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Small things are big things: can we design empathy into services?
Jocelyn CornwellDirector
The Point of Care Foundation
Every system is perfectly designed to produce the results it gets
Starting point 1: systems thinking
Paul Batalden M.DDartmouth Institute for Health Policy and Practice
Starting point 2: design‐thinking
(P)PERFORMANCE
How well it does the job, whether it’s fit for purpose.
Functionality
(E)ENGINEERING
Whether it is safe & reliable.Safety
(A)AESTHETICSHow it feels.
How it is experienced.Usability
Every product & every service has 3distinct elements
THE AESTHETICS OF CARE ‐ SMALL THINGS ARE BIG THINGS
Example 1: a daughter’s story
Overall, my mother received the best care from staff who have treated and respected her as a person, rather than stereotyping her as an elderly person who’s not capable of thinking and doing things for herself.
Example 1 (contd.)Throughout her time in hospital, staff continually called my mother by the wrong name. She has been called Harriet all her life but it is her middle name, so her first name is written on all her records. We drew this to the attention of staff on the ward; it was important especially as she was suffering from episodes of confusion, but it did not stop. Everyday someone from the family would visit her and wipe the wrong name off the whiteboard.
On one occasion, after tracking down a registrar responsible for her care, we explained the situation and he wrote “likes to be called Harriet” in big letters on the front of her notes but it stillhad little effect.
“I had my first round of chemotherapy (epirubicin) five years ago. It was an alarming red and hit you like a train. Nothing’s ever made me as sick. I spent the first night in A&E being rehydrated, having been given insufficient anti‐nausea drugs to take homeand no instruction about how to take them (for example, that you can just take another one if you need to).”
Dr. Anna Donald. BMJ blogs 2008
Example 2: small things have far‐reaching effects
“I have no idea why so many oncologists seem to under‐treat nausea in first‐time chemo patients. Sadism? Incompetence? Probably a lack of understanding of what an enormous shock to the system your first chemo dose is, causing your body to buckle and heave, requiring heavy anti‐nausea cover even if later cycles do not when your body knows what to expect. Combined, probably, with some degree of denial.
It hurts to cause suffering.”
Dr. Anna Donald. BMJ blogs 2008
Patients make up their own minds what they mean
EMPATHY
A person’s capacity for empathy has two distinct aspects
Cognitive• the capacity to understand another’s
feelings
Affective• the capacity to respond appropriately to
another’s feelings
Empathy is normally distributed in the population
All individuals’ capacity for empathy can be switched off or impaired
When empathy is switched off, we are solely in ‘I’ mode. Most of us are capable of switching off occasionally.
We are more likely to switch off when we are:• Tired• Stressed or burned out• Under pressure to do something else• Highly emotional ‐ angry, frustrated, distressed or frightened• Working with digital equipment
Empathy‐by‐design methods
• Simulation• Experience based co‐design• Shadowing• Participant observation• Analogous scenarios
Challenges to empathy‐by‐design1. Scalability
• Deliberate effort required to expose the wider team to ‘out of ego’ experiences
• Simulations
2. Sustainability• It is not enough for a small team to have transformative
experience• One off whole system events don’t work • All involved need to be intrinsically motivated• Stories, artefacts (videos, animations, photos) • Cultural change
Enabling conditions: individual level
To enhance cognitive capacity
• Feedback about what happens later to individual patients• Information about patient’s biography (This is me!)• Opportunities to shadow patients• Opportunities to listen to stories
To enhance affective capacity
• Give front line staff power to resolve problems, take action• Give them access to relevant resources• Appreciation, recognition, reward• Confidence in own capability
Enabling conditions: organisationalCultural norms
• Explicit and shared values in plain English• Intolerance of language that objectifies patients • Intolerance of rude and unkind acts• People‐based priorities
People management and team working• Supervisors ‐ trained to manage people• Opportunities for reflection (Schwartz Rounds and others)• Systematic, frequent feedback from patients
Systems support• Good IT and patient records• Active management of balance demand v. resources
Point of Care Foundation
THANK YOU
www.pointofcareoundation.org.uk