So, welcome. I'm Don Ellison and I am in the core group of Healthcare Reinvention Collaborative. And so far, our other core members on the call today are uh Denise Wiseman. There's Denise. I'm not sure if Key or Jennifer are on yet. Paul is is she? Hey, Jennifer. And Paul is off skiing somewhere today. So, that's our core thus far. So today's discussion is about the role of compassion in health care. As many of you know uh there is a New York time best-selling book out there called compassionics which covers much of the research done in the space of compassion in healthcare. And today we have three very knowledgeable guests who have experience in compassion research as well as clinical applications, global applications, and compassion applied to work colleagues. So I'm really excited to get those different perspectives in the room. Today I want to share um the agreement slide that um we put together for these kinds of events. So, if you'll hold on one second, I'll grab that and just go over that briefly with you. So, these are our agreements. Stay curious, ask for what you need, offer what you can. Camera's on as a default. We understand if there's a reason you don't want your camera on, but we like to see your smiling faces. Um, share your thinking over your conclusions. you'll have a chance to ask these fine guess questions and um I encourage you to share your thinking over your conclusions when you do speak with intention and listen with attention other words speak to the essence and listen to understand so that those are kind of our abbreviated uh agreements that we like to work with. So let me get started by saying that the format of the event today is that I will briefly introduce each of our three guests. So you'll get you'll be introduced to all of them before I start an asking them questions and then I will go one at one at a time to the guests with their question. They will answer. We'll go to the next guest with another question. We'll have all three of them answer one question each and then we will open the floor to questions, comments for the guests from all of you, our HRC uh community. So without further ado, let me introduce our panel. Heather Bistler brings a public health background and extensive experience in global health systems to her role as founder of Humanitar. She developed her approach to organizational compassion cultivation while working as a senior health technical advisor in humanitarian settings focusing on centering respect, dignity, and agency in healthcare delivery for displaced and disadvantaged communities. Her work emphasizes whole system approaches to creating more compassionate health ecosystems. All right. Ponta Vahiti is a nurse, engineer, educator, and researcher regarded as the compassion ambassador. She developed the vehei model to bridge the gap in compassion education. She also hosts compassion circles, peer supports sessions for our healthcare workforce to fill their cup so they can pour it forward. She believes compassion is the ultimate remedy for healing humanity. Melissa Seagull is a healthcare culture transformation consultant who founded interhuman solutions to help create healthy, compassionate, inclusive, thriving workplaces. She provides skill-based training, program development, and restorative practices across major health systems, specializing in having those tough conversations, improving teamwork and collaboration, and increasing overall effectiveness. Her innovative colleagues who care and culture keepers programs along with her use of restorative practices help healthcare teams build stronger relationships, create more compassionate environments, and learn how to support each other during and after challenging moments. All right, now we'll get to our questions. And our first question will be for Heather. All right, Heather, based on your experience designing compassionate health systems globally, particularly with displaced populations, how can we build systems that promote both provider well-being and equitable patient care? What lessons from humanitarian health care settings might help transform our broader health care systems? Easy questions, right? Softball questions, Don. Yep. You betcha. So I think it's important to first think about the nature of compassion. It is relational in nature, right? It arises in response to suffering ultimately. Um we first have an awareness of suffering. We respond emotionally to that suffering. That's the empathy piece. And then we take action to alleviate that suffering. And that's what the the distinguishing piece uh between empathy and compassion is taking action. And I think when we think about health care, we're usually thinking about the core interaction. Person falls sick, calls their doctor, goes in for the exam, doctor, you know, either alleviates symptoms or addresses the root cause of whatever brought them in. I think when I think about designing compassionate health systems is really bringing the thinking about this as a whole systems equation. So it goes beyond that core patient provider interaction. There's a whole number of people uh that are involved in providing that care. Yes, there's the patient and the provider, but the providers are also employees of someone, the health system. There are other support roles in this system. And so I think about this as I think about health systems as a relational field. and how do we cultivate or optimize the relational circuitry within the overall health system. And so it's not just I think there are limitations when we think about you know just how do we make or incentivize providers to be more compassionate to patients. Um you know we all get those uh patient feedback forms after we go to the doctor. How does your doctor do? um where I think in my experience certainly in the humanitarian service sector and I've extended that now into uh you know domestic uh healthcare spaces. I think we fail to think about the fact that providers themselves are part of a an overall system and they are working in relationship with administrators with other people on their team. I was inspired when I first embarked on um this work as you mentioned I was working in an international humanitarian organization and I was really inspired um by I I I work I use human centered design um to build more compassionate health systems and human center designers um take a lot