Values mismatch leads to drop in compassion — study

April 12, 2023

As New Zealand faces another winter of critical health care staff shortages, a new study shows patients and staff are likely to suffer when efficiency is prioritised over compassion by service providers.

Auckland University student and lead researcher, Alina Pavlova.

The study, published in the Journal of Internal Medicine, by New Zealand and Canadian academics, measured the outcomes for compassionate care when health workers feel that there is a mismatch between their values and those of their employer.

They found that when this occured, health care workers had less ability to be compassionate, despite retaining competence to do so. Workers in this situation were more likely to experience burnout and absenteeism, consider early retirement and have reduced job satisfaction.

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Of the more than 1000 New Zealand health care professionals surveyed for the study, half were nurses.

Financial concerns and bureaucratic delays trump safety

A registered nurse (RN), who didn’t want to be named, said she was retiring from her role at a city hospital one year earlier than she would have as a result of a head injury she suffered on the job after a young patient slammed a door on her head.

The nurse, who was not part of the study, was trying to prevent a potential injury to a boy, who had been slamming a door, by using a wedge to keep it open.

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As she opened the door — which had a single pane window — he slammed it on her.

She and other colleagues had “asked and asked and asked” for safety measures — including safety glass on all doors and windows in the unit — to prevent such an incident for over two years, but they had only partially been completed.

Following the incident, the safety work was done. The nurse believes financial considerations and bureaucratic delays had trumped safety for patients, whānau and staff.

‘When we look at organisations’ websites, career posts etc, usually we can see a signal of very humanistic values — compassion, empathy, manaakitanga . . . but this research has shown there is a difference between what organisations say they are and what they really are.’

“There needs to be more [people] in health and safety roles, who are able to approve funding, listen to concerns and act straight away – not after the event.”

Earlier in her career the nurse left a role in public health, after restraints were put on the amount of time she spent with clients.

“They were on your back to close cases, and that felt wrong for me because I knew the families — and the research would suggest — they needed more intense work for a longer period of time to actually make the changes.”

“You would close a case and in six months’ time they would come back with the same issues.”

The nurse and some of her more experienced colleagues continued to provide the needed services, while trying to fight for management to support the treatment they believed was necessary.

Ultimately, she resigned from the role, unable to resolve the conflict between her personal values and those of management.

Organisational responsibility for compassionate care

Alina Pavlova, who initiated the study as part of her PhD in the department of psychology, Auckland University, said previous research focussed on compassion as an individual trait, but the team wanted to look at the wider health care service context and the role of organisations.

Prior research showed organisational environments and culture played a role in the ability of individual clinicians to practice compassion.

“From a psychological perspective, when we are in an environment where we are not able to help, there is a sort of moral distress of not being able to be compassionate, or provide the best possible care.

“So with that in mind we set out to look at differences between personal values, which we hypothesised are more humanist-orientated, and perceived organisational values.”

The study outcomes confirmed there were perceived differences in values, and when this was the case, it resulted in negative outcomes.

“When we look at organisations’ websites, career posts etc, usually we can see a signal of very humanistic values – compassion, empathy, manaakitanga . . . but this research has shown there is a difference between what organisations say they are and what they really are.”

While there was a significant impact on the ability to practice compassion, in value-discrepant workplaces, this wasn’t the case for compassion competence – how competent they perceived themselves to be –  the study found.

“Competence remains high, but it’s just that people are not able to practice in accordance with their values,” Pavlova said. 

‘From a psychological perspective, when we are in an environment where we are not able to help, there is a sort of moral distress of not being able to be compassionate, or provide the best possible care.’

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The study authors urged health care organisations to review their stated values and ensure they are “reflected in policy, targets and priorities throughout the organisation”.

” . . . healthcare organisations need to invest in a careful examination of whether and how these values are embedded and operationalised in the day-to-day practices, behaviours, beliefs, decisional processes and core performance indices, including patient outcomes.”