Blog Explanation

This blog brings together content that is noticeable, important or otherwise interesting from a human givens point of view.

Thursday, 21 March 2013

Compassion is not just for nurses, it's for managers too

21 March 2013

The Francis Report should form a landmark in the quest to address deeply damaging flaws in the health service – and begin to turn compassion from a 'hurrah word' into a concept cemented at the heart of  healthcare design, says Professor Paul Crawford

One of the key elements of the Francis Report into the appalling treatment of patients by Mid-Staffordshire NHS Trust is its foregrounding of systemic failure and the need for responsible management. We can only hope this marks a long-overdue shift in emphasis in the quest to address fundamental and deeply damaging flaws within the health service.

The stock response to the question of compassion depletion – acting with coldness, cruelty or uninterest in the suffering of others – has been far too simplistic for too long. The customary reaction is that the fault must lie entirely with the nurse rather than with the production-line cold clinics and threat cultures in which health systems in high-income societies all too frequently ask their practitioners to work.

As a result, the term "compassion" has come to be used rhetorically or uncritically, often as a kind of "hurrah word" that is connatural with or defines nursing. In fact, compassion is a highly complex and under-researched concept that we might best attempt to capture in a list of adjectives: kind, warm, loving, affectionate, caring, sensitive, helpful, considerate, sympathetic, comforting, reassuring, soothing, attentive and so on.

It is tempting to reflect how wonderful it would be if every nurse could be imbued with these qualities, but this, again, is to massively over-simplify both the problem and the solution. Compassion is not just for nurses: it is for all the professionals who work in the NHS and, indeed, for all those who manage it.

Moreover, compassion does not reside solely in our moral ambit: it is generated by compassionate environments. This is why we need to cement it at the very heart of the design of the healthcare system – across place, process and person – instead of limiting it to individuals and, as has repeatedly been the case, presenting it as a dilemma that the nursing profession alone should tackle.

Growing calls for "compassionate design" have been born out of an increasing body of work centred on the role of dignity and compassion in healthcare and how these phenomena can be measured and enhanced. The King's Fund's Point of Care initiative raised concerns about the NHS's target culture and the way in which relational work and interaction habitually default to the least qualified members of staff.

Peter Carter, general secretary of the Royal College of Nursing, has argued that a major contributory factor to the poor care of older people is a care assistant workforce that is not properly trained. Francis has now added to the mounting disquiet by laying bare the catastrophic extent to which compassion has been overlooked in favour of financial objectives and a desire to hear only good news.

Even now, there are those who maintain that effectiveness and efficiency are paramount, yet the reality is that the current bent for a factory-style NHS causes untold harm to patients and practitioners alike. The conveyor belt mentality it ineluctably cultivates in staff is so prominent that it is not unusual to hear nurses speaking like supervisors at a car plant. The atmosphere is deleterious for all concerned.

Kari Martinsen, a Norwegian professor of nursing science, poses a straightforward question in her book Care and Vulnerability: "Does the hospital, with its rooms, corridors and interiors, invite people to dwell in its midst?" She posits that nurses should not have to contend with surroundings that are "painful to be in" or "rooms with shameful architecture". Later, presaging some Francis observations, she warns: "People must always come before numbers. Statistics, benchmarks and action plans are tools, not ends in themselves. This is what must be remembered by all those who design and implement policy for the NHS."

We ignore at our peril the emerging message that the genuine transformation of hospitals and care homes into compassionate spaces will not occur merely through practitioners applying the right attributes like some kind of miracle cream. The development of a more compassionate NHS will need to go much deeper than mandating angelic nurses or setting up new box-ticking initiatives to be poured in as a skill through linear or values-based curricula.

What we have to see, particularly in light of the Francis Report, is a significant and essential change in both government policy and NHS organisation – a change focused on how services and processes can maximise the likelihood of compassionate relationships from and among nurses and other clinical and non-clinical staff. The rule of the clock or the excuse of being "far too busy" should not blind us to opportunities to encourage meaningful engagement that will ultimately benefit not just patients but practitioners.

We should all demand that our NHS not be turned into a production line. As a starting point, the government, policymakers and managers of healthcare organisations could do worse than spend some time reading up on the psychology of threat and its aftermath. Patients should not have to be treated amid threat cultures that lead to compassion fatigue and moral slide – and, equally, practitioners should not have to work in them. We all deserve better than that.

Professor Paul Crawford holds the world's first chair in health humanities and is the founder/ director of the International Health Humanities Network ( and a founder of the Madness and Literature Network (

