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Becker’s Healthcare Podcast
The Science of Human Kindness in Healthcare with Dr. Alisahah Jackson
00:26:34
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- [00:00]
A
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Alicia Jackson, President of the Lloyd H. Dean Institute for Human Kindness and Health justice at common spirit health. Dr. Jackson, it's a pleasure to have you on the podcast today.
- [00:14]
B
Thank you, Laura. I'm so excited to be here.
- [00:16]
A
And, Dr. Jackson, we're particularly excited to have you here today because I know it's an important time right now to think about human kindness, trust, empathy, compassion, which are all parts of the work that you're doing at Common Spirit Health. And so we're excited to dive in to look more. More into the research, talk about how it can impact families, communities, patients, as well as caregivers. But before we begin, can you tell us a little bit more about yourself and your background?
- [00:43]
B
Yes. No. Thank you. Thank you so much. So I'm a family medicine physician by training, and let my mom tell it. I came out the wound saying I wanted to be a doctor. I do remember some of my earliest memories are walking around with my little Fisher Price, you know, doctor's kit and doctoring on my stuffed animals and my family. And so for me, it was really a calling to go into medicine. I was one of those medical students that liked everything. So kind of the. The. The one who was like, well, what specialty can I choose that I can do a little bit of everything? But also, I really loved family medicine from the standpoint of taking care of whole families, taking care of the whole person. At the medical school I went to, the family medicine doctors were the ones that I really saw out in the community. And I was like, that's what I want to do. So I ended up selecting family medicine and decided, however, to find a residency program that really focused on population health and health equity. And so, thankfully, I matched into such a program in Charlotte, North Carolina, spent some time there, and then practiced in rural South Carolina for a couple of years. And all of that, I think, really shaped my trajectory, if you will, to this role that I'm in now, which I would have never thought that I would be in, which is leading this amazing institute. And I think those experiences really helped me see from a urban, underserved, a rural, underserved perspective, not only the needs but. But also the amazing strengths of those communities and how to really build trust in those communities to help move the needle in some of the health disparities that they were facing. And so I took a fortuitous route. I went into academic medicine for a period of time and then switched over to Administration creating the first community health department at now or then Atrium Health Now Advocate Health, and then had this amazing opportunity to come to common spirit initially in our Population Health Division. And then, like I said in the last couple of years in this role, bringing this institute to life.
- [03:11]
A
That's amazing to hear and a really, really cool journey that you've had throughout your career and your life of being a caregiver. Now the Lloyd H. Dean Institute for Human Kindness and Health justice is taking a data driven approach to kindness, compassion, empathy in health care. Can you share some of the science behind how these elements impact health outcomes and what the institute is doing to integrate them into care delivery?
- [03:36]
B
Yes, yes, definitely. I will just to start though, talk a little bit about why this institute and why now. And so this institute was created at the end of 2022. It of course, was one of the ways to honor Mr. Lloyd Dean and his amazing legacy around always advocating for health equity and social justice, but also this notion that kindness has the power to heal. And so that was definitely a part of the creation of the institute. But the other parts to that were really looking at kind of what was happening in our society at that time. And so we had continued health disparities in a lot of our markets and in some cases worsening health disparities. We also were at a time where we were at the lowest, and quite frankly, still are at the lowest levels of civility ever in this country since it started being measured in the 1930s. We are also at a time where we're not attending places of worship. So the research talks about us being the most unchurched. And again, I don't necessarily bring that forward as a reflection on religion, but I do bring it forward from the standpoint of for centuries, places of worship served as community hubs and they also served as places where we learned the skills of kindness and compassion and empathy. And now not as many of us are attending a place of worship on a regular basis. And then we are in this epidemic of social isolation and loneliness. So even though we're the most digitally connected, we are at the highest rates of social isolation and lonely, particularly not only in our senior population, which I think we tend to think about, but the fastest growing group of individuals who are socially isolated and lonely are young adults. And so just given all of that, looking at all of that, the decision was made to create the Lloyd H. Dean Institute for Human Kindness and Health Justice. And so we really decided, okay, what is the science behind human kindness? We have had, hello, human kindness as a part of our brand for many, many years. And we wanted to say, well, what