Mandating compassionate care is an endeavor doomed to failure as the problem of noncompassionate care lies in the basic organization of modern healthcare and healthcare settings, according an article published in the Journal of Medical Ethics.

Michelle Rydon-Grange, MSc, PhD, of the North Wales Forensic Psychiatric Service in Llanfairfechan, Conwy, United Kingdom, noted that although compassionate care is considered a foundation of the British National Health Service (NHS), research indicates that compassion is often lacking in hospitals. The NHS states that clinical practice should be compassionate, that nurses must be compassionate in everything they do, and that the NHS leadership itself should be founded on compassion.

However, Dr Rydon-Grange pointed out that a providers’ capacity to feel compassion is affected in part by the practice environment. She argues that the typical environment of a modern healthcare setting is at odds with compassionate care. Among organizational characteristics that encourage less compassionate care are understaffing of hospital wards, excessive working shift patterns, and the single-minded focus on wringing ever-greater service efficiencies out of clinicians.

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She also explained that compassionate care depends “not only on the individual clinician but also on…the organizational context within which he or she practices.”

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Poor staff–to-patient ratios result in clinicians who do not have enough time to build therapeutic relationships with patients, leading to clinician stress and burnout. Clinicians facing large numbers of distressed patients will down-regulate compassion to protect themselves against emotional exhaustion. 

Another organizational element that affects compassion is the demand for long hours of work. Shifts of 12 or more hours are associated with increased emotional exhaustion and burnout. Increased fatigue can compromise the ability to regulate emotion and reduce the ability to cope.

The third area that Dr Rydon-Grange believes has a negative impact on compassion among healthcare professionals is service efficiencies. In the modern healthcare setting, clinicians are increasingly pressured to meet performance goals and achieve service efficiencies. The NHS expects clinicians to do more with less. This leaves little time to get to know patients. Evidence suggests that perceived similarity to a “victim” or patient is key to feeling compassion. When clinicians do not know their patients, it is difficult to identify with them and therefore difficult to feel compassion.

Until government policies on compassionate care are based on known psychological principles and until organizational factors detrimental to compassionate care are dealt with, little headway will be made toward improving this element of patient care, Dr Rydon-Grange concluded.


Rydon-Grange M. Psychological perspective on compassion in modern healthcare settings [published online June 29, 2018]. J Med Ethics. doi:10.1136/medethics-2017-104698