Cultivating organizational compassion in healthcare

Experiences and challenges of acute coronary syndrome patients in care provision: a qualitative systematic review

BACKGROUND

Coronary artery disease including acute coronary syndrome (ACS) constitutes the most common cause of death in people with cardiovascular disease. Prompt diagnosis and early initiation of treatment significantly impact on patient outcomes. Positive patient experience with their initial care is linked to positive clinical outcomes.

OBJECTIVE

This qualitative review aimed to investigate patients' experience of care provision and the challenges faced by them during their different stages of care following an ACS.

METHODS

Searches of four databases - MEDLINE, Embase, CINAHL and PsychINFO - were conducted from inception until July 13, 2022, and were limited to English-language publications. Assessment of methodological quality of studies was performed using the Jonna Briggs Institute (JBI) qualitative assessment and review instrument. Data were extracted using the standardised data extraction tool from JBI. Data synthesis following the JBI approach of meta-aggregation was performed. The level of confidence for each synthesised finding was established based on ConQual.

RESULTS

Overall, from 578 records, 10 studies were included with 39 findings extracted from the included studies. The main synthesised findings were the need to provide tailored information and appropriate management at different stages of care, and that timely management and trust in health care workers are associated with greater patient satisfaction and more positive experiences.

CONCLUSION

Patients with an ACS experience many challenges during different stages of their care. Clinicians should be aware of the challenges they face and provide tailored information to patients that is appropriate for their different stages of management in order to best optimise patient experience and improve patient outcomes.

Cultivating staff equality, diversity, and inclusion in higher education in the post-pandemic era: an organizational compassion perspective

The COVID-19 pandemic has exacerbated pre-existing challenges faced by academic staff in UK higher education and drawn attention to issues of Equality, Diversity, and Inclusion (EDI). Amidst global competitiveness and workplace pressures, challenges such as managerialism, increased workload, and inequalities have worsened, significantly impacting mental health. This paper presents a conceptual analysis connecting EDI with organizational compassion within the context of Higher Education. The prioritization of organizational compassion is presented as a means to enhance sensitivity to EDI in the reconstruction of post-pandemic learning environments. Anchored in the organizational compassion theory and the NEAR Mechanisms Model, our study contributes to the intersection of the organizational compassion, EDI and higher education literatures by exploring how fostering compassion relations can contribute to enhancing EDI. This offers a new perspective to creating a more humane and supportive higher education environment.

The physician experience of patient to provider prejudice (PPtP)

Background

Patients can demonstrate prejudice and bias toward minoritized physicians in a destructive dynamic identified as PPtP (Patient Prejudice toward Providers). These interactions have a negative impact on the physical and mental well-being of both those who are targeted and those who witness such behaviors.

Study purpose

The purpose of this study was to explore the PPtP experiences of attending physicians who identify as a minority based on race, ethnicity, citizenship status, or faith preference.

Methods

Qualitative methodology was used to collect data using in-depth interviews. 15 attending physicians (8 male, 7 female, aged 33-55 years) who identified as minorities based on ethnicity, citizenship status, or faith practices were interviewed individually. Interviews were conducted using a guide validated in previous studies and content analysis was performed by two trained researchers to identify themes.

Results

Five themes were identified: A Continuum of Offenses, Professional Growth through Adversity, Organizational Issues, Role of Colleagues, and Consequences for Provision of Care. Findings suggest that although attending physicians learned to cope with PPtP, the experience of being treated with bias negatively impacted their well-being and work performance. Attending physicians also felt that white majority medical students sometimes treated them with prejudice but expressed a commitment to protecting vulnerable trainees from PPtP.

Conclusion

The experience of PPtP occurs consistently throughout a career in medicine, often beginning in the years of training and persisting into the phase of attending status. This makes it imperative to include strategies that address PPtP in order to successfully recruit and retain minoritized physicians.

