Empathy and compassion get all the glory, but this humble concept may be the ticket to better healthcare.
Dear flint-hearted readers,
Good news! You have no need of four ghosts traipsing in and out of your mean lodgings to teach you how to be a better person/doctor, for you have the Back Page.
In this, our last week of newsletters for 2024, we bring these tidings, via BMJ Leader, from New Zealand researchers who set out to define kindness and distinguish it from empathy and compassion, with a view to advancing kindness “as a key tenet of quality improvement and human experience outcomes in healthcare”.
Lead author Nicki Macklin, a PhD candidate at the University of Auckland, reviewed 42 papers to come up with a model for understanding the three concepts and placing them on a stimulus-response-action continuum.
Her aim is to rescue kindness from its “poor cousin” status and harness it as a practical force for improving healthcare.
The Back Page gets a little twitchy when English-speakers set out to nail down the absolute differences between closely related concepts, when the best you can really claim is to have captured a concept in English, at this one point in time, and even that may be kind of arbitrary.
Concepts aren’t perfectly congruent across languages. Study freundlichkeit in German or gentillesse in French, whose roots are quite different, and it’s possible you’ll get different results. Words’ meanings are also notoriously not static but shift over time like the sands.
But the authors acknowledge this limitation, and besides, it feels like a Scroogeish attitude to such a goodhearted study, which aims ultimately to “positively influence quality improvement models, leadership and organisational practices and, importantly, enhance the experiences of the healthcare workforce, patients and families, and communities”.
After surveying the literature, where she says there is very little consensus, Macklin concludes that kindness is “action-based, used with purpose either proactively or reactively … Kindness is given without obligation, has qualities of generosity, friendliness and consideration, and is positive and prosocial in its motivation, involving a desire to aid the flourishing in others.”
This emphasis on action distinguishes kindness from compassion, which is more about noticing another’s suffering, responding emotionally to it and desiring to alleviate it; and empathy, “an internal process that can include both cognitive and affective-level responses to witnessing and trying to understand another’s situation”.
Kindness can occur in the absence of the other two, is independent of emotional state, should be resistant to burnout and “can be planned and used intelligently with purpose”.
For all leaders in healthcare “the call to further develop the science of kindness in the health system evidence base is loud and clear”. The next step is to embed kindness throughout healthcare systems to make them a better place to work and be looked after.
A worthy, if wishful, goal to think about over the holidays.
Send random acts and story tips to penny@medicalrepublic.com.au.
