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