A few years ago, I wrote a post about kindness in healthcare (Kindness is underrated), which referred to a book that had recently been co-authored by a medical psychotherapist. At the time, Dr. Penelope Campling was Clinical Director of a Partnership Trust of England’s National Health Service (NHS).
After reading this volume, the President of the UK’s Royal College of General Practitioners wrote in a book review that ‘everyone should have to read this book’.
What was the name of this book? “Intelligent Kindness: Reforming the Culture of Healthcare”(1). I’m happy to say that I’ve finally found and ordered a copy on-line; I should be reading this one soon, after a few others on my reading list!
In the meantime, Dr. Campling has just penned an editorial in BJPsych Bulletin (published by the Royal College of Psychiatrists); ‘Reforming the Culture of Healthcare: The Case for Intelligent Kindness’.
In this editorial, Dr. Campling outlines some of “the forces that create perverse dynamics that can pull in the opposite direction”(2) of intelligent kindness in healthcare organizations. These are some of the things which we should be trying to do away with, in these environments:
- Tasks which are more emotionally demanding than necessary
- Dysfunctional work teams or groups
- Problematic organisations and structures
- Perverse dynamics; including personal, processes, and systems
She then sets out four key factors which may have led to changes in how society views healthcare. Which could, in turn, have led to changes in how those working in the field may now perceive their roles:
There appear to be four closely intertwined processes at work. None of them is perverse in itself, but separately and together they can create perverse dynamics in the context of healthcare”(2):
- The active promotion of a competitive market economy;
- The process of industrializing healthcare;
- The framework and currency of specification, regulation and performance management; and
- The rise of consumerism and the promotion of patient choice
I’d like to discuss each of these factors from a Canadian perspective:
1. Viewing healthcare as commodity within a competitive market economy – the current situation in the US – runs counter to the United Kingdom (and arguably Canadian) perspective that our goal in the provision of universal healthcare is “an integrated service that prioritizes the needs of vulnerable patients”.
Unlike many (very outspoken) citizens of our largest neighbor, the US, we don’t view it is acceptable that a family would be bankrupted by healthcare costs resulting from illness or injury.
2. The industrialization of healthcare can be viewed negatively more in terms of the mechanization of healthcare delivery than as a desire to give up all of the technical tools that modern medicine has at its disposal. This isn’t an argument to give up laparoscopic surgery, magnetic imaging, or surgical robots.
One of the most common complaints I see from physicians on social media (primarily Twitter) is that using time-consuming and ‘clunky’ EHR/EMR* systems makes them feel that their primary role is to interface with a computer, rather than to care for patients.
3. Performance management. No, we shouldn’t abandon all metrics involved in how healthcare impacts each of us; across the vast spectrum that encompasses perinatal care, preventive medicine, palliative care – and everything in between.
Information, or metrics, are important on issues so diverse that they include population-level health indicators (from infant mortality through to life expectancy), public health data (such as disease prevention and tracking of epidemics), and hospital trend tracking (for example surgical infection rates and re-admissions).
Nor do I feel that there’s no place for individual performance assessments in healthcare. We should be rewarding those who make a positive difference in patients’ lives, and provide incentives to improve (or leave!) for people who have a negative impact on patients.
But I feel that there’s been too much of an emphasis in recent years on performance measures, such as vague patient satisfaction surveys, which don’t necessarily relate to any real improvement in health outcomes.
4. The shift to viewing patients as consumers, in some areas, seems to have replaced one of the core tenets of bioethics. Respect for patient autonomy has been confused with seeing patient choice as mainly influenced by marketing.
The act of selecting a physician or hospital in the US is now akin to choosing a restaurant from which to order pizza. This type of comparison, of restaurant A to restaurant B, can devalue the importance of the relationship between a patient and a physician. Or between a patient and a nurse, therapist, or other healthcare professional.
Dr. Campling’s view seems to be that taken together, over the long term, these four systemic factors may suck the kindness out of healthcare professionals. I wonder how many of us would agree.
* Electronic health record/Electronic medical record.
References:
(1) Ballatt, John & Campling, Penelope. Intelligent Kindness: Reforming the Culture of Healthcare. RCPsych Publications; Jun 2011.
http://www.rcpsych.ac.uk/usefulresources/publications/books/rcpp/9781908020048.aspx
(2) Campling, Penelope. Reforming the Culture of Healthcare: The Case for Intelligent Kindness. BJPsych Bulletin 39.1 2015; 1–5. PMC. Web. 18 Aug 2017
http://pb.rcpsych.org/content/39/1/1