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Compassion - at the heart of practice

I’ve hesitated to write this - I have thought long and hard. Shouldn’t I just ‘crack on’ and forget about some uncomfortable memories? But sometimes I find myself transported back there… by a cat that looks uncannily like a patient from many years ago, or a dog that... ghosts passing across my consulting room table.

There are perhaps three flashbacks that preoccupy me more than most – like an Olympic podium of professional mistakes.

I think I hesitate to go on because I don’t want to appear stuck in the past. However, on the flip side of this coin, my understanding of Quality Improvement (QI) has given me new insights - now these memories appear changed, the present and past have collided - perhaps I can offer some useful advice with the benefit of hindsight and a new understanding?

QI, of course, is a complex discipline and relies upon the use of a range of appropriate behaviours and tools to steadily improve clinical services, so what has it got to do with my bronze, silver and gold recollections? Well, there is one word that perhaps more than any other in the QI toolkit would have been appropriate at the time. It has a power like sunlight to warm and enliven every part of our job; it is compassion.

In this article, vet Olivia Ogińska and I will expand on compassion and explain in more detail how in very concrete ways, it can help with the quality of care we provide.

The subject of compassion is a fascinating area - by routinely using it in our work relationships, we can improve teamwork, and there is also a relationship between a set of managerial skills we can call ‘compassionate leadership’ and the success of QI in practice. This is because compassion nurtures psychological safety at work, which is essential to any QI effort1.

Image of a QI theory

But first, some definitions.

Compassion is defined as a concern for others’ suffering and a desire to alleviate it2 - we can think of it as bringing warmth to our interactions with work colleagues.

Psychological Safety (PS) has been described as a belief that you will not be punished for speaking up at work with comments, questions, concerns or mistakes3. It is typically fostered by a non-authoritarian leadership style. It is a sense that taking inter-personal risk is safe in ‘this place’ and describes a climate in which people feel comfortable being themselves. Research suggests that psychological safety is an important element of a learning culture - a prerequisite for QI in healthcare4. The opposite of PS is an environment in which team members do not feel safe to express concerns or point out the mistakes of others, and bad communication, often a fear of voicing relevant observations, is a contributing factor in many accidents of veterinary medicine5. Evidence suggests that for some veterinary workplaces, PS is currently an issue6.

Quality Improvement (QI) is the term used to cover specific activities designed to make the delivery of healthcare better8 for patients, clients and the veterinary team. It relies upon a non-punitive culture in which learning, and innovation, is encouraged at a local level4.

Benefits of compassion

The benefits of compassion extend beyond enhanced patient care and systemic learning. Companies that embed compassion in their culture can look forward to many strategic benefits, as the BVA’s recent ‘Good Veterinary Workplaces’ policy document has discussed7:

  • Demonstrating compassion to colleagues improves the quality of communication within a team and, therefore, its effectiveness.
  • Compassion improves staff wellbeing and reduces the incidence of burnout, presenteeism, and absenteeism - as a result, staff are likely to be more motivated, and stay in their position longer.
  • A culture of compassion contributes to staff's ability and willingness to ‘go that extra mile’ with clients – improving client satisfaction scores.

To learn more about compassion, Olivia Oginska, an emergency clinician, and coach in positive psychology, who has taken a particular interest in the topic, proposes two parallel approaches to building a culture of compassion in veterinary workplaces:

Amplifying compassion between co-workers

In their book “Awakening compassion at work: The quiet power that elevates people and organizations” Worline and Dutton (2017) describe four steps that are crucial for cultivating a culture of compassion in any workplace9:

Step 1: Recognising others’ suffering

High numbers of veterinary professionals experience a remarkable level of stress on a daily basis. The signs of emotional exhaustion can include: cynicism, irritability, a sense of hopelessness, exhaustion, lack of motivation, sadness, lethargy, insomnia, and drug or alcohol overuse10. Appropriate recognition of these signs can allow veterinary professionals to identify a colleague in need of the next three phases of a compassionate response.

