CHRE Viewpoint #4

CHRE Viewpoint #4

This article is the fourth in our fortnightly series ‘CHRE Viewpoint’, which discusses topical issues in relation to health professional regulation.

Regulating for compassion

There is a common theme in recent healthcare scandals: the failure of compassion. There are frequent references in the report into Mid-Staffordshire NHS Foundation Trust to care which lacked compassion, and to its importance. Compassion is one of the NHS-wide values in the NHS Constitution. The importance of compassionate care is stressed repeatedly in the recent report of the Prime Minister’s Commission on the Future of the Nursing and Midwifery in England, Front Line Care, which found that ’compassionate care is competent care‘ and reports that ’service users and the public told us that above all else they wanted nurses and midwives to be caring and compassionate’. More recently, Transparency in Outcomes, one of the consultations flowing from the White Paper Liberating the NHS, states that ‘Quality of care includes the quality of caring. This means how personal care is – the compassion, dignity and respect with which patients are treated’.

Promoting compassionate care opens up difficult territory for regulation. Clearly, health professionals cannot ‘suffer with’ their patients – the true meaning of compassion – or they would be unable to get through the day. Neither should they be glacial and emotionally distant. How should regulators define that optimum desirable state between these two extremes?

A further difficulty is that compassion implies an intimacy which sits uneasily with health professionals’ obligations to preserve clear personal and sexual boundaries between themselves and their patients. While some patients may welcome a more openly compassionate and expressive approach, others may not wish to engage at this level with health professionals at all, preferring a greater distance to be preserved.

Despite these difficulties, can regulators promote compassion in the sense of instil it where it is lacking? There is some research evidence to suggest that teaching compassion is possible. One study found that where subjects were exposed to compassion-inducing stimuli such as the sound of crying, meditation could heighten activity in the area of the brain associated with compassion. Other research has shown that working in an environment which is demonstrably compassionate and encourages students to pursue cases in which they become involved encourages greater compassion.

However, a more pragmatic approach for regulators might be to concern themselves with conduct and behaviour, rather than trying to influence personal motivations. Conduct and behaviour can be measured, evaluated and assessed in the circumstances in which it took place. Regulators can promote examples and guidance on what constitutes acceptably compassionate behaviour.

Regulators also need to be wise enough to regulate with compassion: to treat regulated professionals with sensitivity and care, in particular those facing allegations of unfitness to practise. The daily pressures of work are stressful; much more so having your fitness to practise called into question, assessed, tested and possibly found wanting.

Douglas Bilton, Research and Knowledge Manager
25 August 2010

This article is based on ideas that arose at a CHRE seminar held on 28 May 2010, at the Royal Society, London. Discussion centred on a presentation by Professor Ron Paterson, Auckland University.