Compassion is not the answer to failings in the NHS

'It is very common to conflate compassion ... with being a good healthcare professional,' says Anna Smajdor. Photograph: Getty Images

In 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.

View the original article here

How we can teach care and compassion

Augmented reality introduces simulations by overlaying computer-generated images via a tablet computer onto a manikin. Photograph: Sheffield Hallam University

Following the publication of the Francis report earlier this year, healthcare professionals across the service faced heightened scrutiny over their ability to show empathy and care to their patients.

While care and compassion has always been the philosophy that has underpinned our teaching curriculum here at Sheffield Hallam University, we have enhanced this by introducing augmented reality (AR) into our teaching.

AR introduces simulations by overlaying computer-generated images via a tablet computer, such as an iPad, on to a training manikin. The student holds the tablet up to the manikin from the bedside and will see a live display of the room they are in but the head and shoulders of the manikin will be overlaid with the video of an actor posing as a patient.

The age and sex of the patient is communicated via the video along with their clinical condition and it is down to the trainee to react appropriately to that patient's needs. The students are currently tested on patients with breathing difficulties, chest pains and other generic conditions, and we are continually adding to our range of scenarios as we progress with this piece of technology.

The purpose of this innovation is to enable students to see the real patient while rehearsing both clinical and non-technical skills on a human patient simulator.

We see the way in which students address their patients, interact with them and develop that all important nurse-patient relationship. In doing this, the essential skills of demonstrating care, compassion, empathy and dignity towards a patient can be realistically assessed, allowing us, as tutors, to give feedback on a student's performance and patient communication.

The response from our students has been extremely positive and we have noticed that having physical eye contact and interaction with a patient has a profound effect on how our students perform, compared to when they are using the manikin.

Health Education England and the recently established learning and education training boards (LETBs) have called for the patient to be put at the centre of healthcare education with the intention of enhancing the significance of patient dignity and respect.

The Willis commission (2012) also identified that real-life settings should lie at the heart of what they now call patient-centred education and nurse training. All of the nursing students at Sheffield Hallam University undertake practice on wards and in the community for 50% of their programme. This involves many hours with real patient clients. However, skills practice in simulated environments can enhance and refine these skills in a safe environment.

The technology is currently being used on our undergraduate courses. However, we are looking to implement this into our postgraduate curriculum and interpret it into several languages.

We currently have around 8,450 students in our health and wellbeing faculty and each one of these students has access to our state-of-the-art technology that we have invested heavily upon over the past decade.

Our other facilities include a simulated hospital ward, operating theatre and immersive visualisation suite, which uses 3D technology for teaching radiography, physiotherapy and oncology.

Our expertise has now attracted international demand, having delivered healthcare training to the Iraq ministry of health, as well as taking our augmented reality training across to our colleagues in San Francisco.

We are extremely proud of our nurse training curriculum and our interactive facilities go a long way in ensuring our graduates are fit for purpose as soon as they complete their training.

Jean Flanagan is assistant dean of nursing and midwifery at Sheffield Hallam University

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here