does the research tell us? How would we better define humankindness from a science lens if we were put on our science glasses and so really spent the first year diving into that research and that science? And what we found was truly, I would say, I think has completely changed how I look at healthcare delivery. So decades and decades of science, let me start there in the spaces of kindness, compassion, empathy and trust. A lot of that research has happened in the academic sector and in the business sector. But there has been recently, over the last, I would say two decades, this research also happening in the healthcare delivery and delivery sector. So what do we see? What does the data tell us? What does the research tell us? A couple of things and I could talk about this all day, Laura. So I'm not going to dive into every single research out there, but just a couple of key things that I would like for people to know as it relates to kindness. When we think about acts of kindness and pro social behavior, what the research tells us is not only are there benefits for the receiver, right? So those receiving on the receiving end of the kind act, but also the giver. So it actually improves our overall health outcomes. If we ourselves are participating in acts of kindness towards others and people who are dealing with anxiety and or depression, what we find again, if they exhibit acts of kindness, they actually have improved social well being, they have increased connectedness, social connectedness. I remember I talked about the social isolation and loneliness. They actually have improved life satisfaction. When you think about our own healthcare workers, so our teammates, what do we see in departments that have high rates of kindness? So again, acts of kindness and pro social behavior, we see improved teammate satisfaction. We see improvement in our healthcare teammates mental health and physical health, which I thought was really interesting that the research showed that. And then for my, you know, if I have some of my, you know, operators or finance people listening in, we also see reduced costs and reduced errors, medical errors. And so again I think there's the kind of the, the feel good, right, the feel good aspect to this work, but there's also very specific business outcomes that can be tied to having a culture of kindness, having a culture of empathy, having a culture of compassion in the workforce. I think one of the things learning from an empathy standpoint and again, plenty of research behind this in the healthcare delivery space, especially for patient perceived provider empathy. So how do I as a patient feel that my provider is acting or behaving as it relates to being empathetic? Again, in Patient provider relationships where the patient perceives their provider as being empathetic. You see increased adherence to medication treatment plans, for example. You see less anxiety, especially in patients who are dealing with cancer diagnosis. And this one I thought was just really, really fascinating. If you go see your doctor because you think you have the cold or the flu or whatever. In patients who see their doctor who they think was very empathetic to them during their visit for just the common code, they have milder symptoms following that visit, and they have one day less of symptoms than someone who saw a provider who they did not think was empathetic. So, you know, just like simple things like that, like, oh, if I have an empathetic provider, you know, I'm not going to have my code as long as someone who maybe did not have that. And then the last thing I would just say specifically about compassion, because I think we're going to get to trust in a separate question. But compassion is something that, you know, talking to my own colleagues, you know, especially in visits, you know, like we have maybe 15 minutes to see a patient and get through, you know, the laundry list of things that we need to get to get to or get through. Maybe this is going to take a little bit longer. You know, I don't know if I have the time to actually have this compassionate visit. Right. Again, what the research tells us, 40 seconds. It takes 40 additional seconds during a patient visit to exhibit compassion. And that. What does that look like? So people are like, okay, that doesn't. What does that look like? It literally are saying things like, I am here for you, making sure we have eye contact. One of the things our Patient Experience team teaches our caregivers in our system is what we call heart to heart communication. So as much as possible, try to be have your heart aligned with the patient's heart. So if you, if the patient's standing, stand. If the patient is sitting, sit. But that heart to heart also helps to make sure that you're having eye contact. Right. With the patient. So 40 seconds. In the grand scheme of things, that is not a lot of time to establish compassion. An amazing provider patient relationship.
- [12:10]
A
Absolutely. Wow, that's fascinating to hear those numbers in the research. And then too, a couple of the ways that you try to help clinicians understand and create that feeling, that culture of compassion and empathy with their patients is just truly, truly interesting to have that kind of understanding. And I know you mentioned trust. So what can you tell us more about that? Trust is a critical factor in healthcare, especially when addressing some of these social Determinants of health. How is the institute leveraging research on trust to improve the patient experience and outcomes, particularly in underserved communities?
