Introduction to the symposium--humanism in healthcare management.
Subject: Health care industry (Conferences, meetings and seminars)
Humanism (Conferences, meetings and seminars)
Authors: Graber, David R.
Kilpatrick, Anne Osborne
Pub Date: 03/22/2009
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2009 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Spring, 2009 Source Volume: 31 Source Issue: 4
Topic: Computer Subject: Health care industry
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 250033752
Full Text: In the last century and in recent years, the healthcare environment in this country seemed to descend into an abyss of officiousness and impersonality, lacking the human warmth and caring that should be integral to the delivery of healthcare. Although most American healthcare organizations succeeded in extirpating humanism from their environments, they continued to extol and publicize their "caring cultures" in mission statements or on their websites. The paradox is that while healthcare organizational leaders know that they should have and are expected to have caring and supportive cultures, they have not acted to move their organizations in that direction. The explanation for this paradox is perhaps only slightly overstated in La Rochefoucauld's (1664) maxim that "hypocrisy is the homage vice pays to virtue." Nevertheless, in spite of the relative paucity of humanistic healthcare organizations, there have always been leaders and clinicians who have manifested and valued the human side of health care, and who have also maintained a focus on providing quality care and managing efficient, successful, healthcare organizations. The problem is that these individuals have not been in the majority, or have not possessed the influence to uplift their total organizational cultures.

Healthcare managers and organizations have often overlooked the human dimension of care, and focused on processes and programs that contribute to efficiency, financial success, technical achievements, and clinical excellence. As important as these aspects of healthcare management are, human beings who are disabled, fearful and in pain, need empathic and compassionate care. The personal dimension of healthcare is of paramount importance and deserves the equal attention of healthcare managers.

This symposium in the Journal of Health and Human Services Administration addresses humanism in healthcare management. The term humanism may not be a perfect for describing the nature of caring and people-centered organizations. Yet, it is one which subsumes and includes an array of positive behaviors and qualities on the part of clinicians and organizations, and it indicates a broader conceptualization of how patients should be served than other terms in common use. In our view, humanism in healthcare is a professional and organizational way of life that focuses on patient and family needs and interests, through quality healthcare, empathy, advocacy, and dedication to serving others. The goal of humanistic healthcare management is to instill and embed humanistic healthcare as a way of life in the hearts and minds of organizational members. More broadly, humanism in healthcare management may be said to involve concern and caring for 1) patients and their families, 2) members of the organization, and 3) the community.

An exemplary healthcare organization will have a strong focus on delivering quality healthcare. The organization will also exhibit caring toward its clients in empathic and compassionate clinical care, and through fostering positive interpersonal relationships between patients and all members of the organization. Humanism, therefore, acknowledges that the patient is a complex human being, whose health requires more than good clinical care. To express this in nonacademic terms, patients and their families want attention, respect, and love. They have important things to say about their lives and their conditions, and would like to be heard.

Recognizing the need for change, a number of healthcare organizations have initiated programs to foster at least some of the elements of humanism. The goal of this symposium is to address the need for greater humanism in healthcare management and to provide healthcare and human services managers with information about how to implement and sustain programs that ultimately will result in vibrant and permanent humanistic cultures.

One focus of this symposium issue of the Journal of Health and Human Services Administration is humanistic healthcare in hospitals and long-term care settings. Another focus of the symposium is to identify how organizational leaders and managers can create and instill a humanistic culture and implement successful humanistic programs in their organizations. This symposium also addresses leadership in nursing and other clinical care settings, and programs to foster humanism and caring in clinical education.

Mohammadreza Hojat has extensively studied empathy in health care and published a comprehensive text on this topic: Empathy in Patient Care: Antecedents, Measurement, Development, and Outcomes (2007). Although it is not possible in this Introduction to describe this book, in it and in his article in this symposium, Hojat cites a number of studies that support the relevance of empathic care to healthcare management. His paper, Ten Approaches for Enhancing Empathy in Health and Human Services Cultures, notes that empathic care has been shown to be related to patient satisfaction, better compliance, lower rates of malpractice litigation, less physician burnout, and reduced healthcare costs. Certainly, it is in the interest of healthcare managers to seriously consider creating empathic, humanistic healthcare cultures.

In this symposium, Hojat describes 10 interventions that may be employed to increase empathy among clinicians: improving interpersonal skills, audio- or videotaping patient encounters, exposure to role models, roleplaying, patient shadowing, actual experience of hospitalization, study of literature and the arts, improving narrative skills, theatrical performances, and use of the Balint Method (Balint, 1957). Healthcare managers can implement many of the programs suggested by Hojat, to enhance humanism among their clinical staff and physicians. It is important to note that these programs may also be employed in training health and human services managers.

