Opinion

Healthcare system is fundamentally incompatible with compassion, healing & wellbeing

Dr Robin Youngson, co-founder of Hearts in Healthcare, shares his latest insights on the long journey to creating a more humane and compassionate healthcare system.  We need a new strategy, he says.

The founders of Hearts in Healthcare have campaigned for a decade to bring more humanity and compassion into the healthcare system. You would think this was a no-brainer: health professionals begin their career with high ideals of compassionate caring. Science proves that patients treated in this way get much better outcomes at substantially lower cost; moreover compassionate care satisfies patients and give meaning and joy to the work of health professionals. It’s truly a win-win-win for patients, providers and funders.

So why doesn’t the practice of compassionate, whole-person care spread like wildfire across the healthcare system? After a decade of efforts, we have to conclude that the existing healthcare system is fundamentally incompatible with compassion, healing and wellbeing.

Dr Don Berwick, the founder and President Emeritus of the Institute of Healthcare Improvement (IHI), when talking about efforts to improve patient safety said, ‘The healthcare system is perfectly designed to achieve the exact outcomes it does every day; the worst plan is to try harder.’ The latest research into patient safety now establishes medical error as the third leading cause of death in the USA, accounting for more than 400,000 deaths a year. A system that maims and kills so many patients can hardly be called compassionate.

Taking a high-level view of the system we have to conclude that, in a capitalist economy, healthcare is perfectly designed to maximise the profits from sickness, not to promote healing, health and wellbeing. Trying harder to make the existing healthcare system humane and compassionate is not only futile but soul-destroying. That does not mean an end to our efforts, nor that we are discouraged, just that we need to change our strategies.

There are four fundamental drivers shaping our healthcare system:

a) Materialistic and reductive science

b) The industrialisation of healthcare

c) Profit motives

d) The heroic model of medical professionalism

 

a) Materialistic science

Basically, we treat sick patients as if they are broken machines that need to be fixed. ‘Real’ science doesn’t include concepts such as compassion or healing. The placebo effect, despite being a powerful healing response, is dismissed in our analysis of medical treatments. We objectify patients by focusing on the disease process, not the person with the illness. Indeed, we even identify patients by their pathology, referring to ‘the gall bladder on ward 6’ and ‘the breast abscess on ward 4.’

b) The industrialisation of healthcare

Modern systems of healthcare resemble factory production lines more than places of healing. Managers view their organisations as machines, in parallel to doctor’s mechanistic views of patients. Their most important priorities are financial targets, efficiency and throughput. From the managers’ point of view, patient care consists of tasks, procedures and bed days. Care, compassion and healing don’t show up on a spreadsheet.

c) Profit motives

Even in non-profit organisations, the profit motive strongly shapes the nature of medicine because most of our interventions are those which earn money for pharmaceutical and technology companies. In a capitalist economy, the healthcare industry makes money out of sickness and has little interest in promoting health, healing or wellbeing. Even cancer is turned into a chronic disease that earns a fortune for pharmaceutical companies.

d) The heroic model of medical professionalism

The heroic model of medical practice doesn’t allow doctors to have feelings. In our daily work we witness horrible disease, injury, pain, suffering and death; we try to survive this trauma by detaching ourselves from our feelings and pretending we are super-heroes who can fix and save every patient. This heroic role-model of being a doctor means that we, in turn, brutalise our students and trainees. In our relations with patients we too often adopt a clinically detached style of practice that doesn’t acknowledge the feelings of patients either.

No room for compassion

These factors together lead to horrifying rates of burnout among health professionals – international surveys report that about 30% to 40% of all health professionals have symptoms of burnout including emotional exhaustion, depersonalisation and cynicism. There’s a fundamental disconnection between the ideals that motivate health professionals and the reality of the work environment.

The four drivers of healthcare so profoundly affect the culture of healthcare that there is little space, time or incentive for compassionate caring. In this setting, the evidence that compassionate care can improve patient outcomes, reduce costs, and give joy to health professionals simply doesn’t stack up. It makes no sense from a materialistic, business or clinical perspective. Having a great idea, backed up with strong evidence, doesn’t change anything at all if it contradicts the predominant world view.

