HIMSS19, as it does every year, sparked a lot of follow-on conversations. One featured event, the Patient Experience and Engagement Summit, reinvigorated the discourse regarding the key role of compassion in patient care. Patients, and those who love them, crave compassion within their experience of healthcare delivery.
When the physician or other care provider demonstrates compassion, it is seen as evidence that the care provider has responded to a core need of patients: Know Me. It also provides assurance that another core need will be fulfilled: Don’t Hurt Me. Compassion is critical to excellent patient care.
Compassion cannot be drawn from a dry well. Physician burnout, or “moral injury” as ZDoggMD (Dr. Zubin Damania) and others so appropriately describe it, empties that well. There are many existent and nascent pressures and demands that impede replenishing the reserves of compassion.
As the crisis of burnout (moral injury, compassion fatigue, depersonalization, etc.) has been recognized, many have prescribed self-help through mindfulness, resilience development programs, counseling, and other programs; as if the issue is one of inherent deficits in physicians and other care providers. Others more eloquent than me have pointed out that those of us who have been trained to provide complex care in stressful situations have shown ourselves to be committed, strong, intelligent, and altruistically motivated. The flaw is not in the provider of care but in the system. It requires systemic response and correction.
If you, like me, believe the preceding to be true, you will ask yourself, “What can our IT team do to begin correcting things?” I think we will do well to apply the patient core needs to our physicians and other care provider colleagues: Know Me. Don’t Hurt Me.
How can we know these hurting and burdened colleagues? We can start by asking about their work experiences and needs, both generally and specific to information technologies. We need to learn and use reflective listening, motivational interviewing, and anything else that will ensure that we understand their core needs and assure them that they have been heard. This should not — in fact, cannot — result in endless customization, which only leads to unsustainable chaos. Instead, get to know as many of your physicians and care providers as possible and aggregate their responses, identifying patterns, priorities, clear pain points, and improvement opportunities. The volume of interactions needed can be managed by using structured interviewing and leveraging your clinical IT support teams. Then formulate a plan and prepare to implement changes in your IT systems that respond to what you have learned.
The key to success with this is going back to physicians and other care providers, telling them what you are proposing to do, showing clearly how it responds to issues and needs they raised, and getting their approval: You heard me and you know me.
Avoiding harm requires that we consider our care providers and engage them before implementing any software or apps that impact their workflow or end-user experience. This means even the CEO’s pet project needs to be subjected to this proactive effort to avoid harm. The executive team will likely be surprised at how positively contributory this knowledgeable and motivated group can be when shown respect and consideration. In my experience, the time needed to avoid harm has been less than the time wasted on healing damage and regaining engagement when we have steamrolled our physician partners and other care providers.
Every effort we engage in must have a goal, and there must be measures of progress toward the goal. So what is the goal of my recommendations to invest time and effort to know, consider, and engage our provider colleagues? It is to increase compassionate care for our patients and those who love them. What represents measurable progress to this goal? Reduced time spent in the EHR, increased satisfaction among this segment of end-users of our IT applications, and increased provider engagement in our continuous improvement efforts.
By now many of you are probably convinced I’ve lost touch with reality! How can this effort increase compassionate care for our patients? First, by truly knowing and avoiding harming physicians and other care providers, we demonstrate compassion for them. Second, by giving them back some time and empowering them in the IT use experience, we reduce the depletion of the well of compassion. Lastly, as they have more time to truly interact with patients, their altruistic motivations will be resurfaced and their care will again evidence deep compassion.