Awtrey, Eli

Kanov, Jason

Lown, Beth A

Pestian, Teresa

Sinclair, Shane

Thienprayoon, Rachel

Winick, Naomi

English

University of Louisville

Compassion is recognized by scholars, spiritual leaders, healthcare researchers and patients as a salient ameliorator of suffering that transcends cultures, patient populations, special-ties, and healthcare sectors. Healthcare worker (HCW) suffering is frequently equated with burnout in the literature, but burn-out is a narrow lens through which to view the full range of challenging and painful HCW experiences; HCW suffering is inclusive of but more broadly focused than burnout. Further, the response to burnout and HCW suffering has largely placed the onus of change on the individual person, but it has become clear that HCW suffering must be approached and tackled as a systems issue, at the level of the organization and the individual healthcare unit [1, 2]. Only when we approach HCW suffering as a systems problem—which means that organizational lead-ers begin to systematically acknowledge and mitigate the myriad factors that contribute to suffering in HCWs—will we create the safest and healthiest environments for our patients, and pre-vent suffering and burnout in the HCWs. This approach defines organizational compassion for HCWs. HCWs habitually encounter deep human sufferingSuffering is distress experienced when physical, spiritual or existential pain or injury disrupts one’s basic personhood [3, 4]. Suffering is part of being human—and since organizations are collective entities populated by humans, suffering is ubiquitous in any workplace. Yet while healthcare aspires to provide care that is compassionate to patients, it has long been known as a particularly harmful context for healthcare workers (HCWs). For instance, HCWs are at risk of workplace violence [5], work-place bullying [6] and moral distress—the belief that they are doing something ethically wrong but are powerless to act differ-ently [7]. The very nature of healthcare is that HCWs habitually encounter deep human suffering which is in itself traumatiz-ing—and further traumatizing is that this suffering is embedded in social structures that worsen inequities in healthcare access and health outcomes. Critically, part of the “hidden curriculum” of medicine is the culture of silence and stigma in acknowledg-ing the distress engendered by healthcare work. As Dr. Adam Hill wrote, “A system of hoops and barriers detours suffering [HCWs] away from the help they desperately need...[And] when mental health conditions come too close to us, we tend to look away—or to look with pity, exclusion or shame” [8].HCW burnout during the COVID-19 pandemicFor these reasons and others, burnout was an epidemic in healthcare prior to the COVID-19 pandemic [9], and the pan-demic has only illuminated at scale the manifold difficulties and suffering experienced by the healthcare workforce. Burnout causes harm to HCWs (depression and substance use disorder [10, 11]), to patients (higher medical errors, poor quality care lower satisfaction [12, 13]) and to healthcare systems (greater patient harm, lower HCW productivity, higher HCW turnover, financial losses [13-15]).Two years into the COVID-19 pandemic, the US is experi-encing an exodus of burned-out HCWs. In fact, HCWs were so harmed during the COVID-19 pandemic that the $1.9 tril-lion national COVID-19 American Rescue Plan included $120 million to support HCW mental health and to help decrease burnout. This is why HCWs during COVID-19  have been com-pared to those first responders who died on September 11, 2001, in which the “enduring narrative of fearless heroes” continues to overshadow the lack of organizational consequences for sys-temic factors that contributed to their deaths [16].  JOURNAL OF WELLNESS1©JWellness 2022 Vol 3, (4)*Correspondence To: Rachel ThienprayoonEmail: Rachel.thienprayoon@cchmc.orgCopyright: © 2022 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Organizational Compassion: Ameliorating Healthcare Worker’s Suffering and BurnoutRachel Thienprayoon MD, MSCS1*, Shane Sinclair PhD2, Beth A. Lown MD3, Teresa Pestian MS4,  Eli Awtrey PhD5, Naomi Winick MD6, Jason Kanov PhD7Received Date: Jan 24, 2022 Accepted Date: March 19, 2022Publication Date: June 15, 2022EDITORIALhttps://doi.org/10.55504/2578-9333.1122Website: https://ir.library.louisville.edu/jwellness/Affiliations: 1Cincinnati Children's Hospital Medical Center, 2University of Calgary, 3The Schwartz Center for Compassionate Healthcare, 4University of Cincinnati, 5University of Cincinnati Lindner College of Busi-ness, 6University of Texas Southwestern Medical Center, 7Western Washington UniversityRecommended Citation: Thienprayoon, Rachel; Sinclair, Shane; Lown, Beth A.; Pestian, Teresa; Awtrey, Eli; Winick, Naomi; and Kanov, Jason (2022) "Organizational Compassion: Ameliorating Healthcare Worker’s Suffering and Burnout," Journal of Wellness: Vol. 3 : Iss. 4, Article 1.Organizational compassion in healthcareCompassion and burnout exist at opposite ends of the spectrum of human experience: whereas burnout includes emotional exhaustion, depersonalization, and low profession-al accomplishment, compassion means emotional engagement, connecting with another’s humanity, and a neuronally-medi-ated sense of reward from helping [1]. Compassion consists of recognizing