Building Empathy into the Structure of Health Care

A physician holding the hand of a patient in comfort.

“The highest form of knowledge is empathy, for it requires us to suspend our egos and live in another's world” - Plato

What is one of the most important things patients look for in health care? If you said “empathy,” you would not be wrong. Patients report that empathy and compassion are just as important as training and experience when it comes to choosing a physician.

Patients also report that they would change doctors if they felt their current physician was uncaring. And when it comes to deciding where to receive care, a hospital's reputation for how they make patients feel may be just as significant as other formal rankings. 

Why Empathy Matters

Empathy is about awareness of other people's emotions and understanding their feelings. Compassion is about taking action in response to empathy. Both are critical for establishing trust with patients and providing care that meets their needs; however, empathy comes before compassion. 

Studies demonstrate how empathy improves patient satisfaction, treatment compliance, and clinical outcomes. Patients are more likely to follow their treatment plan and practice self-care when they feel heard and understood.

Establishing an empathic relationship with our patients also leads to fewer disputes (i.e., litigation) and can improve reimbursement as a result of higher patient experience scores. But, most importantly, taking the time to empathize with our patients allows us to connect with them on a more human level.

Unfortunately, many health care encounters are reported to be lacking in this area. Even though there are physicians who routinely convey empathy to their patients, it is not a universal experience across health care settings.

But what if empathy could be built into the foundation of health care delivery? What if, in addition to caregivers practicing empathy, it was incorporated into the very fabric of the care delivery process?

Creating an Empathetic Culture

To do this, we first need to create an environment that fosters empathy, and this starts at the top. When senior leaders model desired behaviors, those behaviors permeate the entire organization. 

This type of culture develops when people feel seen and heard by leaders and when leaders respond to their expressed needs. It sends a powerful message when leaders convey empathy in their interactions with others and demonstrate that they value an individual's well-being as much as their ability to perform work duties. 

Making empathy a priority means incorporating it into hiring decisions and our onboarding process, including recruitment practices and job descriptions. It should also influence how we recognize and reward individuals.

However, developing empathy in health care organizations is more than just the responsibility of senior leaders. We all play a role in creating an environment where we treat each other with respect and have a genuine concern for each other's well-being.  

Learning Empathy

Is it possible to become more empathetic? This is a long-debated question; however, findings from several studies suggest that empathy training can improve individual performance. For example, Helen Riess, MD, the founder and director of the Empathy and Relational Science Program at Massachusetts General Hospital, has published encouraging findings from her research on empathy training.

Her team provides training to improve physician empathy and refine the healing process through emotional awareness and self-management strategies. However, if we want to ingrain empathy throughout our organizations and teams, we need to provide training to everyone who comes into contact with the patient.

This type of service excellence training is commonplace in other service sectors and is widely recognized for its effectiveness. Several case studies demonstrate that health care is no exception and large-scale training can transform organizations. However, one-time training may not be sufficient.

According to a study published in The New England Journal of Medicine, although empathy increases with training, levels may decrease over time after training. This suggests the importance of following metrics like patient experience and providing ongoing skills development coaching where needed. 

Redesign with Empathy in Mind

Finally, one of the most important ways to embed empathy into the foundation of the health system is by redesigning care processes with empathy-centered design thinking. The goal is to operationalize empathy by directly incorporating the patient's voice into how care systems are developed.

This approach requires a thorough understanding of the patient journey, including their pain points, challenges, and obstacles. This perspective is usually obtained through surveys and focus groups. However, rather than periodically soliciting patient feedback, a better approach is integrating patients into the committees and work groups that design care.

Some cancer centers, for example, work with patients to identify quality improvement priorities based on their experiences with the system. Their entire journey, from when they call the hospital to when they leave, is mapped out to find key moments that shape the overall patient experience. These "touchpoints" become co-design priorities to improve care in ways that show respect and compassion.

We can also apply empathy-centered design thinking to broader programs such as population health management. By attempting to understand and integrate patients' perspectives on barriers to care, living conditions, and social settings, we gain valuable insight into making these programs successful.

Simple Steps

Incorporating empathy into our care process does not have to be complicated or expensive. Adrienne Boissy, Cleveland Clinic's Chief Patient Experience Officer, provides a simple example using the safe surgical checklist. In addition to the safety steps currently present (e.g., confirming the surgical site and procedure), she suggests adding "family updated" to the checklist items.

At Beth Israel Deaconess Medical Center, we have taken steps in our practice to try to incorporate empathy into the care process. For example, our patient intake forms include two important questions at the top: "how would you like to be addressed?" and "what is your main concern for this visit?"

The first question is a simple gesture of respect that can convey an important message about how we value patients as individuals. The second question allows us to ensure that we address their top priorities, not just the ones we assume. We also partner with our breast cancer patient and family advisory council to identify areas for improving the patient experience.

Final Thoughts 

Empathy is at the heart of good health care delivery, perhaps more than we realize. Taking the time to truly understand our patients' experiences helps us to provide better quality care and improve health outcomes.

We can develop an empathetic and compassionate health care system by making empathy a priority, modeling desired behaviors, and redesigning with empathy in mind. In this way, we will transform care organizations into organizations that care.

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