Updated March 1st, 2017
Avedis Donabedian the giant of healthcare safety and quality once said that
“Systems awareness and systems design are important for health professionals, but they are not enough. They are enabling mechanisms only. It is the ethical dimensions of individuals that are essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system.”
The 14 principles of W. Edwards Deming include 11 that are focused on the human factors including , pride of workmanship, education and self improvement. The exhortations of these founders of process improvement and healthcare quality and safety now reverberate in our current efforts to bring culture of safety (COS) to both institutions and medical offices. The core of COS is caring, about our patients, colleagues and the sacred mission of providing help to the healthy, sick and dying.
The mind body connection is an untapped trove of opportunities to promote healing. There is an extensive scientific literature which connects stress reduction and social interaction to multiple physiologic responses. The power of human touch to actually lower blood pressure, reduce heart rate, strengthen our immune system, increase oxytocin (particularly in women) is reported. At DePauw University, Dr Matthew Hertenstein has discovered that touch communicates emotions. Dr Hertenstein stated
"Our study is the first to provide rigorous evidence showing that humans can reliably signal love, gratitude and sympathy with touch. These findings raise the interesting possibility that touch may convey more positive emotions than the face.''
The biochemistry of love has been recently published as well. SEE Extensive research on the physiologic effects of oxytocin have been reported for decades and their effect on healing is being further studied. (1) Reducing stress decreases levels of cortisol (the fight or flight hormone), can help decrease pain, increase hemoglobin levels and stave off potential senility in those over 70. The opposite effect of profound grief/loss leading to premature death has been described in the "Broken heart syndrome". The medical literature has named it stress-induced cardiomyopathy or takotsubo cardiomyopathy which can be caused by an emotionally stressful event. It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection.
Creating the milieu within a healthcare system which both promotes and encourages safety/quality and healing lies at the heart of successful care giving. Maintaining an institutional and personal philosophy of self critical analysis, seeking to improve daily , learning from errors and promoting transparency is founded on compassion and love of patient, care giving and self.
Empowering senior leadership and managing boards with these values sends a clear message to all those on the team nurses, doctors, OR techs , house keepers and parking valets that we believe in our vital mission. A listening ear , easy smile and compassionate attitude may be our greatest healing tools.
Openly talk about these issues at grand rounds, employee reviews, executive and board retreats and summer institutional barbecues and holiday celebrations. Make the philosophy of love of self, colleague and patient actionable at every opportunity.
Nicolas Argy, MD, JD
Copyright © 2017 Nicolas Argy