IN recent years, we have written about the failings in our health system and the need for cultural change.
Kindness has been suggested as a key ingredient to improving the landscape; kindness not just towards our patients, but towards each other, with a specific focus on interactions at medical handover. These suggestions have been well received on social media and by individual hospitals, but long-lasting change has still to take effect within the Australian health care system. The time for this change has arrived.
The coronavirus disease 2019 (COVID-19) pandemic has brought new anxiety, stress and challenges to our health care workers. They remain at the frontline in emergency departments, wards and intensive care units, risking their own health and the health of their families. There is widespread clinician anxiety around personal protective equipment processes and stores. Hospital processes have been thrown into disarray at all levels. New guidelines and protocols have been released which require familiarisation and regular education, including personal protective equipment donning and doffing and new clinical practice guidelines.
Challenges extend beyond direct medical care. Junior doctors have had their examinations and training postponed, medical students have had to learn remotely from home, and many staff have been reallocated to new clinical areas. Private practices have had a sustained period of little to no income. Financial stresses are worsened when so many partners have also lost their jobs. We have not been able to use social gatherings with friends to mentally unwind. Our health care workers with families have faced further challenges – supervising home schooling, missing the support of self-isolating grandparents, living away from their family to protect them from the risk of COVID-19. Others have suggested that only one partner from a family with dependents should take on the risk of working on the frontline. Greeting friends or family with a reassuring hug in these stressful times has also been discouraged due to social distancing recommendations. There are many complexities, uncertainties and losses that have increased anxiety.
With all this trauma, disruption and hardship comes a major opportunity that we should not miss, namely the opportunity for us to embed kindness into the Australian health care system. The need for it has never been greater and is obvious to all. We have known for many years that bullying, harassment and incivility lead to poorer outcomes for both our staff and patients. However, programs focusing on rooting out that bad behaviour have been singularly ineffective. By contrast, programs focusing on supporting kindness and promoting good behaviour can lead to lasting change. This should come as no surprise. For example, it is standard teaching that effective child rearing is achieved more readily by the reinforcement of the desired behaviour than by punishment.
Kindness had been mooted as a route to a safer and more satisfying workplace. Before the pandemic, kindness initiatives were beginning to gain traction and show measurable benefits. Now they are essential. Bringing kindness to the forefront of our interactions may be the help many of us need to get through the uncertain days facing us all. Kindness can be championed by hospital administration and can occur at every level of health care.
During the current crisis, organisations can develop kindness as a key performance indicator, a focus of weekly communications, a behaviour to be championed within their hospitals and a quality to be encouraged, facilitated and supported in their staff. There is a danger that kindness is overlooked entirely when organisations are operating at the level of planning, procurement, budgeting and risk management. Kindness posters can appear in clinical spaces. K-ISBAR can be routine at every handover, making kindness the start and end of every day at work for our health care workers.
Kindness can also be shown in return by health care workers to hospital administration. They too may have uncertainty in their lives and the unenviable tasks of redeploying staff, cutting wages or jobs with the loss of elective surgery, overseeing personal protective equipment purchasing, liaising with government on policies, supporting infection control processes and managing staff exposures or infections. Kindness is equally important when displayed by both our hospital leaders and our workers in the clinical space.
Intriguingly, the wider community has instinctively recognised the benefits of kindness towards health care workers. Recent examples during the COVID-19 pandemic have included:
- the generosity from supermarkets, local skin care companies, chocolate manufacturers and many other businesses to emergency departments and intensive care units to show them that their work is appreciated;
- many words of kindness appearing in the social and print media for frontline health care workers;
- an evening applause from the public for UK hospital staff; and
- the community groups helping health care workers with household tasks, babysitting, shopping and other daily activities.
In the recently released report Public policy and the infrastructure of kindness in Scotland, Simon Anderson and Julie Brownlie make the case for a particular understanding of kindness: one that treats it not just as a somewhat intangible value, or an individual character trait or virtue, but as something that is also concrete, consisting of:
“… the things that people do for one another (both practically and emotionally) in response to moments of perceived need, when there is the option to do nothing”
They write that:
“… kindness involves small-scale and sometimes barely visible practices of recognition, help and support, in which individuals – even if they are acting within organisational contexts – respond to the needs of others in ways that are essentially unobligated, often emotionally complex and always deeply social”
Through this uncertain time, one which may still bring significant stress upon our health care system, we have planned for the worst. We must now plan for kindness, embed this into our everyday interactions. We should not allow a lapse back to the bad old days where teaching by humiliation, unchecked egos, bullying, incivility and unkindness were condoned and perpetuated. Kindness is something we will all need in the coming years and something which we believe must outlast this pandemic. We need to make it stick, so kindness in the health care system becomes the constant when COVID-19 is gone.
We challenge all Australian health care workers with this question: what might we do, stop doing or do differently from today in pursuit of a kinder way of working together?
Associate Professor David J Brewster is Deputy Director of Intensive Care and an anaesthetist at Cabrini Health, and Associate Professor at the Central Clinical School, Faculty of Medicine, Nursing and Health Sciences at Monash University.
Professor Catherine Crock, AM, is a physician at the Royal Children’s Hospital in Melbourne, chair of the Hush Foundation and professor at the Faculty of Health Deakin University.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.