Beyond Resilience and Burnout: The Need for Organizational Change to Promote Humanistic Practice and Teaching in Healthcare

Rapid changes in healthcare organization and practice environments, increasingly driven by business models and commercial interests, are associated with widespread burnout and dissatisfaction among healthcare professionals and pose barriers to humanistic relationship-centered quality care. Studies show burnout and significant stress currently affect over half of US physicians and nurses. Clinicians’ ability to provide compassionate care is significantly challenged. Most solutions to date have included individual interventions designed to enhance well-being and promote resilience. We examined organizational factors that inhibit or promote humanistic practice by faculty physicians in today’s healthcare environment. In this qualitative study, physician faculty who completed a one-year faculty development program in humanism at eight US academic medical centers provided written answers to two open-ended questions: a) What institutional or specific organizational unit-related factors promote humanism for you and others? b) What institutional or specific organizational unit-related factors inhibit or pose barriers, to humanism for you and others? 74% (68/92) of the physicians participated. The constant comparative method was used to analyze responses. We found that organizational culture was the central theme. Motivators of humanism included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities promoting humanism, and practice structures that facilitate humanism. Factors that inhibited humanism included “top down” organizational culture, non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures. Our findings suggest that organizational culture is, at a minimum, equally important as individual interventions. We describe features of organizational culture that reinforce humanistic practice and care in healthcare institutions and offer recommendations for organizational change that support the primacy of humanistic, compassionate, high quality patient care. 

The International Charter for Human Values in Healthcare: An interprofessional global collaboration to enhance values and communication in healthcare

Objectives: The human dimensions of healthcare—core values and skilled communication necessary for every healthcare interaction—are fundamental to compassionate, ethical, and safe relationship-centered care. The objectives of this paper are to: describe the development of the International Charter for Human Values in Healthcare which delineates core values, articulate the role of skilled communication in enacting these values, and provide examples showing translation of the Charter’s values into action. Methods: We describe development of the Charter using combined qualitative research methods and the international, interprofessional collaboration of institutions and individuals worldwide. Results: We identified five fundamental categories of human values for every healthcare interaction—Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare—and delineated subvalues within each category. We have disseminated the Charter internationally and incorporated it into education/training. Diverse healthcare partners have joined in this work. Conclusion: We chronicle the development and dissemination of the International Charter for Human Values in Healthcare, the role of skilled communication in demonstrating values, and provide examples of educational and clinical programs integrating these values. Practice implications: The Charter identifies and promotes core values clinicians and educators can demonstrate through skilled communication and use to advance humanistic educational programs and practice

Risk Tolerance, Self-Interest, and Social Preferences

We use an experimental method to investigate whether systematic relationships exist across distinct aspects of individual preferences: risk aversion in monetary outcomes, altruism in a twoperson context, and social preferences in a larger group context. Individual preferences across these three contexts are measured, and there is no possibility for risk sharing, wealth effects, or updating expectations of the population choices. We find that social preferences are related to demographic variables, including years of education, gender, and age. Perhaps most importantly, self allocation in a two-person dictator game is related to social preferences in a group context. Participants who are more generous in a dictator game are more likely to vote against their selfinterest in a group decision-making task which we interpret to be expressions of social preferences

Modules for basic nursing skills-2, ed. 6/ Ellis

xiv, 694 hal.: ill.; 27 c

“Most people lack capacity here”. The ethical and methodological challenges of conducting research in care homes for older adults

Recent figures suggest that in excess of 80% of care home residents have dementia or significant memory problems (Alzheimer’s Society, 2013), presenting researchers with significant challenges when designing and conducting research in these settings. Whilst not everyone included in this figure will necessary fall under the remit of the Mental Capacity Act, any research planning to take an inclusive approach will have to: (1) justify the inclusion of people who might lack capacity to give their own consent and (2) address the ethical and methodological challenges that this presents. This paper reflects on our own experiences of conducting research in care homes for older people and reports on the challenges we have faced over the last year, as well as the strategies we have adopted to overcome them. We begin by considering the frequently used term “they lack capacity” and relate this back to the Mental Capacity Act and how it is implemented by Research Ethics Committees. After considering the ethical issues, we move on to discuss the practicalities of complying with the requirements of the Act in a care home environment. We share our own experiences of involving ‘consultees’ and discuss the burden this places on care home staff and the implications this has for the design of future research

Using ASCOT to inform care practice

The Adult Social Care Outcomes toolkit (ASCOT) began as a set of research instruments to measure the impact and value of social care interventions by concentrating upon the social care related quality of life of individuals who use social care interventions. This presentation explores the potential to use the ASCOT tools not just to measure social care related quality of life, but to inform improvements in care practice. It focuses primarily upon the care homes version of ASCOT (CH3) which uses mixed methods to measure care home residents’ social care related quality of life. These mixed methods include interviews with residents and staffs as well as detailed observations which provide rich data upon the ‘lived experience’ of residents. It is this very rich data that, we argue, allows the care homes version to have the greatest potential to inform and improve care practice. The presentation also considers how the other versions of ASCOT, namely a structured interview and a self-completion questionnaire, may also feed into informing and improving care practice