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March 5, 2018

How Atrius Health embedded empathy in its organizational culture

Daily Briefing

    Writing in NEJM Catalyst, leaders from Atrius Health share their efforts to "integrate empathy in [their] daily work," which the authors hypothesize contributed to an increase in the organization's Press Ganey scores for "sensitivity to patients' needs."

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    Why Atrius Health decided to build empathy

    According to the authors, their own learning, as well as training from the Cleveland Clinic, suggested that clinical empathy can boost patient satisfaction, improve adherence to treatment recommendations, reduce patient distress, and improve health outcomes.

    Further, at an internal level, when employees believe that their leaders "care about them as human beings," employees may experience reduced stress, display greater teamwork, and feel more engaged in their work, the authors note.

    The 4-step path to launching empathy forums

    To make empathy an integral part of Atrius, the organization created employee forums aimed at helping staff understand the value of empathy, recognize their own strengths and challenges with empathy, and learn how to convey empathy to patients.

    The overarching goal, according to the authors, was to improve patient satisfaction and experience and support a more compassionate, supportive organizational culture.

    Atrius began developing the empathy forums in October 2015, implemented them in phases across the organization's geographic regions in February 2016, and completed the forums in November 2016, the authors write.

    The program, Amplifying Empathy, consisted of four parts, according to the authors:

    1. Train-the-trainer. Atrius asked each practice location to identify a site leader to co-facilitate the forums with an internal Organizational Development & Learning (ODL) consultant or a Human Resources consultant. The internal leaders went through a three-hour train-the-trainer session, in which they practiced forum facilitation with a full script and additional support.
    2. Pre-work. In advance of the forums, participants received material to review, including a short story about a patient's experience, a Cleveland Clinic video, and a self-assessment.
    3. Empathy forums. Forums were held at Atrius' 24 biggest practice sites, and staff from smaller sites were invited to attend. The 90-minute sessions included a didactic presentation of a communication model, "before and after" demonstrations, and role-playing. Facilitators provided specific language for talking with colleagues or patients in distress, noted the importance of eye contact and active listening, and played video demonstrations showing how small changes in body language and word choices can have a large effect on others' perception.
    4. Post work. After the forums, Atrius provided "ongoing reinforcement" in the form of one-on-one meetings, team meetings, and information posted to the Atrius intranet.


    Across 2016, Atrius offered 251 forums, and 92.3% of employees, or 4,246 individuals, attended. Atrius asked participants to evaluate the forums using Likert Scale measurements—one to four—and the average value score was 3.75, above the stretch goal of 3.5.

    The authors note that Atrius saw an increase in 2016 in the organization's Press Ganey Associates survey scores for "sensitivity to patients' needs." The authors hypothesize that the forums may have contributed to the increase.

    In addition, the authors note anecdotal feedback suggesting the program improved care delivery. One clinician noted, "'I find I am listening more, trying to understand what my colleagues or my patients have been through, and am less judgmental.'"

    Challenges to implementing empathy forums

    The authors say that other health systems that are considering holding similar forums should keep in mind "the amount of administrative support needed to manage such a transformative undertaking." For instance, the forums required material preparation, continuing education management, communication, and participation tracking.

    Moreover, the authors say organizations should "have clear criteria for characteristics and attributes (such as credibility and trust) that make their facilitators qualified candidates" and should develop a plan for continued education.

    The authors conclude, "Embedding cultural shifts into an organization like this takes time and practice, so one intervention is not enough to make substantial lasting change" (Strongwater et al., NEJM Catalyst, 1/23).

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