of analogous inspiration and I was inspired by um Richard Branson who's um the founder and CEO of Virgin Group and he said clients do not come first employees come first. If you take care of your employees, they will take care of the clients. Now, I'm not advocating for, you know, either a patient first approach or a provider first approach. And often I see these things in tension with one another. You have your patient advocacy groups over here who are importantly making the patient voice uh more heard and involved in decision-m. you know, more recently, especially postcoid, we are seeing uh provider advocacy groups, provider well-being being taken more seriously, but these are often, you know, they're competing for time and attention in the health system. Um, and meanwhile, it's the administrators who are usually disconnected from both of these groups um that are ultimately making the decisions. And so, the lens that I take and apply is I use human- centered design and I think about this relational circuitry. Um, and to use a medical analogy, I I almost think about it in my starting place is usually doing compassion mapping and taking what I like to call an organizational angiogram. So figuring out, you know, compassion I see as an innate human quality. Um, so I see it as a trait of humans, but it can eb and flow depending on our state or depending on the context that we're in. And doing an angiogram helps us understand, you know, where are the compassion arteries flowing really well? How can we replicate the systems and structures that are enabling that flow? Um, how can we replicate those in other parts of the system? Where is it blocked? Do we need to place a stent in certain parts of the system? How might we shore shore up compassion in these places where it doesn't seem to be as free flowing or the the context seems to be presenting certain barriers to that flow? Um, there's lots more that I could say about this. Um, but I want to pass it off to my other colleagues that are here today to hear their perspectives as well and put this all into context together. Thanks, Heather. That's such an important perspective for us to hear that systems approach um is so um so very important. H is next. She's up for another easy question. Your clinical experience and research has shown that compassion can be measured in clinical outcomes like seeing changes in a patient's heart rate when you're holding their hand. Can you share the most effective ways to teach compassion as a skill especially to those who may be skeptical skeptical or believe it can't be learned? Yes, happy to happy to talk about my favorite topic. So yes, speaking of in clinical settings, one of the moments that really inspired me and propelled me on this journey of studying compassion was when I was caring for a patient um very young with three beautiful young kids and she was about to go into surgery and she was also connected. She had stage 4 um cancer, colon cancer, and she was on TPN connected having uh nutrition through IV and she was connected to a monitor. And when the physician came in to consent her to go to surgery, uh she looked at her and said, "Will I ever be able to eat again before signing the consent?" and the physician kind of shrugged her shoulders um kind of giving a mixed message of maybe I don't think so or I don't know and I looked at her and because she was connected to the monitor the continuous monitor I saw her heart rate increase and of course I saw her face becoming pale and then after she signed and the physician left the room she looked at me and as nurses we have the privilege of spending more time with patients, right? You're you're there to see it all for 12 hours. And so she looked at me and she said, "What do you think?" And I was like, "Okay, what am I going to say?" Because we all learn in nursing school and medical school that we shouldn't promise outcomes. Um, it's also a form of liability, right? But I believe there's there's a fine line between promising outcomes or stripping people of hope. And I think often times what we do in healthcare is that we strip people of hope. And so walking on that fine line, I thought, what can I tell her? So I looked at her and I said, I understand your cancer is aggressive, but I believe in you more than I believe in your cancer. And I grabbed her phone, which as most moms, her wallpaper was her kids, and I gave it to her and I said, "You're going to fight for them." And I again turned my head and looked at the heart rate monitor and it had stabilized. So this along with many many other clinical experiences really inspired me and made me curious into what is this phenomena? ho how easy simple it is to make someone feel better. And so that kind of started me on my journey of delving into the research of it. And when I started a compassionate care initiative, um the first question that I was asked was the definition of compassion. And one of the executives and we went around the room there was like 10 executives and none of them had the same way of defining compassion. So we realize that to be able to define it gives us the ability to measure it, gives us the ability to improve it. So having a standard definition is key to being able to cultivate any virtue. Right? If we're all talking about a different different topic, then there's no way to improve. So I started with that and really delved into the research there's abundant literature on compassion and I think collectively just like Heather said earlier they all collectively say that compassion is having that awareness or empathy or what I call recognition and then taking action or what I call responding to it. So it's that second piece that differentiates compassion from just merely having empathy. So from there you know perhaps my engineering brain was like okay this is way too abstract right and we see it um in healthcare everywhere on posters and walls and elevators on mission and vision statements you know where compassionate care is one of the values in healthcare but when you ask people what are you doing to improve that compassionate care they often don't have a response for you because they don't have a way to define it or to train on it or to measure it. So I took it upon myself to really create a way to define it further and just through observation and a lot of study and other work I came up with um