- [12:48]
B
Yes, so this is a great question and again, this is one that I think sometimes is a little bit difficult for people to understand. And so I always like to just lay the foundation around, you know, a couple things. First, trust is bi directional. So I think as physicians and as providers, we sometimes assume that our patients are going to trust us because we have achieved a certain level of competence. Right? So we have gone through medical school, we've gone through a residency, we have gotten board certified. Like, we've done all of these things to demonstrate competence. And so I think sometimes we just think, okay, well since I've done this, you should automatically trust me because I have demonstrated competence. Right. And that's not the case, especially in communities that have been systematically excluded and where there is significant mistrust or distrust in the healthcare delivery system. So it's bi directional. So yes, of course I want my patient to trust me, but I also need to trust my patient. And so one of the things that we teach our providers is that the patient sitting across from you, they are the expert in their own lived experience. I haven't walked in their shoes. I don't really know their story, but they have and they do. And so really that's just a completely different concept for a lot of our providers because we weren't necessarily trained that way in medical school to think of the patient as an expert as well, like we're trained as the expert. So that's the first thing. Trust is bidirectional. And then the second thing is that is built over time. So we can't also, again, expect if we have a new patient coming in to see us, that they're immediately going to trust us. We probably have to see that patient a couple of times, have a couple of different interactions for them to trust us and vice versa. And so I think just level setting those two key principles around trust can be mind blowing for a lot of people. So that's the first thing I would say, again, looking at the research, again, plenty of research in this space, especially in the business sector, believe it or not, around how do you build trust within the workplace and with, you know, with your staff? And so again, we know that, and I'll speak to this from a workplace standpoint. First, that in teams that high, that have high levels of trust, they have higher quality of life, they're actually more productive, they have higher teammate engagement. And then in regards to Patient outcomes. Again, we see improved health outcomes. There's been a lot of work done in the space of cancer and working with patients who have a diagnosis of cancer and trust, again, improvement in their symptoms, improvement in their side effects from chemotherapy, improvement in their overall quality of life scores. Same with diabetes. There's been a lot of research in this space. And again, we see that in patient provider relationships, where patients trust their provider, they have improvement in their diabetes control, so their actual hemoglobin A1C, they have improvement in taking their medications as prescribed, they have improvement in doing some of the health behaviors. So the, you know, the food that they eat, the exercise that they get, you know. So again, there's like, there's all of this data to tell us that if we have these amazing trustees, patient provider relationships, we see improved outcomes for the patients and we also see improved things for the provider as well. Receiver, we see a reduction in burnout, which is, you know, a critically important topic right now. So again, there's just, there's all this data and science to say we should be delivering humankindness at every touch point and every single interaction that we have with each other within the healthcare system, but also with our patients in our broader communities.
- [17:17]
A
Absolutely. That makes a lot of sense. And I really appreciate those specific examples of spaces where there's that research and that literature available to show exactly how that kindness and that trust can make an impact not only on the relationship between patients and their clinical teams, but also the outcomes that they have and what they're expecting. Experiencing, especially with conditions as serious as cancer and diabetes and others, is just very pervasive and something that can make a big difference. Now, kindness and empathy are seen as individual traits, yet your work aims to systematize them across healthcare. What are some of the concrete ways that the institute is embedding these principles into trainings, policies, and care models at Common Spirit Health? And how receptive are the caregivers to some of these things?
- [18:09]
B
Yeah. So I will say I'm so lucky to work at an organization that really centers around delivering humankindness at every touch point. That is a goal that we have. And so as kind of a researcher and a clinician, it's like, okay, well, how are we going to do that and how are we going to measure that? How are we going to show that we did deliver humankindness at every touch point? So at the institute, we are really focused in four key areas in supporting our organization in this. And so the first one is education. The second is training. The third is research, and then finally evaluation. And so the first year the institute was in existence, we really spent time going into a lot of our markets and just talking to people and asking, what is it that you want to see? What could the institute be helpful in? And education and training were the two that kind of rose to the top of the list. And so we really focus on, again, making sure people are aware of all of this science that I have talked about and helping people understand that it really is critical to how we take care of each other and how we take care of our patients and our communities. A couple of ways that we do this is one, we just launched something called the Common Good Academy, which is really focused on any of our teammates who have responsibilities for quality improvement specifically related to addressing health disparities within their market. Again, also being a part of amazing organization that really centers around health, equity and social justice. We train our teammates on something called the Common Good pdsa, which is the plan, do, study, act framework for quality improvement that is centered around health justice and really pulls in the science of kindness, compassion, empathy, and trust. And so they have to complete a quality improvement project plan that embeds those principles. Of course, we teach them what those things are, and we give them the skills on how to do that, and they create a project plan. And we've been excited to see in our first two cohorts that not only have they completed the plan, almost all of those participants have said, we're going to implement this plan in our market to address said disparity. The other thing that we created based on the information we were receiving from our care managers was around social isolation and loneliness they were seeing in some of our markets. As a part of our social drivers of health screening, we screen for social isolation and loneliness. And in some of our markets, they were seeing that as the number one positive. And so our care managers were like, well, wait, I know what to do for food, I know what to do for transportation. I even know what to do maybe for housing, but I have no clue what to do if someone screens positive for social isolation and loneliness. So we launched or created and launched a curriculum for our care managers focused on that, you know, how to screen what the risk factors are and then what to do when someone screens positive. I will say it was very interesting, though. We found during that process that even some of our own teammates were struggling with social isolation and loneliness, especially some of our remote workers. And so we had to kind of revamp the curriculum to also address, you know, what do you do if you yourself, you know, are feeling socially isolated and lonely. And so that initially was a virtual or in person training. However, we did just transition that to a module based training so more of our teammates could have access to that. So I think those are just two things that I will mention. But we're doing so much more, again, focused on education, training, research and evaluation.
