Building a Culture of Kindness in Healthcare
By Amity Eliaz, MD, MS
Amity Eliaz, MD, MS, is an Internal Medicine resident at Stanford Health Care.
My heart sank as I walked out of my patient’s room. Ten minutes earlier, I stood at his bedside and felt his pulse fade. We knew it was inevitable; still, it did not make it easier. As I held a moment of silence with his wife, I felt my eyes burn as I pushed back tears. I thought of his two young children. All he had wanted was to return home.
I stepped out of the room and walked over to a nearby computer, telling myself to continue pre-rounding. I sank into a chair, my body heavy like lead, and stared blankly at the computer screen. “How are you holding up?” I looked over at the nurse sitting by me, taken aback by her unexpected question. All of a sudden, I wasn’t alone.
We work within a fast-paced, dynamic environment. Healthcare is unique in that we are frequently faced with predicaments that involve life and death. We work to find solutions under the time constraints of both a high-volume healthcare system and the urgency of the conditions our patients face. The end of a night shift may involve finishing H&P notes before the day team arrives, or it may entail standing bedside during a code blue for acute hypoxic respiratory failure.
Within our dynamic system, we carry out different roles. The expertise, tasks, and expectations vary between professions and specialties. Perhaps for that reason, health systems seem to lead to silos–teams, individuals, and departments that appear to function independently, when in reality, they are completely interconnected.
During the busy workday, it is easy to forget that we are all working towards the same goal–to take excellent care of our patients. Between seemingly separate teams, tensions and resistance can arise, which are then reflected in the ways we communicate and interact. A harsh interaction can carry into the next conversation and the next. At the same time, a kind word or positive interaction can have a ripple effect.
Language is powerful. The words we choose and the tone we use impact those around us. Through communication, we can carry out microaggressions or we can facilitate an inclusive environment. We can express annoyance and disdain or we can demonstrate respect and appreciation. Through a few simple words, we can remind our colleagues that they are not alone. On some days, that reminder can make all the difference.
Tang et al. describe the ripple effect of kindness and how cooperative human behavior spreads through social networks [1,2]. It is encompassed in the upstream reciprocity theory that people who receive help are inspired to pay it forward, creating a type of domino effect that can spread through a community and perhaps even shift a culture. When I reflect on my own experiences and listen to the experiences of colleagues, I notice the same pattern: when we behave in a way that is kind, it impacts the behavior and experience of those around us. As kindness spreads, it builds community, provides meaning in our work, and even mitigates burnout [3].
At times, this perspective is met with skepticism. Understandably, as healthcare workers, the extent of our responsibilities combined with our time constraints can make it feel difficult to go out of our way to be kind. The point that is often missed, however, is that kindness does not need to take more time. In fact, I believe that in the long run, being kind saves time. When we are kind, we are able to build a collaborative environment in which we are all working towards the same goal [4]. With that mindset, we are able to reach decisions faster, mobilize resources faster, and find solutions faster. We can share perspectives more effectively and improve patient care.
Kindness is not silence. It does not mean always being in agreement or merely being nice. We can treat each other with kindness and advocate for structural change. Through kindness, we can work towards building an environment that promotes a sense of belonging for all employees of our healthcare system, whether they are physical therapists, nurses, environmental service workers, residents, or any other healthcare worker.
Gilmarten and Saint write that innovation does not always have to be complex [5]. It can be the way we conduct ourselves each day. It can be the words we use and the actions we take. As healthcare workers, we have the ability to contribute to a kind, collaborative culture that has the potential to reduce burnout, increase efficiency, and improve patient care.
References
- Tang, W. et al. How kindness can be contagious in healthcare. Nature Medicine 2021 27:7 27, 1142–1144 (2021).
- Fowler, J. H. & Christakis, N. A. Cooperative behavior cascades in human social networks. Proceedings of the National Academy of Sciences of the United States of America 107, 5334–5338 (2010).
- Curry, O. S. et al. Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor. Journal of Experimental Social Psychology 76, 320–329 (2018).
- Rosenbaum, L. Cursed by Knowledge — Building a Culture of Psychological Safety. New England Journal of Medicine 380, 786–790 (2019).
- Gilmartin, H. M. Finding Joy in Medicine: A Remedy for Challenging Times. New England Journal of Medicine Catalyst (2022). doi:10.1056/CAT.22.0215.
Amity Eliaz, MD, MS
Amity is an Internal Medicine resident at Stanford Health Care. She completed her MD and MS in Global Health at UCSF, where she worked with the UCSF Pandemic Initiative for Equity and Action to improve access to care and address health disparities through public health outreach and research. She is also trained in Health Professions Education, and collaborated with local and international educators to develop educational modules in interprofessional HIV and COVID-19 care for learners across sub-Saharan Africa. While at Stanford, Amity co-founded The Kindness Coalition: an organization and initiative aimed at fostering interprofessional and interdepartmental kindness and collaboration across health systems. She is one of the resident leaders for the Internal Medicine Health Equity, Advocacy and Research program, and co-leader of the Women in Medicine residency group. She is passionate about building an inclusive, collaborative culture in healthcare and improving access to care.
