The Kindness Hub
If you can’t make it to GOK 2018 events, don’t despair!
We encourage you to hold your own events during and after Gathering of Kindness week. Your event could be an organised gathering, a session at a weekly meeting or even just a collection of conversations Film them in short grabs (even on your phone) or tell us about them so we can share them with the community on our More Gatherings page.
Please explore our Kindness resource Hub - a collection of useful resources for you to build kindness at work for yourself, your colleagues, patients and families. Consider running your own mini events or start conversations in your workplace.
And please add your own resources, comments and feedback on the Contact page so we can keep the conversation flowing! If appropriate, we'll add them to the Hub. And please join our Facebook Group to share your thoughts and ideas.
Elizabeth Broderick AO has drawn from her considerable experience in human rights to deliver a series of video insights for us. Watch out for more on our Videos page! They will be a wonderful resource for starting meaningful conversations. We thank Elizabeth for her generosity and wisdom.
We encourage you to host your own gatherings and create discussions among your colleagues and associates.
To that end we have created a range of resources, ideas and inspirations to get your conversations off the ground.
Buy your kindness online now!
Get ready to cap, tee, and even tote for Gathering of Kindness 2018.
Based on demand and feedback the range has been expanded to include the very popular Gathering of Kindness as well as our 2018 hashtag #KindnessWorksHere.
Both equally efficient and scientifically proven to promote the benefits of kindness wherever you wear!
The Hush Collection features music composed and performed by some of Australia's most eminent artists, especially to create a calming environment for patients, carers and health professionals. Some of our music features lyrics which can be used to stimulate conversations about kindness and the value of the arts in health.
Here we include links and information about a variety of organisations, endeavours and resources in research and professional development in specialised and more general applications throughout the health care sector and beyond. Be it information or inspiration, we're here to share.
We have collected some of the literature that discusses the role of kindness in health care. You can use it to find articles to discuss at staff meetings or journal clubs.
In Macedon, Victoria in March-April 2016, 100 leaders, philosophers and innovators gathered to conceptualise ways to transform health care culture. The inaugural Gathering of Kindness was not only inspiring but also provided practical recommendations for advancing kindness in health care.
Here we provide the summary of the two-day event with recommendations for other Gatherings.
Below are a series of posters in different sizes, with each download including 6 different posters with messages of ways to care for yourself and others.
Feel free to display these in your office or around your healthcare organisation!
What is kindness?
Kindness can look like a smile.
It can sound like a please, a thank you, or a hello.
It can taste like a cup of tea or coffee made for you when you're tired near the end of your shift.
It can smell like a flower someone brought in and put on the staff room table, or a cake someone made to celebrate a birthday.
It can feel like a hug on one of those terrible days, or a greeting handshake with a patient.
It comes in all shapes and sizes.
Welcome to the Gathering of Kindness Toolkit! As well as hoping you can join us at our official events, we also encourage you to host your own gatherings and create discussions among your colleagues and associates.
To that end, we have created a range of resources, ideas and inspirations to get your conversations off the ground.
We can add you to our More Gatherings page. Check it out to see who else is having conversations.
Caring for our health professionals
Workshop Resource List
Shree Johnson, Dr Caitlin Weston and Lucy Mayes have compiled this excellent collection of resources for those wanting to delve deeper into the literature on kindness in health care.
From a workshop conducted at Monash Health, November 13, 2018
A tool for 'kindfulness'
By Christine Ireland, teacher.
The Kindness sessions I went to on November 3, 2017, were immediately applicable to not only my line of work, but also to every association with which I am involved with. (Also very applicable to marriage!) It spoke to the fact that we all impact significantly upon each other’s journey.
Professionally, it was about bringing the joy back to the practice.
For me it was apparent from the workshops that even though kindness in the workplace (and life) manifests itself in many ways, but so too does its absence. I then began collecting phrases from the presentations that fitted these two categories. The power of seeing the lists side by side was knowing that items on the negative side could be replaced with items from the positive side. This understanding, this mindfulness it seems gives power to kindfulness.
With a little flexibility and creativity, I have designed this simple tool.
Shapes and Sizes
Organised social gatherings...
...such as off site breakfasts or dinners. A film night, a BBQ. Or smaller on site shared lunch dates or birthday acknowledgments.
...where work is not discussed...like the staff room!
..., such as Frisbee throwing (check it out..there's international competitions!), barefoot bowling (Best in summer).
Encourage staff to attend organisational sponsored sessions such as mindfulness or yoga.
..., such as grand rounds, ward based activities, conferences off site.
Make sure staff feel welcome to attend these, and that their effort and work is acknowledged and supported. We're all busy, but we are also our best resource.
...where a minute or two could be devoted to a 'kindness' question such as:
3 examples of how we show each other we care?
3 examples of how we show our patients we care?
What can we do better, both for ourselves and for our patients?
What are we not doing as well as we could?
...As you leave work for the day, reflect on these, and other questions, for even a minute:
Did I listen to my colleagues today? Did I listen to my patients? Did I interrupt them? Did I speak, and explain things, in a way they could understand? Was I kind to people?
Was I listened to by other team members? Was I treated with respect by the team? Were people kind to me?
Filming your event
We'd love to see footage of your events and post them if you choose. Here are a few quick guidelines for filming and sending.
You can film on your phone. Try to make sure the space is well lit so we can see you. Remember to hold your phone horizontally so it doesn't look like you're all in a phone booth.
No need to film everything, but we'd especially like to see and hear your ideas and conclusions.
When you have your film, send it to our web coordinator, letting us know if you'd like it posted on our Other Gatherings page, and any extra information you'd like to share.
Build your own Kindness Event
Talk, debate, workshop, panel or world cafe topics:
Professional Boundaries - panel discussions or debates e.g. Boundary violations or Broadening our repertoire
Psychological safety in healthcare- why is it so important.
How will we build a community of kindness?
What stories can you tell of when kindness in your workplace made a difference?
Will we come up with a Consensus statement about Kindness
Kind leadership in healthcare- how could that work?
Creativity and the arts- can they bring a new perspective to our workplaces
Surviving bullying in the workplace- self care and caring for others
Practical self-care strategies and practices
The ‘busyness’ epidemic, how to be kind and connected in the modern workplace
How to have kind conversations, communicating with compassion
Emotional intelligence, what it is, what it means in healthcare, how to develop/improve it
Some suggested gathering activities:
Join World Kindness Australia as an organization or individual.