like Don said the V compassion model which reverse engineers compassionate behaviors into a teachable repeatable model that you can equip and empower people with. Right? So why is this necessary? Again, like Heather said, it's two pieces. It's that recognition and awareness and then that second piece of what do you do in response to that recognition. So the way to cultivate it is um to actually cultivate both pieces, right? The empathy piece and the awareness and the recognition as well as the way to respond. And a lot of us don't always respond to the suffering of others. It is inherently in us to love and care each other. It it it's it's an innate trait. But why we don't has reasons that are beyond the scope of this webinar, but I'll just name a few. One of them is trauma. One of them is being exposed to long-term chronic suffering, right? Another one is our own trauma responses. Another one is brain chemistry. like for peu uh our beautiful neurode divergent population it could be a little more challenging to express that they care about you they care about you but that expression could be challenging so through this model I just empower people to be able to in difficult situations where you have to deliver a hard news to someone right and you're speechless and often times you go into your own trauma response maybe I'm freezing maybe I can't find words maybe I have a tendency to flight or fight or whatever my emotional response is. I empower people with ways to know that you know in that moment you have an opportunity to make an impact and you have three options or more but the three options that I talk about is in that moment you can render you can render your presence or your words or instill belief in someone you can resolve a problem that they have or you can provide relief and relief is you know in in healthcare we're often focused on providing physical relief maybe that's because it's asked in surveys that you know how is your pain control but there's an opportunity to also provide um emotional relief and mental relief and we delve into how you can do that and so I'm very passionate about moving compassion from being this abstract aspiration into equipping people with powerful skills to uh actually express it more often and more powerfully and I will close by saying Don the reason why first of all the literature is filled with evidence that it is trainable and compassion education is effective but I will just use common sense to say why um I believe compassion takes two two aspects to it one is your mindset and how you look at life and how you look at other people and we all know mindset can be shifted right and the second piece is how do you express it it's that behavior piece and then again we all know that behavioral science tells us that we can change our behaviors. So that's my breakdown of why compassion is teachable and you can cultivate it because you can shift the mindset uh of your people to understand that others are suffering and everyone is fighting a silent battle behind closed doors and to raise that awareness. And then the second piece is to equip people with ways to express that they do truly care about you. Thank you, Pont, for breaking that down. That was just a beautiful explanation. Really appreciate it. Uh, and next we'll have Melissa. All right. So, Melissa, through your work with culture keepers, restorative practices, and other initiatives focused on colleague to colleague relationships, how have you seen workplace compassion impact both staff well-being and patient care? Can you share examples of how transforming internal culture leads to more equitable and effective healthcare delivery? Yes. So another easy question. Thanks. You're welcome. No, first thanks so much for having me here. I'm really thrilled to be part of this conversation and it was interesting last week I was facilitating a workshop on uh burnout resilience and well-being and it made me think of this very question as I was going through. I talked about the causes of burnout, right, which is associated with lower patient safety and care quality and personal mental health challenges, all of those things. Many of the causes are related to the lack of compassion, right? The lack of leadership support, climate and behavior that we see um in work and work expectations. And so compassion really needs to be at the center of our conversations about improving well-being and improving workplace culture. And so a lot of my work is about teaching and embedding compassion into the workplace. Um, so you mentioned a couple of the programs and so I'll sort of go through some of those. Um, I do a lot of programs around centering compassion and so you mentioned culture keepers and colleagues who care and they're both essentially peer support models a little bit different from each other. Um, and both of those programs really help colleagues learn how to provide support to their peers, right? How do we listen, summarize, reflect, validate all of those things? Um, and also how do we provide resources and options to colleagues some of whom have experienced sort of adverse events, right? or harmful events from other colleagues. Um, and I'll I'll give you actually an example of of that one. I was in a room with senior leaders in a healthcare setting. This was about two years into COVID. Um, and I was sharing a colleagues who care program with them and sort of explaining the power of the program and the power of just asking someone how are you really like you know we pass people in the hall and we just walk on by and we say how are you? We don't we're not really expecting a response. And so this is a how are you really? like I want to know. And one of our senior leaders broke down in tears and said, you know, in two years of COVID, nobody has asked me how I am. Um I've been here almost 247. I haven't stopped um in all of the work to sort of pivot and make all of this happen. Um and no one's asked me that question. Um so these things are really powerful, right? Um really really powerful. And so teaching people how can we make sure that we're compassionate to each other um as we're doing this important work. Um you mentioned uh restorative practices. So that's something else I use quite extensively throughout healthcare. Um and in restorative practices which is actually based on indigenous practices. Um compassion is a