Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice

Abstract

BackgroundChanges in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction.ObjectiveTo identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians.DesignFrom January 1, 2015, through December 31, 2016, faculty from eight US medical schools were asked to write reflectively on two open-ended questions regarding institutional-level motivators and impediments to humanistic practice and teaching within their organizations.ParticipantsSixty eight of the 92 (74%) study participants who received the survey provided written responses. All subjects who were sent the survey had participated in a year-long small-group faculty development program to enhance humanistic practice and teaching. As humanistic leaders, subjects should have insights into motivating and inhibiting factors.ApproachParticipants’ responses were analyzed using the constant comparative method.Key ResultsMotivators included an organizational culture that enhances humanism, which we judged to be the overarching theme. Related themes included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities that promote humanism, and practice structures that facilitate humanism. Impediments included top down organizational culture that inhibits humanism, along with related themes of non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures.ConclusionsWhile healthcare has evolved rapidly, efforts to counteract the negative effects of changes in organizational and practice environments have largely focused on cultivating humanistic attributes in individuals. Our findings suggest that change at the organizational level is at least equally important. Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism. We offer suggestions for organizational change that keep humanistic and compassionate patient care as its central focus.Electronic supplementary materialThe online version of this article (10.1007/s11606-018-4470-2) contains supplementary material, which is available to authorized users.

The Doctor’s Heart: A Qualitative Study Exploring Physicians’ Views on Their Professional Performance in Light of Excellence, Humanistic Practice and Accountability

“…Physicians consider caring about patients and their families, putting patients' interests and concerns first, and gaining and deserving the patient's trust, as this essence. This is consistent with the humanistic realm of actually being with patients when they are suffering, exactly what many patients want and expect from their physician [29]. These findings confirm what has long been recognized, that is motivation is a driving force of behaviour and performance, extending out from the realm of philosophy to the psychological, behavioural and management domains [30].…”

Feedback Redefined: Principles and Practice

“…Such an organizational culture ensures learning and continuous improvement through acknowledgement of areas of weaknesses as well as areas of excellence, willingness to seek help, focus on humanism and accountability to excellent care. [66][67][68] Institutions have a major role in establishing this culture to mitigate the effects of the hierarchical clinical environment, empower learners to take ownership of their professional growth, and enable collaborative bidirectional feedback. This empowerment can be driven by explicit expectations for collaborative calibration of performance against expected goals and clear messages that all professionals have strengths and areas for improvement.…”

The long‐term impact of an interprofessional humanistic faculty development programme: A qualitative investigation

“…Common barriers have been found to be time, stress, bureaucratic culture, and episodic burnout . Ways to alleviate, though not resolve, these barriers to humanistic practices and teaching include determination to live by one's values embedded within a strong professional identity . We contribute to this area of research by qualitatively exploring the long‐term outcomes of MAP‐IT.…”

“…A second limitation is that, while participants were diverse and represented various backgrounds and departments, all participants were from a single health system. Organizational culture has the ability to promote or inhibit humanistic practices and thus, findings may differ across institutions. Future studies should explore the long‐term effects of similar small‐group, longitudinal, professional development programs in other institutions.…”