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

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

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

4 © The Point of Care Foundation 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.

7 © The Point of Care Foundation Empathy

8 © The Point of Care Foundation The capacity for empathy 1.Cognitive: the capacity to understand another person’s feelings 2.Affective: the capacity to respond appropriately to another person’s feelings Our capacity for empathy has two distinct aspects 10

9 © The Point of Care FoundationUsing patient experience to redesign healthcare services Empathy is normally distributed in the population 11

10 © The Point of Care Foundation When empathy is switched off, we are in ‘I’ mode and we all switch off sometimes 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 We are more likely to switch off when we are: 12

11 © The Point of Care Foundation Designing empathy in

12 © The Point of Care Foundation Simulation Experience based co-design Shadowing Participant observation Analogous scenarios Empathy-by-design methods 14

13 © The Point of Care Foundation Challenges to empathy-by-design 1.Scalability Deliberate effort required to expose the wider team to ‘out of ego’ experiences Simulations 2.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 Designers recognise two distinct problems 15

14 © The Point of Care Foundation Enabling conditions: for individuals 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 To enhance cognitive and affective capacity 16

15 © The Point of Care Foundation Enabling conditions: environment of care 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

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