Research defines 'kindness' in healthcare

A researcher has defined 'kindness' and believes this could hold the key to better communication within healthcare teams and improve care for patients.

Nicki Macklin came up with a definition of kindness through a structured analysis of published research papers, and found it was action-oriented, positively focused and purposeful in nature.

“The foundation of kindness is civility and choosing actions that show respect, generosity, openness and inclusion,” says Macklin, a doctoral student in the School of Population Health at Waipapa Taumata Rau, University of Auckland.

“When we get into conflict, which happens a lot in healthcare but also in the wider world, it's a mindset and an approach where you are actively maintaining that other person's respect through the ways you are choosing to respond.”

Macklin found that researchers often conflate kindness with compassion and empathy. Her new paper, with her supervisors Dr Laura Wilkinson-Meyers and Prof Tony Dowell as co-authors, has just been published in the highly respected British Medical Journal Leader [paywalled, but paper available on request].

However, distinguishing the terms is important because kindness exists regardless of other people’s emotional states and can be taught in medical education.

Empathy is an internal, emotional response of wanting to share another’s feelings or situation, whether suffering or joy, and informs action, rather than being an action itself.

Compassion is responding to others’ suffering with a desire to alleviate that suffering, but that may or may not result in outwards action.

Kindness is a set of actions in response to a desire to help others flourish, informed by either an empathetic response or proactively chosen.

Macklin sees potential for greater kindness to be embedded in the culture of teams and organisations, which would improve communication within healthcare teams and with patients, as well as improving patients’ experiences of safety and trust.

“This is something practical that we can measure and expect, for example, in medical education, in policies or in organisations,” she says.

Kindness can exist when clinicians are too burnt-out to be compassionate.

However, organisations need to create environments and cultures that individuals and teams to sustain kindness, before they can expect it from employees, Macklin adds.

Macklin has a background in quality improvement and trained as an occupational therapist.

However, it was dealing with the healthcare system when she had an unwell child that prompted her interest in kindness and led to her patient advocacy work.

“It was not so much the kindness or the absence of kindness to us that affected us the most. What had the biggest impact on our outcomes was kindness displayed within healthcare teams.

“Witnessing our healthcare team undermining each other, not communicating respectfully during conflict, giving us contrasting treatment advice and not working together had the biggest impact on us.

“And, then on the other hand, we witnessed really effective healthcare teams.

“In terms of patient safety and trust, watching our healthcare teams interact with each other had a bigger impact on our sense of safety and trust than how we were treated ourselves.”

Macklin’s next planned publications will report on her subsequent PhD studies involving surveys and interviews with people working in health systems globally and those specialising in patient-centred care in the hope of kindness becoming a principle of healthcare at every level.

The reason this is so important, she says, is it improves patient care.

“Kindness has been strongly linked to patient experience and outcome measures, including safety, better engagement with healthcare services and reduced readmissions to hospital,’ Macklin says.

“On the flip-side, unkindness in healthcare teams - rude manners, unclear or abrasive communication - has been shown in large studies to be the root cause of three out of four patient harm events in hospital settings.

“So, while kindness may sound like a lovely, soft, concept, it’s actually a very serious tool for enhancing patient safety, experiences and outcome measures.”