‘We talk about the federal deficit, but we don’t talk enough about the empathy deficit’ said Barack Obama when he was running for President 8 years ago. He was lamenting the decline in compassion and understanding in American public life, but his prescription was relevant to societies everywhere: ‘we are in great need of people being able to stand in somebody else’s shoes and see the world through their eyes.’
Health care is one area of life where empathy really matters, which is why we’ve made it the focus of this month’s newsletter. At different times, doctors, nurses, patients, managers, carers, citizens and policymakers all need to be able to stand in each other’s shoes and see the world through each other’s eyes. A doctor needs to understand a patient’s concerns when explaining treatment options. A patient needs to understand why an A&E triage nurse has to prioritise cases. A manager needs to understand how their operational decisions will make clinicians feel.
But financial, staffing and access pressures can make empathy harder. And for the NHS – a service founded on the ideal of social solidarity, which relies heavily on the public service motivation of its workforce, and which owes its existence to continued public support – this matters a lot.
The importance of empathy in delivering health care has been known for a long time. A wide range of evidence points to the fact that doctors and nurses who are empathetic tend to provide better care. Studies also suggest that being treated with dignity and respect matters more for patient satisfaction even than pain control. At a time when health care is being transformed by technology and automation, such findings remind us just how important the human factor will remain.
But it also matters that people have empathy for those who work in the health service: society has a duty of care to those who care for us. A case in point would be the shocking levels of bullying or abuse that many who work in the NHS face – highlighted in our recent analysis of the English NHS Staff Survey. Over a third of nurses report being subject to bullying, harassment or abuse from patients or their relatives last year, while for those working in ambulance services the figure was nearly half. One-in-four of the NHS workforce report suffering bullying or abuse from other colleagues too. And this comes on top of high levels of work-related stress, signs of low morale across the service, and severe staff shortages.
A turbo-boost on empathy is the goal of our A Mile in My Shoes exhibition, profiled in this month’s newsletter. In collaboration with the Empathy Museum, the Health Foundation has recorded the everyday stories of people who work across our health and care system, and the exhibition challenges others to listen to them and walk a mile in their shoes. Could you help a family come to terms with their recently deceased loved one’s request to be an organ donor? Or manage the daily 8am telephone onslaught in a GP surgery’s reception?
We need those who govern our health service to be empathetic too, which is why we decided to take A Mile in My Shoes to Parliament last month. These accounts from the front line help shine a powerful light on pressures on the ground – a real testament to the power of storytelling. The demoralised junior doctor who’s considering leaving the country. The home care worker worried about the decline in the social care workforce. The hospital finance manager who tells us it’s simply not possible to provide the services we all want at current funding levels.
Just how empathetic we want our leaders and politicians to be is an interesting question: while we don’t want them to be heartless, we do want them to be objective and take tough decisions. The debate in political science revolves around different types of empathy. ‘Emotional empathy’ (feeling someone’s pain) is important but can’t by itself be the basis of moral judgements because it biases us towards those who are visible. ‘Cognitive empathy’ (understanding the perspectives of others), on the other hand, appears fundamental for good decision-making – and history is certainly littered with policies that failed because those making decisions were too remote from the reality on the ground. Who knows, might the vast NHS reorganisation created by the Health and Social Care Act 2012 have looked a bit different – and attracted less opposition across the NHS – if it had been grounded more firmly in the perspectives of those working on the front line?
Empathy has limits for health care professionals too. We want the doctor to understand how we feel, but we don’t necessarily want them to cry when we cry, and we certainly want them to remain cool in emergencies. And such are the situations health care professionals have to confront on a daily basis – pain, suffering and death – that few could survive without a degree of professional detachment. These psychological burdens of care can be a major factor in staff ‘burnout’, which in turn can make it harder to be empathetic.
The NHS is in for another rough few years. Funding and staffing shortfalls, rising demand from an ageing population, the need to reshape services to meet new care needs and the uncertainty caused by Brexit are putting immense pressure on the service. Getting through it will rely to a large extent on the wellbeing, resilience and professionalism of the NHS workforce. And that will make tackling the ‘empathy deficit’, as Obama put it, more important than ever.
To explore the audio stories online, visit: listen.health.org.uk.
Tim Horton and Tom Hardie explore empathy and person-centredness in the context of technology and AI...