Monday, June 29, 2015

Empathy without action is empty

One of the most compelling videos in recent years is the one produced by the Cleveland Clinic entitled "Empathy: The Human Connection to Patient Care." Since its publication in February of 2013, it has been viewed by over 2 million people. If you don't shed a tear while watching it, I'd be surprised. It reflected very well on the image of the Clinic.

Less covered was the fact that before, during, and after this time, the Clinic was cited multiple times by CMS for flaws in patient safety oversight.  Joe Carlson at Modern Healthcare documented this in a story last June.

A three-month Modern Healthcare analysis of hundreds of pages of federal inspection reports reveals the 1,268-bed hospital spent 19 months on “termination track” with Medicare between 2010 and 2013 as a result of more than a dozen inspections and follow-up visits triggered by patient complaints. 

The Cleveland Clinic, with 36 deficiency complaints, ranked 20th on the list of hospitals with deficiencies stemming from patient complaints.  

How can these two aspects of the same hospital persist side by side?  I think we have to understand that there is often a corporate separation between the public affairs side of the house and the clinical governance side of the house in the hospital world.  The former takes money and creative thought.  The latter takes an unceasing commitment to clinical process improvement and especially to transparency.

This was noted by one of patients who complained, retired Air Force Col. David Antoon:

Hospital officials refused to show the inspectors all of the notes in Antoon's complaint file, and the doctor who claimed to have done the procedure declined to talk to surveyors about how the hospital handled the case, CMS inspection reports show.

Antoon, a commercial 747 pilot in civilian life until the operation left him incontinent, is baffled that medicine has no organization like the National Transportation Safety Board to address safety failures. “You cannot keep things concealed in aviation,” he said. But in healthcare, “They're just gathering data points from patient complaints. And every data point is a damaged life or a death.”

The power of transparency has been asserted and documented time after time.  Most recently, the National Patient Safety Foundation made the case that true transparency--between clinicians and patients; among clinicians within an organization; between organizations; and between organizations and the public--"will result in improved outcomes, fewer medical errors, more satisfied patients, and lowered costs of care."  The Children’s Hospitals’ Solutions for Patient Safety (SPS) Network, which originated in Ohio, is a clear example of these principles.

We also found this to be the case at my former hospital, where in 2008 our Board voted to be forthright about the number and types of cases that resulted in preventable harm to our patients.  At the time I noted:

We will be publicizing our progress towards these goals [of eliminating preventable harm] on our external website for the world to see. In other words, we will be holding ourselves accountable to the public for our actions and deeds. Our steps towards transparency have just been notched up a level.
We even used transparency to learn from one of the most egregious errors that can occur at a hospital, a wrong-side surgery

Years later, the importance of this approach--especially for the future leaders of the profession--was reaffirmed in a note I received from one of our residents (emphasis added): 

For me, a trainee at the time, the most important effect was that [transparency] underlined a shared sense of mission and purpose around quality improvement. The reporting didn't have a big direct effect on my practice--I just tried to learn how to put in central lines the right way, while my elders had already defined what the "right way" was. The indirect effect was as part of a sense of purpose, though.

The absence of a sense of purpose of this kind is toxic. For instance, if you have an advertising campaign that emphasizes our kindness or humanity, but we have no policies or practices that distinguish our kindness or goodness from anyone else's, it may be persuasive to our market as a branding tactic, but it's actively alienating to those of us who work within this system.

In short, empathy without action is empty. The resident concluded:

Conversely, if we walk the walk more than talk the talk, it's inspiring. Posting the data probably influenced very few patients one way or another--but it definitely made many of us feel like we were walking the walk. 


K, RN said...

I LOVED this post because it so hits to the intent behind many organizations that "its more important to look good, than to BE good".

I love the Cleveland Clinic's empathy video as it conveys empathy in its entirety; and the producers of that short clip were very good at knowing exactly what to convey and the emotions behind it.

I think the points you made around full honesty and transparency in who we are as an organization is much more important than any video clip.

In fact, video clips like the empathy clip and hospital awards that may not be deserved HURT organizations because their employees know the truth and it wears them down and they become even more dissatisfied (leading to patient dissatisfaction) and less patient-centered care.

Hospitals will not improve until there is full transparency and truth seeking with all the policies needed to make that happen.
Everyone must walk the talk.

Joan Lowery said...

