Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Raising the Bar of Caring in Healthcare

5/7/2015 7:55:38 AM | 2 comments

Welcome to Mindfulness in Medicine, an ongoing column by best-selling author Anne Bruce designed to cultivate leadership and collaborative relationships among hospital leaders, nurses, providers and ancillary staff. Mindfulness is a powerful leadership tool that enhances emotional intelligence in medicine. It is a tool that, when practiced, can help us develop and implement relational coaching skills and illuminate various ways to improve hospital operations and cross-departmental performance. Mindfulness also improves our capacity for decision-making and participatory medicine, all while enhancing our own health and well-being. Your comments and insights on these postings are greatly valued.

It's probably safe to say that love and caring are qualities most patients desire in their healthcare providers — especially when experiencing a painful or life-threatening condition.
But current emphasis on "patient-centered care" notwithstanding, can we reasonably expect empathy to be part of the healing equation? And given today's competitive healthcare environment, can healthcare organizations afford to sacrifice their limited resources on nonclinical care?

Conflicting Messages

One problem with adding love to the healthcare equation is that clinical care requires a certain degree of objectivity. Even in emotionally upsetting, life-or-death situations, providers must remain rational, weigh the available evidence and make sound decisions. For this reason, health professions students are taught to maintain emotional distance from patients in order to preserve their clinical judgment and prevent compassion fatigue.
The growing need for efficiency also plays a role. Research suggests that provider-patient face time is an important predictor of patient satisfaction. However, in order to fulfill their missions in this era of regulatory change and workforce shortages, healthcare organizations must be excellent stewards of their resources.
Given all this, it's no surprise that many providers bristle at the idea of tying a portion of hospital reimbursement to patient satisfaction. They argue that too much emphasis on these "soft" criteria will actually lead to worse outcomes as organizations lose their clinical focus and capitulate to patient wishes.

Extraordinary Medicine

As a coach dedicated to improving human performance, I can certainly empathize with the challenges facing healthcare professionals and their organizations. But recently, I had the opportunity to witness how integrating love and caring into hospital culture can actually improve patient outcomes — not to mention sharpen the organization's competitive edge.
On a writing assignment for my publisher, I spent several days at St. Jude Children’s Research Hospital in Memphis. St. Jude was founded in 1962 with a mission to save the lives of children with cancer and other catastrophic illnesses. Its research contributions have helped raise survival rates for childhood cancers from 20 percent to more than 80. Doctors across the world consult with St. Jude on their toughest cases.
Another interesting fact about St. Jude is that it never bills a family for a child's care. The majority of its funding comes from individual donors who believe in the hospital and support its mission.
During my time at St. Jude, I was privileged to interview Pam Hinds, RN, PhD, director of nursing research. For more than 20 years, Hinds has been working in an environment where catastrophic childhood illnesses are a daily reality. Despite all this, she has helped build an extraordinary staff and team where love, caring and hope are the orders of the day.
“I point out to people that this work is not about focusing on the intensity of sadness and death that can result from these illnesses," Hinds says. "Instead, we learn to focus on the moment-to-moment miracles that happen here at St. Jude every single day."
Here are Hinds' tips on integrating love, caring and hope into healthcare practice:
  1. Never sacrifice human connection for productivity.
  2. Honor every relationship.
  3. Be a real person to those who need you — get involved with their lives.
  4. Focus on what is most meaningful to others and meet those human needs as best you can.
  5. Understand that much can be said with few words.
  6. Have a mission. When the mission is clear, you will draw the right people to you and your organization.
  7. In the midst of extreme intensity and sadness, always point to the many miracles of survival that surround you.
  8. Remember that everything good that you do goes beyond the walls of where you live and work.
  9. Understand that even dying patients have hope, and that it is your job as a healthcare professional to help sustain that hope, love and caring. (For example, a young patient at St. Jude who knows that he or she is going to die may hold high hopes for the happiness of his or her parents, siblings and friends.)
  10. As a doctor, nurse or other medical caregiver, it is incumbent upon you to look to the future and share your hope and your belief in miracles.

