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.