Abstract
ABSTRACTBackgroundChanges 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.
Highlights
While 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
Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism
We noted that many statements pertaining to motivating factors described individual acts and relationships, or participation by small groups of study physicians in activities designed to shore up humanism: An organizational culture of humanism: Respondents described humanistic culture as being maintained by caring relationships that reflected the study physicians’ values
Summary
One of medicine’s great traditions is humanistic care of those who are suffering.[1,2,3,4,5,6] Deep-seated personal commitment to incorporate human values like caring, compassion, and respect into every health care relationship defines medical humanism and is imbedded within the fabric of medical professionalism.[2,3,4,7,8,9,10,11,12,13,14,15] Yet, while remarkable technological advances have influenced what we can do to patients, much of what patients want and expect from their doctors remains within the humanistic realm of being with patients when they are suffering. OBJECTIVE: To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians. KEY RESULTS: Motivators 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
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