Policy Options by Vickie Cammack and Donna Thomson 30 March 2018
Ask any Canadian what “care” means and you will get rapid-fire answers that include words like kindness, love, concern, compassion and attentiveness. We know with inner certainty what it feels like to be cared for. But ask if these qualities come to mind when thinking about experiences in the health care system and you might get a blank stare or even a smirk.
As patients and caregivers we need emotional support, compassion and respect alongside expert analysis and intervention. If we make a collective decision that caring is a nonnegotiable component of healing, there are steps we can take to put caring back into health care.
Systems that are increasingly controlled by money and data place little value on the hard-to-measure caring currency of the heart. Today’s health professionals have little time for hand-holding or explaining procedures to frail elders, frightened cancer patients or worried family members. When Canada’s altruistic front-line medical staff actually manage to defy “efficiencies” and to take time for a more personal approach, their caring actions reduce trauma, ease suffering and contribute to healing.
There is a popular misperception that caring actions and the time they take threaten the economic efficiencies that drive contemporary Canadian health care. Vicki McKenna, president of the Ontario Nurses’ Association, which was recently in contract negotiations with hospital administrators, remarked: “I have to keep reminding them to stop trying to industrialize health care…When you are caring for people, you have to look at things in a more humanized way.”
It is clear that medical professionals want to deliver kindness and comfort care. After all, a caring, compassionate disposition is usually what drew them into the field. But often they can’t exercise it. For example, the imperative for accountability forces American physicians to do two hours of paperwork for every hour spent with patients.
Henry Mintzberg, Canadian author and professor of management studies, declares, “Health care needs to become more effective by being less efficient.” Medicine is a practice, not a science, he says, and health care is a collection of treatments, not a system. But the art of healing lies in how those treatments are carried out. And Mintzberg says that costs are easier to measure than benefits, which is why medicine has become a business instead of a practice and people have become clients rather than patients.
Prioritizing caring in today’s health care systems is not an impossible dream — it is a decision. And it doesn’t necessitate adding taxing hours to already hectic schedules. Caring is found in moments — it occurs in moments of genuinely meeting and being with patients. The work of the educator and author Dr. Margaret Plews-Ogan provides an inspiring example of how the smallest of caring actions can make a difference. Plews-Ogan teaches her students to include one descriptor that humanizes each patient: “Mrs. X is a 32-year-old English professor whose specialty is Dickens. She is being admitted for…” Or “Mr. Y is an 82-year-old grandfather of 12 who is very concerned about his dog Rex. He is being admitted for…” Before they leave the bedside, Plews-Ogan insists her students look directly at the patient and ask, “Is there anything else we can do for you?”
Patient experience and patient satisfaction with care are correlated with many beneficial outcomes for the patient, their family caregivers and the health care system, including improved patient safety and clinical adherence to treatment guidelines. Canadian seniors reported the lowest level of satisfaction with the quality of health care they received in comparison with 11 other countries (including the US, UK and several European nations) in the 2017 Commonwealth Fund International Survey. How different might those results be if we anticipated the need for humanizing, caring interactions at every step through the maze of our health care systems?
From the perspective of patients and caregivers, caring interactions with providers should be considered the basis for a functioning health care relationship. Canadians should demand the right to kindness, respect and acknowledgement in their relationships with health care professionals.
But demanding authentic, caring interactions is hard to do. After all, it can be extraordinarily difficult to demand anything when caught in the vulnerability and fear that come with illness, disability, pain or injury. It can be hard for health care practitioners as well. Dr. Brian Goldman, host of CBC’s White Coat, Black Art, always believed that caring came naturally to physicians, but the stress and heavy expectations of working for years in the emergency ward left him wondering if he might not be the same caring doctor he thought he was at the beginning of his career. His forthcoming book, The Power of Kindness, explores his search for his lost compassion.
Creating a culture of caring in our health institutions is doable. It could begin with reporting on caring interactions that health care professionals, administrators and team members (including cleaners and cafeteria workers) observe while on duty. Imagine something as simple as “I see caring” as a standard item on meeting agendas for hospital and health care facilities. It would make caring actions visible and heighten awareness of the importance of “warm data” in patient healing and practitioner satisfaction.
Caring can prevail in a system that treats patients as people instead of “health care consumers.” Doctors and other providers need to revolt against a system ruled by efficiencies, and so do patients and family caregivers.
It’s time for change.
Vickie Cammack is a social innovator who has established many groundbreaking organizations dedicated to strengthening community and addressing isolation including Tyze Personal Networks, Planned Lifetime Advocacy Network, and the Family Support Institute of British Columbia. She is a member of the Order of Canada.
Donna Thomson advises governments and health researchers on policies relating to family caregiving, disability and aging. She is the author of The Four Walls of My Freedom: Lessons I’ve Learned From a Life of Caregiving (2014). She blogs regularly at the Caregivers’ Living Room and for Caring Connections at Troy Media.