suffering, emotionally connecting with the distress of the person suffering, and acting to lessen or alleviate the suf-fering [17]. The key feature of compassion that distinguishes it from similar states (e.g., kindness, empathy, or sympathy) is that it arises specifically in response to suffering and requires not simply a desire to act but action aimed at relieving suffer-ing [17]. Compassion is, by its very definition, ideally suited to directly prevent and alleviate individual and collective suffering.Organizational compassion in healthcare is demonstrating leadership behaviors (e.g., rewarding compassionate acts by employees) that help to result in a climate in which compas-sionate responses arise when suffering happens [18, 19]. More compassionate workplace relationships lead to individual and organizational benefits, including enhanced employee trust and commitment to the organization, better perceptions of leader-ship effectiveness, and improved organizational performance [19].Hospitals that embody these “compassion practices” are more likely to have higher ratings and higher likelihood of patients recommending them to others [20]. Still, our understanding of the positive potential of compassion in healthcare is limited by conceptualizing compassion only in response to suffer-ing.  Given the rampant and predictably recurring suffering in healthcare, an expanded view of compassion for HCWs that includes consideration of the prevention of suffering—partic-ularly avoidable suffering that workplaces themselves cause or exacerbate—is necessary [3]. Therefore, we propose this defini-tion for organizational compassion for HCWs: the proactive, systematic and continuous identification, alleviation, and pre-vention of all sources of workplace suffering. The difference between this and previous definitions of organizational com-passion is nuanced, but critical. Compassionate healthcare systems for prevention of HCW suffering While some researchers have described interventions to mitigate burnout, these efforts don’t always directly and com-passionately prevent HCW suffering. Sources of avoidable suffering must be targeted at the systems level, whereas the harm caused by sources of inherent or unavoidable suffering must be minimized [21]. Tools to measure both HCW suffering and HCW experiences of compassion must be developed, tested, validated, and disseminated. While there are tools to measure organizational compassion [22] and compassionate climate [23] at work, these tools were developed for use in the general population—not in HCWs. Yet the research behind these tools provides some insight into how organizational compassion may relate to other outcomes, such as post-traumatic healing [24] and employee well-being [22].Once HCW experiences of compassion at work can be mea-sured, we can then evaluate how those experiences relate to other HCW outcomes such as post-traumatic healing, engage-ment, burnout, resilience, and mental health issues, and thereby develop responsive interventions to improve those outcomes at scale. Leaders and unit managers must be taught about the impact of suffering in their teams, educated in how to evaluate unit-specific sources of distress, and be provided the resources to continuously and meaningfully intervene.Financial models must be created to understand how the cost of these interventions compare to that of the status quo. A 2019 analysis published in the Annals of Internal Medicine found that in the US, physician burnout had been estimated to cost $4.6 billion per year [14]. This figure does not include the cost of burnout in other healthcare workers and does not include the increase in burnout due to COVID-19. HCW suffering must be confronted as the safety emergency it is.  Preventing HCW suffering—and the burnout it engenders—is a far better strategy than waiting to treat it after it becomes a problem [1]. Patients also need and deserve the most compas-sionate care that we can provide. In order to develop systems that reliably enable clinicians to deliver this compassionate care to each patient, we must first focus our attention and resourc-es on the wellbeing of those working in healthcare. Only when organizational leaders systematically acknowledge, prevent, and mitigate the myriad factors that contribute to HCW suffering, will we build the truly sustainable healthcare workforce that the US desires and deserves.REFERENCES1. Lown BA, Shin A, Jones RN. Can organizational leaders sustain compassionate, patient-centered care and mitigate burnout? J Healthc Manag. 2019 Nov-Dec;64(6):398–412. https://doi.org/10.1097/JHM-D-18-00023 PMID:317255672. Montgomery A, Panagopoulou E, Esmail A, Richards T, Maslach C. Burnout in healthcare: the case for organ-isational change. BMJ. 2019 Jul;366:l4774. https://doi.org/10.1136/bmj.l4774 PMID:313629573. Kanov J. Why Suffering Matters! J Manage Inq. 2021;30(1):85-90. https://doi.org/10.1177/1056492620929766.4. Cassell EJ. 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Organizational Compassion: Ameliorating Healthcare Workers\u27 Suffering and Burnout

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Organizational Compassion: Ameliorating Healthcare Worker’s Suffering and Burnout

Organizational Compassion: Ameliorating Healthcare Worker’s Suffering and Burnout

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