- [22:07]
A
That's fantastic to hear. You know, a really great point in terms of making sure that the team understands how they can not only show kindness and empathy and bring that into the work that they're doing, but then measure that with the patients that they connecting with and understand on a deeper level, you know, how they can get at what's truly happening with their patients. Because I know it can sometimes be hard to tell just based on the conversations that you have with people. And as we mentioned before, for some of them, it's not a long time that they have to connect with their patients. So that's great to hear.
- [22:40]
B
I think the other thing too is recognizing that we also have to show kindness, compassion and empathy for ourselves. And that's been also one of the areas that we've been working with a lot of our clinical leaders on how to address some of the issues around burnout.
- [22:55]
A
Got it. Absolutely. Yeah. That's so critical and really helpful. Now, before we wrap up, I wanted to ask you, how is the Institute measuring success and what are some of the early insights you can share about the effectiveness of this approach? And especially thinking about those critical constituencies you mentioned, obviously patients, their families, but then to clinicians and then looking at yourself, how do you really think about all of those things and make sure it's top of mind that you're bringing this kindness, compassion, trust into everything that you're doing?
- [23:28]
B
Yes. No, thank you. I thank you for this question. I actually think this is where we have the most opportunity now that we have this emphasis on delivering human kindness at every touch point. Exactly to your point, how do we measure that? And so for us at the institute, again, because our four key focus areas on education, training, research and evaluation, that is currently where a lot of our assessments lie or exist. And so, for example, education. For every curriculum or every program that we deliver with an educational component, we have pre and post knowledge assessments. So again, we want to see that you take a test prior to see where your knowledge is, you take the course and then did that improve? And we are actually seeing between 20 and 40% improvement in knowledge in this space. So in the science of humankindness, but also in the space of health Equity and social justice. That's one area. If we're educating, of course we want to see knowledge improvement training. We're really looking more at behavioral change. Right. And so we're teaching skills to our teammates that lead to an actual behavioral change. We're just in the early stages of this and so. But I think some of the things we have already identified as opportunities are questions in our teammate engagement surveys and our patient experience surveys, adding specific questions around kindness, compassion, empathy and trust. We have some of those already and we're doing a pretty good job, I have to say, at a baseline. But there's always opportunities to improve. So really doing some correlation between the departments who are receiving the training and do we see any changes in some of those scores? And then the last thing I would say that we are specifically measuring right now is for those individuals that who participated in the Common Good Academy, as I mentioned, really focused on quality improvement. Since they have decided to implement those quality improvement plans, we're actually tracking to see if they make an improvement in the market disparity. And we have seen in some of those markets so far, they have actually eliminated the disparity. And so I just think that is fascinating. That's one of the things that I'm probably the most excited about, as you see here on my screen, that we really do have this belief that health justice starts with humankindness. How can we add to the body of knowledge? We are in the process of writing these things up so we can publish the results to really solidify this point that health justice starts with human kindness.
- [26:17]
A
I love that. Dr. Jackson, thank you so much for joining us on the podcast today. This has been a really fascinating conversation. I appreciate all the examples that you shared with us. Look forward to connecting with you again soon.
- [26:29]
B
Thank you so much, Laura.