In 2016, to provide an exceptional care experience built on trusting relationships for its 740,000 patients and 5,500 medical practice employees throughout the greater Boston area, Atrius Health implemented empathy forums.
Implementing empathy forums for a large organization takes an enormous amount of resources and time but is a worthwhile approach for improving patient care.
Leaders from clinical practice locations should co-facilitate with an Organizational Development & Learning or Human Resources consultant to lend credibility for the program with their colleagues.
Sessions should consist of multiple learning methodologies to keep them interactive and engaging.
This type of change takes time and repeated practice. While we held 90-minute in-person sessions with pre-work assignments, many people suggested that the forums be longer to cover more content.
Patients today assume that their clinicians know how to provide competent care. More important, most patients remember how their clinicians made them feel when they went to the doctor’s office for a visit. They want to know that providers are seeing things from the patient’s perspective and that they are cared for as human beings. Our learning about relationship-centered care, along with training from the Cleveland Clinic, indicated that clinical empathy can enhance patient satisfaction, increase adherence to treatment recommendations, reduce distress, and improve health outcomes.
Furthermore, the benefits of empathy expand beyond the clinician-patient relationship to daily work within our organization itself. When employees feel that their supervisors, co-workers, and leaders care about them as human beings, it can lead to reduced stress, greater teamwork, and enhanced employee engagement; this also has the potential to support the compassionate care we strive to provide our patients every day.
To facilitate practice-wide transformation to integrate empathy into our daily work, Atrius Health created forums for our medical practice employees. As an organization built on longstanding and trusting relationships with our patients, we felt this action was closely aligned with our mission. By creating forums to engage clinicians and staff in conversations around empathy, we sought to help our employees recognize the importance of demonstrating empathy on patient care and teamwork, to support people in identifying their strengths and challenges in practicing empathy, and to learn the processes, behaviors, and words that convey this skill. We did this work with an overarching goal of improving the overall satisfaction and experience of care for our patients while fostering a more compassionate, communicative, and supportive organizational culture for our employees.
We began designing the forums in October 2015, implemented them in phases across our North, Urban/River, West, and South regions in February 2016, and completed them in November 2016. We designed and delivered the empathy forums in a way that was relevant, practical, and easy to implement to best meet our operational needs. Each forum was co-facilitated by a leader based at one of our practice sites who partnered with an internal Organizational Development & Learning (ODL) consultant from our corporate headquarters, or a Human Resources (HR) consultant working at that practice location.
We paired site-based practice leaders with ODL partners based on schedules and availability, or their site’s internal HR consultant in the event that an ODL representative could not co-facilitate. We held the forums at our 24 largest practice sites, and invited staff from smaller locations (such as our imaging department or endoscopy office) to attend.
Our Amplifying Empathy program is a four-part endeavor:
- Train the trainer: We asked each of the participating 24 practice locations to identify leaders within their sites to co-facilitate the forums with an ODL/HR partner. Our ODL staff designed and facilitated a required 3-hour train-the-trainer session for site-based practice leaders and HR consultants where they practiced forum facilitation with a full script, videos, and other resources and materials.
- Pre-work: Two weeks before attending a forum, all participants received pre-work designed to introduce them to the groundwork of the session and cover materials that would not be included in the forum due to time constraints. The pre-work included a short article about empathy in the workplace, a short story about a patient’s experience with empathy, a Cleveland Clinic video titled “The Human Connection to Patient Care,” and a self-assessment about demonstration of empathy. We also asked everyone to come prepared to discuss their successes and challenges in showing empathy.
- Forums: Site Leaders and an ODL or HR consultant co-facilitated the 90-minute, in-person forums. These sessions were designed to include large- and small-group discussion. They included a didactic presentation of a communication model and video demonstrations of before and after scenarios utilizing our own physicians and employees. Participants were also provided case studies and the opportunity to practice empathy in role-playing scenarios. We designed these programs to be as interactive as possible to meet all learning styles.
- Post-work: After the forums, ODL sent all participants guidelines on empathy and provided guidance to leaders for ongoing reinforcement of the concepts. This included coaching and feedback during 1:1 meetings, team meetings, and huddles, as well as storytelling and information about available resources on our intranet.
Our empathy forums provided many benefits, including the opportunity and encouragement for employees to discuss a topic that often goes overlooked and can make people feel vulnerable. The facilitators provided language to use when talking to colleagues in distress or patients struggling with a challenging situation. The sessions also reminded our care providers of the importance of making eye contact and actively listening; video demonstrations illustrate that a minor shift in how we communicate using body language and eye contact, along with word choice, can have an enormous impact on how we’re perceived by others.
The empathy forums were designed by Atrius Health’s Director of Organizational Development & Learning, and two internal ODL consultants. Facilitators included 75 practice site and clinical leaders, all HR Consultants and Directors, and all ODL consultants for a total of 131 trained facilitators.
In 2016, we observed an increase in our quarterly Press Ganey Associates, Inc. survey scores for “sensitivity to patients’ needs.” This was a time in which empathy forums, along with increased internal transparency of patient experience feedback, sharing of improvement materials, and patient experience goal setting occurred. Because the empathy forums included the vast majority of Atrius Health employees, it is hypothesized that these forums may have contributed to the improvement. The design of the empathy forum rollout and survey measurement methodology does not permit analysis of causation and definitive conclusions.
A total of 251 forums were provided across the organization. We had 4,246 participants — or 92.3% of our employees — attending the 90-minute forums. This translates to 6,369 participation hours among attendees. Additionally, participants completed an evaluation at the end of each forum based on Likert Scale measurements of 1 to 4 (1 being the lowest and 4 being the highest). Results of the question measured to determine value to participants was 3.75, which exceeded our average stretch goal of 3.5.
The anecdotal feedback we’ve received also indicates a positive impact on the delivery of care to our patients. As one clinician stated, “This class gave me tools to help wrap up a conversation with a patient without rushing out or making them feel like I did not value them or their time.” Another said, “I find I am listening more, trying to understand what my colleagues or my patients have been through, and am less judgmental.”
Where to Start
For health systems interested in holding similar empathy forums, it is important to understand the amount of administrative support needed to manage such a transformative undertaking. Material preparation, management of the continuing medical education process, communications, and tracking participation all take a vast amount of time. Facilitators need to be fully prepared in terms of understanding the content along with knowing the best practices for facilitation. Organizations should make sure they have clear criteria for characteristics and attributes (such as credibility and trust) that make their facilitators qualified candidates for the role. It is also important that everyone is consistent with the framework and content of the program. Finally, organizations should think ahead and develop a plan for what they will do to continue the learning process. For example, we have developed empathy videos and e-learning materials available to our staff and clinicians. We also implemented a 2-hour workshop on empathy into our new employee and clinician orientation programs.
Embedding cultural shifts into an organization like this takes time and practice, so one intervention is not enough to make substantial lasting change.