Benefits of Caring

So what can we learn from the St. Jude experience?
First, it suggests that emotional involvement and clinical excellence can comfortably coexist — indeed even synergize. It's not every day you hear a healthcare leader like Hinds talk about miracles, hope and the need for personal involvement. And yet her hospital achieves some of the world's best survival rates for aggressive childhood cancers.
Second, notice that Hinds' care and concern extends to team members. In my experience, the way providers treat patients usually carries over into how they treat each other. When organizational culture affirms relationships, providers tend to value one another's contributions and support colleagues through difficulties. In such a non-punitive environment, fear and suspicion diminish, errors become growth points and true transparency can flourish.
Finally, Hinds statements reflect a strong sense of identity. A hospital that decides to cultivate love and care attracts providers who share those virtues. As I discussed in a previous post, criteria for hiring and promoting in today’s hospitals must go beyond technical competence to include a higher degree of emotional intelligence. Fully integrated human beings who are at once skillful, intelligent, strong and loving deliver the most value for our patients and organizations.

Permission to Care

If healthcare organizations want providers to openly express love and care, some work is required to overcome the previous cultural conditioning those providers may have internalized. They need to know they're in a place where love and openness are not taboo and are in fact encouraged and celebrated.
One of the most efficient ways to accomplish this is to provide leaders and role models. This means hiring and promoting people who not only deliver excellent clinical care, but also mirror the organization's values. Ultimately, these qualities become ingrained in the hospital culture, encouraging a more open expression of love, hope and caring.
It's also important to address systemic barriers to love and caring. For example, is the organization's sexual harassment policy written so strictly that it unintentionally stifles openness and affection? Are cultural differences affirmed and celebrated?
When it comes to promoting love and care, St. Jude — and many other organizations that consider themselves serious medical environments — are succeeding. Healthcare providers are moving past the cultural myths that have restricted their comfort in reaching out to patients and coworkers more authentically.
From the beginning and in the end, humans are born to care. Our institutions can either magnify or shrink our capacity to do so.
What will your organization do to magnify these mindful virtues going forward? What tips can you share with readers about this very conscious and mindful behavior in medicine?

About the Author

Anne Bruce has provided training and performance coaching for MedAmerica and CEP America. She also serves as MBSI's Employee Development Coach and Leadership Facilitator. Anne is a bestselling author with more than 20 books published by McGraw-Hill Publishing, New York. She considers her award-winning life-coaching book, Discover True North: A 4-Week Approach to Ignite Passion and Activate Potential (McGraw-Hill Publishing) to be one of her most "mindful" books to date. She also leads a popular Discover True North Expedition group on LinkedIn. Anne can be reached at 214-507-8242 or by writing to her at

[Image credit: "130709-N-WD757-169" by Navel Surface Warriors licensed under CC BY-SA 2.0, image edited to adjust brightness]


Anne Bruce
Ms. Hinshaw, thank you for taking time to respond to my "Mindfulness in Medicine" article this month on "Raising the Bar of Caring in Healthcare." Your advice to establish an environment that enables all healthcare providers to be champions for caring is invaluable. Your insights on this topic are greatly appreciated.
5/11/2015 5:21:17 PM

Dolly Hinshaw
Excellent article! As a healthcare consultant and trainer for over 20 years I have had the privilege of collaborating with hospital providers. As a recent patient with numerous stays in acute and post-acute facilities I have experienced professionals with a "mindfulness" spirit of caring beyond my expectations. The NorthShore University HealthSystem in Illinois has a culture that demonstrates a balance of significant medical expertise and providers that support the values of treating an illness and caring for the patient and their family with grace. My tip is to establish an environment that enables all healthcare providers to be champions for caring.
5/8/2015 1:09:42 PM