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

• Type of Material: Article
• Authors: Elizabeth A. Rider, Harvard University; MaryAnn C. Gilligan, Medical College of Wisconsin; Lars G. Osterberg, Stanford University; Debra K. Litzelman, Indiana University; Margaret Plews-Ogan, University of Virginia; Amy B. Weil, University of North Carolina; Dana W. Dunne, Yale University; Janet P. Hafler, Yale University; Natalie B. May, University of Virginia; Arthur R. Derse, Medical College of Wisconsin; Richard M. Frankel, Indiana University; William T Branch Jr., Emory University
• Language: English
• Date: 2018-07-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s11606-018-4470-2
• Title of Journal or Parent Work: Journal of General Internal Medicine
• ISSN: 0884-8734
• Volume: 33
• Issue: 7
• Start Page: 1092
• End Page: 1099
• Grant/Funding Information: The authors are grateful to the Arnold P. Gold Foundation [grant number FI-14-008] for generous support of the research.
• Keywords: JOB-SATISFACTION; Science & Technology; INTERVENTIONS; compassionate healthcare; HIDDEN CURRICULUM; humanism; Life Sciences & Biomedicine; organizational culture; leadership; PATIENT; VALUES; values; MEDICINE; Health Care Sciences & Services; LONGITUDINAL FACULTY-DEVELOPMENT; HUMAN DIMENSIONS; burnout; PHYSICIAN BURNOUT; General & Internal Medicine; PROFESSIONALISM; faculty development; Medicine, General & Internal
• Research Categories: Health Sciences, Education; Health Sciences, Medicine and Surgery

Abstract

Background: Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction. Objective: To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians. Design: From 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. Participants: Sixty 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. Approach: Participants’ responses were analyzed using the constant comparative method. 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. Conclusions: 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. 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.