core value. And the way that we think about restorative practices is that people are an integral part of the community. We don't just have an individual off by themselves, right? We're all part of a community and we have needs and obligations to that to that community even when harm has been caused. And so we use both responsive and proactive restorative practices in healthcare. So responsive looks like, you know, something happened, a team isn't working well together or there's been harm that's been caused. And so we employ a restorative practice um again using compassion throughout the process to repair the harm, to figure out what's happening, how do we communicate better, right? How do we work through that? Um and come together productively at the end. And then proactively again, how do we embed compassion in our workplace communities? Right? We can set group norms and behaviors. We can plan how we're going to communicate. How do we support each other? What do we do when something happens that is harmful? Um, and I'll give you an example of this one as well. Actually, uh, just this past year, I was working with a multi-disiplinary group of physicians. Um, and there was a lot of harm in this small team and they needed to really work well together. Um, so we went through a process. Um, they weren't effectively communicating. there was a lot of sort of interpersonal harm. Um, and at the end of that process actually we went from people who literally wouldn't look at each other in the room to folks who were in a room together and laughing and joking and supporting um, and just completely changed the way this little work unit worked together. Um, and that was after using a restorative practices process. Um, the third piece is really around training and Pont talked a lot about right her trainings around compassion. A lot of trainings really center compassion in this work, right? How do we teach leaders and team members how to change their work unit culture? How do we check in with each other? How do we provide support? How do we listen? All of those things. And so trainings around like being inclusive, um checking our assumptions and viewing each person as an individual, which of course impacts equity of care. Um actually this morning I was just in healthcare setting doing an upstander training for um a group of leaders, right? How do we stand up for each other during those potentially harmful interactions and make it clear what behavior norms are okay in the workplace? Right? Um and it was interesting. I was working with a leader just a couple months ago. We actually went through a restorative process and then um I was doing some coaching with this leader and he said, you know, I now understand that when I walk into a room, what I say really impacts others in the room. Um and they're all humans with feelings. And I thought, you know, after I sort of digested um what this individual said, those two sentences say a lot about how we traditionally have changed leaders, how to show up in space, how we need to be training leaders to show up in space, and the change that can happen through some of these processes um to really shift our culture, right, from one of top down and just do it, do it, do it, right? And instead really thinking about things and putting compassion at the center. Thank you, Melissa. I just love that idea of putting compassion at the center. Wow. You know, that is so transformative. Truly. All right. Thank you to all of our panel guests. We really appreciate the work that you're doing and that you're um willing to be here today um to share it with the HRC community. I'd now like to open the floor for discussion. Um you know, please open your mic or put something in the chat if you have a question. um ask our panelists about their work, share your own experiences, connect with these initiatives, explore how you might um get involved with them. Uh what questions or comments do you have for our panel? Um I have a quick story um that ties in kind of what all three amazing panelists talked about. um because my business is employee experience for the last decade in healthcare specific. Um but it really wasn't until my wife's battle with cancer that I got to see it through the patient's eyes. I've seen all the research um around employee experience and what creates extraordinary human experience. But during my wife's battle, I got to do my own kind of non-scientific study. Um, where I got to watch her hang on every worded instruction of the nurse that made her laugh, coincidentally tune out the physician that wouldn't even make eye contact. And there was one place where I was actually working with the CHRO of this large system that was caring for my wife. And there was this one floor where everything just felt different, right? And Heather, you mentioned uh relational circuitry. That is right up my alley. Um because the dynamic teams that work in healthcare are different than any other industry. I got to see because they don't tree up to a traditional org chart. You know, there there's we had a environmental services person that would always, you know, uh talk to us by and call us by name. We had a food service employee that sang to my wife when she brought lunch. Then we had the Dur the doctors and there was just this one floor at this health system that it was just different. It just felt different. And I went up to the team leader and not the not the team leader that all these people reported to because they all reported different people but the person that was really in charge and I asked them what what do you do on this floor because the feeling is just different. And she said two things. We teach everyone to lead with compassion and we have each other's backs. And that speaks to what Melissa said as part of supporting each other. And I've seen all the research. It's the number one indicator of employee engagement is when someone strongly agrees to my teammates have my back. And Pantia, you know, um she told that beautiful story on my podcast, which is about experience and healthcare. And it still just touches my heart. But one of the things Pant said to me when we've collaborated is, you know, I hate the fact I have to build a business case for compassion. You know, but it's funny that incident I went to the CHRO of that health system and I said, "Hey, I want you to do me a favor. I