I STARTED working with children with leukaemia and other cancers in 1998. On my first day on the job, I realised how extreme the environment was where we had to restrain these children to do procedures on them.

Over the course of their cancer treatment, which lasts 2–3 years, they have repeated procedures, such as bone marrow tests and lumbar punctures. The sedation we were using was not managing their pain adequately. The children were often highly stressed and upset during the procedure but were often sick with anxiety for days before any visit.

I was concerned about the impact of this stress on the families, so I met with a group of parents and talked with them about their experience of their child undergoing procedures. We called ourselves “Together We Achieve”. We’d grab a plate of sandwiches and I would ask them: “What is it like when your children come in for these procedures?” And they’d say: “Actually, it’s the hardest part of the cancer journey for us”. But none of them had ever complained.

Blessed with the unwavering support of the visionary hospital CEO, we set out to change our small part of the health care system to a totally different environment. We started to make improvements based on feedback from the families. I became intrigued by patient- and family-centred care and the value we could gain from partnering with families in their care. The families knew about many aspects of the hospital system of which the health professionals were simply unaware. I realised that the expertise that the families brought to the table could improve our efficiency, reduce costs, highlight gaps in the system, improve safety and improve patient and staff satisfaction. Over a decade, the group drove a transformation so striking that children attending the hospital for a routine visit were known to complain to their parents if they didn’t have a lumbar puncture scheduled.

One important aspect of this transformation arose when families talked about the challenge of being in hospital environments. “It’s not somewhere you feel at ease and comfortable.” The sounds and the “look” of hospitals raise people’s anxiety when they are feeling vulnerable. We talked about how we could change this for patients and families.

With the help of many of Australia’s foremost composers and musicians we set up the Hush Foundation to transform health care culture and environments through the arts. Since 2000, we have produced 15 albums of music that are now used across Australia to reduce stress and anxiety in health care environments.

We found that when you bring creative people into the clinical space and they experience it, as artists and composers, they can see what is needed, and use their expertise to make it more calm and optimistic. It is a process that has been quite magical.

The effect of the music on patients and families is profound. But then I noticed something else. The music affected our team in the operating theatre – I could see greater respect being built between team members.

It’s about feeling cared for and looked after. Musicians, composers and other artists would meet the staff and comment: “You are doing an unbelievable job. I’m so grateful for what you do, and I’d like to help”. Then they made this beautiful music for us to play in our workspace. Oftentimes, the whole “feel” of the room is transformed; teamwork is visibly strengthened, and what I see as a “culture of kindness” develops. This culture has helped us to be 100% focused and engaged in our work. We all feel safe to speak up in these spaces, and we know that’s important because our patients’ welfare depends on it.

In 2011, playwright Alan Hopgood, AM, joined the Hush team by crafting patient and staff stories into a dramatic play called Hear me. The play explores issues of communication breakdown, bullying and poor staff behaviour, patient-centred care and patient safety. Each performance is followed by a discussion forum. Qualitative analysis of 8000 audience comments and suggestions for improvement are currently being undertaken. The play has been performed over 130 times in hospitals around Australia and internationally.

Themes emerging from the comments show a widespread concern about a health system where bullying is common, staff often feel undervalued in their organisation, patients may not feel they are being listened to and kindness can be hard to find.

Bullying, harassment, poor staff culture and health professional stress are all topical in the literature and in the media. It is well known that these cultural issues impose high costs on health organisations through poorer staff performance, absenteeism and sick leave. Poor staff behaviour is also directly linked to worse patient outcomes.

Yet, despite these poor outcomes having been known for well over a decade, staff at all levels have been slow to accept this link. Reporting such behavioural problems is virtually impossible. As health organisations have slowly responded, the typical response has been more policies and procedures on bullying and harassment, zero tolerance statements and “weeding out the bad apples”. These responses seem like they would help, but they are all negative and reactive. They can be ineffective and even counterproductive. And they are inconsistent with what we know about behavioural change; namely, that interventions that reinforce positive behaviour are often more effective and better accepted than those that punish undesirable behaviours.

What we need to do is change the conversation and talk instead about a kind health system and how we may get there. Because, at the moment, good as parts of it are, health care organisations are often not great places to work. They can be hard places for the patients and families when they’re at their most vulnerable. They  are not nearly as safe as they could be. But the answer is not to focus on the negative interactions around us. By focusing the conversation on where we want to go – towards a kind healthcare system – we can have a far greater impact. This is the mission of the Gathering of Kindness, a week-long festival that brings together people from all walks of life to continue the conversation.

Kindness does three vital things. Kindness makes best use of your team – if you are kind to those around you, then they will be there to provide support and assistance and kind behaviours in return. Kindness brings the safest environment – by fostering a culture where people aren’t afraid to speak up, mistakes or risks can be dealt with openly, and before they have consequences. Lastly, kindness creates unexpected wonderful moments of joy – seeing children coming running into the waiting room, full of excitement to watch the musicians is something I will never forget.

Australian nurse ethicist Megan Jane Johnstone, who has done extensive studies  on kindness and generosity in health care, has noted that the renewed emphasis on these qualities  is viewed by some as “misguided” – even that “health professionals are just ‘too busy to be kind’”. She goes on to say that there is now a growing recognition that kindness has restorative and even curative possibilities in health care. Kindness needs to be “instated as an essential adjunct to health care interventions”.

