November 2011 VOL 2, NO 6

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AONN 2011 Second Annual Meeting Coverage

Compassionate Care Helps Drive Better Patient Outcomes

Robb Johnson 

Significantly high levels of physicians and other medical professionals believe that compassion in healthcare makes a significant difference on whether the patient lives or dies. And yet, of physicians who were polled not long ago, only a little more than half believed that the system is actually compassionate today. Robb Johnson, director of programs for the Schwartz Center for Compassionate Healthcare in Boston, addressed this poll and how it ties in with the compassion concept and the work of the center.

Set up in 1995, the center carries out the vision of Ken Schwartz, a healthcare attorney who died of lung cancer at age 40, who suggested that what meant the most to him as a patient was the compassionate care he received from his caregivers.

One notable program at the center is known as Schwartz center Rounds, a forum that allows professional caregivers from a diversity of disciplines to get together to address difficult emotional and psychosocial issues pertaining to patient care and develop strategies for addressing challenging cases.

“Caregivers can learn new strategies for treating patients more compassionately while providing support to one another and building stronger teams. This is really a provider-directed program for providers,” says Sean Walsh, the executive director of AONN.

According to Walsh, it’s essentially a 1-hour program at lunchtime. The Schwartz Center basically provides a type of training orientation process for a hospital to undertake, and then they run the training program with a planning committee located within that facility.

The training sessions run 6 to 12 times a year. It’s an interdisciplinary forum and is cross-disciplined; it creates an interactive discussion acrossdisciplines. The program is focused on the psychosocial aspects, or the heart or emotional side of the work, not on clinical problem solving.

Patients and families do not generally attend, but once a hospital or clinical setting has the Rounds running, they are encouraged to invite a patient or family group into a Round to actually share their story, so that can be kind of a crossfertilization of ideas, according to Walsh.

On another front, the Schwartz Center recently began piloting a program with CRICO/ RMF (Controlled Risk Insurance Co/Risk Man - agement Foundation), the insurance company for Harvard teaching hospitals. They are working with clinicians on a project in which all the cases that are used in case discussions are based on actual closed malpractice cases. And 70% of claims are actually based on breakdowns or problems in the communication between provider and caregiver, possibly situations that may lack in compassion.

Robb Johnson, director of programs for the Schwartz Center, says that it is possible that the profession’s compassion can be impeded by a negative source of energy, burnout. He says one measure of burnout in healthcare provider populations is the Maslach Burnout Inventory, which considers various measures. One measure is emotional exhaustion, which essentially means you are at the point where it is becoming difficult to engage or to assert your needs with others. Another measure is depersonalization, which can be measured by negative pessimistic attitude, maybe hostility or hostile behavior toward your coworkers or toward your family, and a lack of a sense of personal achievement.

“From my past direct work experiences with people with HIV and AIDS and with victims and survivors of violence, there were times when I felt like I had light shining out of my head and I thought, ‘I’m doing good work.’ And there were other times when I was so conscious that what I just said or what I just did fell flat or was the wrong thing at the wrong time,” Johnson says, relating to the depersonalization measure.

He adds, “For me, the unfortunate part of my personality is I tend to remember the ones that didn’t go so well a lot longer than I remember the ones that went well. But we don’t need heroic performances all the time. It’s impossible to be on 100% or perfect all the time.”

He suggests that what medical professions really need is to develop a system of coping strategies and support that will keep you going. Johnson queried his audience about times when they felt like they were heading toward burnout. He asked for audience members to share personal strategies used to help bring them back to where they could devote energy and enthusiasm to life or to work again.

He asked a second question of the audience: “What are a couple of things at your workplace or perhaps your family system that your social system has done that have helped you cope and stay engaged and avoid burnout?” The first question is a personal strategy; the second one is a system support strategy.

One audience member, Patty Grow, RN, MSN, FNP-C, family nurse practitioner and patient navigator from University of Texas Medical Branch at Galveston, works in the breast cancer area of the branch. At her facility, she says one of the strategies is to use prayer of some sort.

“This is very quick and simple. We go into a room, and we hold hands, and we pray as a team. We can do the best thing for our patients if we take care of ourselves. Sometimes we pray with the patients as well. I’m also a survivor, and this is one strategy that works for us,” she says.

According to Johnson, a significant evaluation of the compassionate care–based program was published in the Journal of Academic Medicine last June.

“What we found was that people were coming away with concrete strategies for dealing with challenging situations, and they were feeling, at least by self-report, that they had an enhanced or renewed compassion for folks,” Johnson says.

A high percentage reported a greater appreciation for what their colleagues do, and they felt more a part of a caregiving team. And a significant number reported feeling less alone in their work, according to Johnson.

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