Nominate staff as World Kindness ambassadors- hold a certificate ceremony
Mindfulness /Yoga sessions
Leadership Walkarounds- leadership highly visible and engaged at every site
Use volunteers in Gathering of Kindness T-shirts
Live or recorded Hush music is available for use in clinical areas
Filming of events and staff comments, vox pops we can share later as a community
Gather staff ideas on how to promote kindness and joy at work.
Involve staff in painting corridors or other places where possible.
Exhibitions- photos or artworks
Hold a Walk for Kindness
Comms and media support - press release templates (to come)
HUSH plays: Hush can provide our healthplays for your organisation.
“What Matters” (New Kindness play being launched during GOK 17)
“Do You Know Me”
Hold a Film Festival - we have an ever-expanding collection of videos designed to provoke thoughtful conversation
Thanks to Noni Bourke for providing the image below. Click to download a copy to use as a poster or postcard.
More resources available right here:
A bibliography for research projects
Hush music covering kindness-related topics or to encourage calm.
Further resources and worldwide associates
A summary of the 2016 Gathering with suggestions for holding events
Media articles about Gathering of Kindness and related topics
T-shirts and other clothing items to identify yourselves and hand out to volunteers
Public speaking, consulting and training from experts in patient and family centred care
Share your questions and suggestions on our Facebook Group
And when you're ready, you can share your gathering on our More Gatherings page
You are not "My Patient"
by Katrina Hall
You are not my patient
I do not own you
I do not control you
I do not have any rights over you
I do not manage you
You are a person
You are a person I am sharing my day with
You are a person who deserves my respect
You are a person I can offer advice and support to
You are a person who may share things with me
You are a person who has your own story
You are a person who has your own ideas
especially about your body, your health and your life
You are not My Patient, you are you.
Host your own events - and tell us!
Let us help to showcase your Gathering of Kindness events. Leave your details on the Contact page to register the name of the event, date, time, venue and a link to further details. You'll be included in the list of other events on the More Gatherings page. Remember to visit this Toolkit page and other pages in The Kindness Hub for more advice and shared information.
The Kindness Exchange
The Kindness Exchange provides a collaborative place online to share and promote local kindness innovation and improvement projects. This is the place to showcase the great work that is happening to promote Kindness and Joy at work across Australia and Internationally. It is also an opportunity to recognise the commitment and expertise of staff working in healthcare.
Submit your small and large-scale Kindness innovations and improvements to share with and benefit the broader health system. You can submit your initiative using the form here or download a copy. Read more below.
About Kindness Exchange
The Kindness Exchange provides a collaborative place to share and promote local Kindness innovation and improvement projects from all healthcare organisations across the World.
It is designed to share solutions that can be adapted to suit other local health challenges, without the need to duplicate work that has already been undertaken.
Small and large scale innovations and improvements generated are recognised and shared to benefit the broader health system.
The Kindness Exchange aims to:
Collect and promote information and resources about current Kindness projects, and improvements across Australia and beyond.
Provide resources to assist and encourage health professionals to make improvements and foster Kindness in their own healthcare setting/organisation.
Deliver a learning platform for new ways of improving and innovating for local needs and share experiences and lessons.
Connect health professionals with others who share similar interests to improve the patient/consumer and staff experience.
If you prefer, use this Word version and email it to firstname.lastname@example.org
If you’ve designed or implemented a project that aims to improve the patient or staff experience, the Kindness Exchange is a great opportunity to share your project with a wider audience and recognise the efforts of your team. You’ll have a page on the Kindness Exchange dedicated to your project, so other's can see what you’ve achieved and work out if it will help them solve a similar health challenge in their organisation or facility. Your summary can be used for a number of purposes, like sharing with your team, applying for speaking opportunities or promoting your project in the community. You don’t even need to have a completed project to publish it on the Kindness Exchange – we also accept projects that are in the planning or implementation stages.
Your project will be assessed by our team against the eligibility criteria outlined below.
Only high-quality projects that score at least nine will be considered, so it is important to ensure your submission is relevant, useful and current.
RELEVANT: Is it relevant to all health services?
5: Highly relevant to all health services and possibly internationally
4: Relevant to many health services across Victoria and nationally
3: Relevant to a number of health services in Victoria
2: Relevant to a small number of sites in some areas
1: A unique project that’s not relevant to other areas and settings
USEFUL: Does it provide enough information to implement the project in other settings?
5: Provides all information and resources required for wider implementation
4: Provides most of the information required for wider implementation
3: Provides useful information but doesn’t consider wider implementation
2: Provides some information but focuses on implementation in pilot sites
1: Provides very little information about implementation of the project
CURRENT: Is it a unique project that has been implemented or evaluated recently?
5: Developed in the last 12 months and is considered topical and a high priority
4: Developed in the last 12 months and is part of an ongoing improvement program
3: Developed in the last 18 months and is part of an ongoing improvement program
2: Developed 2-3 years ago but content is now outdated and has no limited relevance
1: Developed three or more years ago and has no clinical relevance today
The Kindness Exchange is a public website, which means it’s available for anyone to read. For this reason, you’ll need to be careful when including politically-sensitive information or negative outcomes. Consider whether what you are writing will impact your organisations’ reputation or generate negative media attention. If you’re not sure, contact us for clarification
How to submit your KINDNESS Project
Fill out the online form or download the Word version and email to email@example.com.
The publishing process
Our team will use the eligibility criteria to determine whether your project is suitable for publication on the Kindness Exchange.
We will work with you to develop your project summary to the highest standards, by providing feedback and edits on your submission.
You will have the opportunity to review our edits and provide any further information, changes or approvals required.
Once everyone is happy with the content in your summary, we will publish it on the Kindness Exchange.
Your project will have a dedicated URL that you can use to share your project with your team or other stakeholders. New projects will also be mentioned on the Hush Website .
The Hush Collection features music composed and performed by some of Australia's most eminent artists, especially to create a calming environment for patients, carers and health professionals. Some of our music can also be used to stimulate conversations about kindness and the value of the arts in health.