Step 2: Generously interpreting it

Physical signs of burnout can easily be misinterpreted and perceived negatively as, for example, stubbornness, laziness, or incompetence. The approach described by Worline and Dutton (2017) encourages co-workers to look at others through the filter of compassionate concern and consider all possible reasons for a negative behaviour before judging it. Unresolved, and potentially hidden, personal issues could be causing recurring pain and be significantly distorting a person’s conduct, performance, and attitude.

Step 3: Feeling empathy towards suffering colleagues

Research shows that medical professionals tend to limit their compassion towards colleagues for fear of losing authority or ‘professionalism11’. Contrary to this belief, the evidence suggests that showing empathy enhances coping and is correlated with positive subjective wellbeing12,13. Based on that it seems important to reassure veterinary professionals that not only does exhibiting compassion not lessen their authority, but it can improve mental resilience.

Step 4: Acting to alleviate it

Showing compassion towards co-workers can seem daunting, particularly when our relationship with them is not close. However, it does not have to be taxing, uncomfortable or time-consuming. Veterinary professionals are encouraged to develop a personal ‘compassion toolkit’ that contains small gestures and behaviours that can be universally applicable in a situation when somebody’s suffering calls for a compassionate act. Such gestures could include a small gift, a kind acknowledgement, or sitting next to them and giving them our time, attention, and a chance to talk.

Amplifying compassionate leadership

It is widely agreed that leaders play a crucial role in shaping any workplace culture through overt attitudes and behaviours1,14,16. In healthcare, leadership shapes organisational culture, and exerts a strong influence on patient safety15.  A study performed on a large population of nurses from 17 countries showed that practising compassionate leadership provides positive outcomes at all levels, from individuals and teams to the system as a whole16. Cochrane et al. (2019) describes compassionate leadership behaviour as assuming “responsibility for supporting, guiding, and communicating about compassionate care … reward[ing] success, motivating staff and clinicians, and creating a fully aligned culture of compassion17. It is a top-down commitment extending through all organisational levels”.

Exercising compassionate leadership in veterinary workplaces can involve setting an example of compassion towards employees and paying careful attention to staff needs. By recognising and celebrating compassionate behaviour amongst team members, leaders can re-enforce these interactions, which then helps the compassionate culture become a long-lasting, natural part of the veterinary practice. 

Although it remains unclear to what degree compassion is innate versus learnt, research indicates that training can amplify compassion-based qualities17,18,19.

Compassion is a powerful team behaviour for improving care quality, and, from a business perspective, effectively improves staff retention and teamwork. From personal experience, I know that it can sometimes feel superfluous to fire-fighting urgent tasks, and just getting through the day. However, used in a thoughtful way, compassion is a valuable professional quality. I realise now that if I had shown more compassion to myself all those years ago, these mistakes may not have been quite so difficult to accept. I also know now that showing compassion helps us learn so that mistakes aren’t repeated – compassion really is a powerful medicine.

Checklist: What can you do next?

 

References

1. West, M. et al. (2017) Caring to change: How compassionate leadership can stimulate innovation in health care. Available at: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Caring_to_change_Kings_Fund_May_2017.pdf [Accessed 4 August 2021]

2. Goetz, J.L., Keltner, D., and Simon-Thomas, E. (2010) Compassion: an evolutionary analysis and empirical review. Psychological Bulletin, 136 (3), pp. 351–374. https://doi.org/10.1037/a0018807

3. Edmondson, A. C. and Lei, Z. (2014) Psychological safety: The history, renaissance, and future of an interpersonal construct. Annual Review of Organizational Psychology and Organizational Behavior, 1 (1), pp. 23–43. https://doi.org/10.1146/annurev-orgpsych-031413-091305

4. Nembhard, I. M. and Edmondson, A. C. (2006) Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27 (7), pp. 941–966. https://doi.org/10.1002/job.413

5. Oxtoby, C. et al. (2015) We need to talk about error: causes and types of error in veterinary practice. Veterinary record,  177 (17), p. 438. https://doi.org/10.1136/vr.103331

6. Turner, M. (2017) The use of a modified medical safety culture assessment tool to investigate veterinary patient safety culture in small animal practice. Masters thesis, University of London.