Perception and engagement in unprofessional behaviors of medical students and residents: a mixed-method study

BACKGROUND

The present study aimed to investigate perception and engagement in unprofessional behavior of residents and medical interns and explore the factors affecting their engagement in unprofessional behavior.

METHOD

This study has an explanatory (quantitative-qualitative) mixed-method design. This study was conducted at Shahid Sadoughi University of Medical Sciences in 2022-2023. Participants, including residents and medical interns (n = 169), were entered by stratified random sampling. A survey was conducted in the quantitative step. A by an unprofessional behavior in clinical practice questionnaire (29 items) was used. For each behavior, the participants were asked to report whether they (a) participated in the behavior and (b) stated that the behavior Is unprofessional. In the qualitative step, 17 participants contributed. The qualitative data were collected by semi-structured interviews and analyzed according to the conventional content analysis approach Graneheim and Lundman introduced.

RESULTS

The highest ratio of participants' engagement in unprofessional behavior was reported in 'failure to introduce yourself and nurses and physician assistants to the patient and his family' (n = 145 (85.8%)). The results showed the proportion of participants who engaged in unprofessional behavior more than those who did not participate. There were associations between participants' engagement in each behavior and their perception of that particular behavior as unprofessional. (p = 0.0001). In the following behaviors, although the participants acknowledged that these behaviors were unprofessional, those who participated in the unprofessional behaviors were significantly more than those who did not participate: failure to comply with clinic regulations and policy (p = 0.01), eating or drinking in the hallway of the clinic (p = 0.01), medical negligence in duties in the clinic setting (p = 0.04) and failure to perform duties in teamwork (p = 0.04). The qualitative results were explored in a theme entitled "internalized unprofessional culture," including three categories "encouraging contextual risk factors towards unprofessionalism," "suppressing of unprofessionalism reporting," and "disbelieving professionalism as a key responsibility."

CONCLUSION

The results indicated that most participants engaged in unprofessional behaviors. The findings resulted from the internalized unprofessional culture in the workplace. The findings showed that engagement in unprofessional behaviors resulted from personal and systemic factors. The weakness of responsibility recognition and identity formation as a professional facilitated the engagement in unprofessional behaviors at the personal level. Furthermore, systemic factors including the contextual risk factors (such as deficiency of explicit and hidden curriculum), and the suppression of unprofessionalism reporting mechanism as a hidden factor played an important role in normalizing unprofessional behavior and promoting engagement in unprofessional behaviors among the participants. Recognition of the nature and extent of students' unprofessional behaviors facilitates educational discussion among teachers and students in this field. The results might assist to establish an assessment system and feedback mechanism to solve the problem of the "failure to fail" problem. In addition, these results provide medical educators insights into the development of professional courses that equip learners with adherence to professionalism and coping skills to deal with unprofessionalism in the healthcare system.

The impact of organizational compassion in health care on clinicians: A scoping review

BACKGROUND

The unprecedented exodus of workers from the healthcare system is a patient safety crisis. Organizational compassion in health care is the proactive, systematic, and continuous identification, alleviation, and prevention of all sources of suffering.

AIMS

This scoping review aimed to describe the evidence regarding the impact of organizational compassion on clinicians, identify gaps, and provide recommendations for future research.

METHODS

A comprehensive librarian-assisted database search was conducted. Databases searched were PubMed, SCOPUS, EMBASE, Web of Science, PsychInfo, and Business Source Complete. Combinations of search terms regarding health care, compassion, organizational compassion, and workplace suffering were used. The search strategy was limited to English language articles and those published between 2000 and 2021.

RESULTS

Database search yielded 781 articles. After removing duplicates, 468 were screened by title and abstract, and 313 were excluded. One-hundred and fifty-five underwent full-text screening, and 137 were removed, leaving 18 eligible articles, two of which were set in the United States. Ten articles evaluated barriers or facilitators to organizational compassion, four evaluated elements of compassionate leadership, and four evaluated the Schwartz Center Rounds intervention. Several described the need to create systems that are compassionate to clinicians. Lack of time, support staff, and resources impeded the delivery of such interventions.