Please use the music in your own kindness gatherings and discussions. You can use the supplied lyrics and descriptions to facilitate conversations.
The tracks can be streamed here. If you'd like to purchase CDs, please visit the Shop Hush page. You will be supporting our work and assisting the development of more inspiring music!
From Hush volume 16: A Piece of Quiet
This inspiring piece features reflections on kindness by kids from Jesse's grade 6 class, spoken by Matilda Rintoul and Leila Winsbury.
“Kindness is when someone says you are a friend.
If you make a mistake it is kindness that people give to you, to help you realise that you did something wrong.
Even though someone doesn’t like someone, they can still be kind."
Sticks and Stones
From Hush volume 16: A Piece of Quiet
Like other songs from Hush 16, this is inspired by stories of young patients fighting serious illness. This song by Naomi Crellin addresses bullying and the importance of speaking out.
"You can turn sticks and stones into microphones
And make your feelings heard
It only takes a word
It begins and ends with you."
Finding my Brave
From Hush volume 16: A Piece of Quiet
A shining example of the strength a child can summon in adversity, the words by Josh Concilia and Sophie Toll are a fresh way to look at illness.
“I imagine it as a big, dark faceless creature with muscles.
It tries to scare me and take over my body, but it doesn’t know I am a superhero."
Dance of the Paper Umbrellas
From Hush volume 13: The Magic Island
A gentle but joyous orchestral piece from one of our most loved composers.
"The idea for Dance of the Paper Umbrellas started when I visited the ward at the Royal Children's Hospital in Melbourne and witnessed what wonderful work Dr Catherine Crock and her team do. It was a moving experience that was still with me, when a few days later I sat at my piano. I wondered what kind of piece I could write the would be uplifting. I wanted to enter the world of magic and possibilities. I imagined a cake adorned with multi-coloured umbrellas. A dance formed in my head, starting with a pattern in harp, marimba, plucked strings and flutes"
A Hula Hoop of Space
From Hush volume 16: A Piece of Quiet
An insightful observation about personal space, permission and empathy from 11-year-old Sienna.
“People have a hula hoop of space. Let them have that space. If you want to go inside it, then ask."
From Hush volume 16: A Piece of Quiet
A song about knowing your own strengths and appreciating the strengths of others.
"Talents can be:
Finding nice leaves; walking far; being interested in things or being good at describing things.
I think one of my main talents is laughing… and annoying my brother.”
The Ocean and the World
From Hush volume 16: A Piece of Quiet
A beautifully dreamy song By Naomi Crellin about the inspirational power of writing "your own storybook"
"And she said to me:
'You see, it wasn’t long ago life was dark and dim'
Her boat began to sink; she’d let the ocean in
She sank beneath the waves, but found that she could swim."
The Gathering of Kindness Anthology
Order the Anthology
To order the Anthology, visit our store.
Cost: $25 plus $5 shipping per book (contact us for more information)
Who is this book useful for?
Anyone who works in the healthcare industry. Anyone who wants to learn how to build a kind culture. Anyone who wants to understand the different perspectives of people on every side of healthcare. Anyone who enjoys reading stories from real people. Anyone who wants a thought-provoking read for their waiting room or coffee table, or who wants to stimulate discussion at their own Gathering.
This book is designed to be visually appealing and is perfectly suited to be read in small parts. The Gathering of Kindness Anthology will show you the variety of human thought.
The healthcare industry has struggled to separate itself from a culture of bullying and stress. Rather than focusing on merely escaping this culture, the way forward is to focus on the type of culture we do want to create - a kind healthcare system.
Based on this philosophy of taking the positive direction, the first Gathering of Kindness event was run in Melbourne in 2016. A wide variety of people attended - not just doctors, but patients, family, administrators, politicians, media, lawyers, students, musicians, and artists. We wanted some way to record the conversations and ideas that came from this wonderful assembly of people, so at the end of the conference we collected contributions from over 40 of the participants. It is from these contributions that the Anthology was formed.
The Gathering of Kindness Anthology is a collection of incredible stories, ideas, action plans, and creative impressions of this kind healthcare system, and how to get there. And by purchasing the book, you'll be supporting the Hush Foundation and helping continue the quest for kindness.
Here we present a collection of thought-provoking and inspiring videos from kindness colleagues. They are a wonderful resource for starting meaningful conversations. We will continue to add to the collection.
Paul Levy on Kindness
Paul Levy, former hospital CEO and health blogger, explains that kindness is not a directive but a reflection of the underlying values of virtually every health professional.
Chris Turner - When rudeness in teams turns deadly
At TEDxExeter, emergency medicine consultant Chris Turner discusses research and describes real-life experiences where rudeness between staff impacts outcomes.
Small Acts of Kindness
An inspiring look at how acts of kindness can transform the patient experience. Produced by Far West Local Health District, NSW
The Honourable Linda Dessau
Patron in Chief of the Hush Foundation, Her Excellency the Honourable Linda Dessau, Governor of Victoria, talks about the need for a more compassionate healthcare system and the contribution Gathering of Kindness 2017 can make to the conversation. We thank her greatly for her kind words!
Dr Rajagopal, human rights award winner for his work in palliative care in India, and the 'spiritual leader of ethical medicine', has much wisdom to offer the cause of kindness. We also recommend you look at Hippocratic, the documentary about Dr Raj.
We are kind by nature. Dr Raj reminds us that we are innately kind, but our circumstances don't always allow that kindness to be expressed.
What healthcare needs Dr Raj believes health care has been too disease-focused and needs a greater focus on empathy, dignity and respect.
More from Elizabeth Broderick
The importance of Kindness. Liz talks about handing dignity back. "We are all born equal in rights and with dignity".
Being Too Busy. It's at our busiest moments that we need to remember kindness. "We're too busy NOT to be kind".
Upgrade to Kindness. The most effective leaders communicate with authenticity and shared vulnerability.
Breaking the Kindness Barrier. The power of story allows us to connect at a deeper level.
Elizabeth Broderick AO has drawn from her considerable experience in human rights to deliver a series of video insights for Gathering of Kindness. These videos, which could be used to open a discussion, emphasise why kindness should be a driver of all interactions in health care.
Check the Playlist on our YouTube channel for the full collection.
We thank Elizabeth for her generosity and wisdom.