know you typically don't measure it this way, but I want you to pull employee experience scores and age caps from this one floor in the cancer center." And he goes, "Well, Jeeoff, that's going to be really hard to do. That's not how we really look at it." I said, "Please just find a way." And he called me a month later and he said, "Jeff, through the roof, both like I've never seen anything like that." He said, "How did you know?" And I said, "Cuz I felt the compassionate care from every single person on that floor." So, um, I think you guys all hit it right on the head. This, you know, Melissa mentioning supporting each other. Um, Heather with the talking about how administration is disconnected. you know, they they don't patient experience is over here, employee experience is over here when it's the same thing and they're not even working together and different budgets and they just don't know. And it was it was such a pleasure to be able to point that out to the administration that is so disconnected that is in their ivory tower and tell those stories of the food service employee saying to my wife and etc etc. But wonderful job by all three of you. Thank you. Jeff Marlene has a question unless one of you wanted to respond to what Jeff had to say. I I appreciate the sharing. Um it's sometime we sometimes come into this with personal stories. Um this past year I also had a personal um story right that that happened in my family and it it changes the way you look at things. Um, and I think it can be a really beautiful sort of, oh, this is what it's like to be sort of on that side, right? And recognizing that and I think it brings it gives us more compassion as we as we do our work. So, I really just appreciate the share. Yeah. Thank you, Melissa. I appreciate I'm sorry. Go ahead, Heather. Um I was just going to mention that I um authored a uh literature review on the anticcedants of compassion uh last year and one of the things that we found um that actually predisposes someone to compassion is their own experience of hardship. And so there is this tension. You don't wish hardship on or trauma on anyone, right? But it does offer a a portal of sorts to understand what suffering is and then how to show up for somebody else. And this gets to the other point that I wanted to mention, a thread that I I'm I'm seeing through all of these um shares, including Jeeoff, your your beautiful um experience that you shared, is this idea of to me it's about cultivating common humanity to see our humanity in each other. And one of the practices, I'm I'm guessing Ponta Melissa, you may use this one as well. One of the um really great, really simple tools that that I've used in the past is the the just like me meditation. You can call it a meditation or just like a guided exercise, right? But like just like me uh pont you too have experienced exper you've had experiences of difficulty you've experienced anger you've experienced sadness you've experienced joy and there's a way to facilitate this where you you go through like everinccreasing circles of um people who are you know first very close to you. it's really easy to to understand your um how you're similar and you've experienced similar types of emotions and experiences to the people close to you. Doing that in ever outward circles is more challenging. But once you realize that we as humans have all experienced the same range of human emotions, it makes people so much more relatable and it makes it so much easier to um to walk in another's person's shoes. for the administrator who doesn't walk the floors necessarily every single day of a healthare worker to realize that even if they're not close to that experience, they understand the experience of feeling joy, feeling sadness, feeling disappointment and then to make decisions using that perspective um is a lot easier. So that's the thread I'm seeing here is how do we cultivate common humanity in health systems so these can be overall containers of well-being. Thanks, Heather. Stephen Tweed has his hand raised. Thank you. Love this uh this conversation. Pante and I have communicated at some point in the past. Um, and and I'm the CEO of Leading Homeare in Louisville, Kentucky, and started the Homeare CEO forum. And my research came out of uh I was introduced to the Compassionics work uh by some homeare folks, and I started exploring and looking into this. And I've came up with this premise that in the home care industry, if we can bring in more caregivers with a higher baseline level of compassion that we can create an organization that has more compassion. So my question for the three of you is, is there a way to measure baseline level of compassion? And is that a valid assumption that we can actually go out and recruit caregivers who who bring some basic compassion to the role? Um, and I know we've talked about developing compassion. Uh, but I'm interested in this question of can we go out and recruit them and identify it and bring them in and and raise the overall level. Um, I I have some I have some thoughts. I'll be curious for what um, Panta and Heather think as well. I've never tried to actually measure compassion in that way. That being said, when I hire people, um, as part of the interview, I ask a lot of questions around, tell me a situation in which, right, X and Y happened. And when you do that, you can get a sense of how that person reacted in a situation and whether or not they brought or how they brought compassion to that situation. And so I find those types of questions can be really helpful to sort of assess whether or not this person right might be able to to show compassion from the get-go and also there's a development component I think um once people come. So that's sort of my short answer be curious for others thoughts. Yeah, that's a great point, Melissa. And one of the things that we have been doing is looking at hiring people that fit the culture of the organization. And if compassion is a core value, then we want to and so we've developed what we call the culture fit interview guide where we develop a set of basic interview questions around that. So to your point, yeah, we've we've looking at we've looked at how we uh qualitatively assess does this person bring bring some compassion. But yeah, thank you that I appreciate that a lot. Like to hear from the others. Yeah. Can I make Okay, just