Do We Have to Choose Between Quality and Compassion?

Blog post for Creating Human Work Environments
November 10, 2012

View article at Creating Human Work Environments 

There are many trends in health care these days, two of which focus on quality and compassion within the system. One can even speak of a Quality Revolution, given the strong emphasis this concept is currently receiving. Quality focuses on issues such as efficiency, safety, evidence-based medicine, decreasing treatment variability, and cost-containment. Quality is a growing focus in both the UK and the US:

“Health Care Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which health care providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice,” (Mary Ann Bailey, (UK), The Hastings Centre).

Reports on quality issued by the Institute of Medicine:
Crossing the Quality Chasm: A New Health System for the 21st Century (2001)
To Err is Human: Building a Safer Health System (1999)

Influential organizations concerned with quality include:
Ko Awatea (in New Zealand)
Institute for Healthcare Improvement
The Hastings Center

We could say that there is a Compassion Revolution occurring also. Compassion encompasses mindfulness, promoting human relationships, healing, recovery, patient empowerment, collaborative models of care, and patient-centered care. The growing interest of clients and professionals in holistic and integrative medicine can also be seen as partly driven by the motivation to enhance compassion in health care. Some leaders in the Compassion Revolution include:

Robin Youngson (New Zealand) who has written a book called Time to Care, and created the organization, Hearts In Healthcare, Parker Palmer (US) whose book, The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life, has led to the creation of The Center for Courage and Renewal which is running its 2nd Annual Health Care Institute, Integrity in Health Care: The Courage to Lead in a Changing Landscape in 2013. 
ALIA Institute (Authentic Leadership In Action) (Canada): is an organization that promotes mindfulness-based leadership, and it grows out of the Shambhala organization. In 2011 they ran a program called, Leaders In Health.
Physician Heal Thyself
Heal Thy Practice

It could seem that these are two different revolutions going on at the same time and that only one can “win.” We could emphasize quality instead of compassion, but we then end up with a doctor-patient relationship that is formulaic, technical, and more focused on cost-saving than care-giving (some may say we are already at this point). Doctors would become interchangeable technicians and patients would become passive recipients of care (“docile bodies” to quote Foucault). We could emphasize compassion over quality, but this doesn’t seem to be a desirable outcome either, to have health care professionals who are kind and nurturing, but incompetent and unsafe.

Do we have to choose between having quality or compassion in health care?

We could identify compassion as a variable of quality in health care, but how can we make sure that compassion would remain more than just a window-dressing variable? For instance with the biopsychosocial model of health, the psychosocial aspects are often considered not as important as the biological dimension in teaching and practice. So often in medicine, money and numbers trump more humanistic values. How do we create a model of health and illness and a health care delivery system that values both quality and compassion?

In terms of the identity of the physician, this tension manifests itself in the forces arguing that physicians should be technicians limited to evidence-based and protocol-based interactions or healers who spend time with patients at a human level and creatively pursue various treatments. The concept of there being two important aspects of medicine, the art of medicine and the science of medicine, seemed to co-exist peacefully for some time, although now there seems to be a rift between evidence-based quality and compassion-based focus on human relationship and multi-modal approaches. Science and economics threaten to push the art of medicine and humanitarianism into the background.

Is there some way to unite these two seemingly different revolutions? Could we have health care that is compassionate, safe and efficacious? How could this be done? These are the kind of questions that this blog, Creating Human Work Environments, would like to explore.

David KopaczArticles