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this podcast is brought to you by
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knowledge of Wharton
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[Music]
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welcome to knowledge at Wharton I'm
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Andrew bassini joining me today is Dr
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Ingrid nambard
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she's a Wharton Healthcare Management
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professor and her latest research is an
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intriguing look at something that as
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patients we all want more of but can
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sometimes be in short supply especially
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when we go to our busy doctor's office
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or hospital and that's a feeling of
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empathy her published paper is titled A
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systematic review of empathy and health
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care and we want to mention one of her
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co-workers Dr Guy David Wharton
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Healthcare Management professor
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Dr numbard is here with me today to talk
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about the latest research Ingrid thank
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you so much for joining me I've been
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looking forward to talking with you on
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this program Angie thanks for having me
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it's nice to have the opportunity to
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talk more about this research and
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particularly the importance of empathy
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in healthcare which I think is a really
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important topic
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well I want to start with a really basic
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question which is why is empathy in
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healthcare important I mean if I go see
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my doctor and I know that she's board
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certified she graduated top of her class
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I know I'm going to get good care so
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what difference does it make if she
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doesn't make me feel warm and fuzzy I'm
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so glad you started with that question
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because I think we often skip over this
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most basic point and assume that
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everyone is clear on that right you go
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in you're going to get great care and
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you may get great clinical care but
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that's different from empathy and I
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think there's some we sort of also
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assumed that everyone is clear on what
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empathy is and its role in healthcare
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broadly speaking empathy refers to
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understanding another person's feelings
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and their thoughts and feeling those
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congruent thoughts and states in the
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context of Health there there's actually
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a specific definition of empathy now and
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empathy is defined in healthcare as
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understanding and feeling a patient's
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emotions and perspective and offering a
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response for example how you communicate
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with that patient that reflects
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understanding and that actually aims to
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help them so this question that you
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asked why does empathy matter in health
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care well when there's insufficient
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empathy there's really that basically
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means there's diminished understanding
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of the patient's perspective on the
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other hand when there is higher empathy
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there's understanding and in principle
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that understanding matters because it
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cultivates efforts to better meet
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patient needs through both interpersonal
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choices such as speaking with care and
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operational choices such as connecting
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patients with resources whether they
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need mental health providers or they
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need Transportation things that really
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can facilitate their care experience and
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their actual care and health
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we know from I think now looking at the
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research and even if you thought about
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this theoretically that the more that
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understanding is present the more likely
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patient-centered care plans are likely
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to be made the better the patient care
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experience will be the greater patient
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adherence to their plans will be that
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all means that we can expect on the
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outside of that better patient worker
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and organizational outcomes whether you
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think about clinical outcomes or you
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think about worker job satisfaction
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because they're getting the information
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they need to be able to treat patients
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the way they should
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and they're getting better patient
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experience ratings so
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you know why it matters it's the
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beginning of a positive Cascade I think
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for patients and health care and even
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for workers that's a really great way of
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looking at it so let's talk a little bit
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about this study I thought it was
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interesting that in the paper you
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mentioned that there's a great deal of
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disjointed information out there about
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empathy in healthcare but that's
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actually emerging as its own research
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field so what were you and your
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co-authors hoping to contribute to this
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literature with with the paper that you
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just published
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sure so you know we have been looking at
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the data for quite well I do a lot of
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research on patient care experience in
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addition to sort of understanding the
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organizational side of care
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and the data at this point is pretty
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robust that a lot of patients are having
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poor patient care experiences and
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there's been this growing attention now
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to the relational side of healthcare
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that's really led to a lot of
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investigation over the last several
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years really 50 years now about what
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facilitates and what hinders empathy
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what outcomes come from empathy how best
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can we measure empathy who is likely to
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give you empathy who is unlikely to give
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empathy who is likely to get empathy who
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was likely to not get empathy and then
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how do you go about increasing it and so
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these investigations have been occurring
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for the last 50 years we see that
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largely they've been occurring by
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individual researchers independent
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investigations and they've been
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published in a wide variety of journals
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whether it's Health Services Research or
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medicine or general management journals
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what that means is we've seen this large
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body of work growing over the last 50
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years
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that really means that we can now say
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that there is a field of empathy there
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is an actual research field of empathy
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because there has been a lot of
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attention in this field
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but it's all disparate and so there's
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that's the state you haven't had yet the
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research that integrates all of that
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knowledge and so my colleagues and I
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have been really thought have been
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really thinking about this and thought
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you were reached a time now where we
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need to pause we need to pause and take
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stock of the field we need to see what
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lessons can be extracted from the 50
