Many of us have witnessed changes in the last 40 years to improve cultural diversity and sensitivity in  the workplace. In many organizations, training is provided to learn about other cultures, obtain a baseline of knowledge and gain a general acceptance of differences.

As we move from just accepting our differences to acknowledging and embracing our differences, we build our own cultural competency. Cultural competence emphasizes the idea of effectively operating in different cultural contexts and altering practices to reach different cultural groups. We learn new patterns of behavior and we apply them to the appropriate setting.  Sometimes we are successful, sometimes we make mistakes. But rather than just accept, we continue to attempt to reach out and truly connect.

In the healthcare setting, healthcare providers, come from a position of power. Healthcare providers can have power over the healing process including medications, activities of daily living, meals, family, and pain.  But how do we reduce the power imbalance to obtain the therapeutic alliance, the bond of trust that allows us to learn from the patient and family, improve communication, compliance and outcomes? How do we reduce or eliminate possible cultural power imbalances between each other that may inhibit the team delivery of compassionate, quality care?

As defined by Tervalon and Murray – Garcia, Cultural Humility is the lifelong commitment to self-evaluation and self-critique to develop beneficial and non-paternalistic relationships.  Each of us is a unique intersection of various aspects of culture. There may be norms but there are variations of the norm, therefore a checklist of required elements identified with a culture will not create a culturally competent individual.

Through humility, we accept our humanity and relate to others free of pride, power and arrogance. Through humility, we accept that is impossible to learn all cultures, we cannot know everything but we become familiar, that knowledge of culture does not create mastery and standardization of practices and that perceived mastery can lead to miscommunication or mismanagement of care.

We do not live in a culture-free world. Every day we are exposed to variations of culture in our families,  our friends, co-workers and patients. Our very humanity continually involves and is influenced by other cultures including our clothing, food, entertainment, and healthcare among other domains of life.

What can we do each day to approach life with love, an open heart to create connections built on a foundation of cultural humility, caring and respect?

Ask questions in a humble, safe manner

Seek Self-Awareness

Suspend Judgment

Express kindness and compassion

Support a safe and welcoming environment

Many healthcare organizations are currently focusing on hiring for care, concern and compassion, especially now that the CMS is targeting patient satisfaction as a key quality indicator related to reimbursement. I know we all want to bring in those individuals with true service orientation and heartfelt empathy. Above and beyond reimbursement, our patients and families deserve respect, care, concern and compassion.

Although I am a firm believer that compassion and empathy can be learned and hard-wired, I do understand that everyone experiences varying degrees of empathy. For some individuals, the learning curve for moving empathy to a compassionate response is much higher.

Healthcare organizations do not always have the means and capacity to start developing empathy from scratch with new hires, regardless if they are direct or non-direct care positions, therefore, compassion and empathy are essential and must be evaluated in the interview process. Once we have empathy and compassion on board in the organization, we can support the patient experience with service scripts and use personal empathy and compassion to build a connection with the patient.

So how do we explore compassion in an interview?

Certainly candidates can tell us good, detailed stories in response to a behavioral interview question,  but is the story authentic?  Does the story come from the heart? We have to determine that we are not just receiving a highly crafted story, but better, have they and can they demonstrate compassion even with the going gets tough.  As you move through the interview, do you see and feel the compassion and caring from the candidate?  Do they not only know what compassion is, but is it represented in their body language and their response to behavioral, situational and demonstrative interview questions?  Do they know how to connect with a patient through appropriate touch? For some positions, we may take the time to have candidates demonstrate a specific technical skill. Should we not do the same for something as critical as care and compassion?

You can readily teach a service script to a new employee and coach to hard-wire it into daily patient interactions. It can be much harder to teach them the innate internal warmth and satisfaction, the altruism of helping others. We must evaluate not just what is said, but how the words are supported through tone of voice, cadence, facial expressions, compassion “sounds”, body language and touch.

For a sample list of interview questions to explore compassion and empathy during your structured, interview process, please click here for a free download “10 Questions to Explore Compassion and Empathy in an Interview.”

“Courage is almost a contradiction in terms. It means a strong desire to live taking the form of readiness to die.”  

GK Chesterton

There’s a reason the universe sent me this quote even though I did not subscribe to the sender. It got me thinking about the types of situations in life when we need a bit of courage or even perhaps a lot of courage. Courage to get up every day after a loved one dies. Courage to share disagreement in a fruitful manner. Courage to be compassionate.