The Leadership Lottery. There is a need for leadership which includes compassion and encourages authentic communication in both directions.
The Culture of Care. Elizabeth calls for a healthcare culture addressed by empathy and individual responsibility.
Solutions. Using your "compassionate self" to turn your emotions into positive action.
The Culture of Bad Behaviour. Being willing to call out bad behaviour has a lasting impact on the culture of your organisation.
Mindfulness and Kindness Liz talks about the importance of self-awareness in managing our behaviour.
Congratulations Liz congratulates Dr Catherine Crock AM on her work building the movement for kindness.
Dr Gordon Schiff: Knowing your patients better
Gordon Schiff, MD, General Internist and Safety Science Director for the Harvard Medical School Center for Primary Care Academic Innovations Collaborative, talks about having a strong personal relationship with patients and the danger of taking a too "academic" approach to patient care.
More from Dr Schiff
Reaching Across Boundaries. Gordon talks about keeping "arm's length" from patients and the need to reach across those boundaries.
Communication Consistency. Gordon talks about "sub-optimisation" and the importance of communication in best outcomes.
Dr Catherine Crock: A New Health Care Culture
Dr Catherine Crock AM, Founder of the Hush Foundation and Gathering of Kindness, shares her vision of a transformed healthcare culture, in which bullying is addressed and kindness is a fundamental guiding principle.
Hearts in Healthcare: ICU and Patient Experience
I woke up in intensive care. My eyes were swollen shut. My jaw was wired closed. There was a machine forcing air through a hole in my throat. I couldn't see, I couldn't speak, I couldn't drink, I couldn't even breathe for myself but I could hear EVERYTHING.
From Hearts in Healthcare
Hon Lara Giddings MP: A More Resourceful Health System
Former Premier of Tasmania and supporter of the Hush Foundation Hon Lara Giddings MP talks for Gathering of Kindness about the difference between budgetary resources and the limitless and free resource of Kindness.
Cleveland Clinic: Empathy: The Human Connection to Patient Care
Patient care is more than just healing -- it's building a connection that encompasses mind, body and soul. If you could stand in someone else's shoes . . . hear what they hear. See what they see. Feel what they feel. Would you treat them differently?
Dr Benjamin Veness: A New Way to Measure Care
Dr Benjamin Veness talks about the need to find new ways to measure the effectiveness of health care. Kindness is hard to quantify but needs to be considered along with more measurable performance indicators.
Cleveland Clinic Empathy Series: Patients: Afraid and Vulnerable
When you're in the hospital, everything changes. You depend on caregivers for everything. Each word, each touch, each visit really matters. "Cleveland Clinic's Empathy: The Human Connection to Patient Care" told part of the story. But there's much more. You'll be moved by these life-changing stories, and astonished when you learn what these patients have in common.
Great Work Stories: Moses and Mindi
How does a hospital janitor play a critical role on the healing team? When Mindi's son needed specialized lifesaving surgery, she, her husband and little McKay flew across the country to find a qualified team. Surrounded by renowned doctors and world-class facilities, they were surprised to find the care and healing McKay needed came from the last member of the hospital's staff they would have expected.
From O. C. Tanner Co.
Carnegie UK Trust
Over the last few years, the Carnegie UK Trust have prioritised kindness, focusing on it in their research, strategy and approach - believing it to be at the heart of our wellbeing.
You can find a series of recent publications thanks to authors Simon Anderson and Julie Brownlie here: https://www.carnegieuktrust.org.uk/publications/public-policy-and-the-infrastructure-of-kindness-in-scotland/
For information on research and qualitative findings head to: https://www.carnegieuktrust.org.uk/project/kinder-communities/
The world is full of kindness. You only have to look...
Colleagues and friends across the world are actively contributing to the conversation for kindness in health care. Here we include links and information about a variety of organisations, endeavours and resources in research and professional development in specialised and more general applications throughout the health care sector and beyond. Be it information or inspiration, we're here to share.
Please alert us to any further connections you feel may be valuable via our Contact page.
Beauty Within Medicine
Founded in 2012 by Dr Lucy Desmond, Beauty Within Medicine celebrates "Diversity, Equality and Community" and focuses on creating resources that help bring these key values to medical education. We especially find their "Ward Stories" enlightening and inspiring.
You can hear Lucy talk in detail about her work on the Creative Careers in Medicine podcast.
Center for Compassion and Altruism in the Workplace Compassion Database
This project from Stanford Medicine includes research, education, lectures and other events, video resources and a comprehensive database of work in the field of compassion and altruism in the workplace.
Institute for Compassionate Leadership
Founded in 2012 by Lodro Rinzler, an author & meditation teacher based in New York City, the Institute for Compassionate Leadership (ICL) serves to empower socially conscious, self-aware, and compassionate leaders by educating aspiring change-makers in meditation, community organizing, and 21st century leadership skills built for today's workplace environment.
Free podcasts are available on their Soundcloud page.
Hearts in Healthcare
Robyn Youngston is an anaesthetist from New -Zealand who is the co-founder of Hearts in Healthcare, a global social movement for health professionals, students and all those who are passionate about “re-humanising healthcare”. He has generously made all of his powerpoint slides and resources accessible free of charge to anyone who would like to use it.
Planetree - Burnout among healthcare workers: can we turn the tide?
Burnout within the healthcare profession is on the rise. It affects quality of life of personnel, quality of care for patients and families and the bottom line of healthcare organizations. Planetree, supporting patient-centred care, offer a Caregiver Quality Checking Tool along with a brilliant array of other solutions for professionals seeking better care for patients and staff.
Kindness: an underrated currency
From the British Medical Journal, an editorial discussing recent research into the transformative power of kindness in healthcare, and argues for qualitative measures and outcomes to be equal to the quantitative when considering "our core purpose of delivering the best care possible".
Can doctors learn from super chickens?
Associate Professor David Brewster and Dr Malcolm Clark refer to William M Muir's "super chickens" research to point out the importance of teamwork over individual performance, and share the view that breaking down our culture focusing on individual acclaim can address the ongoing reality of bullying in the healthcare workplace.
Why being kind can help you live longer
UCLA's recently founded Bedari Kindness institute applies scientific rigour to the study of a normally more emotive topic. Their studies include anthropologists examining how kindness spreads between people, sociologists analysing how those who behave unkindly could be persuaded to be kind, and psychologists researching how kindness can improve mood and reduce depression symptoms.
