Skip to 0 minutes and 2 seconds PROFESSOR BRENDAN MCCORMACK: Care and compassion– it’s interesting how it has evolved over the last few years, and we probably could see it as a reaction to rebalance what matters in health care and how people actually view what’s important. And I think it’s interesting that it focused on care and compassion as a combination, really, because if we’re talking about care, then we should automatically be talking about compassion anyway. So there is something about making them distinct entities when, in fact, for me care is also compassion, and care without compassion isn’t care. So we have a dilemma, I think, about how we are using those terms and how they actually are being manifested, then, within systems– within health care.
Skip to 0 minutes and 47 seconds But I think the good thing about it is that it is a reflection of people really trying to come back to what it is that’s important in terms of people’s experience in care. And it is interesting that we’re seeing it right across the world as a movement in response, I think, to a lot of financial issues, and in response to a lot of economic issues. But I think, also, in response to people starting to figure out what’s important to them when they are in the receipt of care, how they actually try and do a good job, and the core values that they arrived in to work with in the first place.
Skip to 1 minute and 21 seconds So it’s not a surprise, in a way, that it’s become a global movement when you look at what’s happening to the global economy, to what’s happening around the world, and how settled people might be. But I think we have to be careful about how we position it as not the thing that matters, because I will always come back to the point that if we’re talking about care, then we are automatically assumed to be talking about compassion.
Skip to 1 minute and 45 seconds PROFESSOR JASON LEITCH: So I wonder if the rebalancing thing is actually true. So I trained, well, too long ago– 19 to 25 years ago and I was taught– as a dentist originally, and then as a surgeon– of course that care and compassion comes together, but there were technical elements of the care that I had to get right. Now maybe you could argue there was an emphasis on the technical elements. I had to be a surgeon who didn’t do harm. I think we’ve corrected some of that over the last 10 years around the world– in the developed world, for sure. Inside our theatres, inside our primary care practises, inside our nursing in the community– we’ve made that safer.
Skip to 2 minutes and 30 seconds And we’ve made that safer using improvement science techniques. So have a name, set a measure, do iterative changes to make it better. And the compassion bit maybe got lost in some of that technical emphasis, but I don’t like the idea that somehow one trumps the other, or one of is better than the other. Technical care has to be delivered and it has to be right. So I don’t want to go to intensive care and get an infection, and I don’t want to go to the community midwifery service– that would be unlikely for me but– to go to that service and not get the checklist done correctly for blood pressure, for whatever it is that’s done there.
Skip to 3 minutes and 11 seconds And I think now we’re seeing a new combination of those two elements, because I now see improvement science being applied to compassionate interventions– which is the real revolution, I think. So can you set an aim, a set of measures and some changes, some recipe, that you might test then say to health care environment– a social care environment– to actually make the care more compassionate. Because people have thought for years, no, you can’t make them nicer. You can’t make the system nicer. That’s impossible. Well, turns out maybe there are some examples now where you can use improvement science to make it nicer.
Skip to 3 minutes and 51 seconds PROFESSOR MARY RENFREW: And what you’re both saying is hugely in alignment with the work that we’re bringing into place in the Scottish Improvement Science Collaborating Centre, and a lot of the work we’re doing is reflected in this whole MOOC. But what we’ve been looking at is the evidence base for large scale, sustainable change that has outcomes that include safety and reliability and also care and compassion, and health, and well-being. And it’s really clear from the evidence that you have to do those things together. You have to have the evidence for doing the right thing, but you have to have the evidence for doing it in the right way. And that bringing those two things together is what actually improves outcomes.
Skip to 4 minutes and 37 seconds So if you only do the technical side people don’t necessarily have the improved clinical outcomes as much as if you’re doing them together. Now where is the evidence for that? There’s evidence in various different dimensions. One is actually catastrophic failures of care, and where what we’ve seen in the investigations of failures– both in health care and in social care over the last few years– is that pretty well all of them are failures primarily of care, and compassion, and respect. Either respect, if you like, of the caregiver for the person being cared for, but also between health caregivers, social caregivers, for each other. Which is actually part of this conversation as well. It’s not just about caring for patients and families.
Skip to 5 minutes and 27 seconds It’s also caring for each other as interdisciplinary professionals and carers. So we’ve seen from the failures of care that actually failures of care and compassion lead to very unsafe environments for people. But we also see, from a number of different kinds of evidence– if you bring in the quantitative evidence, and the qualitative evidence, and you look at it together from a whole range of different ways– it’s really clear that keeping people safe in that safe space is actually very much about that combination of doing the right thing in the right way with that respectful, individualised, person centred, compassionate way.
Skip to 6 minutes and 10 seconds So that the system ends up with the person at the heart, instead of the person end up trying to fit the system. And we’re seeing that in all sorts of ways, and we’re testing that kind of improvement programme out, if you like, at large scale at the moment in a neonatal care project that’s coming through where, obviously, compassionate care is really important for those babies and their parents. And also in the older people setting where, again, that compassionate care is critical. But, actually, I might argue that there isn’t a setting where that compassionate care isn’t critical. Adults, children, old, young, primary care, care in people’s own homes, acute care in hospitals.
Skip to 6 minutes and 58 seconds Any of those settings it’s hard to think of anywhere where being treated with compassion is not fundamental to people’s health, recovery, and well-being.
Skip to 7 minutes and 8 seconds PROFESSOR JASON LEITCH: When we talk about improvement signs the whole world gets confused. The simplistic way of me thinking of improvement is how to do a thing and make it better? Everybody has two jobs– to do the job they’re doing to the best of their ability, but also to improve their job, to make the system in which they work better. And it seems to me the simplest description of that is decide what it is you want to do– seems a good stopping point– measure how you’re going to get there– so have some kind of data, or story, or something that will tell you how you’re doing– and then have changes. Have things that you will do to get better.
Skip to 7 minutes and 47 seconds So learning to ride a bike. My aim is I’m four years old. I want to ride a bike with no stabilisers. So my measure is how far I can go riding a bike. The changes I will make is, well, I think I want mum to hold me for the first two days, and then maybe gradually to let me go. And I might take off one stabiliser so I know I can lean on the left and still kind of– but over time I’m going to test new ways and a week later I might take both stabilisers off, and I’ll put my feet on the ground and have a go.
Skip to 8 minutes and 18 seconds And I’m tested again, and then within two weeks I’m riding my bike. My aim is met, I’ve measured it properly, and I have a recipe of tests and ideas. And that, in its simplest form, I think, is what we’re trying to do with improvement science. Whether we’re improving the technical elements of care, or the compassion and caring elements of care. As if you can divide them, of course.
Can compassion be learned?
To what extent is compassion necessary in order to provide care?
One of the recommendations from the Francis Report, also picked up by the Willis Commission, is the need for identifying compassionate professionals at the point of recruitment onto pre-registration programmes; in other words, before they’ve even started. But, identifying compassion in individuals is hard to achieve with any degree of objectivity and certainty, so the need to teach care and compassion persists.
Can compassion be learned (and therefore taught)? In this video, three experts share their views on this critical question, among others, with you.
Share you thoughts in the discussion below and consider the ideas of others, respecting the range of views that are expressed.
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