Embedding kindness in the health care system can be done. As with most major changes in health care, it helps if hospital boards are more proactive in assessing their role. It also helps if leaders have a vision of what can be achieved. But it starts with individuals – colleagues showing a level of kindness and care towards each other which will flow on to the patients and families. Let’s talk about kindness performance indicators instead. Staff and patient perceptions of cultural and behavioural issues can be part of the performance assessment at all levels. It can be transformative to teams and make a big difference to the joy and meaning in our work and to the lives of the people in our care.

Dr Catherine Crock, AM, is a physician at the Royal Children’s Hospital in Melbourne and chair of the Hush Foundation, which is holding a Gathering of Kindness week from 30 October to 3 November, 2017.

 

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Poll

Health professionals are too busy to be kind
  • Strongly disagree (67%, 64 Votes)
  • Disagree (22%, 21 Votes)
  • Agree (5%, 5 Votes)
  • Strongly agree (4%, 4 Votes)
  • Neutral (2%, 2 Votes)

Total Voters: 96

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10 thoughts on “Patient, staff safety and wellbeing: time for kindness

  1. Ian Hargreaves says:

    The most kind institutions were the country hospitals where I trained.

    In the country hospitals, every patient was somebody’s nephew, or the lady next door, or your brother-in-law’s best mate. People were not left waiting an inordinate length of time, and were treated humanely, because they were all part of the one community. They were ‘us’, not ‘them’.

    The big city hospitals tend to become mired in their policies and procedures manuals, which say all the things that one has to do, other than simply being nice. I like to apply what I call the Relative Test: Would I be happy for my relative to be treated this way? (Obviously, a test to apply to the relatives you like, not the ex-spouse whom you wish to see dead!)

    It takes very little extra time to explain and reassure when doing any procedure which is frightening and painful for the patient, whether it is a lumbar puncture, taking out a suture, or giving an injection. While the technical skill is clearly paramount (getting the lumbar puncture in, and administering the intrathecal not the intravenous dose of the drug), there is no reason this cannot be done in the most pleasant or least upsetting way possible.

    Having sat with the accreditation team last week at one of my hospitals, there was an intense focus on how to get the certainty of operating on the right part of the right patient 100% of the time, because that is what the Australian standards require, but no specific focus on being kind to the patient. Just as an airport security check can be annoying and frightening rather than reassuring, the systemic procedures we have can be daunting to the ‘nervous flyer’.

    Perhaps having mandated standards of patient-assessed kindness may be the only way of ensuring that Hospital administrations actually take seriously their role of whole patient care.

  2. Gordon Harvey says:

    Your poll asking if “health professionals are too busy to be kind” seems a little problematic to me, or at least the assumption behind it is. It implies that kindness is another duty that requires an additional time burden, but surely kindness is more about the way people act, rather than being an additional action. How much more time does it take to communicate with empathy? It might take time to train to incorporate kindness into our communications, but once that’s done it ought to be embedded, as Dr Crock puts it. It could even save time by reducing misunderstood communications and even lost work hours for victims of bullying.

  3. Lynette Reece says:

    Fantstic, I love what you are doing and will check out your music. We are never too busy to be kind.

  4. Randal Williams says:

    Chronically being too busy can result in burnout and depersonalisation–but in general being busy should not preclude courtesy and kindness to our patients. It is more a reflection of the underlying personality of the doctor, than the pressure of work. The majority of doctors and nurses are kind to their patients. Interesting that when surgeons get a major complication, the patient is often grateful because the surgeon has spent so much time with them and their families. Litigation more often arises from poor communication and offhand, dismissive behaviour.

  5. Anonymous says:

    Unfortunately we do medicine like a business nowadays. This means there are measurable things the managers are interested in as they are defined as their KPIs: theatre start in time, wait lists, staff costs etc.
    Kindness, staff satisfaction and quality are very hard or impossible to measure and hence don’t have a value.

    As much as I agree that costs need to be kept reasonable as there is no money tree for medical costs running medicine on business models from other industries is a fundamental flaw.

  6. Kath Browning Carmo says:

    Love this article. Kindness cures – physician and patient.

  7. Sue Ieraci says:

    In these times of “too much medicine”, it is important to be able to offer something other than a test or a pill. Human kindness and physical comfort are important. In hospital, both listening and offering a cup of tea or a warm blanket can do a lot more to improve wellbeing than a scan or an unnecessary treatment.

  8. Wally Jammal says:

    A wonderful article that captures the essence of what we should all be doing in health care, no matter what part of it we play- that is providing patient centric care, in a cost effective fashion, whilst at all times trying to improve the patient AND provider experience. A just (and kind) culture that puts patient safety at the forefront of its purpose is the only way to go.

  9. Michael Keane says:

    What a wonderful article and sentiment. Kindness does go a long way for patients. And showing kindness to fellow healthcare workers, especially junior members, can make for a really positive work environment.

    As one example, we all made mistakes when we were junior doctors/ healthcare workers. We should understand and show kindness to our juniors and support them. Show some preemptive kindness when these (predictable) mistakes happen.

    Sometimes kindness can initially take extra time when it comes to patient care, but in the long run of the entire patient’s hospital stay or longterm treatment it can save time.

    Great article. Wouldn’t it be good if it became an expected routine to model kindness to both patients and staff in front impressionable juniors coming through

  10. Bruce Joy says:

    Catherine, I’m always inspired by your work and mission. Thanks for setting out to change your “small part of the health care system to a totally different environment.”

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