LINKING EVIDENCE TO ACTION

Little research has been done to understand and evaluate the impact of compassion on US clinicians. Given the workforce crisis in American health care and the potential positive impact of increasing compassion for clinicians, there is an urgent need for researchers and healthcare administrators to fill this gap.

"Get on with it. Cope." The compassion-experience during COVID-19 in UK universities

Introduction

The COVID-19 pandemic caused major disruption to all sectors including higher education during the years of 2020 and 2021, thus providing a window into how different types of suffering can combine and the role of compassion in alleviating pain. Higher education within the United Kingdom provides a case example in this study, but the lessons about compassion are transferable to other contexts, particularly those in the neoliberal public sector. The impact of the pandemic period on teaching in universities has been well documented but there has been far less written about the wider experiences of staff who worked through this period, their suffering and the extent of compassion within their work lives.

Methods

29 interviews were conducted and individuals were invited to talk through the story of their pandemic experiences from March 2020 to the interview date of December 2021. Storytelling is a common method in organization studies and, although research into compassion in organizations is nascent, this method has been used in other studies.

Results and discussion

Previous research has examined organizational compassion in short periods of crisis and this study therefore provides a contrasting perspective on how compassion shifts over a longer period of suffering. A distinction is drawn in this study for the first time between "formalized" compassion processes in the organization which structurally prioritized compassion for students over that of staff, and "informal" compassion shown between staff to each other and between students and staff. The more that formalized compassion was evident, the less apparent it was in interpersonal interactions due to staff wellbeing being compromised and a systemic failure to recognize the dependence of student compassion on the wellbeing of staff. The findings therefore lead to theorizing that although neoliberal universities are perceived as being full of organizational neglect, compassion was structurally embedded for students but at the expense of staff.

Managing healthcare employees' burnout through micro aspects of corporate social responsibility: A public health perspective

Background

Globally, an increasing number of healthcare workers (HCW) suffer from the issue of burnout (BO) annually. The critical issue of BO undermines the capacity of HCW to deliver superior healthcare services on the one end, it negatively affects the mental health of HCW on the other hand. Although HCW in developed and developing countries face the risk of BO, however, this issue is more critical in developing countries due to poor infrastructure, resources and social inequalities. The BO syndrome has recently been recognized as a public health concern, and new approaches are required to manage this epic, especially in healthcare management, effectively. In this respect, past research recognizes the role of corporate social responsibility (CSR) in influencing employee outcomes. Especially the micro aspects of CSR (MCSR) have recently received growing attention from academicians and practitioners. However, most existing MCSR investigations relate to the positive aspects of individual psychology, leaving the terrain unattended on how MCSR can help employees in reducing negative work outcomes for example, BO. To close this critical gap, the basic aim of this study is to investigate the relationship between MCSR and BO. Further, to understand the underlying mechanism of how and why MCSR may reduce employees' BO, this study introduces two mediators, work engagement (WE) and intrinsic motivation (IM) and one moderator, compassion at work (CW).

Method

The data for the current study were gathered randomly from HCW serving in different hospitals of a developing country. Specifically, we collected the data in three separate waves. A self-administered questionnaire was used as a data collection instrument by following a paper-pencil methodology. The response rate in this study remained close to 64%. Both male and female HCW participated in this study. We validated the hypothesized relationships with the help of structural equation modeling in AMOS software.

Results

The results confirmed that MCSR negatively predicts BO, and WE and IM mediated this relationship. Moreover, the moderating effect of CW was also confirmed.

Conclusion

The findings of this study help healthcare administrators to mitigate the epic of BO among HCW by carefully planning and executing MCSR policies.

The measurement of compassionate leadership: Adaptation and Spanish validation of the compassionate leadership self-reported scale

BACKGROUND

A culture of shared leadership is widespread among palliative care teams based on a commitment to valuing and including all people equally. As compassion is a core value for end-of-life care work, compassionate leadership may be the best way to lead in palliative care.

