An Epidemic of Empathy in Healthcare
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Index
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Accountability
closure requiring, 133–134
creating effective systems of, 161
holding management responsible for, 184
intense feedback creating, 175
lacking when patients see too many clinicians, 27
measuring performance with units of, 120
Accountable care organizations (ACOs), 44
Acting methods, as work of empathy, 59–61
Adler, Dale, 181
Affection model
as model for social action, 158
as nonfinancial incentive, 175
organizations not taking full advantage of, 176–177
Affordable Care Act of 2010, 44, 91
Aging Game, 64
AMA Manual of Style, in medical journals, 75
Analysis
advances in data, 118–122
divorce epidemic, 140
of drivers of patient loyalty, 44–46
inherent weaknesses of, 159
obesity epidemic, 138–140
patient experience, 99–104
for patient-experience data from hospitalization, 46–47
transparency vs. avoiding, 175–179
Anxiety
measuring patient satisfaction by relief from, 93
reducing unnecessary patient, 73–74, 110–111, 190
relieving in palliative care, 29
waiting time for patients as source of, 168
Appreciative inquiry exercises, 171–172
Apprenticeship, healthcare training through, 181
Archives of Internal Medicine paper, 99–101
Arrowsmith (Lewis), 22
Arts, studying for empathy, 66
Avoidable suffering, 110–112
Axelrod, Robert, 70–71
Bad apple approach, healthcare improvement, 157
Balint training program, 67
Banting, Frederick, 21–22
Beepers, Mayo Clinic, 125–126, 130, 179–180
Behavioral change
appreciate inquiry for, 171–172
changing focus as, 156
financial incentives for, 172–174
governing board role in, 182–186
new measurement goal in, 162–164
nonfinancial incentives for, 175
nuanced approach to, 156–157
overview of, 155–156
providing examples of, 180–182
providing tools for, 182
shared purpose for, 164–172
social action models for, 158–162
tradition lever for, 179–180
transparency as incentive for, 175–179
Benchmarking
advances in data analysis, 118–122
data interpretation issues, 105–106
Best, Charles, 21–22
Best practices, brokerage, 130–131
Beth Israel Deaconess hospital, 126
Biochemistry, advances in 70s/80s, 77
Biological basis, of empathy, 56–57
Blinding, transparency vs., 175–179
Boissy, Adrienne, 182
Bonds, social network connections, 145
Boston Marathon bombings, 166
Boston Medical Center, 127
Brigham and Women’s Hospital, Boston
appreciative inquiry exercises, 171–172
highlighting positive examples, 143
learning from other healthcare centers, 127
patient stress test at, 17–19
Brokerage
accumulating social capital through, 152
defined, 125
encouraging variation with, 134
levels of, 130–131
overview of, 125–130
Brokers, 131–132
Brokovich, Erin, 135
Bundled payment contracts, 38–39
Burnout, clinician, 31–32
Burt, Ronald S., viii, 125, 132
Business imperative, epidemic of empathy as, 35, 43–47
CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys, 91
Cancer
advances in late twentieth century, 26
chemotherapy for incurable, 103–104
downside of progress, 27–30
Mayo Clinic team care for breast, 4
medical progress in, 11
sub-specialization in treating, 3
technological advances in 70s/80s, 76
Capital, defined, 124
Cardiac defibrillation, 24–25
Cardiology
advances in late twentieth century, 24–26
history of, 22
medical research in WW II, 22–23
technological advances in 70s/80s, 76
Cardiopulmonary resuscitation (CPR), 24–25
CARE (consultation and relational empathy) measure, 68
Carpet bombing, for improvement, 157
Cash flow, and resistance to change, 37
Centers for Medicare & Medicaid Services (CMS), 90–91
Change, resistance to, 36–37
Chaos
medical progress introducing, 53
as risk of modern care, 16–19
transparency vs., 175–179
Chemotherapy, 76, 103
CHF (congestive heart failure), 113
Christakis, Nicholas, viii–ix
on empathy as contagious, 1–2
on how networks spread values, 134
on impact of positive examples, 181–182
Rules of Life in the Network, 140–144
social network science study on obesity, 137–140
Christmas Eve soccer game, WW I, 71
Cigarette smoking, social patterns of, 2
Clarity, about healthcare goal, 42–43
Cleveland Clinic
appreciative inquiry exercises, 171
bundled payment contracts of, 38
empathy video, 7
nonfinancial incentives, 175
patient satisfaction survey of, 82–83
patient-centered experience at, 158
publishing clinical outcomes, 40–41
same-day access at, 126, 169
Clinical imperative, 47–51
Clinical outcomes
empathic coordinated care for high-value, 189–190
governing board role in behavioral change of, 183
hierarchy of, 50
measuring what matters to patients, 190–191
organizing patients/providers to improve, 191
Clinicians
data measurement issues of, 104–105
drivers of patient loyalty to, 45–47
feeling judged by patient experience measurement, 104
importance of shared purpose, 164–167