And so our experience has been that no matter how fired up and enthusiastic health professionals are about bringing their hearts to work, this impulse is too often crushed by the daily realities of the work environment. A few courageous individuals manage to overcome the culture of the system but they are often labelled as mavericks and a threat to authority.

So at Hearts in Healthcare, after many years of effort we have come to the conclusion that it is futile to try to change the existing healthcare system. Healthcare is in deep crisis: rapidly escalating costs, appalling outcome measures, epidemics of obesity and diabetes, and widespread burnout of those dedicated to care. It’s a dying system and the best we can do within the old system is palliative care.

Palliative care asks the question, ‘If we give up all hope of surviving this illness, what’s important in life itself? How can we live our remaining months or years well and achieve the most important life goals?’ It’s a process of finding hope and healing that connects to the deepest human values of love and compassion.

A new strategy

So while Hearts in Healthcare will no longer try to fix the existing healthcare system, we will continue to offer compassionate support and give hope to individual health professionals working in the dying system; we’ll encourage them to rediscover the heart of their practice and find meaning in compassionate caring. When all else is lost, reconnecting to your deepest human values is the path to healing. Contrary to widespread belief, having an emotional connection to your patients protects you from burnout. But empathy alone is not enough, we must step forward into compassion. The health managers deserve our compassion too; they also suffer in a broken system.

Complex systems change through a process of evolution: new species, which are better adapted to survive, emerge and gradually multiply, while the old species decline. So acknowledging that the old healthcare system is dying, we should instead devote our time and attention to creating new healthcare organisations founded on a better set of values and beliefs:

  • A science of consciousness that sees every patient as a highly responsive, mind-body being, not just a biological machine; the experience of care matters as much as the treatment.
  • Systems of care that value human connection as much as efficiency.
  • Alternatives to the profit motive that emphasise generosity, compassion and service, not greed.
  • A system of training that offers compassionate support to students and young professionals so they keep an open heart through the emotional trauma of early practice, not a hardening into detachment.

Taking a high-level view we know that most patient deeply desire whole-person, compassionate care; many health professionals are aching for the opportunity to care in this way; moreover we know this kind of care will achieve much better outcomes at lower cost, while giving satisfaction to all parties. If we can catalyse a new ‘marketplace’ to bring together health professionals, patients, technology experts, social entrepreneurs and funders we might see the rapid emergence of new provider organisations.

It’s already begun. Buurtzorg is a community nursing service in the Netherlands. Starting with just 12 nurses in 2007, Buurtzorg has grown to 8,000 nurses and has almost completely replaced the old system of care. Buurtzorg nurses work in self-organising teams of twelve and they have no managers. They have complete autonomy to deliver compassionate, whole person care within the communities they serve. So what are the outcomes, compared with the old task-driven system? The consulting company Ernst & Young reported:

  • Patients are recovering in half the time
  • Productivity is improved 40%
  • ER visits are reduced 30%
  • Average patient satisfaction rating are 9/10, the highest of any healthcare service in the Netherlands
  • The nurses have voted Buurtzorg the ‘best employer in the country’ three years in a row.

So our new strategy at Hearts in Healthcare is to become a catalyst for the emergence of new organisations like Buurtzorg. If you want to be part of the change, join our Facebook Group ‘Compassionate Healthcare Incubator‘ to share your insights, ideas and solutions. We’re inviting patients who are seeking wellness and health professionals who want to provide compassionate, whole person care. We welcome health managers who want to be part of a new order; social entrepreneurs who see beyond capitalist economic systems; educators who understand holistic science; technology experts; and investors who can see the potential in new organisational forms.

This is not just a place for conversation and ideas – we have the deliberate intention of bringing people together to create new healthcare organisations in an emergent process, starting wherever the ground is most fertile.

We’re aiming to start in primary and community care. Almost all of the determinants of health and wellbeing exist in community – if we get this right we eliminate most of the need for hospital care. I’m sixty years old and in robust good health: I don’t take any regular medications and I’ve never spent a night in hospital as a patient. Why can’t this be the right and expectation of every citizen?

