'It is very common to conflate compassion ... with being a good healthcare professional,' says Anna Smajdor. Photograph: Getty ImagesIn February 2013, the Francis report was published, detailing "systemic failings" at Mid Staffordshire NHS trust which were said to have brought about the deaths of hundreds of patients and caused suffering to many more. In response to the report, David Cameron urged, among other things, that healthcare professionals' pay should be dependent on their ability to demonstrate compassion in their jobs. But is Cameron right to think that incentivising compassion is the right way to go about healing the health service?
It is very common to conflate compassion, or other virtues such as empathy, with being a good healthcare professional. How can someone care for a patient if he or she does not care? The terminology here is unhelpful.
To care can mean either to feel a certain way or to carry out certain activities. The words are identical, and the meanings may overlap, but feeling and doing can be very different things.
In a publicly funded health service, the doing takes precedence over the feeling. This sounds harsh when we think of the frailty and vulnerability of patients. But we cannot afford to romanticise the realities of modern healthcare provision. One can replace a hip without caring about the particular person on whom one is operating, or empty a bedpan without feeling any special emotion about the patient who has filled it. The first concern of the health service is to ensure that the hip is replaced and the bedpan emptied, and that these tasks are achieved safely and efficiently – not to police staff feelings.
In fact, ascribing the failings in Mid Staffordshire to a lack of compassion raises some very difficult questions. How could one hospital come to be staffed entirely by individuals who lacked this basic feeling? And if lack of compassion were the root cause of the trust's failings, why were the uncaring staff to be suffering as well as patients? Given the low morale among staff detailed in the Francis report, it is more plausible to suppose that the failings in Mid Staffordshire came about despite the healthcare staff being no less than averagely compassionate.
There are two key issues to consider here. First, compassion is not a necessary component of healthcare, since the essential tasks associated with healthcare can be carried out in the absence of compassion. Second, compassion is not sufficient to prevent catastrophic failures in healthcare of the sort described in the Francis report. Undoubtedly, compassion is one means by which a person can be motivated to intervene when she sees a loved one suffering. But healthcare professionals are not treating loved ones. They are responsible for many individuals, working to fulfil many tasks as efficiently as possible in situations where time and resources are limited.
For these reasons, it is dangerous to rely on compassion as the motivation that ensures the necessary tasks are carried out. Reminders, routines and checklists offer alternative ways of ensuring that crucial healthcare tasks are undertaken – independently of how people feel. Of course, these systems are not infallible: they require intelligent management, responsiveness and foresight. They may be undermined by the encroachment of poorly considered incentives that deflect staff from the tasks required to keep patients as healthy and safe as possible.
The proposal to incentivise compassion imposes a whole new set of burdens on the health service. Resources will have to be diverted towards the management, measurement and monitoring of compassion. Meeting newly defined compassion targets will become a priority for doctors and nurses. Is this what we really want, or are we setting our healthcare professionals up for further failures?
Anna Smajdor is lecturer in ethics at the University of East Anglia
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.
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