interest in patient-centered care vs., 168
tactics for acquiring empathy, 62–67
Closure
accumulating social capital through, 152
decreasing variation through, 134
defined, 125
overview of, 131–134
Clustering, mapping network, 149
CMS (Centers for Medicare & Medicaid Services), 90–91
Code Comfort protocol, 128
Cognitive empathy, 54–55, 57
Common ground, in brokerage, 130
Communication
driving patient recommendation, 46
training programs, 182
Communication the Cleveland Clinic Way: How to Drive a Relationship-Centered Strategy for Exceptional Patient Experience (Boissy and Gilligan), 182
Compassion
care concerns, 11–13
fatigue, 80–82
satisfied, 81
Competition
based on value, 39–41, 53
improving empathy, 9
Conceptual issues
defined, 97
patient experience data, 98–104
Condition-specific subsets, measuring effectiveness of care, 185–186
Congestive heart failure (CHF), 113
Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives (Christakis & Fowler), 134
Connections, social network, 145
Consultation and relational empathy (CARE) measure, 68
Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, 91
Consumer online reviews, 177–178
Contagious behavior, social networks
overview of, 135–137
Rules of Life in the Network, 140–144
study on obesity epidemic, 137–140
Conversion disorder, 135–137
Cooperation, evolution of, 70–71
Coordination of care
driving market share, 46, 185
embracing for high-value healthcare, 189–190
impacted by teams, 138
importance to patients, 141
at Mayo Clinic, 170, 180
waiting time and, 110–111, 120, 171
Cosgrove, Toby, 82–83, 164
Cost, accepting responsibility for, 188
CPR (cardiopulmonary resuscitation), 24–25
Crossing the Quality Chasm (IOM, 2001), 49, 86–88
Cultural differences, brokerage, 131
Cutler, Elliott, 22
Dafny, Leemore, viii
Dana-Farber Cancer Institute, 127
Data
advances in analysis of, 118–122
advances in quality/collection of, 113–118
governing board role in, 183–186
improving measurement of, 106–108, 162–164
on inherent vs. avoidable suffering, 110–112
measurement issues, 104–106
patient experience concerns, 96–98
tracking spread of emotion, 147–149
types for integrated practice units, 121–122
weaknesses of outcome measures vs., 159–162
Death
Code Comfort protocol for dying patients, 128–129
Harrison’s philosophical view of in 1950s, 24
HCAHPS performance/clinical outcomes, 101–102
medical progress and view of, 25
widower effect study, 137
The Death of Ivan Ilyich (Tolstoy), 66
Deep acting, emotional labor, 60–61
Delivery of interventions, network targeting, 147
Diabetes, discovery of insulin, 21–22
Distraction, as barrier to empathy, 72–76
Electronic data collection, 114–118
Emotional contagion, 57
Emotional empathy, 54–55
Emotional Intelligence (Goleman), 54
Emotional labor, empathy as, 6, 59–61
Emotions
language of healthcare, 7–8
tracking spread of in healthcare social network, 147–149
Empathic concern, 54
Empathy
concept of, 54
creating epidemic of healthcare, 1–2, 7–9
emotional labor at core of, 6
as essential, 54–56
as goal of healthcare, 5
steps for building organizational, 187–193
trend of nonempathic care, 2–4
Empathy as response
Balint training program for, 67
barriers to, 70–71
biological basis of, 56–57
as cognitive process, 57–58
distraction as enemy of, 72–76
erosion of empathy, 76–80
as essential, 54–56
essential to excellence, 82–84
exposure to role models for, 63–64
hospitalization/illness experiences for, 65
improving interpersonal skills for, 62–63
improving narrative skills for, 66
overview of, 53–54
recognizing lack of, 80–82
recording/videotaping/observing patient encounters for, 63
role playing for, 64
shadowing patients for, 64–65
short course for, 67–68
study of literature/arts for, 66
theatrical performances for, 67
what it looks like, 68–70
work of, 59–61
Empathy in Patient Care (Hojat), 57–58
Empathy: The Human Connection to Patient Care video, 83
Engagement data, 186
Epidemic
conventional use of word, 1
creating empathy as, 7–8
of empathy, 1–2
loneliness, 151
of nonempathic care, 2
Erosion of empathy
overview of, 76–80
recognizing when empathy is lost, 80–82
E-surveys
advances in data collection, 114–118
online reviews and, 177–178
Examples
highlighting positive, 143
learning empathic care from, 180–182
Experience-sampling method, spread of emotion, 147–149
Fatalism, in Osler’s era, 21
Feedback
from e-surveys, 114–118
from patient experience data, 96–98
Fee-for-service system, patient loyalty, 44
Fenton, Joshua, 99–101
Figley, Charles, 80
Financial capital
boards reviewing quality data before, 183
building social capital and, 191–192
defined, 124
in social capital, 124–125
Financial incentives
physician interest in, 167–168
strengths and weaknesses of, 172–174
using for financial issues, 192
Fleming, Alexander, 22
Focus, changing healthcare, 156
Fowler, James H.
