs in medical education have increased over the past two decades, there is a lack of rigorous program evaluation. The aim of this study was to determine quantifiable outcomes of Harvard Medical School's (HMS's) Fellowship in Medical Education and evaluate attainment of its goals. METHOD: In 2005 and 2009 the authors collected curricula vitae (CVs) and conducted within-subject analysis of 42 fellowship graduates and also conducted comparison analysis between 12 academic year 2005 fellows and 12 faculty who did not participate in the program. The authors identified 10 metrics of academic advancement. CV analysis for the 42 graduates started 2 years prior to fellowship enrollment and continued for 2-year intervals until June 2009 (10 years of data collection). CV analysis for the comparison group was from 2003 to 2009. The authors also analyzed association between gender and academic outcomes. RESULTS: Fellowship graduates demonstrated significant changes in 4 of 10 academic metrics by the end of the fellowship year: academic promotion, educational leadership, education committees, and education funding. Two metrics-educational leadership and committees-showed increased outcomes two years post fellowship, with a positive trend for promotions. Fellowship graduates significantly outpaced the comparison group in 6 of 10 metrics. Women did significantly more committee work, secured more education funding, and were promoted more often than men. CONCLUSIONS: Findings indicate that the HMS Fellowship in Medical Education meets programmatic goals and produces positive, measurable academic outcomes. Standardized evaluation metrics of longitudinal faculty development programs would aid cross-institutional comparisons.

Compassion Is a Necessity and an Individual and Collective Responsibility Comment on "Why and How Is Compassion Necessary to Provide Good Quality Healthcare?".

Compassion is a complex process that is innate, determined in part by individual traits, and modulated by a myriad of conscious and unconscious factors, immediate context, social structures and expectations, and organizational "culture." Compassion is an ethical foundation of healthcare and a widely shared value; it is not an optional luxury in the healing process. While the interrelations between individual motivation and social structure are complex, we can choose to act individually and collectively to remove barriers to the innate compassion that most healthcare professionals bring to their work. Doing so will reduce professional burnout, improve the well-being of the healthcare workforce, and facilitate our efforts to achieve the triple aim of improving patients' experiences of care and health while lowering costs.

Can compassionate healthcare be measured? The Schwartz Center Compassionate Care Scale™.

OBJECTIVE: Assess psychometric characteristics of an instrument to measure patient ratings of treating physicians' compassionate care in a recent hospitalization. METHODS: We used Cronbach's alpha to examine scale reliability, exploratory and confirmatory factor analysis to examine scale structure of two sets of items on compassionate care. We used Mokken analysis to determine if items in each set belonged to a unidimensional scale. RESULTS: Results indicated that both sets of items had strong reliability when used to rate individual physicians (Cronbach's α=.97 and .95). A one factor model was a good fit to both sets of items. Mokken analysis supported unidimensional scales. Both sets of items correlated with an overall measure of patient satisfaction with physicians and even more strongly with an item measuring emotional support. CONCLUSIONS: A patient-rated scale reliably measured hospital physicians' compassion and correlated significantly with an item measuring overall patient satisfaction and a specific measure of satisfaction with emotional support. Measurement of compassionate healthcare should be included in research, educational assessment, and quality improvement programs. PRACTICE IMPLICATIONS: Clinicians should participate in efforts to enhance their ability to demonstrate compassionate care including eliciting and sharing information and acting collaboratively to ameliorate patients' socioemotional concerns and needs.

Toward more compassionate healthcare systems Comment on "Enabling compassionate healthcare: perils, prospects and perspectives".

Compassion is central to the purpose of medicine and the care of patients and their families. Compassionate healthcare begins with compassionate people, but cannot be consistently provided without systemic changes that enable clinicians and staff to collaborate and to care. We propose seven essential commitments to foster more compassionate healthcare organizations and systems: a commitment to compassionate leadership, to teach compassion, to value and reward compassionate care, to support clinical caregivers, to involve and partner with patients and families, to build compassion into the organization of healthcare delivery, and a commitment to deepen our understanding of compassion and its impact through research. Acting on these commitments will help us attend with care to the ill, injured, and vulnerable in every interaction.