AIMS

The aims of this study were twofold: (1) to adapt and validate the Compassionate Leadership Self-reported Scale in a sample of palliative care professionals; and (2) to study the relation between compassionate leadership and associated concepts of self-compassion, awareness and self-care.

METHODS

A cross-sectional survey of 296 Spanish end-of-life care professionals was conducted. Analyses included descriptive statistics, a confirmatory factor analysis (CFA) with four-correlated factors, reliability estimates and a structural model.

RESULTS

Results suggested there were medium to high levels of compassionate leadership in the sample. The CFA showed an adequate overall fit: χ² (98) = 277.595 (p < 0.001); CFI = 0.986; SRMR = 0.047; RMSEA = 0.088 [0.076, 0.100]. Reliability estimates for four subscales of compassionate leadership (attending, understanding, empathising and helping) were also adequate, ranging from 0.72 to 0.96. Finally, the structural model predicting compassionate leadership suggested that the dimensions of attending and understanding were most highly related to positive self-compassion and awareness; empathising, to self-care and awareness; and helping, to positive self-compassion and self-care.

CONCLUSION

The Compassionate Leadership Scale has adequate psychometric properties when used to assess compassionate leadership in the context of end-of-life care. Our results indicate that self-compassion, awareness and self-care are important correlates of such compassionate leadership.

Compassionate Discourses: A Qualitative Study Exploring How Compassion Can Transform Healthcare for 2SLGBTQ+ People

Compassion can be seen as a necessary, but often lacking, concept and practice in healthcare. Due to the cis-heteronormative nature of societies, people who identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) often experience health disparities and disparities in accessing compassionate healthcare. We aimed to explore the meanings of compassion in healthcare for Canadian 2SLGBTQ+ people. Using a poststructuralist framework, 20 self-identifying 2SLGBTQ+ participants were interviewed. Data was analyzed through discourse analysis. Three main discursive considerations are discussed, including (1) meanings and expectations of compassion in healthcare, (2) compassionate healthcare is not guaranteed, and (3) prescription for care: self-compassion for healing and health. The results provide insights into how compassionate healthcare is framed for 2SLGBTQ+ participants and how compassion is often lacking for them due to discourses of cis-heteronormativity and healthism.

Facilitating big-data management in modern business and organizations using cloud computing: a comprehensive study

Modern digital life has produced big data in modern businesses and organizations. To derive information for decision-making from these enormous data sets, a lot of work is required at several levels. The storage, transmission, processing, mining, and serving of big data create problems for digital domains. Despite several efforts to implement big data in businesses, basic issues with big data remain (particularly big-data management (BDM)). Cloud computing, for example, provides companies with well-suited, cost-effective, and consistent on-demand services for big data and analytics. This paper introduces the modern systems for organizational BDM. This article analyzes the latest research to manage organization-generated data using cloud computing. The findings revealed several benefits in integrating big data and cloud computing, the most notable of which is increased company efficiency and improved international trade. This study also highlighted some hazards in the sophisticated computing environment. Cloud computing has the potential to improve corporate management and accountants' jobs significantly. This article's major contribution is to discuss the demands, advantages, and problems of using big data and cloud computing in contemporary businesses and institutions.

Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia

BACKGROUND

Unprofessional behaviours of healthcare staff have negative impacts on organisational outcomes, patient safety and staff well-being. The objective of this study was to undertake a qualitative analysis of narrative responses from the Longitudinal Investigation of Negative Behaviours survey (LION), to develop a comprehensive understanding of hospital staff experiences of unprofessional behaviours and their impact on staff and patients. The LION survey identified staff experiences and perceptions related to unprofessional behaviours within hospitals.

METHODS

Two open-ended questions within the LION survey invited descriptions of unprofessional staff behaviours across seven hospitals in three Australian states between December 2017 and November 2018. Respondents were from medical, nursing, allied health, management, and support services roles in the hospitals. Data were qualitatively analysed using Directed Content Analysis (DCA).