Rules of Life in the Network, 140–144
social network science study on obesity, 137–140
on spread of values in social networks, 134
Framingham Heart Study, 138, 146
Framingham Offspring Study, 138
Friedman, Richard A., 55
Friends, Rules of Life in the Network, 143–144
Functional magnetic resonance imaging (fMRI), mirror neurons, 56–57
Galton, Francis, 109
Ganey, Rod, 90
Geisinger Health System
bundled payment contracts, 38
emulating practices of, 128
financial incentive of, 173
Gilligan, Timothy, 182
Goal, healthcare
clarifying, 42–43
emotional labor and, 6
measurement, 162–164
meeting patient needs as primary, 187–188
overview of, 5
peace of mind as, 5–6
quality of patient care, 87–88
reduction of suffering as, 7
shared purpose as, 164–167
Gove, Matt, 166–167
Governing board role, behavioral change, 182–186
Grady Health System campaign, 166–167
Groups
cultivating sense of ownership as, 120–121
positive examples of, 181–182
shifting accountability to individuals vs., 161
Happiness, mapping in networks, 148–149
Harken, Dwight, 23
Harrison’s Principles of Internal Medicine (Harrison), 24–25
HCAHPS. See Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey
Healthcare marketplace
basic dynamics of, 37–39
competition in, 9, 39–41
Healthcare Research and Quality (AHRQ), 91
Heart. See Cardiology
Heart rate, empathic relationships, 57
Hennepin County Medical Center, 171
Hierarchy of clinical outcomes, 50
Hippocrates, 21
Holistic approach to healthcare, 4–5
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey
on empathy as essential to excellence, 82–83
measuring patient satisfaction, 91–92, 106
outcomes for hospitals in top quartile, 101–102
Hospitalization, developing empathy from own experience of, 65
Hotels, 1980s hospitalization as, 88
House, Suzanne and Jerry, 27–30
Human capital, 124
Hurricane Sandy, 166
Illness experiences, developing empathy by own, 65
Imitation, in brokerage, 125–131
Imperative
business, 43–47
clinical, 47–51
competing on value, 39–41
overview of, 35
resistance to change, 36–37
strategic, 41–43
in this time, 37–39
Improvement. See Performance improvement
Incentives
driving epidemic of empathy with, 153
financial, 167–168, 172–174
nonfinancial, 175
transparency, 175–179
Infants, empathy in, 57
Information, patients’ inherent need for, 112–113
Information brokering
defined, 125
levels of, 130–131
overview of, 127–130
Inherent suffering, 110–112
Innovation, in brokerage, 125–131
Inspiration, rescuing organizations via, 166–167
Insulin treatment, history of, 21–22
Integrated practice units (IPUs), 121–122
Intermountain Healthcare, Utah, 128, 170–171
Interpersonal Reactivity Index (IRI), 77
Interpersonal skills, and empathy, 62–63
IPUs (integrated practice units), 121–122
IRI (Interpersonal Reactivity Index), 77
Isolation, social, 149–152
Jackson Memorial Hospital, 89
James, Brent, 159–160
Jen, Phyllis, 78
Johns Hopkins Hospital, 19–21, 127
Keegan, Marina, 152
Krautwurst, Katie, 135, 137
Language of emotions, 7–8
Leaders
acknowledging need for sacrifices, 165
driving closure in organization, 132–134
role in behavioral change, 182–186
Learning, enabling brokerage via, 131–132
LeRoy incident, 135–137
Lewis, Sinclair, 22
Literature, empathy from study of, 66
Loneliness in healthcare, 149–152
Loyalty, patient, 43–47, 103
Malpractice claims, 89–90
Management. See Leaders
Mapping social networks, 145–147
Market forces, embracing, 188
Market share
business imperative of patient loyalty and, 43–47