Post on 25-Dec-2015
1©The Point of Care Foundation
Small things are big things: can
empathy be designed into
care?Jocelyn Cornwell
The Point of Care Foundation
May 2014
2©The Point of Care Foundation
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
3©The Point of Care Foundation
Starting point 2
Every product /service has 3 elements
3
(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
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.
8©The Point of Care Foundation
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
10
9©The Point of Care Foundation Using patient experience to redesign healthcare services
Empathy is normally distributed in the population
11
10©The Point of Care Foundation
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:
12
12©The Point of Care Foundation
• Simulation
• Experience based co-design
• Shadowing
• Participant observation
• Analogous scenarios
Empathy-by-design methods14
13©The Point of Care Foundation
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
15
14©The Point of Care Foundation
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
16
16
15©The Point of Care Foundation
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
17
17