Healthcare professionals choose patient care for altruistic reasons, yet mostly expecting there will be challenges and obstacles along the way. This is especially striking when considering how being in the service of a fragile population who require help isn't an easy task. With this in mind, many are motivated and adamant about improving patients' health and quality of life — until they get hit by the reality of the working conditions and deteriorated healthcare work culture. Compassionate care is expected from healthcare workers to improve the patient experience and ease suffering. How would the healthcare workplace change if we could reflect compassion and kindness to our colleagues in work environments, since many healthcare professionals are suffering from diverse health problems and struggling with their health?

What makes it too stressful to work in healthcare/patient care?

According to research, approximately 40% of healthcare workers show permanent health problems mostly related to heavy workload and work stress (Worringer et al., 2020). Healthcare workers are stressed due to many reasons as there are personnel shortages, increasing workload, rapidly expanding knowledge base, changing government regulations, malpractice suits, longer working hours, high clientele expectation and peculiar problems, and the hazard of workplace (workplace violence). These conditions turn the workplace into high-pressure environments while providers are expected to show extensive empathy towards others. These factors often lead to emotional burnout, which may subsequently lead to reduced achievement motivation, reduced job satisfaction, increased interpersonal conflict, and compassion fatigue (Scarlet et al., 2017). Compassion fatigue and employee engagement are correlated when providers are too physically and emotionally exhausted to feel compassion for others. It is clear that humans cannot show compassion towards others when they are not mentally and emotionally at peace. 

Health Problems of Healthcare Workers

Moreover, there is increased morbidity in healthcare workers compared to the general population. Some data shows that even a medical field specialty can determine how long you live or how sick you could become (Gorman et al., 2013). Due to the SARS-CoV-2 outbreak, its psychological pressure has spiked and many people serving in healthcare are facing suffering from PTSD, anxiety, and depression. When it comes to seeking help for mental sufferings, healthcare workers are reluctant, which might be because of two preventing barriers: career advancement and concerns over confidentiality (Mohanty et al., 2019). An individual experiencing emotional exhaustion is also likely to experience depression and might struggle to give compassion to others, receive compassion from others, or practice self-compassion (Scarlet et al., 2017).

Can Compassion be Taught?

There has been a historical discussion regarding if compassion can be taught. Some medical educators claim that students naturally pick up compassion during their training while interacting with suffering patients. We can not underestimate the influence of professional role models on integrating genuine compassion in work environments. However, it may be hard to distinguish between  compassion that is truly felt from compassionate behavior that is imitated. 

There are various compassion specialists in the field who are doing meaningful work. Dr. Kristen Neff is one of the leading experts who has done lots of projects on self-compassion. Dr. James R. Doty, the founder of CCARE, offers compassion cultivation training and conducts research focusing on the benefits of implementing compassion in the medical education curriculum and work environment. A study led by his team specifically sought to investigate whether Compassion Cultivation Training (CCT) reduces work-related burnout, interpersonal conflict and increases mindfulness, compassion toward self, and job satisfaction scores. The general conclusions are that CCT may improve healthcare providers' health, such as self-reported mindfulness, self-compassion, compassion toward others, and interpersonal conflict. The results supported the correlation between compassion and improvement of mental health resilience in healthcare workers, thereby improving patient care (Scarlet et al., 2017). More studies and conversations will happen around this area, considering the increase of the healthcare workforce's mental struggles. Work culture affects people's emotional health because emotions can be contagious; thus, being proactive and promoting compassion and kindness among colleagues is definitely a part of the solution.

Barriers to implementation of compassion into work environments/leadership

Compassionate culture amongst healthcare staff and a healthy work environment are essential to improving patient experiences and improved clinical outcomes. If this notion is inevitable both for patients' and the workforce's health and safety, why is it so hard to apply it? Significant barriers are making this more complicated than it sounds. Burnout, anxiety, and depression are the common mental barriers against compassion. If a person feels under threat, the mind's compassionate components likely turn off, and instead finds ways of protecting oneself from potential danger. It is clear that the current healthcare system undermines the existing compassion in the workforce.
 
Until recently, most initiatives to address clinician burnout have focused on improving the resilience of individuals. These measures are necessary but insufficient. It is now recognized that organizations have a significant role in causing, preventing, and mitigating clinician burnout (Campling, 2015). Organizations must address burnout because resilience won't withstand unsupportive or toxic organizational cultures, mostly if those who speak up are silenced or forced to leave. Moreover, compassionate leadership won't endure inadequate resources (including short-staffing) and insufficient support. Evidence shows that "happy staff makes happy patients," and investing in staff well-being and support is a clear leadership priority. There must be an institutional commitment to enhancing autonomy, transparent communication and working collectively for better poor work conditions. 
Leadership must be proactive and take concrete actions to create a compassionate work culture before it reaches an unturnable level where the workforce can not provide compassion for their patients. Healthcare leadership and organizations can invite skilled coaches into the process of creating a more compassionate and kind work culture. As a valuable resource, coaching (personal, professional, or in a group setting) will shed light on both individual and collective barriers and struggles in implementing compassion and will lead to self-chosen transformational solutions and goals to make desired changes and outcomes. Although leaders might be the ones making more significant decisions, the organizations should offer coaching services at any level of the staff members. This way, all workforce will take an active part in this process.

The work culture in healthcare is fragile and easy to deteriorate due to the stress and mental burden; for that reason, these actions and efforts should be continuous. Compassionate behavior towards our patients or our colleagues will only be truly internalized when it becomes an indispensable virtue of the system and professional network.

References

1. Worringer, B., Genrich, M., Müller, A., Junne, F., & Angerer, P. (2020). How Do Hospital Medical and Nursing Managers Perceive Work-Related Strain on Their Employees? International Journal of Environmental Research and Public Health, 17(13), 4660–. https://doi.org/10.3390/ijerph17134660
2. Scarlet, J., Altmeyer, N., Knier, S., & Harpin, R. (2017). The effects of Compassion Cultivation Training (CCT) on health‐care workers. Clinical Psychologist (Australian Psychological Society), 21(2), 116–124. https://doi.org/10.1111/cp.12130
3. Gorman, T., Dropkin, J., Kamen, J., Nimbalkar, S., Zuckerman, N., Lowe, T., Szeinuk, J., Milek, D., Piligian, G., & Freund, A. (2013). Controlling health hazards to hospital workers. New Solutions, 23 Suppl, 1–167. https://doi.org/10.2190/NS.23.Suppl
4. Mohanty, A., Kabi, A., & Mohanty, A. (2019). Health problems in healthcare workers: A review. Journal of Family Medicine and Primary Care, 8(8), 2568–2572. https://doi.org/10.4103/jfmpc.jfmpc_431_19
5. Campling, P. (2015). Reforming the culture of healthcare: the case for intelligent kindness. BJPsych Bulletin, 39(1), 1–5. https://doi.org/10.1192/pb.bp.114.047449

About the Author

NAZAN ARTUN PhD, RPh

Dr. Nazan Artun is a true renaissance woman: a pharmacist, coach, and award-winning singer-songwriter-guitarist. She holds a doctoral degree in Biotechnology with a focus on Pharmacogenomics and Personalized Medicine. She built a creative career and a scientific one simultaneously, earning her Ph.D. between gigs and studio sessions. She helps professionals and leaders in pharma and healthcare improve their performance, tap into their creativity, overcome imposter syndrome, gain clarity on their goals, communicate genuinely and confidently, and navigate office dynamics to create healthier and more compassionate work environments with less staff turnover and burnout. She has published numerous scientific and perspective articles in Thrive Global, Pharmacy Times, in addition to Academic Journals.