Compassionate Care


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Robb Johnson, MPH, MBA

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  • It’s a pleasure to be here with you today – and I’ve truly enjoyed learning more about your work through the sessions I’ve attended. When I was asked to come share with you today I was told the one of the things folks were interested in hearing about is how you can sustain compassion as you do tough work in sometimes challenging conditions. I think I have an inkling about that challenge from my years working in HIV/AIDS and victims of violence programs. As you heard from my bio, I’ve spent time both in and out of healthcare over the past 20-plus years – and I’m here to tell you that you are doing hard work. Working for the environment mostly felt a heck of a lot healthier than working in healthcare. But a passion for human service brought me back – and I imagine that’s part of what keeps you here too.
  • I’ll start today by sharing a short video about how -- and why -- the Schwartz Center was founded back in 1995: --------- As a healthcare attorney, Ken was keenly aware of the trends facing healthcare in the early 1990s. Healthcare was becoming more like a business. With healthcare spending spiraling, there were growing pressures to contain costs and do more with less. (Sound familiar?) In that context, Ken was worried that financial pressures would take the humanity and empathy out of the healthcare system. And that continues to be a concern of ours today. While Ken was an extraordinary individual, he knew he could have been any one of us. During his illness, he spent hours talking with his friends, family and caregivers about his legacy—he envisioned an organization that would promote the patient-caregiver relationship and provide hope to patients, support for caregivers, and sustenance to the healing process. What emerged from Ken’s tragic death was the Schwartz Center for Compassionate Healthcare, a national, nonprofit organization focused on strengthening the relationship between patients and caregivers. Today, we are based at Massachusetts General Hospital in Boston, but our programs reach more than 70,000 caregivers a year in 34 states – and there is a waiting list of healthcare institutions that want to participate in our programs.
  • There is a growing body of evidence that demonstrates how patient-caregiver relationships and effective communication are associated with improved clinical and functional status, increased patient and physician satisfaction, greater adherence to clinical guidelines and treatment protocols, patient trust, and significant reductions in medical malpractice claims. In fact, the Schwartz Center is currently working on a pilot project with a major medical malpractice carrier whose data shows that 70% of malpractice claims are related to breakdowns in communication. Beyond the research, I bet every one of you in this room can think of a personal experience that demonstrates the positive impact of good communication and connection --- and probably another example of what can happen when communication breaks down. We decided to go a step further last fall and commissioned a national poll of 800 recently hospitalized patients and 500 physicians to find out what patients and doctors think about compassionate healthcare.
  • With that backdrop of what patients are expecting, and with the understanding of what a difference Compassion can actually make, is anyone feeling a little pressure to perform ? Superheroes are great, but what we really need are some systematic supports to allow you to do your best work. The Masslach Burnout Inventory (MBI) looks at three key components of burnout: E motional Exhaustion, Depersonalization, and [lack of] Sense of Personal Achievement . Clinicians and administrators alike need to be attuned to burnout warning flags, and build in personal caretaking strategies and systemic supports to manage stressors. (Anecdote from Medical Error session in Stoughton.) [ Interactive Exercise here ] Schwartz Center Rounds is one tool – one which we believe can be quite powerful.
  • Schwartz Center Rounds utilize a case-based format to stimulate discussion about an identified topic with a skilled facilitator to encourage interaction and highlight salient points. A physician leader and planning committee at each site choose a case and identify a small panel of caregivers to share perspectives on the social and emotional challenges it raised. H eld regularly 6-12 times per year A hallmark of the program is interdisciplinary dialogue. Professionals from diverse disciplines participate in the Rounds, including physicians, nurses, social workers, psychologists, allied health professionals and chaplains. After listening to panelists’ brief presentations, caregivers in attendance are invited to share their own perspectives on the case and broader related issues. Patient identifiers are omitted to protect confidentiality, and all participants are expected to maintain the confidentiality of what caregivers themselves share. Patients and family members do not generally attend. However, once Rounds are well established, sites are encouraged to occasionally hold a special Rounds session where the case presentation includes a patient or family member perspective, enabling caregivers to comment and ask questions. These are always powerful Rounds. Purpose: -- To provide a forum where caregivers from diverse disciplines discuss difficult emotional and social issues inherent in patient care; -- To discuss how communication among caregivers and between caregivers and patients influences care
  • Mostly Hospitals -- Some Nursing homes, outpatient practices;
  • We recently received an email from a doctor who started Schwartz Center Rounds at his hospital in Fort Washington, Pennsylvania. Here’s what he said about their first session: “ Our first Schwartz Center Rounds was a home run. We had about 120 people. It was a case of a little two-year-old girl from Haiti who was brought to our hospital for multiple surgeries. She came with her father and so all of the nurses became her surrogate mothers. In the middle of her treatment, things went badly and she almost died. She survived but the caregivers who treated her experienced an emotional roller coaster. When her pediatric surgeon said “surgeons are not supposed to have feelings” as her eyes became wet, I knew we were on to something special. Toward the end of the session, our head of diversity who had been very involved with this family appeared in the room with the child and her father. There were few dry eyes in the audience. I wish you had been there. It was so moving. I can’t imagine any other session will top this.”
  • Rounds are an opportunity for dialogue that doesn’t happen anywhere else in the hospital.”
  • more heart in what we do with patients…the connections are deeper, we are less afraid of difficult topics.
  • Illustration by George Ulrich Nila Webster: I have a wish for all of the caregivers whose tireless efforts make a difference in the lives of their patients. My wish is that they take the time to replenish and restore themselves, to experience the relaxation response documented by Dr. Herbert Benson and the synchronization of the rhythm of breathing to the rhythm of the heart advanced by French psychiatrist Dr. David Servan-Schrieber , and to find an oasis of serenity. May this time be that of pure healing, that as they fortify others, they too are fortified.
  • Rounds details: Schwartz Center provides: Start-up training: Phone consultation & site visit Materials to build support and encourage attendance Ongoing consultation and quality assurance Periodic peer learning meetings for Rounds leaders Internet resources specifically for Rounds leaders Site agrees to: Secure support of senior management Appoint a physician leader, facilitator and administrative coordinator Establish a multidisciplinary planning committee Adhere to Schwartz Center Rounds model Submit evaluation summaries Acknowledge Schwartz Center support and Rounds funders Bd. Priorities given high demand: Focus expansion where we have clusters now ( New England, NY, NJ, PA, DC, MI, IL, FL, TX, CA) Plus academic medical centers and NCI Community Cancer Centers
  • Compassionate Care