Humanism in management and leadership has been extensively addressed in the management literature. However, the primary focus has been on involvement and attention to the needs of employees, and less on the customer. Humanism in healthcare might be said to involve patients, employees, and the community, so the scope and relevance of humanism may be much greater in healthcare than in other industries. It also should be easier to implement because of the healthcare mission. In The Healthcare Leader as Humanist, Anne Osborne Kilpatrick describes a number of leadership models and considers their relevance to healthcare. Kilpatrick notes that effective humanistic, healthcare leadership involves two major accomplishments. One is creating a positive human relations culture where employees are engaged and feel valued. Secondly, management has a clear role in creating and supporting programs that are specifically targeted to increasing caring and compassion among clinicians and all staff members.

Jean Watson has long been known as a pioneer and an advocate for returning caring and humanism to nursing. Her 1989 book, coauthored with Em Bevis, Toward a Caring Curriculum: a New Pedagogy for Nursing, and her theory of human caring have both been enormously influential in nursing education and practice. A key underlying theme in Watson's work and her paper in this symposium is that nurses find meaning, fulfillment, and validation of their professional lives through embracing a caring/healing ethic.

In her article, Caring Science and Human Caring Theory: Transforming Personal/Professional Practices of Nursing and Health Care, Watson describes the International Caritas Consortium. Participating organizations convene twice a year to deepen and sustain Caritas Nursing, which seeks to bring caring, love, and heart-centered human-to-human practices back into the experience of nursing.

Caritas Nursing is an example of an organizational culture change to instill humanism into care: one that health and human service managers can help implement and support and one that can have only positive repercussions for the organization. Perceptive healthcare managers should realize that they can develop positive patient and community relations by fostering a motivated clinician workforce and a culture of caring and humanism. As Watson states in her paper, caring and economics can coexist for the organization's cost benefit and cost effectiveness.

Nicholas Castle, Kevin Hughes, and Jamie Ferguson consider the role of nursing home managers in Humanism in Nursing Homes, the Impact of Top Management. Their paper discusses the capacity of administrators and nursing directors to provide humanistic leadership in the face of a demanding regulatory environment, and with numerous other essential management responsibilities. The paper also describes a number of new models of nursing home care, such as the Eden Alternative, the Wellspring Institute, and resident-focused initiatives. Few would argue that American nursing homes are not in need of major changes in their living arrangements and in the interpersonal dimension of care. However, by implementing models such as those described by Castle and colleagues, a few innovative facilities have already created environments and patterns of care that have little resemblance to those of traditional nursing homes.

The paper by David Graber, Organizational and Individual Perspectives on Caring in Hospitals, describes some of the pioneer individuals and organizations who have supported or created humanistic, healing cultures in hospitals. In addition to discussing what organizations have done and can do to promote a humanistic environment, the paper also considers the role of individual clinicians in hospitals, such as physicians, nurses, therapists, and nursing assistants. The results of a study by Graber and Mitcham (2004) are presented to provide insight on what exemplary, caring clinicians do, in their interactions with patients. This includes the nature of their relationships with patients and how they express caring and compassion in the midst of busy schedules.

As we begin the twenty-first century, the human side of care is becoming more and more expected and valued by patients and their families. Healthcare organizations, particularly hospitals, are increasingly seeking to improve patient satisfaction scores. The interests of people and healthcare organizations are beginning to coincide, as healthcare organizations realize the value of compassionate, humanistic care. The editors hope that this symposium issue will provide both theoretical and practical information to assist healthcare leaders in developing successful, caring organizations.

REFERENCES

Balint, M. (1957). The doctor, his patient and the illness. New York: International University Press.

Bevis, E., & Watson, J. (1989) Toward a caring curriculum: a new pedagogy for nursing. New York: National League for Nursing.

Hojat, M. (2007). Empathy in patient care: antecedents, measurement, development, and outcomes. New York: Springer Press.

Graber, D., & Mitcham, M. (2004). Compassionate clinicians: taking patient care beyond the ordinary. Holistic Nursing Practice, 18:(2), 87-94.

La Rochefoucauld.(1664). Sentences et maxims de morale. The Netherlands. Maxim 218.

DAVID R. GRABER

ANNE OSBORNE KILPATRICK

Medical University of South Carolina
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