We agree with Drs. Ventres and McAuliffe that systemic change in medical education and practice is necessary to address the challenges of “power, prestige, and profit” that can work against institutional and organizational compassion and collaboration. The triple C “compassionate, collaborative care” is a necessary starting point to achieving systemic changes. The following suggestions and reflections highlight some approaches to the challenges of the “triple P.”
The first is to remember that humans are hardwired to experience compassion and to be motivated to relieve suffering. We admire initiatives that align the forces of power and prestige within an organization on behalf of compassion and collaboration, among other core values of health care professionals.
Second, successful “change” initiatives require engaging all stakeholders in articulating these core values and developing processes that enable their consistent demonstration in behaviors with patients, learners, peers, coworkers, educators, and leaders. These processes may include values-based employment, education/training, and codesign of education and practice, among others.1–3
Third, we take heart in a recent systematic review and meta-analysis of interventions to address physician burnout, an occupational condition which, by definition, impedes experiencing and offering compassion. The authors found that both individual-focused and structural or organizational strategies significantly reduced burnout among physicians.4 Both strategies are necessary.
Finally, whether initiating individual or organizational change, we remember Victor Frankl,5 a psychiatrist, neurologist, and concentration camp survivor, who asserted that no one could remove from a person the last of the human freedoms: to choose one’s attitude and to make decisions that offer us a sense of purpose and meaning in life.
Perhaps the place to begin humanizing health care is by choosing to be compassionate with ourselves and everyone we touch, while working together to create organizations and health care systems that truly represent the core values and purpose of all health care professionals.
Beth A. Lown, MD
Associate professor of medicine, Harvard Medical School, and medical director, The Schwartz Center for Compassionate Healthcare, Boston, Massachusetts; firstname.lastname@example.org.
Sharrie McIntosh, MHA
Vice president for programs, New York State Health Foundation, New York, New York.
Martha E. Gaines, JD, LLM
Distinguished clinical professor of law and director, Center for Patient Partnerships, University of Wisconsin Law School, Madison, Wisconsin.
Kathy McGuinn, MSN, RN, CPHQ
Director of interprofessional education and practice partnerships and special advisor for quality initiatives, American Association of Colleges of Nursing, Washington, DC.
David Hatem, MD
Codirector, Learning Communities, University of Massachusetts Medical School, Worcester, Massachusetts.
1. Lee VS, Miller T, Daniels C, Paine M, Gresh B, Betz AL. Creating the exceptional patient experience in one academic health system. Acad Med. 2016;91:338–344.
2. Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service. BMJ Qual Saf. 2016;25:509–517.
3. Suchman AL, Williamson PR, Litzelman DK, Frankel RM, Mossbarger DL, Inui TS; Relationship-Centered Care Initiative Discovery Team. Toward an informal curriculum that teaches professionalism. Transforming the social environment of a medical school. J Gen Intern Med. 2004;19(5 pt 2):501–504.
4. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis [published online ahead of print September 28, 2016]. Lancet. doi: 10.1016/S0140-6736(16)31279-X.
5. Frankl V. Man’s Search for Meaning. An Introduction to Logotherapy. 1992.4th ed. Boston, MA: Beacon Press.