Hearts In Healthcare |Opinion

Compassion cannot flourish when healthcare is a commodity

Opinion by Robin Youngson

Why is technology the dominant force in healthcare and not human caring? Why is it so difficult to create a humane and compassionate workplace? Why do we have epidemics of burnout and disillusionment among health workers? How do we put the heart back in healthcare?

We’ve been trying to rehumanise the healthcare system for many years. It’s time to admit that many of the recent strategies we employed at Hearts in Healthcare didn’t work out the way we expected.

Here’s some of the things we tried:

  • Working with other companies to develop training in compassionate communication – video modules and e-learning programs
  • Consulting to organisations in NZ, Australia, USA, Canada and the UK
  • Delivering keynote conference speeches, in return for a speaker’s fee and expenses
  • Running workshops within health providers

While our volume of work continually increased, none of these strategies catalysed the change we expected. There’s something wrong with our thinking.

 

Our unconscious beliefs about the nature of the world

A remarkable book by Charles Eisenstein, “The More Beautiful World Our Hearts Know is Possible” offers us clues. He writes about the fundamental assumptions of our Western culture, which underpin our science, our economy, our education, and societal values.

We live in a material Universe, which has no intelligence, no consciousness and no purpose. Our reductionist science seeks to break everything down into fundamental particles, which interact according to laws of physics. Thus we can view the world as an elaborate machine. Spirituality is something other; it has to exist in a separate domain from the material world. It is not part of our science, our economy, our education, or our workplace.

Man’s mission is to dominate the natural world and turn it to his material advantage. Economic growth is the holy grail. To sustain growth in a world of finite resources we have to convert ever more of nature’s gifts and human talents into commodities. Corporations control and sell access to water, to seeds, to medicine, to music, to ideas, and they control our communication media – all are commodities to be bought and sold. Farms no longer feed and nourish their local communities – they grow commodity crops sold in a globalised marketplace to maximise profits. What were once family and community gifts, such as childcare and eldercare, are now commodities too. It’s a world of “human resources” and “intellectual property”.

We might say that modern healthcare is the commodification of caring.

In this world of control and domination, the fundamental theory of our economy, of our science, of our education – and even our democracy – is competition. We live in a nasty ‘Darwinian’ world of competing genes and individual economic agents who strive to maximise material self-interest. Actually, Darwin’s theory of evolution has been perverted to fit the story. He wrote extensively about group cooperation, altruism and the evolutionary advantages of social systems.

 

A world of interbeing

Eisenstein suggests a different story for the world: a world of interbeing. In a world of interbeing, all things are connected. Matter itself has consciousness and there is nothing to divide the material and the spiritual world. Our every act has consequences at a distance. In the world of interbeing, one small act of compassion has the power to change the world. In this world everything we give to others is also a gift to ourselves. It’s a world of abundance, generosity, reciprocity and mutual caring.

Compassion is a human gift, not a commodity. It belongs in the world of interbeing. It cannot flourish in a material world of competition and domination.

 

Why many of our strategies didn’t work

To succeed in our desire to create a movement for compassion in healthcare, we have to be the change we want to see. Our work has to live in the world of interbeing.

When we charge for our consulting services, or demand a speaker’s fee, or offer a training program in return for payment – we are turning our contribution into a commodity, to be bought and sold. It says to the world: “We are the experts, offering our intellectual property in exchange for money.

But compassion is not a commodity. None of these strategies catalysed widespread change.

So what did work?

Our work is gaining ground at the level of individuals. My book, TIME TO CARE, has inspired health workers to reconnect to the heart of their practice and to find joy in the connection with patients. When I give a presentation, it is the human stories, and my vulnerability and humility that affects an audience, not the science and evidence (though that helps to awaken curiosity?).  When we use group processes like ‘Reawakening Purpose‘, we uncover the wonderful gifts, talents, courage and skills that every health professional has to offer. We don’t lecture, we draw out what is already there. We are humbled and inspired by the people we meet everywhere.

From my new viewpoint, it is foolish to select and recruit “compassionate nurses”, to mandate “compassion training” and to incentivise compassionate caring. Every health professional has the capacity for compassion; it’s the work environment and not the innate personality traits of the health worker that largely determines behaviour.

Some of our successes were unexpected gifts. A collaborator translated and published my book into the Dutch language; she found a publisher and a sponsor. Another volunteer has just finished the German translation. I didn’t ask for this to happen. These are gifts, offered to the world.

So what do strategies look like in the world of interbeing?

We’re trying to move away from transactional relationship and we’re investing in the ‘gift economy’. My next book, I will freely give away (at least in e-book format). If people find value they can make a donation. We no longer specify a consulting fee. Pay our expenses, we say, and decide after the event what our contribution was worth – then make a donation.

We’re beginning to move our strategies out of the organisational context: community seems to be the natural frame in which to build shared commitment to compassionate healthcare among multiple stakeholders.

In Louisville, Kentucky, in the USA, we’re using the setting of a compassionate city to enable a diverse coalition of organisations committed to compassionate healthcare: we have senior leadership support from competing health providers, insurance companies, non-profit groups, community and professional associations, universities, and even the Mayor’s office. Our focus in Louisville is the issue of burnout among both health professionals and teachers. See the ‘Happiness in Healthcare‘ project for more details.

A radical new approach to funding a compassionate healthcare strategy

On previous visits to Louisville, we’ve accepted professionals fees, expenses and honoraria from sponsoring organisations. This time we’re trying a radically different approach: we are crowdfunding our entire visit.

Our intention is to offer our time and energy completely free to any individual or organisation who is supporting this work, for the six week duration of our visit. This project is owned and funded by the community – there are no dominant organisational interests.

To learn more about our strategy, see our crowdfunding campaign on Indiegogo.

Will it work? We don’t know. We’ve raised the stakes – it’s an all or nothing campaign. If we don’t reach our funding target in thirty days, we don’t make the trip. Please support our bold attempt to rehumanise healthcare across an entire city. Share the story and consider making a donation.

We’d love to hear your opinion on these innovative strategies – please share your thoughts by posting a comment.

3 Responses to “Compassion cannot flourish when healthcare is a commodity”

  1. Kathy Torpie says:

    Robin,

    I agree wholeheartedly that the reason why change in healthcare is so slow is because it lacks solutions based on systems thinking rather than the now outdated-but-thoroughly-entrenched Newtonian reductionist thinking. But change has to come from within a system. If it is to be maintained, every part of the system needs to change together and to continually adjust as a single unit to alterations within the system. In my opinion, the problem with commodifying healthcare isn’t that money is exchanged for services, but that the balance between the healing/caring and profit motives is completely out of whack and acts in oppositional rather than co-creative ways. Money is necessary. Science is necessary. Technology is necessary. AND positive human interpersonal relationships and interaction is necessary.They all depend on and influence each other.

    The idea of crowd funding from those most likely to directly benefit from creating a compassionate city is a brilliant balance. It is a form of “Koha” that hasn’t been corrupted by confusing it with “charging” a specific “price”. Although I don’t live in Louisville, as a member of the wider system, changes made there will indirectly influence me. So, I’d like to donate! Thanks for your heart!

  2. Christine West says:

    Feel confident this is the way to go. Well done guys! Be so interesting to see what happens the first time

  3. Peta Joyce says:

    Love the honest reflection and resulting analysis. More courageous commitment from you two! Am donating, go well….Peta

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