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Small things are big things: can

empathy be designed into

care?Jocelyn CornwellThe Point of Care Foundation

May 2014

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Paul Batalden M.DDartmouth Institute for Health Policy and Practice

“Every system is perfectly designed to

produce to produce the results it gets.”

Starting point 12

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Starting point 2

Every product /service has 3 elements

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(P)PERFORMANCE

How well it does the job, whether it’s fit for purpose.

Functionality

(E)ENGINEERING

Whether it is safe & reliable.Safety

(A)AESTHETICSHow it feels.

How it is experienced.Usability

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The aesthetics of care: small things are big

things

Example: a daughter’s story

Overall, my mother received the best care from staff who have treated and respected her as a person, rather than stereotyping her as an elderly person who’s not capable of thinking and doing things for herself.

Example (contd.)Throughout her time in hospital, staff continually called my mother by the wrong name. She has been called Harriet all her life but it is her middle name, so her first name is written on all her records. We drew this to the attention of staff on the ward; it was important especially as she was suffering from episodes of confusion, but it did not stop. Everyday someone from the family would visit her and wipe the wrong name off the whiteboard.

On one occasion, after tracking down a registrar responsible for her care, we explained the situation and he wrote “likes to be called Harriet” in big letters on the front of her notes but it still had little effect.

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Empathy

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The capacity for empathy

1. Cognitive: the capacity to understand another person’s feelings

2. Affective: the capacity to respond appropriately to another person’s feelings

Our capacity for empathy has two distinct aspects

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9©The Point of Care Foundation Using patient experience to redesign healthcare services

Empathy is normally distributed in the population11

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When empathy is switched off, we are in ‘I’ modeand we all switch off sometimes

• Tired, stressed or burned out• Under pressure to do something else• Interacting with a person who is ‘unpopular’ for

whatever reason• Highly emotional - angry, frustrated, distressed or

frightened• Working with digital equipment

We are more likely to switch off when we are:

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Designing empathy in

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• Simulation

• Experience based co-design

• Shadowing

• Participant observation

• Analogous scenarios

Empathy-by-design methods14

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Challenges to empathy-by-design

1. Scalability

• Deliberate effort required to expose the wider team to ‘out of ego’ experiences• Simulations

2. Sustainability• It is not enough for a small team to have transformative experience• One off whole system events don’t work • All involved need to be intrinsically motivated• Stories, artefacts (videos, animations, photos) • Cultural change

Designers recognise two distinct problems

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Enabling conditions: for individuals

•Stories •what happens later to individual patients?•patient’s biography - handover, ward rounds (This is me!)

•See with their eyes: shadow patients/ observe care

•Look after your self: self care, reflection, resilience

•Build/train confidence in own capability

To enhance cognitive and affective capacity

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Enabling conditions: environment of care

Cultural norms

• Express shared values in plain English• Reject language that objectifies patients • Intolerance of rude and unkind acts• Express priorities in human terms

Management and team working

•Train supervisors and hybrid managers to manage others•Create opportunities for reflection (Schwartz Rounds and others)•Support systematic, frequent feedback from patients

Systems support

•Good IT and patient records•Actively manage balance demand v. resources

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THANK YOU

www.pointofcareoundation.org.uk