5 points of light in the darkness of ‘healthcare’s moral emergency’

Western medicine is in a big-picture bind. Its present state has it often acting more like a high-tech patient-processing machine than a high-touch people-healing mission. 

As a result, its very purpose is in question. 

This can and must change, argue three distinguished healthcare thought leaders. 

“Industrial healthcare has become a system that offers care for people like you rather than cares for you,” the trio write in an opinion piece published May 20 in The BMJ. “Meanwhile clinicians across every system report spending the majority of their time not with patients but grappling with the administrative apparatus surrounding them, their attention and their energy drained before the clinical encounter even begins.”

The authors are quality-improvement authority Robert Klaber, MD, of Imperial College London, Harvard public-policy expert Donald Berwick, MD, and Mass General Brigham researcher Maureen Bisognano, MS. 

The latter two are emeritus presidents of the nonprofit Institute for Healthcare Improvement (IHI) in Boston. Berwick, in fact, co-founded the IHI and is a former CMS administrator and vice chair of the US Preventive Services Task Force.

In the concise commentary, Klaber and co-authors offer a guarded but hopeful prognosis for healthcare’s recovery from its largely self-inflicted ills. 

Here are five key excerpts. 
 

1. There are two lexicons in public policy: the rational—focused on measurement, efficiency and resource—and the relational—concerned with feelings, narrative and human connection.

Citing the work of British business guru and charity executive Julia Unwin, Klaber and co-authors state that the rational lexicon “has not been wrong, but it has crowded out the relational—and the consequences of that imbalance are now seen and felt everywhere.”

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‘Healthcare across the globe has lived almost entirely inside the rational lexicon for 30 years. There is an urgent need to re-establish the relational balance.’

2. Healthcare organizations in which staff feel supported, valued and engaged have consistently lower patient mortality rates. 

“Looking after patients requires looking after staff,” they write, quoting organizational psychologist Michael West. “The mechanism is not mysterious,” Klaber and colleagues add. “Clinicians who have joy in their work give more of themselves.” 

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‘The conditions for joyful practice—clarity of purpose, psychological safety, feeling that what matters to you is actually valued—are both achievable and measurable.’ 

3. Kindness should be repositioned from soft adjunct to being at the business end of delivering high quality care.

After all, this human attribute has been linked empirically to better staff retention, higher teamworking scores and improved patient outcomes, Klaber and co-authors point out. 

The “What matters to you?” movement uses those four simple words to define a complete philosophy of care, the authors state. “To ask what matters to a person is to see them as a person,” they add. “It shifts the encounter from the clinician’s diagnostic frame to the patient’s lived reality. It changes the balance of power from ‘I am taking care of you’ to ‘let us work together.’” 

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‘Michael West’s evidence on high-performing teams confirms what every experienced clinician knows: Psychological safety, deep listening, inclusive leadership and the courage to show compassion are not incidental to quality—they are quality.’  

4. The framework we already possess points the same way as this very evidence. 

The evolution from Triple Aim—improving the experience of care, improving the health of populations and reducing per capita costs of healthcare—to Quadruple and then to Quintuple Aim has reflected “a progressive moral recognition,” the authors observe. 

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‘Population health, patient experience and reduced cost cannot be achieved with a demoralized workforce—and cannot be achieved equitably without confronting structural disadvantage.’

5. The currents pulling healthcare away from its human dimension are structural, powerful and, in some parts of the world, accelerating. But they are not irreversible. 

“Every ward round, every clinical consultation, every leadership conversation is a small but powerful opportunity for all of us to balance relational practice with the rational systems and processes that surround us,” Klaber, Berwick and Bisognano write.

“The evidence is clear,” they conclude. “When healthcare systems invest in joy, kindness, compassionate leadership and asking a simple question—‘What matters to you?’—patients do better and staff thrive.” 

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‘We do not need to wait for system reform. We can begin now on our collective leadership challenge to reconnect healthcare with its mission and purpose.’