At least one of the new organisations will be in New Zealand, the home of Hearts in Healthcare. And we’ll be excited to see projects emerging in other countries. Come join us.

14 Responses to “Healthcare system is fundamentally incompatible with compassion, healing & wellbeing”

  1. Bruce Munsky says:

    Thank you for bringing humanness back to healthcare. I’m a trauma survivor and a part of Carolinas Healthcare Systems Retreat to Improve the Patient Experience. I’ve personally experienced feeling like my traumas / injuries were being treated and not the person, me. I helped to start the Trauma Survivors Network, which allows me to support other trauma Survivors as well as their family members or friends and hear current trauma patients stories of times when they felt like medical staff didn’t care and didn’t have the time to care. My life is dedicated to making a difference in healthcare. One of the ways I do this is by speaking to all hospital employees about the impact their compassion and empathy has on a patients recovery. It’s not just the nurses and doctors who have a impact on the patients health and recovery. It’s anyone that interacts with patients at the hospital. This includes the sanitary engineers (janitors), radiologists, cafeteria workers, etc. I look forward to learning more about how you are improving healthcare.

    • Robin says:

      Thanks Bruce, I particularly appreciate two of your comments: Firstly, that you use Appreciative Inquiry to share what’s best rather than focusing on problems; Secondly, that you understand that every single employee of a healthcare network is part of the creating the experience of care.

      • Bruce Munsky says:

        My compassion for improving the patient experience in our healthcare system and making a difference in patients lives has brought me back to the Hearts in Healthcare webpage. Does your organization, Hearts in Healthcare, discuss or teach how the placebo effect impacts patients health and recovery? I’ve read many placebo and nocebo effect research studies as well as seem many examples of both in hospital Trauma centers. I’ve seen patients get worse just because the doctor said they would. I’ve made myself stay sick, not heal, and get worse by believing and thinking what the doctor’s diagnosis and having no hope. The placebo and nocebo effects are triggers to the plasticity of the brain. Thanks for letting me ramble. I’m curious to learn if there is a focus on the placebo / nocebo effect and just the overall impact of a medical professional’s words on a patient’s health & recovery.

        • Robin says:

          Hi Bruce, apologies for the delayed posting of your comment and my reply – we had a back-end glitch on our website that was sending some submitted comments direct to the “Deleted” folder! In answer to your question – YES! The Placebo effect is widely misunderstood and I like the idea that it should be called the “Meaning response”. The most powerful impact of this response occurs with compassionate practice. I present very widely about the scientific evidence supporting the effects you mention. For your reference, we created a handy one-page info-graphic to summarise the ‘Top ten scientific reasons why compassion is great medicine‘. Yes, the nocebo response is powerful too, which create a considerable ethical dilemma when doing informed consent before procedures. I take trouble to counteract the harmful effect of mentioning possible complications by then doing “Informed hope”.

  2. Jerome burne says:

    http://healthinsightuk.org/2016/04/29/meet-a-doctor-who-thinks-for-herself-and-wants-you-to-as-well

    http://healthinsightuk.org/2015/10/20/utopia-a-realistic-blueprint-for-an-honest-drug-industry

    Completely agree with your diagnosis that we have a health system designed to produce results that have nothing to do with health. I’ve been writing about it on my blog for a while. Above are the addresses for two of posts (one written by me one not) that make a similar point.
    Happy to talk if you are interested
    Regards Jerome

  3. Angela says:

    Hi Robin, I have been a GP for 25 years and the older I get the more compassionate I have become. The more compassionate I have become the more I have become connected with my patients, the stronger the partnerships, the better the choices we are empowered to make together in their health decisions, and the more enriched I feel at the end of every day. This grows every day. Sure, I get sad sometimes, and tired, but enriched and fulfilled, I dont need mental health days, I dont have heart sink patients and I wouldnt swap my job for anything. I attended your seminar about a year ago and for the first time realise I dont need to feel guilty about this, and that this is something to be celebrated, thankyou for bringing the joy into the light

  4. Robin…a strong message, yet you inspire hope within…that there is still a chance to make a difference by approaching things in a different way. I have huge respect for what you and Meredith have been doing and I am excited about what will come next. I will certainly join you in the new page and offer my full support in any way you feel it is apprpriate….