Who heals the healer?
From JAMA Network, Huma Farid MD shares her very personal experience of losing, and then rediscovering empathy, and the role of the doctor-patient relationship in each other's wellbeing.
The amazing health benefits of kindness
Michael Roizen, M.D., and Mehmet Oz, M.D. explain in Renew Houston research that shows how even the simplest acts of kindness like a daily hug can increase wellbeing and reduce the likelihood of getting sick.
This article from wrapem.org by ED physician Dr Ellen Meyns, FACEM discusses the impacts of disrespectful treatment of medical staff by their colleagues, and the ripple effect felt by other staff, teams, patients and families. Often unintentional, simple incivility can impact decision-making and contribute to burnout.
Applying Community Organizing Principles to Restore Joy in Work
This article from NEJM Catalyst by Jessica Perlo, MPH and Derek Feeley, DBA suggests "Caring and healing should be joyful activities, not sources of stress" and share their experience of using a community organising approach to foster joy in the healthcare workplace.
For the sake of doctors and patients, we must fix hospital culture
When hospitals fail to create a culture where doctors and nurses can speak up patients pay the price, say resident physicians and journalists Blair Bigham and Amitha Kalaichandran. Published by BMJ.
Empathy is a skill that improves with practice
Stanford Psychologist Jamil Zaki, author of The War for Kindness: Building Empathy in a Fractured World discusses research that finds empathy is not determined by our genes but is a skill that can be developed. Published by Stanford Medicine.
Creative health: the arts for health and wellbeing
British All-Party Parliamentary Group on Arts, Health and Wellbeing Inquiry Report. Download this very informative and thought-provoking document discussing the ways the arts can be employed to improve health in the community, workplace and care environments.
Negative workplace cultures and patient care
Professor Johanna Westbrook, Director of the Centre for Health System Safety Research, Australian Institute of Health Innovation at Macquarie University, writes in the Sydney Morning Herald about the impact of workplace culture on patient care and even safety.
Kind doctors have healthier patients
A new book “Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” provides evidence that doctors who practice kindness and compassion have better patient outcomes.
Can the Arts Help Critical-Care Health Professionals Cope?
A new federally funded research lab at the University of Colorado Anschutz Medical Campus is looking into how creative arts therapies could strengthen resilience in critical-care health professionals.
UT College of Medicine Chattanooga trains doctors to show compassion, kindness
University of Tennessee College of Medicine Chattanooga student Robert Goodrich designed and distributed his own compassionate care survey.
When the doctor becomes the patient
Former Federal AMA President Dr Steve Hambleton shared his gratitude for the efforts both large and small made by staff at Canberra Hospital to make him feel safe and welcome when he suddenly became ill at a meeting.
Prof. Catherine Crock AM and Lucy Mayes at the IHI/BMJ Conference, Melbourne September 2018
Professor Catherine Crock AM, founder of the Hush Foundation and Gathering of Kindness, and Lucy Mayes, author of Beyond the Stethoscope: doctors' stories of reclaiming hope, heart and healing in medicine will be at the International Forum on Quality and Safety in Healthcare in Melbourne, 10-12 Sep, 2018, organised by the Institute for Healthcare Improvement (IHI) and BMJ.
When doctors are bullied, all of society is harmed
Dr Ranjana Srivastava shares stories of her personal feelings of disempowerment and that of her colleagues in the face of the embedded bullying culture in hospitals.
Harnessing hope: the role of music and play in one girl's struggle to fight cancer
This article from ABC Radio Sydney explains the role of play music therapy in Hiyam's hospital experience, focusing on the person while the medical team focuses on the illness.
Soft Skills will improve our health system
In this article from the Sydney Morning Herald, Hush Foundation board member and passionate supporter of Gathering of Kindness Dr Frank Daly, and Chairman of North Sydney Local Health District Trevor Danos, explain how training in compassion and empathy can profoundly impact the health system.
Health Professional Radio - Building Better Relationships Among Patients and Health Professionals
Dr Catherine Crock AM discusses the concerning culture growing in the medical industry the past few years where the patients and health professionals don’t communicate properly and never see eye to eye.
Falling Through the Cracks: Greg's Story
This new film explores the journey of Greg Price, a 31-year-old Alberta man, who died in 2012 of complications from surgery for testicular cancer. Initiated by Greg's family, it uses Hollywood-style storytelling to help educate medical students about treating patients as people.
Read an appraisal by Dr Brian Goldman here .
Learn about the film and the Greg's Wings charity here.
For those interested in learning more about research in this field, we have collected some of the literature that explores the role of kindness in health care. You can use them, for example, to print out and discuss at a staff meeting or journal club.
Please visit here regularly for new material, and feel free to alert us to other work via the contact box at the bottom of the page.
Our great thanks go to Ali Maudarbocus for compiling the collection.
Kindness: At the Center of Patient Experience Strategies. Journal of Healthcare
The author discusses the efforts of University of California Los Angeles (UCLA) Health to transform its culture into one centered on their patients' experience. Topics mentioned include patient satisfaction data reported by the U.S. Centers for Medicare & Medicaid Services on its Hospital Compare website in 2008, selection of patient engagement strategies by organizations based on their organizational readiness, and UCLA Health's strategies to improve patient experience as reported by patients.
By Padilla T.
Management [Internet]. 2017 Jul [cited 2018 Oct 6];62(4):229–33
The relationship between perceived organisational threat and compassion for others: Implications for the NHS. Clinical psychology & psychotherapy
The National Health Service (NHS) is known to be a challenging place to work, with financial and performance targets placing increasing pressure on the organisation. This study aimed to investigate whether these pressures and threats might be detrimental to the quality of care and the compassion that the NHS strives to deliver. Quantitative data were collected via self‐report questionnaires from
healthcare professionals across 3 NHS trusts in England in order to measure Self‐compassion; Compassion for Others; Perceived Organisational Threat; and Perceived Organisational Compassion. Qualitative data were also collected to explore the threats considered most pertinent to healthcare professionals at present. The key findings suggest that an increase in Perceived Organisational Threat may reduce an individual's ability to give compassion to others; however, Self‐compassion and Perceived Organisational Compassion were better predictors of Compassion for Others. This highlights the need to consider compassion at a systemic level, providing interventions and training not only to cultivate self‐compassion in healthcare professionals, but also to encourage compassion across the NHS more generally. In promoting self‐compassion and increasing the level of compassion that employees feel they receive at work, healthcare professionals may be better able to maintain or improve their level of compassion for service users and colleagues.
by Henshall LE, Alexander T, Molyneux P, Gardiner E, McLellan A.