I want to make I want to make a quick comment on this. A very good excellent discussion. I've been thinking about this actually. Uh uh you know one of the things is quantifying the in the in the the the guest is asking the question is a very good question. How do you quantify uh this compassion or empathy? I think we can create a mathematical function that can be connected to rewarding. You know we are accustomed to thinking about rewardies or salaries or anything is a 9 to5 job or whatever the job system number of hours you present but can we connect this to more engineering way connect them to a mathematical function that can produce results I think we could do that I think we can quantify compassion is a very qualitative the abstract sometimes that's a problem you know lots been we've been talking about for a long time about that but I I think we need to implement the reward system connected to the reward the the to the empathy and the compassion I think it makes a difference I think a more engineering and quantifiable I'm interested in the Pantia is talking about that a little bit and and and then then you can comment on that thank you thank you thank you for both questions I'll try to answer both in one uh I will say that I put a link to an opensource uh article that I had the pleasure of co-authoring with UCSD scientists. Uh it's a scoping review on the measures of compassion and empathy that are currently validated. I myself am working on u creating a measure which would be based on when people experienced your suffering or became aware of it, how did they respond? So that respond piece, right? And the outcome. So I believe it's outcome driven at the end of the day. It doesn't matter if you succeeded. One of the examples I use to drive that home is I always tell people if you've lost your keys right around the house and if you say which I think many of us have and if you go around and tell people in your home that has anyone seen my keys and the other people someone's on the couch and they're like shrug their shoulders and they're like no I haven't seen it. Right? And then someone in your household gets up and says let me help you find it. let me look for it with you. Right? And they get up and they start looking and they don't find it. Right? In which scenario do you feel better? The outcome is the same. So you haven't found the keys either way. Right? In the first scenario, you just went on your own and searched and you didn't find it. In the second scenario, someone got up and helped you. They actually cared. The outcome, if you look at it, you haven't found the keys. But I'm almost going to guess most of you are going to feel better in the scenario where someone got up to help you. Right? So that's the true measure of compassion is how do you make someone feel at the end of the day, right? Um and the measures of it, what's out there in the literature is already compiled into a scoping review for you. But going back to Stephen's question of how can you measure baseline compassion, right? Uh, I like a good challenge and I would say that instead of trying to select employees that are more compassionate, although there are telltale signs of who you know is inherently more has more skills to express empathy and compassion, I would challenge you to cultivate compassion for your current workforce. And the reason why I say that is because those that do not express their compassion are often hurting. And by you equipping them with compassion skills and showing them compassion, you're improving their well-being. Compassion is actually the most powerful workforce well-being tool. So, so I would like to challenge you to actually take your current employees and cultivate compassion amongst them and you will see the well-being improve as well rather than selecting people that have more compassion. I hope that answered both questions. Good. just to jump in here. I think um there's a tension that that's arising and what I'm hearing is that well for I'm a public health professional by by training and by background and there's the common adage what gets measured gets done right if you're not measuring it you're not going to be oriented to towards producing outcomes in that area and so yes we do need some kind of measures that are fit for purpose to measure compassion and um I I'm excited to pont to go look at the ones that you've develed developed and codified um or have found to be validated. I also shared another link um part of an effort that I've been involved in on the compassion measures toolbox. Um and there are a number of measures at a number of different levels, but most of the measures that have been developed are at the client level. So a client um responding to how they felt in the patient interaction. Um the one that I like best is the Sinclair compassion questionnaire, the SCQ. Um, and there was a recent landmark study that came out that found that the um, SECQ um, far and away above any other measure predicted the uh, quality of the um, the quality of their experience more than anything else. Um, and so it's really a testament to the fact that compassion does matter. What I haven't seen yet and what I'm really interested in developing is an organizational compassion score. I fully support and have been engaged in a number of interventions to train people in how to express compassion more fully. the the step that I'm trying to work on is how do we enable the whole system to embody it so that those folks because there's a danger if you put a trained person back or a transformed person back into a system that has not yet been transformed. This can give rise to moral injury in a system, right? You see you see the light, you see a new way of doing things, but you're blocked. You know, you turn this way and you realize you can't, you know, express your compassion fully in that direction. turned that way and there's some other issue that arises that that also expresses that uh prevents that full expression of compassion. And so I'm curious about there's there's a multitude of different aspects and you brought some up Melissa issues like around burnout, around engagement, um a whole host of different ways that we might measure the ability to fully embody and express compassion in a system. And so how are we measuring that whole system's ability for compassion to flow freely throughout? And