This summer, a Fairfax County, Virginia man captured the decidedly disrespectful conversation of his medical team during his colonoscopy. The Washington Post video of that conversation has since become required viewing in training sessions for medical professionals around the country.
In an era when we KNOW that compassionate care yields measurable improvements in patient quality ratings, how is it that we even have to have this conversation?
I suspect that it has to do with assumptions we make that medical professionals are driven by compassion, and that compassion is an inexhaustible resource.
Also, we assume that everybody knows just what compassion actually looks like! I’ve read countless recommendations that medical organizations make a point of rewarding compassionate practices by staff, most of which decline to get concrete about which behaviors they are talking about.
So I was really glad to find Recommendations from a Conference on Advancing Compassionate,Person- and Family-Centered Care Through Interprofessional Education for Collaborative Practice. This document actually advances a model and framework for Collaborative Compassionate Care (Triple-C) to forward the Triple Aim.
(For the uninitiated, the Triple Aim is:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and
- Reducing the per capita cost of health care.)
Along the way, they even make the radical suggestion that perhaps, a Quadruple aim should be contemplated, the fourth aim supporting healthcare professionals’ wellbeing.
The framework lists the behaviors which characterize compassionate care-giving at a fairly concrete level, for example:
- Can be silent while maintaining presence and focus on the other person
- Uses head nods, “continuers” (e.g., uh huh)
- Uses reflective listening skills (simple and complex reflections or reframing)
- Bases comments on what’s just been said
- Summarizes what has been said to ensure understanding
Which is great, and pretty much what I’ve been looking for. Even better, the authors take the time to map these behaviors to standards already extant — Ones put out by Association of American Medical Colleges , United States Medical Licensing Examination, Accreditation Council of Graduate Medical Education,American Board of Internal Medicine, and the American Association of Colleges of Nursing. Which is to say, these behaviors are not something “extra,” a new demand on our clinicians, but rather have long been baked into expectations for these individuals.
It’s just that we’re only now realizing we have to get very explicit about the skills we want to recruit for and reward.