Paul, your comments about the Cleveland Clinic’s unwillingness to deeply address their patient safety issues really ‘hit a nerve’ and ‘bone of contention’ that I have for ANY organizations that ‘talk the talk’ but fail to ‘walk the walk.’ This, tragically, is especially true in the healthcare field and it’s a damn shame. Your example of the Cleveland Clinic’s failure to, in practice, live up to their powerful and inspiring Empathy videos is a casebook example.

I, too, have unfortunately found the same marketing billboards and other public-image only deceits evident in some of the so-called premiere medical establishments in my area. They apparently regard spending PR and advertising dollars on what too often turns out to be false messages easier and more palatable than examining and addressing the recurrent systemic issues that haunt these old-line, silo-entrenched institutions. It’s really maddening and patients have long caught on to it.

In preparation for some non-healthcare leadership communications courses I am putting together, I am reading Kouzes’ and Posner’s update of The Leadership Challenge (Fifth edition.) More than 30 years of research amongst hundreds of thousands of constituents around the globe consistently identify the four characteristics they most admire in leaders: Honesty; Forward-looking; Competent and Inspiring. Conversely, their research into the most exemplary leaders around the globe consistently surfaces five core behaviors: “Model the Way” (or, as we know it, “Walk the Talk;”) Inspire a Shared Vision; Challenge the Process; Enable Others to Act; Encourage the Heart.

As I read the research this morning, I reflected upon the relative ease with which one can create an inspired vision. However, it takes consistently and persistently ‘walking the talk; ‘enabling others to act;’ and ‘challenging the process’ to create the kind of change that healthcare so desperately needs. It takes commitment; hard work and a willingness to continually do what it takes to match behavior with vision and messaging. Shame on the Cleveland Clinic and all other institutions that are unwilling to consistently open and honestly challenge the processes that need to change!

When institutions espouse change but are unwilling to implement it in courageous, honest and consistent ways, it hurts the very fabric of the institution….the people who work in it… as cynicism and distrust set in. And, cynicism and trust are powerful poisons that can wreak havoc on achieving desired, yet challenging and urgently-needed outcomes. Bravo to you, Paul, for bringing this up and for shedding light on the difference between true leadership and doing what it takes to actualize inspired change versus just paying lip service for the sake of PR.

Anonymous said...

I think this issue is a very important one, the idea of the window dressing vs. the reality. I too enjoyed and was moved by the Cleveland Clinic empathy video – the reality though is that we have a whole to examine here, much like ourselves as leaders and as people; in all our fallible, less than perfect reality.

Full transparency and honesty means that we open up to the good, the bad and the ugly, and I believe we have to start with ourselves and our own caregivers. The folks on the front lines (to K's comments) become very quickly disillusioned if their day to day reality is in stark contrast to the public relations departments media message.

Thanks for pushing/pulling the conversation.

Carole said...

I have both family and friends that are Dr's and Nurses, my Husband has worked his entire career in hospitals, in the military and as a civilian. They all know and have see a lot. What I picked up on many years ago was that they hold a lot of what they experience inside their Hearts and minds. Either because it's the way they try and cope or believing sharing would burden others. (family). I've on many occasions suggested them not keeping it in, feeling it can't be healthy for them. When I seen that picture I teared up and got chills, i thought of everyone that I have lost ( my mom who I lost to medical errors ) and everyone that's still here with me that I love and adore. Especially those in his place who can relate.Trust me when I honestly express because of every bad or negative encounter a patient has had with a e.r. Wait and unresolved medical issue, hospital stay, a Dr. a Nurse, whomever and whatever. and they have decided the bad outweighs the good ,they've built up this wall of distrust, feel helpless and hopeless . it's huge!!! it's important!!! it's a must! a need! for the public to see this...I for one needed to see that, to remind me not to lump my (our) experience with a few with all the rest, that was real for me and it helps me cope with my loss. Hugs and kisses to him and may God bless him his colleagues and the family for their loss.

Carole said...

And I must add... Zero accountability which adds insult to injury- the biggest and worse betrayal of all.

Anonymous said...

You said this right. I wish you could show what I have from a doctor who I have recorded that talked about me (not positively) to another person off the street. Not only a HIPAA violation (although I doubt the govt. would do anything), I had complained about this doctor before and the hospital did was to blow me off.

If we had a way to make things just as public as we the patient wanted it to be, with gag orders being illegal to stop hiding the mistakes, that would shape up things.

If they're say they're improving health every day, then they need to be public every day.

Paul Levy said...

Sorry Anon 19Dec 2pm, I don't publish comments about alleged criminal acts. You must seek redress through law enforcement officials.