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years of research and we need to see you
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know if we take that maybe we can
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provide greater clarity about the way
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empathy is operating in our health care
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System that's one thing the other thing
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is we can then start to identify where
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we need to do more research where
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practice needs to change in order to
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achieve those goals and so we decided to
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do a systematic review of the 50 years
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worth of research empirical quantitative
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research on empathy and our research
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covered at 450 articles that met our
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criteria
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it was a tremendous amount of data to go
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through and so let's talk about the
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takeaways from that research you guys
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did find that more empathy ends up with
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Better Health Care outcomes and that
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there are five factors that predict
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empathy can you take us through those
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those factors sure so
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we found that there are five as you said
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the first is that provider demographics
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seem to matter those are things like the
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number of years a professional has been
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in in their specialty we also see that
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it varies by characteristics like gender
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and the specialty so perhaps not
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surprisingly uh primary care physicians
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those in Behavioral Health tend to
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display more empathy than our our
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colleagues who are maybe more on the
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surgical side or say is the sort of
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cute experiences with patients so those
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provider demographics actually matter
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who is providing empathy can matter
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provider characteristics matter and in
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that bucket we find things like the
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personality whether somebody's an
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introvert or their knowledge their
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attitudes towards different people and
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the like the third category that we
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identified are how providers behave
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during their interactions and that's one
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of the things we probably we pay
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attention to the fact that people talk
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in different ways and speak to people in
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different ways and that certainly
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appears in the data that people vary
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providers vary in the way that they
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communicate the tone they use the words
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they use they also vary in aspects like
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their body movement in the interaction
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are they closer to you or further do
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they create distance or not have
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distance
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and how much you know whether they give
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adequate consultation
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fourth bucket of things that we find are
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Target characteristics so when we say
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Target we're referring largely to
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patients as the person who'd be the
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target of that empathetic interaction
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so it varies by the type of condition
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the person has so the the disease that
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they're battling perhaps where some of
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the data would suggest that certain
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conditions are more likely to elicit an
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empathetic response than other
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conditions
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uh someone's socioeconomic status
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whether they have more income or less
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income tends to influence the level of
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empathy that's directed towards them and
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then the fifth category of things that
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we found in the literature is
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organizational context so
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things that are organizational include
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how long is the visit that the patient
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has with their provider the shorter
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visits there's less empathy that's
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typically found in that context how long
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the waiting time is leads to differences
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and perception of how much empathy there
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has
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the five categories I think are actually
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really interesting because what I'm
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giving you the the high level categories
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within each one of those categories our
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research showed there are multiple
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factors well speaking of that let me ask
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you because when you mention the
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provider characteristics I was curious
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about whether you found differences
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between male providers and female
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providers because we often it's a
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stereotype but we often associate more
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empathy with women was there a
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difference there was okay
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a stereotype that holds true
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I can even check I can even check the
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numbers quickly
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if you want to be precise with that sure
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well and while you're doing that I'm
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going to set you up with my next
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question which is in that paper that you
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you also looked at some interventions
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that can increase empathy among these
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Health caregivers things that that can
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be done to maybe raise their awareness
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about it what are those interventions
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and how do they work yeah so I mean
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naturally once we just once the field
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has appreciated that empathy might
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matter we start to think about well how
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do we increase it and most of those have
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been
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individual level educational
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interventions so things like training
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participants how to do a particular
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skill like how to communicate well in an
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empathetic way we see uh some studies
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that focus on having a courses so a
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person goes through a series of lectures
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about how to be empathetic or what
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empathy Behavior entails sometimes there
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are workshops where role play uh and get
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feedback on how you behave simulations
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visuals videos
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the category that probably most uh
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caught my attention is treatment for
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empathy so there are studies that show
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uh I hadn't heard about this before we
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did this research transcranial direct
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current stimulation so actually
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stimulating that part of the brain
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with empathy not sure I want to submit
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myself to that but
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the New Direction
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um
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and so there there are a lot of options
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that are on the table for improving and
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increasing empathy
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most of them educational interventions
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so it's really no different than any
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other kind of training we might get at
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work uh we have you know training how to
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use our software our operating systems
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training on sexual harassment diversity
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training there's all sorts of training
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out there so this is another method
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another way to improve your what how
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your performance at your job yeah
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for us though the thing that was
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surprising when we looked through the
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literature was not that education may
