Compassion Practices and HCAHPS: Does Rewarding and Supporting Workplace Compassion Influence Patient Perceptions?

The Center for Medicare and Medicaid Services’(CMS) 2013 implementation of value-based purchasing (Federal Register 2011a) ties hospital reimbursement to quality metrics, including patient ratings of the care experience, specifically, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. This shift provides incentives to hospitals to emphasize care quality in general and patient perceptions of the care experience in particular (Federal Register 2011a). Although some studies show that structural factors (e.g., profit status, Jha et al. 2008), nurse staffing ratios (Kutney-Lee et al. 2009), and cultural competence (Weech-Maldonado et al. 2012) relate to HCAHPS, our understanding of how organizational practices can influence HCAHPS remains limited. Organizational practices are more likely to influence HCAHPS when they elicit care that patients view as high quality—attentive and responsive to their individual preferences and needs (i.e., patient-centered care, Heskett et al. 1994; Kahn 2005; Rathert, Wyrwich, and Boren 2013). In other words, compassionate care that notices, feels, and responds to the suffering of others (von Dietze and Orb 2000; Lown, Rosen, and Marttila 2011) represents a specific form of patient-centeredness (Institute of Medicine 2001; Rathert, Wyrwich, and Boren 2013). Prior work theorizes and finds that organizational practices can foster compassion. These practices benefit organizations by enhancing the degree to which an organization and its employees notice, feel, and respond to workplace suffering (Dutton et al. 2006; Lilius et al. 2011). We build on this growing body of research to theorize how two organizational practices tailored to noticing, feeling, and responding to the multifaceted sources of suffering in an organization (i.e., caregivers, families, and patients) affect HCAHPS. Specifically, we explore how compassion practices—recognizing and rewarding compassionate acts by caregivers and compassionately supporting caregivers in coping with the stresses and traumas experienced at work creates a context whereby it is easier to effectively detect, feel, and respond to suffering. Recognizing and rewarding compassionate acts makes caregivers more likely to establish a connection with their patients (Kahn 1998) and provide more holistic care that treats the whole person rather than just illness (Brody 1992; Cassell 2002). Rewarding compassionate acts also fosters empathic concern that enables caregivers to quickly notice when patients are “off” or “not themselves” (Lilius et al. 2011) and customize their treatment accordingly. By reinforcing more holistic and personalized care, compassion practices are likely to elicit satisfaction with the caregiving experience (Innis et al. 2004; Wolosin, Ayala, and Fulton 2012) and more favorable patient perceptions of care quality (Jha et al. 2008). For example, numerous hospitals utilize “Daisy Awards” that publicly recognize compassionate care in nursing (Daisy Foundation 2011). Practices that support caregivers can help manage the costs of compassion to caregivers (Hoffman 2008) like compassion fatigue or exhaustion resulting from absorbing others’ suffering (Figley 1995). Without organizational mechanisms for managing such strain, burnout (Kahn 1993; Maslach and Goldberg 1998) and reduced productivity (Frost 2003) can result. Organizational practices can help caregivers cope with the demands of their work (Lilius et al. 2011) by creating outlets (e.g., pastoral care) and forums (e.g., meetings) to process their emotions and provide support (Kahn 2005). For example, Cleveland Clinic has “Code Lavender” teams that respond to employees in need of emotional and spiritual support resulting from work-related trauma (Gregoire 2013). Being supported in this way can increase psychological engagement (Kahn 1990) and connection to the organization (Lilius et al. 2008), making caregivers more likely to reciprocate and generalize compassionate behavior (Abendroth and Flannery 2006; Fowler and Christakis 2010) and provide high-quality care. Appendix SA2 provides additional examples from prior research and our own qualitative work regarding compassion practices.