The prioritisation of economic values in the health care system may not be explicitly stated in PR material, but is felt by staff in every memo and scheduling and waitlist decision
Opinion: You may have heard that New Zealand health care is in crisis, with chronic staff shortages, those still working in health care enduring long shifts and massive workloads, leading to staff burnout, increased staff turnover and compromised patient care.
We can assume that compassion – a caring response motivated by the desire to alleviate the suffering of others that is both mandated by health care codes of practice and which promotes better outcomes for patients and health care professionals – is increasingly difficult to sustain in a modern health care environment.
To combat this critical challenge, we have to look back as well as forwards. The problems in modern health care are entrenched and systemic, with roots stretching back to the neoliberal reforms of the 80s and 90s. Covid-19 has compounded matters. How did New Zealand turn one of the world’s premier public health systems into a work environment that is so fraught and stressful that many staff are either circling the drain or going down it?
Ultimately, like many of our social and economic problems, we did this to ourselves. Rather than caring for patients and the workers that care for them, health care organisations responded to the challenges that faced them by becoming progressively more fiscal, relying on corporatised solutions – cost-cutting, optimising “efficiencies”, staff “resiliency” training, and generations of key performance indicators – all designed to squeeze the last drops from the elusive health care dollar, and therefore health care workers.
The current state of health care would suggest this approach hasn’t helped. Yes we have shiny websites of health organisations with PR-vetted value and mission statements promoting their values of excellence, diversity, inclusiveness, and even compassion, but less evidence that such values are practised as well as they are promoted.
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Our team is aiming to shed light on how organisational environments affect compassion. Prior studies that have investigated compassion in health care have focused on how it fluctuates among doctors, mostly based on the premise that if we could “just find or train the right people” we would maintain clinician wellbeing and compassion in our health care workforce. Our approach is based on the premise that staff are drawn to health careers because they want to care for others, but that environmental factors make doing so difficult.
Rather than again rewriting mission statements to ‘virtue signal’ humanistic values, health care organisations should consider exactly how values such as compassion are reflected in their day-to-day organisational practices
Our internationally collaborative study of more than 1000 health care professionals, representing all 20 New Zealand DHBs and recently published in the influential Journal of Internal Medicine, showed that the values of staff and the values of organisations are vastly different, that the very values that motivate health care workers were consistently seen as less important to organisations.
In the eyes of their employees, health care organisations place a lower value on humanity, autonomy, and holistic care, but a greater value on control, authority, and financial considerations. Clinicians will tell you they knew this already, but documenting this discrepancy is crucial, if we want to begin to address our health care crisis.
Value discrepancies are likely to have serious costs for health care – “actual” costs, not just pesky human costs. Our study showed that value mismatches predicted a range of negative outcomes. For health care professionals, working in an environment that conflicted with their own values meant lower work satisfaction, greater burnout, higher absenteeism and a greater intention to retire early. Additionally, patients also suffered – value mismatches predicted a lower ability for health care workers to express compassion. In other words, caring in environments at odds with your values is hard and almost certainly costly.
It’s worth noting that health care websites and organisational mission statements rarely promote their economic values, trumpeting instead the importance of “compassion”, “manaakitanga” and “respect”. Yet organisational-performance targets – those chafing Key Performance Indicators (KPIs) our employers seem so enamoured of – reflect economic rather than humanistic values. The prioritisation of economic values may not be explicitly stated in communications and promotion materials, but they are felt by staff in every memo, every scheduling decision, every patient discharged to free up a bed and every waitlist decision. KPIs dominate the landscapes in which health care workers work and exert a profound influence on their behaviour, just like workers in any environment.
Although the origins and sustenance of compassion in health care are complex, our proposed solution is simple: rather than again rewriting mission statements to ‘virtue signal’ humanistic values, health care organisations should consider exactly how values such as compassion are reflected in their day-to-day organisational practices, procedures and protocols, and performance indicators, including patient outcomes.
Despite the ocean of data characterising modern health care, most organisations do not actually assess staff wellbeing or whether patients feel cared for. Although the cynic might suggest that health care organisations don’t seek ratings of compassion because they don’t really want to know the answer, we need to value compassion in health care in a concrete way.
If we actually value compassion, it needs to be prioritised in organisational metrics and performance indicators, not just words in mission statements, or something we assume should be carried in the hearts of its staff. Compassion is not currently a “carrot” in health care, but maybe it should be.