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make a difference because for all the
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all of the areas in which you said we
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see those kinds of programs being
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deployed for us looking at the data it
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was surprising that there were no
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studies of organizational interventions
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and so even because when we looked one
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of the factors that we found was
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significant was organizational context
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so we know that organizations can matter
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I guess in some sense thinking about it
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the absence of organizational
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interventions May reflect the fact that
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we think of empathy as a human trait
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right so why make it part of the
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organization right you don't need to be
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trained in empathy you don't need to be
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framed in empathy of course we're all
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human so we know how to be empathetic
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but if you think about it if empathy
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benefits from if the provision of
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empathy benefits from having dedicated
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time and people and processes and
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Leadership then it totally makes sense
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that we need to direct greater attention
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to organizational interventions for
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improving empathy and so I think my
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co-authors and I are now very much of
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the mindset that we need to have more
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empathetic systems and institutions that
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are structured in such a way that they
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create and they really create conditions
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for anybody to receive empathy and and
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you know in a non-arbitrary way
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throughout their whole service of care
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and we've seen that like we've seen that
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organizational interventions can work we
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see it around patient safety it used to
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be that you thought safety was the type
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of thing that a provider delivered to a
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patient Innovation was the type of thing
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that an entrepreneur delivered and yet
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now when we look in healthcare It's Not
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Unusual to see a Chief's patient safety
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officer or a chief Innovation officer or
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roles that are dedicated exclusively to
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ensuring those goals and they're taking
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that route rather than training
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clinicians there can be role-based
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approaches really centered on
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non-clinicians to be able to deliver and
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so we might want to move in that
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direction I think my colleagues and I
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would be excited to see more
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interventions that say okay this is
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something that organizations need to be
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attentive to there are a lot of options
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out there I'm going to circle back to
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that idea but before I do I do want to
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ask you a particular question about uh
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two demographics which is black patients
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and Hispanic or Latino patients now we
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all know that those two groups have
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worse Health Care outcomes across a
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number of measures whether it's covid
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whether it's heart disease whether it's
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we're hearing a lot lately about
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maternal mortality and I'm wondering if
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greater empathy for those patients could
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translate into Better Health Care
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outcomes it should the simple answer is
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that it should if you recall my earlier
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remarks to your very first question
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about why does it matter why does it
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matter why does it matter it's largely
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about understanding people their
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emotions their needs and where they are
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in their care and their state
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if we were to have greater empathy we
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would expect that there would be greater
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understanding such that the choices that
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are made the conversations that happen
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in the course of care would be more
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attentive to the needs of the person
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that means they would get the you know
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the communication would be culturally
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competent like there are things that
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would occur you need transportation we
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would provide transportation because we
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would understand the circumstances we
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would understand and therefore make
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choices and make care plans that would
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allow people to be successful in their
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health care and so I do think empathy is
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part of it's it's part of the process if
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we want to do some of those disparities
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we need to be better about understanding
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where people are granted it is a
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complicated question with
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yeah there are a lot of
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everybody is one of the the factors that
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might improve health outcomes for those
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those two groups so going back to the
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options about uh the ways to to increase
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empathy in healthcare providers this is
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a study that's really the first of its
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kind as we mentioned before you're
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talking about 50 years worth of data
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that you guys numbers that you crunch
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through
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um and it's an emerging field so what do
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you want to look at next what's next for
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this this particular research
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for us the main motivation in taking on
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the last 50 years of research was that
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we wanted to be better prepared to do
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work that could make a difference
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and for us the next step would be to
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we'd love to be able to collaborate with
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a health system interested in thinking
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about uh think not just thinking about
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it actually trying and trying a
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role-based organizational intervention
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it's in some sense we think it's time so
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we've been doing the training of
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individuals for years and we're still
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not at the level we need to be so that
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is appearing like insufficient that is
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insufficient to allow systematic
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systematic empathetic health care so
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role-based organizational intervention
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we would love to be able to study that
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we'd love to see the feel take off and
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other people think about other
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organizational interventions that might
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be used to in order to build empathy
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that sounds yeah that sounds really
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interesting I would actually love to
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have you back after you complete that
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study and we can talk about that too
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um thank you so much for joining me
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today to talk about something that I
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think needs a lot more attention
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thank you for having me it's been great
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to have the chance to talk about this
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work
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attention to empathy and Healthcare
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right well if you enjoyed this
00:15:47
conversation you can find more just like
00:15:48
it on our website where you can also
00:15:50
find all our articles on the latest
00:15:52
research in business for knowledge of
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Wharton I'm Angie bassini thanks for
00:15:56
joining us
00:15:58
for more insight from knowledge of
00:16:00
Wharton please visit
00:16:01
knowledge.worton.upenn.edu
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[Music]
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