Clinical psychology & psychotherapy. 2018 Mar;25(2):231-49.
Leading with compassion in health care organisations: The development of a compassion recognition scheme-evaluation and analysis
The purpose of this paper is to report an evaluation of a leading-with-compassion recognition scheme and to present a new framework for compassion derived from the data.
The scheme highlighted that compassion towards staff and patients was important. Links to the wider well-being strategies of some of the ten organisations involved were unclear. Awareness of the scheme varied and it was introduced in different ways. Tensions included the extent to which compassion should be expected as part of normal practice and whether recognition was required, association of the scheme with the term leadership, and the risk of portraying compassion as something separate, rather than an integral part of the culture. A novel model of compassion was developed from the analysis of 1,500 nominations.
The model of compassion can be used to demonstrate what compassion “looks like”, and what is expected of staff to work compassionately.
A unique model of compassion derived directly from descriptions of compassionate acts which identifies the impact of compassion on staff.
by Hewison A, Sawbridge Y, Cragg R, Rogers L, Lehmann S, Rook J.
Journal of health organization and management. 2018 Apr 9;32(2):338-54.
Measuring health care workers’ perceptions of what constitutes a compassionate organisation culture and working environment: Findings from a quantitative
Health care organisation cultures and working environments are highly complex, dynamic and
constantly evolving settings. They significantly influence both the delivery and outcomes of care.
Phase 1 quantitative findings are presented from a larger three phase feasibility study designed to develop and test a Cultural Health Check toolkit to support health care workers, patients and organisations in the provision of safe, compassionate and dignified care.
A mixed methods approach was applied. The Cultural Health Check Healthcare Workers Questionnaire was distributed across two National Health Service Hospitals in England, UK. Both hospitals allocated two wards comprising of older people and surgical specialities.
The newly devised Cultural Health Check Staff Rating Scale Version 1 questionnaire was distributed to 223 health care workers. Ninety eight responses were returned giving a response rate of 44%. The Cultural Health Check Staff Rating Scale Version 1 has a significant Cronbach alpha of 775; this reliability scaling is reflected in all 16 items in the scale. Exploratory factor analysis identified two
significant factors “Professional Practice and Support” and “Workforce and Service Delivery.” These factors according to health care workers significantly impact on the organisation culture and quality of care delivered by staff.
The Cultural Health Check Staff Rating Scale Version 1 questionnaire is a newly validated measurement tool that could be used and applied to gauge health care workers perceptions of an organisation's level of compassion. Historically we have focused on identifying how caring and
compassionate nurses, doctors and related allied health professionals are. This turns the attention on employers of nurses and other related organisations.
Implications for nursing management
The questionnaire can be used to gauge the level of compassion with a health care organisation culture and working environment. Nurse managers and leaders should focus attention regarding how these two factors are supported and resourced in the future.
McSherry R, Pearce P.
Journal of nursing management 2018 Mar;26(2):127-39
The colours and contours of compassion: A systematic
review of the perspectives of compassion among ethnically diverse patients and healthcare providers.
To identify and describe the perspectives, experiences, importance, and impact of compassionate care among ethnically diverse population groups.
A total of 2296 abstracts were retrieved, out of which 23 articles met the inclusion criteria. Synthesis of the literature identified the perspectives, facilitators and barriers of compassion in healthcare within ethnic groups. Compassion was described as being comprised of healthcare provider (HCP) virtues (honesty, kindness, helpful, non-judgment) and actions (smile, touch, care, support, flexibility) aimed at relieving the suffering of patients. The importance and impact of providing compassion to ethnically diverse patients were also identified which included overcoming cultural
differences, alleviating distress at end-of-life, promoting patient dignity and improving patient care. This review also identified the need for more contextual studies directly exploring the topic of compassion from the perspectives of individuals within diverse ethnic groups, rather than
superimposing a pre-defined, enculturated and researcher-based definition of compassion.
This review synthesizes the current evidence related to perceptions of compassion in healthcare among diverse ethnic groups and the role that compassion can play in bridging ethno-cultural differences and associated challenges, along with identifying gaps in literature related to
compassionate care within diverse ethnic groups. Establishing an evidence base grounded in the direct accounts of members of diverse ethnic communities can enhance culturally sensitive compassionate care and improve compassion related health outcomes among diverse ethnic groups.
Singh P, King-Shier K, Sinclair S.
PloS one. 2018 May 17;13(5):e0197261.
What are healthcare providers’ understandings and
experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada.
Healthcare providers are considered the primary conduit of compassion in healthcare.
Although most healthcare providers desire to provide compassion, and patients and families expect
to receive it, an evidence-based understanding of the construct and its associated dimensions from
the perspective of healthcare providers is needed.
The aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model.
An empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.
Sinclair S, Hack TF, Raffin-Bouchal S, McClement S, Stajduhar K, Singh P, Hagen NA, Sinnarajah A, Chochinov HM.
BMJ open. 2018 Mar 1;8(3):e019701
Compassion from a palliative care perspective.
“Compassion lies at the heart of good medical care, particularly for the most vulnerable end-of-life patients. However, even though compassion is crucial and central to medical care, it is poorly researched. Our goal was to understand patients’ experiences of compassion and lack of compassion so that we can inform doctors and nurses what compassion is and is not from a dying patient’s perspective. We found that though compassion is so valuable and treasured by patients, it is not that complicated and in fact is “cheap”, meaning it does not take much time and effort from the clinicians. Dying patients see compassion as clinicians connecting with them, talking to them in a way
that can be understood, treating them with respect, showing some interest in them and having a positive presence for them.”
Fernando A, Rea C, Malpas P.
NZ Med J. 2018 Jan 19;131(1468):25-32.
Kindness Can Move Mountains
a short commentary on how a simple act of kindness can make a big difference in someone’s life when there is chaos (in this case, Hurricane Harvey).