RESULTS

From 5178 LION survey responses, 32% (n = 1636) of participants responded to the two open-ended questions exploring staff experiences of unprofessional behaviours across the hospital sites surveyed. Three primary themes and 11 secondary themes were identified spanning, i) individual unprofessional behaviours, ii) negative impacts of unprofessional behaviours on staff well-being, psychological safety, and employee experience, as well as on patient care, well-being, and safety, and iii) organisational factors associated with staff unprofessional behaviours.

CONCLUSION

Unprofessional behaviours are experienced by hospital staff across all professional groups and functions. Staff conceptualise, perceive and experience unprofessional behaviours in diverse ways. These behaviours can be understood as enactments that either negatively impact other staff, patients or the organisational outcomes of team cohesion, work efficiency and efficacy. A perceived lack of organisational action based on existing reporting and employee feedback appears to erode employee confidence in hospital leaders and their ability to effectively address and mitigate unprofessional behaviours.

Wrestling With the Invincibility Myth: Exploring Physicians' Resistance to Wellness and Resilience-Building Interventions

PURPOSE

Physicians are expected to provide compassionate, error-free care while navigating systemic challenges and organizational demands. Many are burning out. While organizations are scrambling to address the burnout crisis, physicians often resist interventions aimed at enhancing their wellness and building their resilience. The purpose of this research was to empirically study this phenomenon.

METHOD

Constructivist grounded theory was used to inform the iterative data collection and analysis process. In spring 2018, 22 faculty physicians working in Canada participated in semistructured interviews to discuss their experiences of wellness and burnout, their perceptions of wellness initiatives, and how their experiences and perceptions influence their uptake of the rapidly proliferating strategies aimed at nurturing their resilience. Themes were identified using constant comparative analysis.

RESULTS

Participants suggested that the values of compassion espoused by health care organizations do not extend to physicians, and they described feeling dehumanized by professional values steeped in an invincibility myth in which physicians are expected to be "superhuman" and "sacrifice everything" for medicine. Participants described that professional values and organizational norms impeded work-life balance, hindered personal and professional fulfillment, and discouraged disclosure of struggles. In turn, participants seemed to resist wellness and resilience-building interventions focused on fixing individuals rather than broader systemic, organizational, and professional issues. Participants perceived that efforts aimed at building individual resilience are futile without changes in professional values and sustained organizational support.

CONCLUSIONS

Findings suggest that professional and organizational norms and expectations trigger feelings of dehumanization for some physicians. These feelings likely exacerbate burnout and may partly explain physicians' resistance to resilience-building strategies. Mitigating burnout and developing and sustaining a resilient physician workforce will require both individual resistance to problematic professional values and an institutional commitment to creating a culture of compassion for patients and physicians alike.

Compassionate Nursing Care Model: Results from a grounded theory study

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research.

Theorizing compassionate leadership from the case of Jacinda Ardern: Legitimacy, paradox and resource conservation

During times of suffering such as that inflicted by the COVID-19 pandemic, compassion expressed by leaders helps to ease distress. Doing so, those in a position to provide resources that might facilitate coping and recovery are attentive to the situations of distress. Despite an abundance of leadership theorizing and models, there still is little academic literature on compassionate leadership. To address this limitation, we present an exploratory case study of New Zealand Prime Minister Jacinda Ardern, someone widely recognized for her compassionate leadership and frequently described in paradoxical terms (e.g. ‘kind and strong’; embodying ‘steel and compassion’). We address her compassionate leadership through the lenses of paradox theory, legitimacy theory and conservation of resources theory. We contribute a heuristic framework that sees various types of legitimacy leveraged synergistically to build resources and alleviate suffering – providing further legitimacy in an upward spiral of compassionate leadership.

Emphasising compassion for co-workers in medical training and healthcare organisations to address bullying

The over-representation of bullying in healthcare is incongruent with the compassion of healthcare professionals. This issue needs to be addressed at the levels of medical training and organisation by extending the emphasis on compassionate patient care to include care for co-workers.