This article first appeared in Public Servant magazine

Why Happiness Should Be a Global Priority

Posted: 18/03/2013 23:00, by Richard Layard
This Wednesday sees the very first United Nations International Day of Happiness, which is being celebrated around the world on 20 March. This follows a recent resolution adopted by all members of the UN General Assembly calling for happiness to be given a greater priority. So why are people now taking happiness so seriously at national and global levels?
Happiness means the quality of life as each person experiences it. This is a key outcome in itself and is an important measure of success for any country, regardless of the level of economic development. It tells us whether people are leading lives they find satisfying and fulfilling. So information on the causes of happiness helps policy-makers to choose policy goals that serve the real needs of their people.
But, in addition, happiness is a major determinant of the other goals that policy-makers care about. Personal resilience predicts educational performance better than IQ does; and higher wellbeing improves work performance and workers' earnings. By contrast depression and anxiety account for 40% of underperformance at work, 40% of time off work and 40% of disability. Their overall cost amounts to some 10% of GDP. Greater happiness increases life expectancy; by contrast depression reduces life expectancy as much as smoking does. So happiness is a major contributor to many of our most important social goals.
As a result of 30 years of research, we now know a lot about what affects happiness. The main influences are economic, personal/social and environmental. On the economic front, income is important in every country, and poverty is a major source of unhappiness. But it is not the only thing that matters. In most countries income explains less than 2% of the overall variance in happiness (the other identifiable factors explain about 20%). Across countries, income differences explain about 6% of the differences in average happiness, while social factors explain a great deal more. Work is also vital for happiness and its importance goes well beyond the income which it provides. Education is also important, largely as a factor affecting productivity, income, employment and health.
Turning to personal/social determinants of happiness, the most important in developed countries is mental health. In these countries it accounts for 40% of all illness (weighted by severity) - more than heart disease, cancer, lung disease and diabetes all combined. It is also largely a disease of working age so that it has massive economic consequences, while physical illness is more concentrated in later life. In poorer countries by contrast physical illness has major impacts at every age but mental illness remains an equally important cause of low wellbeing.
Another crucial determinant of happiness is the quality of human relationships - above all in the family but also in the community and at work. Secure employment is vital for those who want to work and personal security against violence is vital for everyone. Good governance is essential too - wellbeing studies show the corrosive effect of corruption, and the crucial role of personal freedom and the rule of law.
Finally comes the environment. Research shows clearly the importance of today's environment for people who are alive today - including housing, urban design, transport systems, and green space. But the environment is also important in a quite different sense, since how we treat the planet today determines the world which future generations will inhabit. So when we are considering happiness and quality of life, we must take into account those future generations as well as our own.
The implications of all this evidence are far reaching. Here are six of the most important actions which are required if we want to create a happier society:
  • Mental Health. Evidence-based treatment should be as available for mental illness (including depression and anxiety disorders) as it is for physical illness.
  • Economic Policy. Employment is so important that no risks should be taken with economic stability, simply in order to increase economic growth.
  • Communities. Measures to promote economic growth should be accompanied by explicit policies to sustain social cohesion, stable family life, and personal security.
  • Equality. More equal incomes are desirable because extra money improves wellbeing more for the poor than the rich. Moreover a greater spirit of equality in a country increases mutual respect and trust, which are crucial for wellbeing.
  • Schools. Schools should aim explicitly at developing young people who are emotionally resilient and eager to contribute to the social good.
  • Families. Stable families are so important that every society needs its own system of support for couples in conflict.
Governments should make the happiness of the people the main outcome which they pursue. As Thomas Jefferson said "The care of human life and happiness... is the only legitimate object of good government". That is why there is now a growing demand to include subjective wellbeing in the new post-2015 Sustainable Development Goals.
But, perhaps most importantly of all, we need to encourage a more empathic and caring culture, where people care less about what they can get for themselves and more about the happiness of others.
This is why I'm supporting the Day of Happiness, when Action for Happiness is encouraging people everywhere to make a personal pledge to live in a way that contributes to the happiness of others. If more of us made that our central purpose in life we would have a far happier and more cohesive world.

Friday, 15 March 2013

Our upside down world

The United Nations has estimated the cost of ending world hunger at about $195 billion a year. 

( Twenty-two countries have pledged to donate this money by contributing 0.7% -- less than 1% -- of national income to international aid, but the goal has yet to be reached. Five countries have already met the goal, while others are on target to meet it in a few years. Some, including the U.S., are lagging.)

Global Weight Management Market is estimated to be USD 385.1 billion in 2010 and expected to reach USD 650.9 billion in 2015 (source: Transparency Market Research)

Basically, the money we are spending on failing to avoid getting fat could solve world hunger three times over with change. Who decided to call us homo sapiens.....?

RSA Animate - Smile or Die

Monday, 4 March 2013

Too much medicine campaign - BMJ

The BMJ's Too Much Medicine campaign aims to highlight the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care.
There is growing evidence that many people are overdiagnosed and overtreated for a wide range of conditions, such as prostate and thyroid cancers, asthma, and chronic kidney disease.
Through the campaign, the journal plans to work with others to increase awareness of the benefits and harms of treatments and technologies and develop ways to wind back medical excess, safely and fairly. This editorial by BMJ editor in chief Fiona Godlee and overdiagnosis researcher Ray Moynihan, senior research fellow at Bond University, Australia, explains more about the campaign:
Dr Godlee said: "Like the evidence based medicine and quality and safety movements of previous decades, combatting excess is a contemporary manifestation of a much older desire to avoid doing harm when we try to help or heal.
"Making such efforts even more necessary are the growing concerns about escalating healthcare spending and the threats to health from climate change. Winding back unnecessary tests and treatments, unhelpful labels and diagnoses won’t only benefit those who directly avoid harm, it can also help us create a more sustainable future."
Next steps
The BMJ is a partner in the forthcoming international scientific conference, Preventing Overdiagnosis, to be held in September 2013 in Hanover, New Hampshire. The conference seeks to bring together the research and the researchers, advance the science of the problem and its solutions, and develop ways to better communicate about this modern epidemic. Registration is now open at
As part of the campaign the BMJ will produce a theme issue in early 2014, featuring the best papers from the conference.
The BMJ and the Consumer Reports journal will launch a series on how the expansion of disease definitions is contributing to overdiagnosis, featuring common conditions including pulmonary embolism, chronic kidney disease and (pre)dementia. Underscoring the need for caution, each article will feature a limitations section, highlighting the caveats accompanying this evolving and complex science.