um I guess the tension looping all the way back around to where I started. The reason I think this organizational score is important and that we don't just leave it at the provider level is that I I get concerned sometimes that a compassion score or measure particular at the individual employee level can be used in a punitive way as well. Um, and so that's why I really appreciate Pontto what you're saying around let's turn towards our existing employees and think about how we can engage them. Think about again what they might be enduring or what are they bringing to work every single day. What are they navigating at home before they show up at work that might be a barrier to their full expression of compassion. So how can we compassionately show up again to create this container of flourishing for everyone involved in the system? So this is where I think we really need to expand beyond that individual uh that individual score. Go ahead, Melissa. Yeah. No, 100%. I I agree with you. And I think you know it's interesting. I've seen a couple of organizations try to go through a whole culture shift to bring compassion more to the forefront. And where I've seen it hasn't worked is where we're focusing on okay this individual and this individual and this indiv we all right those people need to do that instead of it really being an entire organizationwide with and this is really key the senior leaders walking the walk because so often we have senior leaders who say what a great idea we're going to bring in some folks and we're going to do these things and y'all are going to do them and it's fantastic and what happens when we do that is that right we actually it's not sustainable and so it needs to really we need to look at the whole organization from the senior leaders sitting in the seauite right all the way through including our frontline team members um to really make sure that that we're actually changing culture and that we're not pointing at an individual right and to your point measuring compassion and saying did you fail or did you not right that's not it can't be about that yeah and we have a couple of hands hands raised Rachel you've been patient why don't you go first want to thank everybody for the really wonderful speeches about compassion and empathy, which I I think are really at the core of the culture change that we need. is one that that where we're prizing that and it's seen and celebrated and it's often sort of um in a performative way something that's a value in many organizations but in reality the actions that go along with it are sometimes discouraged or or even punished because they're at odds with profit incentives and productivity and is the competitiveness and so I what I was hearing a That wasn't a word that was stated, but I'm hearing, you know, in between the lines is psychological safety. Yeah. And that's something I talk about a lot is that, you know, how do we create psychological safety in a workplace? And also, you know, for as healthcare providers, we have to create that for our patients, but it's harder to do that if we're in a state where we don't feel psychologically safe. And then there's also sort of zooming out a concept of psychological safety for an organization that that a lot of the toxicity that we have is because there's there isn't sort of a fundamental culture of psychological safety at the organization which is affecting the leaders which is affecting the employees and so on and so forth. Um I have this book there's um Timothy Clark uh is is somebody who does a lot of work about psychological safety and I uh he has these uh four questions to ask um is sort of towards like assessing yourself about your own capacity for psychological safety that I wanted to read out here first. Do you truly believe that all persons are created equal? And do you accept others and welcome them into your society simply because they possess flesh and blood even if their values differ from your own? Second, without bias or discrimination, do you encourage others to learn and grow? And do you support them in that process even when they lack confidence or make mistakes? Third, do you grant others maximum autonomy to contribute in their own way as they demonstrate their ability to deliver results? And then fourth, do you consistently invite others to challenge the status quo in order to make things better? And are you personally prepared to be wrong based on the humility and learning mindset you have developed? Love this. Yeah, great questions. So, I don't know that I have any conclusions, but it's always something I'm thinking about and I appreciate when people are coming in and opening up this conversation. I I I wanted to have one more comment about the sort of should we recruit people with higher capacity for you know sort of baseline capacity for compassion versus should we try to develop that and I think we should probably do both. It's like very important for people in leadership positions to have a high capacity for that because they're the ones who set the psychological safety for the people below them. It's been my professional and personal experience that you can't create psychological safety if you are in a power dynamic where you have less power. The person with the most power in the room has to be the one to set that stage. So I I'm a psychiatrist and so that is the you know especially big deal for me as a physician to patient. Um, and I'm the one who has to set that. Like the patient can't come in and decide that they're safe and make sure that I'm safe. But, you know, for me towards leadership, trying to to use those same skills, that doesn't work. 100%. Thank you, Rachel. Thank you. Great contribution. I I think we have time for one more question. Marlene, I know you've had a burning question for a while now. Um, thank you. And really this follows with what Dr. Siki just um mentioned essentially and and I would direct this question to Heather. So in light of all of this as you're creating a system that supports compassionate care, how do you do that? What are the things that you need to build and design and it's great if you have a blank slate but that's one side but the other is if it's an existing organization and system. So that's my question. Thank you. Thank you Marlene. And the thing that I have to say is there's no broad blanket prescription for anyone