  5. Dr. Abdelbasit Ayoub says:

    Why we do not reach out to the decision makers and sell them the new idea of compassionate care. We have Buurtzorg community nursing service in Netherlands a successful case study to share to get the buying in. In order to create the change we want, we need to target health care professionals in all levels. In the past few years we were targeting individual health care providers who have no authority to change. In fact, at certain stage, I felt that I am adding to their frustrations with the current systems and made them feel powerless, simply because they cannot change systems and policies.

    I think we need to focus on selling our ideas to the managers and decision makers. We need to sell them the idea in a language they understand:
    • Compassionate care improves customer satisfaction.
    • Compassionate care reduces healthcare professionals burnout
    • Compassionate care improves productivity
    • Compassionate care improves employees’ satisfaction and engagement.
    • Engaged employees give more productivity and have less interpersonal conflicts at workplace.
    • Compassionate care save costs and reduce medical errors
    • Compassionate care keeps employees aligned with the organizations strategic objectives.

    Finally, let us talk to them with the language they understand.
    Your ideas, comments and suggestions on how to start is highly appreciated.

    Dr. Abdelbasit Ayoub

  6. Deborah Coleman says:

    Hi John. I was a medical social worker at Providence Medical Center in Medford Oregon USA. I started a non profit. Education to the public including insurance companies and training caregivers in Gerontology, working with Seniors in their home which is where they want to stay. It was birthed by a 87 years old senior who said to me, ‘Deborah I’m old I’m not sick’. Her comment pierced my heart and I felt I had to do something. Initially resistance has now turned into support. The non profit is client driven. How can I know where I have not been yet. Enjoying the ride.

  7. Thank you Robin! Some weeks ago I posted here in Germany on “Basecamp” this aspect of how we can change this “sick System” as you say “In a capitalist economy, the healthcare industry makes money out of sickness and has no interest in promoting health, healing or wellbeing. Even cancer is turned into a chronic disease that earns a fortune for pharmaceutical companies.” and we are the members of supporting this, because their seem no alternative. We are required to change this.
    You will meet us in Dresden and we’ll see how your great Incubator-Idea may start to grow also here in Germany. For myself, I leave the System after 21 years as a general practioneer and now I’am creating a Mind Body Medicine practice for single and group settings. See you in Dresden! Heartily U L I

  8. Robin says:

    To be honest, John, I struggle with this every day of my clinical practice. I find it very hard to work within a system that so violates my values. So I just take care of individual patients the best I can, offering compassion and kindness, which warms my heart. I daily practice appreciation, gratitude, mindfulness and self-compassion. I choose to focus my attention on the extraordinary privilege of intimate encounters with patients each day, rather than the frustration of the system. I admire, encourage and support my colleagues with compassion also, aiming to make my workplace a happier place to be. And I spread the word about the importance of compassion, sometimes finding surprising allies. I know that my caring makes a huge difference to individual patients and that outweighs the challenges and difficulties. And I believe the old system cannot survive much longer and more humane organisations are emerging already. Sometime, we just have to quit a job and find a more compassionate place to work. Every person who does that is part of the process of evolution towards a more humane system.

  9. John McBurney says:

    Wow. If I understand you correctly the problem cannot be solved in the context of the current system and the best we can hope for is to offer care and support to the workers within the system who pay a terrible personal price for working healthcare. There is no way to make the mine safe The only way to be safe is to stay out of the mine.

    So where is the hope for those of us laboring away in the mine?

    • I like the hearts in healthcare philosophy. The points you talk about are what led me to transition from working as an administrator in hospitals to learn to become an energy healer so I could help in bridging traditional care with alternative, less invasive more compassionate heart centered care. I have trained many nurses and massage therapists in the simple art of Reiki, a practice anyone can do for themselves and others and it has become my passion to share this gift of love and healing with as many people as I can. Thank you for the work you have begun to share!
      love and light, Marilynn

Leave a Reply to Angela

“When all members of an organization are motivated to understand and value the most favourable features of its culture, it can make rapid improvements.”