Yes I do believe sometimes it does take courage to be compassionate. We are greeted everyday with opportunities to demonstrate compassion. But sometimes we make excuses why we cannot be compassionate at that moment.  A small inner voice may say, “someone else will help” or “they don’t deserve compassion”, “I don’t have the time”, or  “others will ridicule me.”   We may need courage to slow down, be in the moment, be selfless and show compassion. We may need courage to be compassionate without criticism or judgment. And courage to be compassionate when we really don’t feel like it.

We may not think twice about being courageous and demonstrating compassion when it is truly a life or death situation. Perhaps the true courage to be compassionate is when we can easily turn our head, walk away, and ignore another’s suffering.

Customers have high expectations of excellence and sometimes we forget, especially during the holiday season, that there is a human being on the other side of the counter who wants to get her/his shopping done and spend time with their family just as much we do. Hmm, is it a consumer right to be rude, gnarly, impatient and difficult? Is it a patient right to be rude to the front office staff? How can we participate in instead of just receive great service?

For just one holiday moment, as a consumer, let’s give the spiritual gift of patience to the customer service representative who may have been on their feet for the last six hours, bagging merchandise and passing out change and receipts to a hundred faceless customers. Bring a gentle smile to the frowning medical representative who may be on his or her last nerve of seasonal illnesses flanked by holiday crazy. Take a moment and share a word of encouragement and a sincere, heartfelt, Merry Christmas, Happy Holidays or whatever greeting of loving kindness you choose to the service associates, regardless of the industry, who are working hard to help us through this holiday season. Be the gift.

One of our primary focuses on improving the patient experience has been providing tips and tools to script and standardize the dialogue and interaction between the caregiver and the patient. Therefore, we can script our way through registration, room admission, hourly rounding as well as daily tasks to care for the patient. It could be possible to regurgitate a script without ever looking at a patient and showing care, concern, empathy, kindness and encouragement through even a facial expression.

In one of my recent workshop discussions about being “in the moment” with a patient, one of the attendees shared what worked for her was being attentive enough to identify and recall the color of a patient’s eyes.  This focused activity helped her slow down and insure the patient saw the love in her face.

There are many barriers to practicing compassion in the workplace. Technology, time, push for efficiencies, communication styles, professional distance and power and organizational culture can all play a part in preventing compassionate interactions.

Can your staff define compassion?

Does your staff know the difference between compassion and service?

How do you “hard-wire” your brain for  empathy?

Do your patient interactions tend to be task – driven or focused on comfort?

How does the absence of compassion impact the perception of care and concern?

What can you do to be in the compassionate moment with the patient – to show the care, love, and concern you have for their well-being and comfort through the healing process?

Yes, being compassionate seems so easy at times – especially when you can visually see the person in pain and suffering. When the pain scale is obviously a 9.5 on a scale of 1 – 10. When we see videos of natural disasters such as our fires in Texas and floods in the Northeast. Extending compassion becomes much more difficult when we begin to wonder if a person deserves our compassion – that in some way they have not earned our compassion and thus we hold back on acts of kindness.

Compassion is not a reward. Yes, sometimes we have to triage our compassion for those that are suffering more, as in emergency situations. Healthcare providers must quickly analyze who receives treatment first, but ideally, no one goes without a compassionate connection. But, perhaps we don’t always see the emotional or physical pain scale measure of 1-7. Those pains of life that can make us uncomfortable yet we carry them, hide them, and show our best self so no one sees our suffering. Yet we do suffer. Each us. In different ways and measures. No one is a true zero always.

So just for today, let’s ask ourselves:

Do I find myself withholding compassion to others?

If so, why do I withhold compassion?

Am I comfortable extending compassion to those that I cannot see are in pain?

Does someone have to be a physical pain for me to feel compassion?

How can I open my heart to the invisible pain?

eBook – $7.99

(PDF, ePub, and Kindle)

Hard Cover – $12.95

Practical tips and encouragement for caregivers of terminally ill loved ones.

No matter what your knowledge base, caring for a parent with a terminal condition is a solemn, courageous, loving yet chaotic journey. Caring for two parents who are on separate paths to eternity can be doubly painful. Managing the End…Bridging the Beginning is a caregiver’s guide based on the author’s own family experience with caring for her mother during the last year of her life and her father’s rapid decline after a 10 year battle with his own chronic condition.

Weaving a soulful and heartfelt story and offering over 90 practical tips and words of encouragement, Lisa draws not only from her experience caring for both parents but also her professional experience to support the caregiver in experiencing life’s natural journey of the dying process, grieving and rejoining life as what she joyfully calls “a leave-behind.”