organization to say here follow steps one through 10 and at the end of it you will have a compassionate organization healthcare or otherwise. And this is the beauty of using human- centered design to me enables and it gives me the tools to help organizations navigate that transformation themselves and determine what is most important and where they want to invest their energies and what's possible to tackle and what's not possible at this moment. So um I mentioned earlier that I use compassion mapping as one of my first um one of the first things that I do when I go into any organization and it's a number of different exercises. It might be and it depends on the organization. It might be some journey mapping. It might be individual interviews but from that really able to you know draw broad insights about what what these relational dynamics are like in an organization and from there presenting those insights back to the organization and saying here's what I'm seeing from an outsider perspective, right? does this reflect your experiences? And then we can fine-tune um what that's like um and ensure that you know what I've heard reflects the lived reality within the organization. And from there we can start to collectively co-create the problem statement. We can't address all of this all at once. What's the piece that we want to um that we want to address right off the bat? And so all of these are a co-created process. And so this is why else um Human Thunder's design is so powerful. This isn't uh uh your typical management consulting firm uh McKenzie or whatever that comes in and diagnoses and says here's the plan implement this and they walk away right we're co-creating this as we go through and that enables the the organization and it is critical Melissa as you pointed out that the senior leadership has to be on board with this and engaged with it in a substantive way otherwise and I run into this situation you get so far and then you just you get these roadblocks So that senior leadership needs to be a part of co-creating this all along the way. And so you know from these insights you develop a problem statement that you want to address. And from there I embark on a uh design workshop. And here we are using really creative um creative exercises. We remove constraints based thinking. And this is another piece to me that's super important is engaging the power of our imagination. I have a nine-year-old daughter and it is incredible to me every day the way that she sees the world. And you know, anyone with kids or who has, you know, young people in their lives, I'm sure, can attest to this. And somewhere along the way, you know, as we grow into adulthood, we kind of turn off this capacity or use it um less than we did as kids. But it is so powerful. Um and so the design process I I engage people in activities in a way that you know usually we start from okay here's the budget and we start from that constraint space thinking what can we do within this budget. Well you're already like in a little box when you're thinking with those constraints on if you think expansively and you are in a for a future oriented modality you know it gets us out of well here's all the problems we have this tiny budget. what can we do with it? And instead, if we think in our ideal world and we're thinking 20 years into the future, what is the system that we want to design? How can we design that system to be as compassionate and life-giving and regenerative as possible for everyone that had touches into that system? That's a really different orientation to problem solving. You start there and then you work backwards. Then you can start to bring in the constraints and say, okay, well, from that now we have a budget of this much. how might we, you know, refine that idea to work within this? The other thing that human- centered design offers is a really rapid iterative process. So I work in public health or historically I've worked in public health where you design a program you implement it for five years you have the measures that you're tracking for that period of time and yes you have like minor adjustments that you might make along the way as you're tracking those outcomes but by and large it's like you you design the program you implement as close to fidelity as possible and you kind of hold on tight and hope that it gets to the outcome that you want. Whereas human- centered design, you might implement a prototype uh for 3 months, for 6 months, and you have just a few key metrics that you want to see, is it changing this thing? And you're constantly checking in, well, if we tweaked this here, if we, you know, turn that dial there, um what are the changes in that outcome measure? And so very quickly, you're learning from your failures. Um and you're able to get to that, uh desired product or service or u strategy much more quickly. And all of this at every moment is a co-creative effort um with the teams. So that's how I approach doing this at an organizational level. Um and you know I have to also say it's again it's not going to solve all the problems all at once and working in these big health systems that are part of an even larger I mean it's healthcare in the US in particular is so complex, right? It's almost 20% of US GDP. Um and so everything there's layers upon layers of context in the system. Um, and so really that's where like a tightly defined problem statement, this creative process can help create both incremental, fractional, and yet transformational outcomes at the end of the day. And I'd be happy to talk to you, Marlene, in more detail about the specific circumstances of the system you might be in at any point in time or anyone here on on today's call. Thank you, Melissa, Pont, Heather. This has been a uh such a robust conversation about compassion. Our HRC's public events are meant to kind of figure out, you know, what the levers are that we can push or pull uh to transform health care as it is today because we know it can be better and we're working towards that positive outcome bringing our ruckus makeries together at events like this. So really appreciate all three of you and everyone else that attended and asked questions and you know this is what our um this collaboration is is about this wicked collaboration. So we're about to jump into network conversations where you'll be given an opportunity for