Empathy, Psychological Safety, and the Interprofessional Team: Improving Client Outcomes and Reducing Burnout

Vivian Campagna, DNP, RN-BC, CCM, ICE-CCP; Chief Industry Relations Officer of CCMC

 

Empathy has always been a crucial tenet in the ethos of case managers and disability management specialists. As client advocates, we lead with empathy to understand where clients are and meet them there. But to provide them with the best outcomes possible, we need empathy embedded across our care teams — for clients and for one another. Empathy can help mitigate the overwhelming burnout in health care that has only intensified with the COVID-19 pandemic. This begins with empathetic leadership that promotes psychological safety.

Empathetic leaders embrace open communication, encouraging team members to share their perspectives. Our goal is not to agree with everyone, but to understand them. Empathetic leaders listen with an open mind. They listen before they speak to avoid forming opinions that can hinder that openness.

Most people are not perfect empathetic leaders. Much like learning, empathy is a continuous practice. I am always working to cultivate a more empathetic leadership style. I tend to have strong opinions, but I try to regularly check myself to ensure I remain open to others’ as well.

I recently presented at the National Committee for Quality Assurance (NCQA) 2022 Health Innovation Summit on this topic, discussing the importance of compassionate empathy, psychological safety, and the role that an interprofessional team can play in driving both. It was a deeply fulfilling presentation, and it’s a privilege to share my key points with you.

A lack of empathy drives detrimental disconnect, burnout, and loss of talent. I experienced firsthand the impact of a leader lacking compassion during my time working as an operating room (OR) nurse. In the early stages of my pregnancy, I brought the OR manager a note from my obstetrician conveying the need for me to take regular breaks. She told me the note meant nothing and I’d get a break only when she authorized it. I quickly transferred out of that work environment.

My story proves a simple, but powerful point: When we perceive a lack of compassion and consideration for our wellbeing from leadership, our personal connection to our roles and the likelihood that we will stay are greatly diminished. In contrast, empathetic leaders make their teams feel understood and valued, providing invaluable flexibility when needed.

Another example: When I was a hospital director, a staff member consistently showed up late. Instead of jumping to disciplinary action, I asked the employee about what was going on in their life that led to the late arrivals. I learned that the school bus didn’t come to their house in time for them to make it to work by 8 a.m., and they couldn’t leave their young child alone at the house without ensuring the child got on that bus. By taking a closer look at the situation, we identified a need for unique accommodations to fit the individual’s circumstances.

Empathetic leaders realize that everyone can face extenuating circumstances. Sometimes, no matter what people do, there are barriers they can’t overcome to meet rigid expectations. Leaders must ask questions about our teams’ perceptions and lives so that we can be aware of the big picture, including external factors that may shape behavior.

Empathetic leadership is always essential, but during crises that induce higher levels of burnout—such as the COVID-19 pandemic—empathy can be the backbone of a team’s resilience. Dire situations call for increased transparency about setbacks and require leadership by example. There is a clear difference between conceptual comprehension and comprehension gained through direct experience. For instance, an ICU director hiding out in their office while staff overextend themselves to care for critical COVID-19 patients might send an email expressing awareness of staff’s struggle, but it could be perceived as disingenuous unless that struggle is shared. During the pandemic’s peak, as with most crises, when employee wellbeing was most at risk, leaders perceived as most empathetic and trustworthy by employees rolled up their sleeves to help their teams on the front lines, shoulder to shoulder. This approach built mutual respect and trust, contributing to psychological safety.

Amy Edmondson first coined the phrase “psychological safety" in her book, “The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth.” The book describes Edmondson’s findings from a research study on medical errors, during which she discovered that the most effective hospital teams reported the most mistakes. She discovered it was because these teams felt comfortable enough to share and learn from their mistakes. Thus, they had a strong sense of what she termed psychological safety, or a sense of security when speaking openly without fear of repercussions. For example, as Edmonson describes, a lack of psychological safety may lead a nurse practitioner not to speak up when a doctor forgets to order a lung growth medication for a prematurely born infant. Psychological safety improves client care by enabling everyone to help one another and grow.

Psychological safety is not only promoted by empathetic leadership, but also and especially by interprofessional teams, which allow people to bring their whole selves to the workplace. An interprofessional team is comprised of people of different professions who understand and respect one another’s expertise and roles.

No one person knows everything. The interprofessional team acknowledges that, valuing each person’s expertise equally and relying on one another to fill in knowledge gaps. Interprofessional teams have leaders but are not hierarchical, as leadership can shift at each moment based on whose role is most relevant to optimize client care.

There is a tremendous need for greater integration of the interprofessional team model across health care settings. In a hierarchical setting, a physician might feel challenged by a case manager who questions his decision to discharge a client at a particular moment. In an interprofessional team, it might be considered a good question, reminding the physician of factors outside their perspective.

In a health care system that’s constantly evolving, with people’s lives at stake, we must always feel comfortable expanding our knowledge, asking the questions we need to ask, and getting the help we need. Greater adoption of the interprofessional team begins with education — collaborative classes in which students in schools of nursing, medicine, social work, pharmacy, and other professions learn collaboratively and develop respect for one another’s expertise.

Our work as case managers and disability management specialists is a continual and fundamental learning experience. Health care is changing astronomically in very short periods of time. If we don’t keep learning and examining situations from various perspectives, we can’t give the best of ourselves and we limit our ability to grow. Every person brings their own unique knowledge, and listening to one another helps fill in any gaps in our own knowledge.

I’ve always said that perspective is reality in the eye of the beholder. By giving one another the opportunity to express our own realities, we can acknowledge and learn from one another, and we can establish an environment richer in understanding to optimize our clients’ care. The best possible client care and personal growth are so worth the consistent effort. These are ideals we all must strive toward.