Subjects addressed in the book include:

• Practicing “TCOY”
• Managing difficult conversations with the loved one
• Proactively managing work responsibilities
• Practical tips for managing estate matters
• Tips for family and friends of caregivers who are supporting the experience.

Through sharing her story, Lisa hopes to bring encouragement to caregivers, guidance for a peaceful end, comfort during grief, and strength for a new beginning.

This book is sold by BookLocker.

I was passively listening to a television interview with a recent Biggest Loser winner. When asked what kept her motivated and inspired to lose more than 125 pounds she said, “When I saw the love and compassion in the face of my trainer, I knew I could do this.” As Larry Dossey states in his article Bedside Manner: A Case for Compassion, “Compassion can be conveyed in moments; it is not proportional to time.”

As we teach our scripting and process flows, do we include the power of a compassionate expression? Do our patients see the love and compassion or do they just hear the care and concern? Or, do they just hear the script? Do our colleagues and subordinates see and hear empathy, compassion, care and concern? How is your internal compassion enlightening your message of care and concern?

For one moment once a day, share a compassionate expression with someone you know, someone you don’t, someone who is kind and helpful to you, and someone who is not. And yourself. Let us not discount the power of a moment of compassionate expression.

I’m not the best about my internal memory lists – hence, we drove 35 miles on Sunday to go bike riding in the country and I left my helmet at home. I’m also not wild about relearning the alphabet at almost 51, so, quickly back to the house, I picked up the helmet, and we were off to a new destination – and a written list for this activity. As many times as I ride, I can’t believe I left the helmet but honestly, rather than wrack my brain trying to remember everything for a bike trip, a short list would suffice to prevent this error from occurring again.

In the Checklist Manifesto, Atul Gawande, shares his experience and insight into the application of checklists in the healthcare environment to improve patient safety and efficiency. In addition, there are additional potential outcomes in regards to cost-savings from duplication of efforts, tests, etc. An interesting by-product of the checklist is the significant increase in communication and perception of teamwork within the groups effectively using a checklist.

An historical discipline used in other industries including the airline and architectural industries for safety and project management, Gawande proposes the checklist is the key to taming a high-tech world – a world in which our information doubles every year. That’s a lot of data to digest and assimilate!

Gawande creates the distinction between errors in ignorance (lack of knowledge) and errors in ineptitude (poor utilization of knowledge.) For some, it may be humiliating to use a checklist – to potentially admit a human mind cannot store the vast number of processes and complex problem solving required on a required basis. But it happens in our personal life as much as it does in the HR, Risk Management, Finance Department, the OR, on a med-surg unit or ICU.

So what does this have to do with compassion?

Perhaps as we create and fine-tune our checklists for patient safety, quality and efficiency, we add one more little “to do.” Personally and empathetically communicate care, concern, comfort and encouragement to the patient. Check. Complete.

 Experiencing our own pain or suffering may be easy. Experiencing and responding to other’s pain may be challenging. Our “others” in the world are a combination of individuals who are close to us and who we love and cherish, those who love and cherish us back, strangers who we have not created a judgment call on so therefore are neutral, and those who we have hurt us or who are challenging to connect with in a genuine, loving manner.

In our daily lives and activities, we come across our “others” from the moment we arouse. We may awake with our significant other, get our children ready for school, Skype our in-laws to check on them, chase the garbage collectors on the street to come back and pick up one more bag, drive to work and avoid a near collision, meet the tired, out-going shift at work, receive directives from our manager and so on through the day of interacting at some level with the “others.”

During the day we may greet others with a “Good Morning” or “Good Day” or sometimes “Hope you are having a fabulous day!” On emails we may sign off with “Best wishes”, “Many blessings” or “May you have wonderful Monday!”

What are we doing with these greetings and affirmations? We are doing more than just breaking the ice or bridging an uncomfortable moment. We are in essence practicing loving – kindness and wishing the best for that person.

To build our compassion, we can actively practice loving-kindness to promote positive affirmations and acknowledgement of our human interconnectedness. It’s generally easy to practice loving-kindness to those we love and are emotionally close to. It may be a bit more uncomfortable for some to practice loving-kindness to a difficult boss, a challenging, dramatic co-worker, or the postal worker who has left your package at your neighbor’s house for the third time.

So, a daily challenge. For one day, or maybe one hour, as you connect with others in the phone, email, on the road or at the checkout counter at the supermarket, shut off the judgment center of your brain that may determine who receives a loving-kindness thought and/or greeting. Intentionally share a deep, personal, verbal expression of loving-kindness to bring you, as Rick Hanson in Buddha’s Brain suggests, into the loving circle of “us.”

May you have a wonderful day!

Tweet