Texas Heart Institute Journal. 2018 Apr;45(2):61-2.
A Framework for Reducing Suffering in Health Care
This article discusses types of suffering, including those that are avoided by empathy, trust and staff coordination.
by Deirdre E. Mylod and Thomas H. Lee, MD
Harvard Business Review
November 14, 2013
Confronting Unprofessional Behaviour in Medicine
In medicine, we have tolerated and continue to tolerate behaviour that harms each other, our patients, and our relations with society. The solutions will need to come from within the medical profession because the context and culture of our work are unique.
Jo Shapiro, Center for Professionalism and Peer Support, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
The BMJ, March 08, 2018
Kindness and Competition: Are we striking the right balance in medical education?
This paper discussing workplace stress, bullying and harassment quotes the work of Dr Catherine Crock.
Brewster DJ, Rees CE, Leech M, Thompson G. Kindness and competition: Are we striking the right balance in medical education?
A More Egalitarian Hospital Culture is Better for Everyone
A new study proves that hospitals can change, and that a more open culture can help patients do better.
By Pauline W. Chen, M.D.
May 13, 2018
Why Focusing on Professional Burnout is Not Enough
Abstract: Professional burnout rates in healthcare are well documented and are at an all-time high. But the goals of delivering exceptional patient care and improving the health of our communities go beyond preventing and treating caregiver burnout. At the Institute for Healthcare Improvement, we suggest shifting the focus from “burnout” to “joy in work.”
Jessica Perlo and Derek Feeley. Journal of Healthcare Management, March-April 2018, vol 63 issue 2
Code Lavender: Cultivating Intentional Acts of Kindness in response to Stressful Work Situations.
Abstract: Providing healthcare can be stressful. Gone unchecked, clinicians may experience decreased compassion, and increased burnout or secondary traumatic stress.
Code Lavender is designed to increase acts of kindness after stressful workplace events occur.
Davidson, JE, Graham, P, Montross-Thomas, L, Norcross, W, Zerbi, G. The Journal of Science and Healing; 2017;13(3); 181-185.
Patients as Ethnographers
Abstract: This reflection describes an innovative methodology to observe and measure work place culture in the healthcare setting. Dr. Launer draws on his personal inpatient experience and proposes that ethnography; the study of cultures, could provide an accurate perspective of culture in the workplace. An ethnographical study is an avenue to engage with patients during their own hospital admission in real time. This would provide an opportunity for the patient to give an account of their observations and health care experience of technical care, the human interaction around them, and the implications for patient safety.
Dr. John Launer. BMJ vol 93 Issue 1100
IHI Framework for Improving Joy in Work
This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to better understand the barriers to joy in work, and co-create meaningful, high-leverage strategies to address the issues of burn-out and low engagement levels of staff which ultimately leads to poor patient care.
Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI. White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.
Breaking the Rules for Better Care
"If you were to break or change any rule in the service of a better care experience for patients or staff, what would it be?"
Berwick D, Loehrer S, Gunther-Murphy C. Journal of the American Medical Association. 2017 Jun;317(21):2161-2162.
Adding kindness at handover to improve our collegiality: the K-ISBAR tool.
This reflection from the Medical Journal of Australia proposes adding kindness at handover to improve collegiality.
Brewster, David J, Waxman, Bruce P. Adding kindness at handover to improve our collegiality: the K-ISBAR tool. MJA 209 (11). 10 December 2018.
NEJM Catalyst Leadership Talk: What if Our care Were Designed by Patients?
"I want to ask ourselves to imagine, what would it be like if our care was designed by patients? And if our leaders were selected by patients? And if our organisations were designed by patients?”
Stephen Swensen, MD, MMM, FACR
Management by Enlightened Self-Interest: Technique versus Kindness.
Abstract: The day of the pat answer is past. The day of the quick fix is over. Today we are looking beyond the quarterly report into the next century. We now speak of winning combinations, enduring values, and lasting corporate structures. This article examines the application of "enlightened self-interest" to the leadership functions in the highly competitive, hyperturbulent health care industry. Empirical evidence is offered that demonstrates that prosocial leadership behavior enhances the willingness of workers to sustain not only a high level of quality work performance but also an advanced degree of citizenship behavior in the workplace.
Campbell, C. A. Health Care manager Journal, 1997
Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs.
Abstract: Current daily general practice has become increasingly technical and somatically oriented (where attention to patients’ feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP–patient communication have shifted from a focus on listening and empathy to task-oriented communication.
Derksen FA, Olde Hartman TC, Bensing JM, Lagro-Janssen AL. Br J Gen Pract . 2016;66(653):e887-e895.
Reforming the culture of healthcare: the case for intelligent kindness.
Abstract: There has been increasing interest in the culture of healthcare in the light of the two reports by Robert Francis into the care at Mid Staffordshire. This editorial encourages a comprehensive exploration of the conditions that promote a benign caring culture and make outbreaks of cruel neglect and abuse of patients less likely. Creating and sustaining such a culture is dependent on being honest and realistic about the forces that threaten to undermine it. The editorial argues that being able to confidently articulate the positive values that should define healthcare culture is particularly important at this time. The case is made for a conscious focus on the concept of intelligent kindness.
Campling P. British Jounal of Psychiatry Bulletin; 2015; 39(1): 1-5
Cultivating compassionate care.
Abstract: The term compassion is at the forefront of current healthcare policy, yet its meaning and how it can be realised in practice is far from clear. This article debates the meaning of compassion in the context of practice and argues that it essentially involves how people relate to each other. It highlights key processes to enhance compassion with self, patients and their families, healthcare professionals and the organisation.
Dewar B. Nurs Stand . 2013 [cited 2013 Apr 24-30];27(34):48-55; quiz 56.
Kindness, not Compassion, in Healthcare.
Quote: “...by examining the meaning of compassion and where it sits in the spectrum of beneficence, I hope to provide convincing arguments that compassion is misused—it is the wrong adjective for the ideal type of interaction that should characterize the care we encourage be delivered in medical settings. In the spectrum of beneficence we should not aspire to compassionate care; instead we should aspire to kindness in caregiving.”
Faust SH. Cambridge Quarterly of Healthcare Ethics; 2009;18(3); 287-299.
