Small things are big things: can empathy be designed into care? Jocelyn Cornwell The Point of Care Foundation May 2014

Dartmouth Institute for Health Policy and Practice Starting point 1 2 “Every system is perfectly designed to produce to produce the results it gets.” Paul Batalden M.D Dartmouth Institute for Health Policy and Practice

How well it does the job, whether it’s fit for purpose. Starting point 2 3 Every product /service has 3 elements (P) PERFORMANCE How well it does the job, whether it’s fit for purpose. Functionality (A) AESTHETICS How it feels. How it is experienced. Usability (E) ENGINEERING Whether it is safe & reliable. Safety

The aesthetics of care: small things are big things

Example: a daughter’s story Overall, my mother received the best care from staff who have treated and respected her as a person, rather than stereotyping her as an elderly person who’s not capable of thinking and doing things for herself.

Example (contd.) Throughout her time in hospital, staff continually called my mother by the wrong name. She has been called Harriet all her life but it is her middle name, so her first name is written on all her records. We drew this to the attention of staff on the ward; it was important especially as she was suffering from episodes of confusion, but it did not stop. Everyday someone from the family would visit her and wipe the wrong name off the whiteboard. On one occasion, after tracking down a registrar responsible for her care, we explained the situation and he wrote “likes to be called Harriet” in big letters on the front of her notes but it still had little effect.  

Empathy

The capacity for empathy 10 Our capacity for empathy has two distinct aspects Cognitive: the capacity to understand another person’s feelings Affective: the capacity to respond appropriately to another person’s feelings

Empathy is normally distributed in the population 11 Using patient experience to redesign healthcare services

When empathy is switched off, we are in ‘I’ mode and we all switch off sometimes 12 We are more likely to switch off when we are: Tired, stressed or burned out Under pressure to do something else Interacting with a person who is ‘unpopular’ for whatever reason Highly emotional - angry, frustrated, distressed or frightened Working with digital equipment

Designing empathy in

Empathy-by-design methods 14 Simulation Experience based co-design Shadowing Participant observation Analogous scenarios

Challenges to empathy-by-design 15 Designers recognise two distinct problems Scalability Deliberate effort required to expose the wider team to ‘out of ego’ experiences Simulations Sustainability It is not enough for a small team to have transformative experience One off whole system events don’t work All involved need to be intrinsically motivated Stories, artefacts (videos, animations, photos) Cultural change

Enabling conditions: for individuals 16 To enhance cognitive and affective capacity Stories what happens later to individual patients? patient’s biography - handover, ward rounds (This is me!) See with their eyes: shadow patients/ observe care Look after your self: self care, reflection, resilience Build/train confidence in own capability 16

Enabling conditions: environment of care 17 Cultural norms Express shared values in plain English Reject language that objectifies patients Intolerance of rude and unkind acts Express priorities in human terms Management and team working Train supervisors and hybrid managers to manage others Create opportunities for reflection (Schwartz Rounds and others) Support systematic, frequent feedback from patients Systems support Good IT and patient records Actively manage balance demand v. resources 17

www.pointofcareoundation.org.uk Thank you