7. Good veterinary workplaces [BVA] [online] Available at: https://www.bva.co.uk/take-action/our-policies/good-veterinary-workplaces/ [accessed 4 August 2021]

8. Gush, C. and Rayner, A. (2020) What is Quality Improvement? Starting the conversation with your team [RCVS Knowledge] [online] Available from: https://knowledge.rcvs.org.uk/news-and-events/features/what-is-quality-improvement-starting-the-conversation/ [Accessed 6 August 2021]

9. Worline, M.C, and Dutton, J.E. (2017) Awakening compassion at work: The quiet power that elevates people and organizations. San Francisco, CA: Berrett-Koehler

10. Stoewen, D.L. (2018) Burnout: Prescription for a happier healthier you. The Canadian Veterinary Journal, 59 (5), pp. 537-540

11. Papadopoulos, I. et al. (2000) Obstacles to compassion-giving among nursing and midwifery managers: an international study. International Nursing Review, 67 (4), pp. 453– 465. https://doi.org/10.1111/inr.12611

12. Pizzolon, C.N. Coe, J.B. and Shaw, J.R. (2019) Evaluation of team effectiveness and personal empathy for associations with professional quality of life and job satisfaction in companion animal practice personnel. Journal of the American Veterinary Medical Association, 254 (10), pp. 1204-1217. https://doi.org/10.2460/javma.254.10.1204

13. Thomas, M.R. et al. (2007) How do distress and well-being relate to medical student empathy? A multicenter study. Journal of General Internal Medicine, 22, pp. 177-183. https://doi.org/10.1007/s11606-006-0039-6

14. Detert, J.R. and Burris, E.R. (2007) Leadership behavior and employee voice: Is the door really open. Academy of Management Journal, 50 (4), pp. 869-884. http://dx.doi.org/10.5465/AMJ.2007.26279183

15. Vogus, T. J. and Sutcliffe, K. M. (2007) The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Medical Care, 45 (10), pp. 997–1002. https://doi.org/10.1097/mlr.0b013e318053674f

16. Foster, K., Cuzzillo, C. and Furness, T. (2018) Strengthening mental health nurses' resilience through a workplace resilience programme: A qualitative inquiry. Journal of Psychiatric Mental Health Nursing. 25 (5-6), pp. 338-348. https://doi.org/10.1111/jpm.12467

17. Cochrane, B.S. et al. (2019) A culture of compassion: How timeless principles of kindness and empathy become powerful tools for confronting today’s most pressing healthcare challenges. Healthcare Management Forum, 32 (3), pp. 120-127. https://doi.org/10.1177/0840470419836240

18. Dutton, J.E., Lilius, J., and Kanov, J. (2007) The transformative potential of compassion at work. In: Piderit, S., Fry, R. and Cooperrider, D. (eds.) Handbook of transformative cooperation: New designs and dynamics. Stanford, CA: Stanford University Press. pp. 107-126

19. Lilius, J.M. et al. (2011) Understanding compassion capability. Human Relations, 64 (7), pp. 873-899. https://doi.org/10.1177/0018726710396250

 

About the authorsMark Turner

Mark Turner BVSc MRes MRCVS

Mark graduated from the University of Liverpool in 1996 and in 2017 completed a Masters degree at the RVC investigating patient safety culture in the UK veterinary professions.

The research project investigated contemporary knowledge of patient safety behaviours in practice including significant event reporting and auditing.

He has an interest in the application of patient safety as a tool for improving staff engagement and success. He has written for Vet Times, Companion magazine and appeared as a guest blogger for the BVA/RCVS Vet Futures project.

 

Olivia Ogińska MRCVS

Olivia OgińskaOlivia is a veterinary surgeon, positive psychology coach, international speaker, certified workplace conflict mediator and creator of Vet Gone Real platform, through which she provides coaching and mental support to individuals and veterinary teams in Europe, North America and Oceania. 

 

 

 

 

 

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August 2021