These findings are based on workshop discussion and a short review of the literature on compassion and concepts related to it. More details are presented in our discussion paper Enabling compassionate care in acute hospital settings (116 kb) .

What compassion is

• ‘A deep awareness of the suffering of another coupled with the wish to relieve it’ (Chochinov 2007)
• ‘empathy, respect, a recognition of the uniqueness of another individual, and the willingness to enter into a relationship in which not only the knowledge but the intuitions, strengths, and emotions of both the patient and [the physician] can be fully engaged’ (Lowenstein 2008).

What compassion is not

• The focus on compassion should not reside merely at the ‘sharpest ends’ of care – i.e., in emergency situations, or when a patient is known to be dying. Lack of compassion in mundane aspects of general acute and everyday care also takes its toll on patients and staff – and indeed it is these ‘little things’ that patients or carers often recall as having been either present or lacking in their experiences of care.
• Nor should compassion be seen as being ‘sweet and nice’ but, rather, as being honest in the face of difficult situations.
• It’s not one size fits all: compassion can have very different meanings in different settings, and for individual staff and patients.

What prevents compassionate care?

• Natural, human defences: Staff develop mechanisms to cope with their regular, frequent or in some cases continuous exposure to their fellow human beings in varying states of suffering, terminal illness and death.
• The emotional toll: Compassion requires that people give something of themselves; it entails an emotional response and frequently involves generosity. Showing compassion can be more of a challenge for staff who are already fatigued or subject to stress and may create a frustrating gap between their intentions and their capabilities.
• Staff stress and burnout: In surveys, healthcare staff regularly report higher levels of depression and stress than other public sectors workers.
• Conflict between perceptions of professionalism and compassion: Participants felt that professional detachment was a particular challenge for those occupying leadership or supervisory roles – because compassion is associated with emotion, it may be seen as a failure to maintain an appropriate professional distance or authority.
• Medical training: The psychosocial aspects of care-giving have tended to command secondary status in medicine and increasingly in nursing training. Training that emphasises professional detachment and positions compassion as ‘soft and fluffy’ may have a detrimental impact later on the interpersonal relationships between staff and patients – and to the quality of care delivered.
• Lack of systematic role modelling or mentoring: Though compassion may often be an intuitive behaviour for those entering the health care professions, without systematic modelling and continual reminders of its importance, compassion can become more of an assumed behaviour marked by rote gestures and less of a practised one.

How do we enable compassionate care?

• The power of patient stories: Patient stories – particularly the experience of being a patient or close to a patient – can have an eye-opening effect on the way that health care professionals choose to deliver care. Harnessing the power of these personal stories, through role-playing exercises, first-person accounts or imagined narratives of what it’s like to be a patient, could very well effect a major shift in how staff perceive their ability to shape patients’ experience of care.
• Learning from palliative care: With its primary emphasis on patients’ experience, on physical and psychological comfort and quality of life, the palliative care setting can serve as a model of how to better integrate a focus on compassion into delivery of care.
• Changing the physical environment: Good organisational layout allows staff on wards and in clinics to work together better as a team, to enable staff to better get to know and look after patients and each other. This might increase the likelihood of good interactions and observation among staff and between staff and patients.
• Providing staff with a forum for open and honest dialogue: A safe and recrimination-free setting in which to discuss the everyday challenges and pressures of the job, to air concerns and share stories of patients and their care, provides staff with support and is essential to encouraging communication within the team and to improving team dynamics. (The Schwartz Center Rounds®, which The Point of Care will be piloting in the UK, is one such approach designed to provide staff with this kind of forum.)
• Role modelling/mentoring: Those in senior positions can enable compassion among staff by modelling compassionate behaviours – towards themselves, staff and patients – often through relatively simple gestures, for example, encouraging a junior colleague to take a meal break or by taking one themselves. Mentoring should be of particular importance in teaching hospitals.
• Careful implementation of the right kind of measures: Long-term holistic approaches to measurement should look not only at indicators of good basic care – staff responsiveness to call bells, patients’ feeding needs and pain management – but also at other arenas in which the ability of staff to deliver good quality care might also reveal itself – through staffing retention and recruitment, for example.
• Feeding back to staff on their performance: Staff should be told what is valued in an organisation and given recognition, as failure of recognition ties into staff stress and low levels of organisational morale.