Humanizing the healthcare experience: the key to improved outcomes.
Abstract: This is an uncertain time to be in medicine. Most of us entered the profession to be of service to patients, to provide great clinical outcomes, and to be fairly compensated. Today, when asked whether physicians would recommend the medical profession to their children, most of them say no.1 When pressed further, many point to an industry that is focused more on cost reduction, efficiency, and the adoption of health information technology that is dehumanizing medical care. When we add the increasing administrative and regulatory compliance burdens to the practice of medicine, you begin to understand the increase in physician burnout.
Duffy MB. Gastrointest Endosc . 2014;79(3):499-502.
Kindness in medicine: appeal and promise.
Quote: “But in addition to helping patients, acts of kindness can transform how clinicians view themselves. A focus on kindness can be restorative and rekindle the enthusiasm that initially prompted careers in healthcare. To seek joy and meaning in clinical work is a challenge recently issued by Leape, et.al. Kindness can be key to achieving such objectives.”
Freeman JW, Hoffman WW. S D Med; 2011
Catching rudeness is like catching a cold: The contagion effects of low-intensity negative behaviors.
Abstract: In this article we offer a new perspective to the study of negative behavioral contagion in organizations. In 3 studies, we investigate the contagion effect of rudeness and the cognitive mechanism that explains this effect. Study 1 results show that low-intensity negative behaviors like rudeness can be contagious, and that this contagion effect can occur based on single episodes, that anybody can be a carrier, and that this contagion effect has second-order consequences for future interaction partners. In Studies 2 and 3 we explore in the laboratory the cognitive mechanism that underlies the negative behavioral contagion effect observed in Study 1. Specifically, we show that rudeness activates a semantic network of related concepts in individuals’ minds, and that this activation influences individual’s hostile behaviors. In sum, in these 3 studies we show that just like the common cold, common negative behaviors can spread easily and have significant consequences for people in organizations.
Foulk T, Woolum A, Erez A. Journal of Applied Psychology. 2016 Jan;101(1):50.
Acknowledging small acts of kindness.
Summary: An editorial that highlights, according to the author, the very best of nursing practice
Gallagher A. Nurs Ethics ; 2012;19(3):311-2.
"Tu Souffres, Cela Suffit": the compassionate hospital.
Abstract: The authors propose that the characteristics of personal (individual) compassion may be extrapolated to the concept of corporate (organizational) compassion. Modern health care facilities attract staff members who are able to exercise varying degrees of compassion in their busy daily routines. However, little discussion has taken place on how health care organizations might best harness and integrate aspects of individual compassion to create an organization with compassion as a core value. We define three characteristics of a “compassionate hospital” as 1) the presence of a healing environment, 2) a sense of connection among people, and 3) a sense of purpose and identity. We suggest how a “top down” focus on compassion as a core value by clinical leaders could maximize the compassion of health care workers, and reduce the suffering expressed and/or experienced by health care workers and patients in today's health care facilities. The compassionate hospital concept is intended to act as a proposition for health policy researchers and decision-makers in health care so as to reduce the suffering of sick patients, and to restore a sense of well-being, meaning, and purpose among health care workers.
Kearsley JH, Youngson R. J Palliat Med . 2012 [cited 2012 Apr];15(4):457-62.
Ten approaches for enhancing empathy in health and human services cultures.
Abstract: Empathy is defined as a predominantly cognitive attribute that involves an understanding of experiences, concerns and perspectives of another person, combined with a capacity to communicate this understanding. Empathy in the context of clinical care can lead to positive patient outcomes including greater patient satisfaction and compliance, lower rates of malpractice litigation, lower cost of medical care, and lower rate of medical errors. Also, health professionals' wellbeing is associated with higher empathy. Enhancing empathic engagement in patient care is one of the important tasks of medical education. In this article, I briefly describe 10 approaches for enhancing empathy in the health care environment: improving interpersonal skills, audio- or video-taping of encounters with patients, exposure to role models, role playing (aging game), shadowing a patient (patient navigator), hospitalization experiences, studying literature and the arts, improving narrative skills, theatrical performances, and the Balint method. I conclude that empathic engagement in the health care and human services is beneficial not only to the patients, but also to physicians, other health care providers, administrators, managers, health care institutions, and the public at large.
Hojat M. J Health Hum Serv Adm . 2009 [cited 2009];31(4):412-50.
Your Best Life: Kindness is Its Own Reward.
Abstract: The article focuses on kind deeds which enrich the lives and can lift the mood of the most disheartened soul. It states that unforeseen complications can be portrayed in kind manner and orthopedists should embrace unexpected outcomes and should try to convey to a patient's family or friends. It mentions that in order to cross journey of vocation in orthopedic surgery, kindness to oneself is essential and difference in resiliency in medicine is due to presence of uplifts one receives.
Kelly JD 4th. Clin Orthop. 2016;474(8):1775
Leadership with Compassion: Applying Kindness, Dignity and Respect in Healthcare Management.
Summary: The compelling book prompts fresh, and perhaps controversial, ideas about themes such as the role of the apology in healthcare settings; a whole chapter is dedicated to encouraging staff to say sorry when mistakes are made.
Lewis C. Globis Mediation Group; 2013
'Telling the Truth…With Kindness’.
Abstract: Cancer in a parent can have harmful effects on a child’s ability to cope with the situation, in particular if communication about the disease is limited. The aim was to evaluate whether the parent-child group run by a psychoanalyst and a doctor at the hospital helps facilitate communication about the disease with a child and helps to sooth the child and his/her symptoms.
Compassion and the science of kindness: Harvard Davis Lecture 2015.
Abstract: The article discusses the importance of kindness in the consultations of general practitioners (GP) in Great Britain. It states that kindness should be in the central of the engagement of physicians with other people. It mentions that kindness activates the soothing and affiliation component of the emotional regulation system of the brain.
Mathers N. Br J Gen Pract. 2016
Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care.
This report highlights how working conditions can affect health care workers and recommends seven strategies for organizations to improve workplace safety.
Lucian Leape Institute. Boston, MA: National Patient Safety Foundation; 2013.
Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.
Abstract: Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be ‘all changed, changed utterly’. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?
Newdick C, Danbury C. J Med Ethics. 2015;41(12):956-62.