As politics continue to play an ever-present role in the future of health care, providers, patients, plans, and other professionals are looking for ways to improve care quality and build meaningful, successful connections among their care teams; this is where humanism and compassion have a role to play and the results are measurable.
Value-based care, patient-centered care, collaborative care—these terms inform the current discussion of health care delivery in the United States. Despite varying interpretations of their meanings, at the core of each of them all is an attempt to heal a system that is cracking under the weight of run-away costs, less than optimal quality of care, patient dissatisfaction, and provider burnout.
While advances in technology and molecular biology increasingly offer more targeted approaches to treating diseases, which have allowed for more individualized and personalized care, they often cannot and do not offer on their own, what patients seek when sick, care. And research is showing that care matters. It matters for outcomes. It matters for patient satisfaction. It matters for cost, and it matters for provider well-being.
In particular, research is growing on the benefits of returning to principles of care in the clinical setting and health care system as a whole, using what some define as humanism, others compassion, and others empathy (Sidebar.)
What underlies all of these is the emphasis on the importance of the human connection in health care, putting the patient at the center of care, and building a collaborative, trusting relationship between provider and patient to ensure the needs and wants of the patient are addressed.
“Humanism is the focus on the interests, values, and dignity of humans,” said Richard I Levin, MD, president and CEO, The Arnold P. Gold Foundation, a foundation established in 1988 devoted to studying and advocating for humanism in health care. “If we translate that into the health care ecosystem, it translates into providing optimal health care, which requires simultaneously [providing] compassionate, collaborative, and scientifically excellent care.”
Stephen Trzeciak, MD, MPH, professor, chair & chief of medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, underscored the word “compassion” as the cornerstone of humanism and coined a new term “compassionomics” to signify it as a rigorous area of research that can be measured to understand better its influence on health outcomes.
In Dr Trzeciak’s recently published book, Compassionomics: The Revolutionary Scientific Evidence That Caring Makes A Difference, he and his coauthor Anthony Mazzarelli, MD, report on the findings they culled from a systematic review of 281 original science papers on compassion. “We found striking signals that compassion matters not just in meaningful ways but also measurable ways,” he said. “Compassion is associated with beneficial effects for patients, patient care including the cost of care, and greater health care provider satisfaction and reduced burnout.”
Referring to this evidence, Dr Levin pointed out that these findings support the importance of compassion or humanism in achieving the quadruple aim in health care: (1) improving the patient care experience; (2) improving the health of populations; (3) reducing the cost of care; and (4) improving the work life of health care providers (and reducing burnout).
As an example, Dr Levin cited data showing that the number of tests for the same health outcome could be reduced by 50% by providing an empathic, compassionate, health care environment.
“The critical component is providing an environment in which both the patient and provider feel better about the experience of receiving and providing care,” he said, adding that this also leads to lowering the utilization rate of “the remarkable armamentarium of tests modern medicine provides.”
Patient at the Center of Care
Fundamental to the inclusion of humanism or compassion in health care delivery is a central focus on the patient. Although patient-centered care has become integrated into the lexicon of health care since the 2001 Institute of Medicine’s Crossing the Quality Chasm: A New Health System for the 21st Century, in practice it remains elusive as discussed in a recently published article in Health Affairs. The article discusses a number of barriers that have impeded the delivery of health care that is truly patient centered. Among them are inadequate trust and respect, and a nonsupportive medical culture.
Both these barriers can be seen as a lack of compassion or humanism in the health care setting.
Scott Wallace, associate professor and managing director, Value Institute for Health and Care, University of Texas at Austin, highlighted the need to restructure the health care model to return to placing the patient at the center of care. He and his colleagues are building care resources based on Elizabeth Teisberg and Michael Porter’s Integrated Practice Unit Model that fundamentally restructures care around how the patient experiences health care instead of the traditional model in which doctors are trained and paid.
Essential to this model is a caring, collaborative relationship among clinicians and patients built around empathy that aims to prioritize outcomes that matter most to patients. The model emphasizes the need to assess function outcomes, which include outcomes of care (ie, survival, extent of recovery), outcomes during care (ie, patient experience), and long-term health (ie, sustainability of health).
“We’re looking at how do we get dramatically better outcomes for patients, improvement in the outcomes that matter most to the patient for the money that we spend on health care,” said Mr Wallace. “If we reorient health care by dramatically improving outcomes that are most important to patients, then we serve the purpose of health care on multiple levels, it is better for patients, but also better for clinicians because they are actually doing what they got into medicine to do.”
Early evidence of the improved outcomes using the model are compelling, said Mr Wallace. The model is being used in a spine center at the University of Texas in Austin that focuses on the main needs of patients who present with back pain—pain reduction and improved functionality. Treatments prioritized at the center are exercise, nutrition, and psychological approaches vs surgery.
Prior to opening the clinic, uninsured patients were waiting 14 months on average to see an orthopedic surgeon.
“Within 4 months of opening the clinic, we had eliminated the 1200 person wait-list and reduced the rate of surgery by about 60% with 85% of patients reporting a dramatic reduction in pain,” said Mr Wallace. “This is a vivid example of high value care, meaning care that delivers improved outcomes, is not as expensive, and works really well for a lot of people.”
Clinical Skills and Behavior of Compassion
Placing the patient’s experience at the center of care requires skills and behaviors on the part of the provider characteristic of principles of humanism and compassion (Table).
Dr Trzeciak emphasized that these skills or behaviors are teachable and, importantly, require little time to exert a huge impact.
This last point is critical. Dr Trzeciak cited evidence from a Harvard study showing that 56% of clinicians reported they did not have enough time to treat patients with compassion.
“The reality,” said Dr Trzeciak, “is that when you look at the scientific literature, the evidence shows that a meaningful connection takes less than one minute.”
“The notion that [compassion] takes too much time is not supported by the evidence,” he said.
Another misconception about compassion also is debunked by the evidence, said Dr Trzeciak. “Historical training in medical school that too much caring and too much compassion will burn you out is actually not supported by the scientific evidence,” he continued. “In fact, the preponderance of evidence showed the exact opposite—that building compassionate connections in relationship with patients actually builds resilience in health care providers and resistance to burnout.”
And low compassion, Dr Trzeciak said, is associated with higher burnout. “The evidence suggests that those who do not have compassion with patients and don’t build relationships are more predisposed to developing burnout under the same amount of stress.”
Measuring Outcomes Linked to Compassion
Underlying the rigorous approach to studying compassion, Dr Trzeciak stressed the importance of creating metrics to assess the benefits of compassion in the health care setting.
“The first step is getting the patient perspective on compassion. If we don’t know what our patients perceive about compassion, we won’t have any compass to guide us in the clinic,” he said.
To gain a better perspective on how patients perceive clinical compassion, Dr Trzeciak and his colleagues developed and validated a tool. The tool comprised five questions that are easy and quick for patients to complete.
Mr Wallace also emphasized the importance of developing metrics, and importantly, measuring what is most important to patients. “The problem with the facile analyses of health care is that if you only measure one thing that is what everybody works on,” he said. “You want to think about outcomes in multiple dimensions.”
Focusing on the patient requires assessing three main outcomes, according to Mr Wallace. These include capability (can the patient do things that he/she wants to do), comfort (is the patient’s suffering reduced), and calm (can the patient live her/his life while getting care).