    1. 1. Compassionate Care Robb Johnson, MPH, MPA Director of Programs The Schwartz Center for Compassionate Care
    2. 3. Does Compassion Matter?
    3. 4. Major Poll Results <ul><li>84% of patients and 81% of doctors believe compassionate care makes a difference in how well patients recover from illness </li></ul><ul><li>81% of patients and 71% of doctors believe compassionate care can make a difference in whether a patient lives or dies </li></ul><ul><li>Only 53% of patients and 58% of doctors believe the US healthcare system is a compassionate one </li></ul><ul><li>20-point gap between the compassionate care patients wanted and what they actually experienced </li></ul><ul><li>67% of patients and 55% of doctors are concerned that current changes in the US healthcare system will make it more difficult for caregivers to provide compassionate care </li></ul>
    4. 5. Yes, but how can we keep it up?
    5. 6. Schwartz Center Rounds ®
    6. 7. Piloted at Massachusetts General Hospital in 1997 <ul><ul><li>Now in 240 sites in 34 states, plus UK, reaching 70,000 caregivers per year </li></ul></ul>
    7. 8. Topics <ul><li>Noncompliant patient </li></ul><ul><li>Caring for a colleague </li></ul><ul><li>Team conflict around treatment plans </li></ul><ul><li>Does stopping treatment mean giving up? </li></ul><ul><li>Pain management in the addicted patient </li></ul><ul><li>Cultural and religious barriers </li></ul>
    8. 9. Evaluation of Rounds’ Impact <ul><li>87% of respondents reported gaining new ideas/strategies for challenging patient situations </li></ul><ul><li>87% reported more compassion for patients and families </li></ul>Lown BA, et al. Acad Med. 2010.
    9. 10. <ul><li>93% reported greater appreciation for the roles/contributions of colleagues from other disciplines </li></ul><ul><li>88% reported a greater sense of belonging to a caregiving team </li></ul><ul><li>76% reported feeling less alone in work with patients </li></ul>Lown BA, et al. Acad Med . 2010.
    10. 11. <ul><li>Caregivers reported feeling less stressed and better able to cope with the emotional demands of clinical work </li></ul><ul><li>Approximately 50% reported changes in practices or policies within the department or hospital at large. </li></ul>
    11. 12. Other Benefits <ul><li>CME for physicians, CEUs for nurses, social workers, and chaplains </li></ul><ul><li>Helps satisfy ACGME communications requirements for residents and fellows </li></ul><ul><li>Rounds included in Joint Commission toolkit for meeting patient safety goals </li></ul>
    12. 13. In participants’ own words… <ul><li>“ Rounds are a place where people who don't usually talk about the heart of the work are willing to share…their vulnerability, to question themselves. Rounds are an opportunity for dialogue that doesn’t happen anywhere else in the hospital.” </li></ul>
    13. 14. <ul><li>“ There is more heart in what we do with patients…the connections are deeper, we are less afraid of difficult topics. Since we know there is support for us in the institution, we’re willing to take more risks.” </li></ul>
    14. 15. <ul><li>“ We initiated Schwartz Center Rounds in 2002 and they are still going strong, with an average of over 100 attendees each month. The format allows for a free exchange of ideas, feelings, and reactions, reinforcing the common humanity of caregivers, patients, and families. They are clearly now part of the fabric of our institution.” </li></ul><ul><li>Raymond J. Mayewski, MD </li></ul><ul><li>Vice President and Chief Medical Officer </li></ul><ul><li>University of Rochester Medical Center </li></ul>
    15. 16. <ul><li>For information on our other programs, including Schwartz Center Grants </li></ul><ul><li>to support innovative programs across the country, please visit our website. </li></ul><ul><li> </li></ul>
    16. 17. <ul><li>     Thank you for life </li></ul><ul><li>And death </li></ul><ul><li>And life again </li></ul><ul><li>For the seed of hope </li></ul><ul><li>Born of each sad end </li></ul><ul><li>- Nila Webster, from </li></ul><ul><li>The Gift of You, the Gift of Me </li></ul>
    17. 18.
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