Leadership and Empathy
By Benjamin Zigun, MD, JD, MBA, Chair of Psychiatry, Griffin Hospital, Derby, CT
This article is part two of a two-part series. Part One can be found here.
In Part 1 of this series, we explored the importance of empathy, particularly in regard to the provision of healthcare to patients and by extension to their family members. We concluded that while there can be circumstances that try our patience, when it comes to interactions with patients and their families, maximal empathy should be encouraged and demonstrated. In Part 2, we consider the leader’s role in healthcare, how the role has grown more complex, and we focus on the interplay between leadership and empathy.
Qualities of Effective Leaders
Much has been written on defining leadership. Successful leadership requires the ability to secure and maintain an engaged group of followers who will join the leader in their mission and on the organization’s journey over time. Great leaders inspire. They identify gaps or opportunities for improvement, and they bridge those gaps by guiding an organization out of its comfort zone. Sometimes small changes are needed, and other times there needs to be significant creative destruction. Great leaders foster cohesive teams and system approaches that bring organizations to the next level. The Sine Qua Non for leadership may be the ability to connect with and motivate others; these involve the ability to communicate with respect and compassion (which are similar but not identical to empathy). Without the capacity to motivate, the leader will lose followers (see Figure 1 for a list of qualities of effective leaders).
The healthcare leader role seems to grow more complex every year. Healthcare leaders are charged with juggling multiple missions (see Figure 2), among which are trying to please multiple stakeholders who often have competing agendas. Regulation, competition, new technologies, and an aging population add complexity to the mix (see Figure 3 for scientific, epidemiologic and societal sources of complexity in healthcare). Effective leaders learn to balance optimism with pragmatism. They are not pushovers nor do they stick their heads in the sand. They hold themselves and their staff accountable, particularly for the core values of their organizations.
Recalling from Part 1, we choose empathic patient care because it is the right thing to do, because it is how we would like to be treated, and because it is a differentiator in a competitive marketplace (see Figure 4). Since empathy is a key ingredient to the compassionate delivery of healthcare, it is incumbent upon healthcare leaders to “set the tone from the top.” Healthcare leaders themselves must embrace empathic patient care and continually demonstrate it as a core value of their organization’s culture. Great healthcare leaders work to identify gaps in empathic patient care and bridge those gaps.
Balancing Compassion with the Practicalities and Exigencies of Modern Healthcare
When it comes to interacting with patients and their families, healthcare leaders must demonstrate the same level of empathy expected of a healthcare worker who provides direct patient care. But healthcare delivery involves far more than the interface between the caregiver or healthcare leader and the patient. Healthcare leaders face simultaneous challenges with multiple stakeholders across a variety of competing interests; consequently it is not possible for leaders to address each situation with maximal empathy. There will be scenarios outside of patient/family interactions, where maximal empathy will not be appropriate. Even under these circumstances, the healthcare leader should demonstrate the highest degrees of respect and maturity.
Consider the following scenarios:
- A vendor consistently delivers items late or of poor quality
- A sitter for a suicidal patient falls asleep on the job
- A staff member diverts narcotics
- A physician displays disruptive behavior
- A nurse receives consistent patient complaints about rudeness
- A cashier embezzles money
Should a healthcare leader display rosy-cheeked empathy in these situations? Here, the healthcare leader must apply and enforce accountability. Fairness, justice, respect and compassion will be appropriate; empathy may or may not be.
When an Employee Seeks Special Treatment
An employee may approach a supervisor to talk (see Figure 5 for a list of pointers) and the reason for the discussion may not always be readily apparent (see Figures 6 and 7 for lists of common stressors). The employee may seek advice, guidance, an excuse, permission or special dispensation about a unique personal situation. The healthcare leader should express respect, concern, an opportunity to talk and possibly empathy. The employee should be encouraged to offer possible solutions. The opportunity should be extended for further discussion (see Figure 8 regarding limits to active listening). The supervisor should remain objective, maintain healthy boundaries and avoid getting defensive. The supervisor should not ignore or run away from the situation. He/she should not force discussion nor exhibit poor boundaries (see Figure 9 for “Do’s and Don’ts”). If it becomes apparent that the employee’s needs are too complicated for the supervisor, who finds him/herself in over their head, the supervisor should consider referring the employee to an Employee Assistance Program (EAP). Situations can arise where an employee might try to take advantage of a supervisor’s warmth and empathy and present the expectation for special dispensation that exceeds reasonableness. If this occurs, empathic relativism will come into play.
Differing Perspectives on the Appropriate Level of Expressed Empathy
Figure 10 graphically displays a theoretical model of the competing interests for expressed empathy from the viewpoints of the employer and the employee. The worker’s satisfaction curve is represented in green and the employer’s in red. The apex of the triangle denoting “good leadership” identifies the sweet spot at which the worker’s satisfaction and the employer’s satisfaction are maximized. Areas of too much leniency (“doormat”), too much strictness (“heartlessness”) and stinginess are also labeled.
In the case of employer-employee relations, the need for expressed empathy will not be maximal as it is for most situations of patient care. Expressed empathy toward employees will be unique to each situation, in other words, contextually-based. Here, the appropriate empathic response should be customized and individualized (see Figure 11).
The employer should be aware of the potential for legal pitfalls if workers are not treated equally and fairly. Employers should consult with HR experts and/or legal counsel if an employment situation could deny fair treatment to a protected class or threaten a protected right, such as FMLA. Similarly, the provision of special treatment (borne out of empathy) to one employee might set a precedent for necessary future equal treatment of all other similarly-situated employees (see Figure 12).
Putting it All Together
Healthcare leaders should embrace empathic patient care as a core value for themselves and their organizations. Generally, maximal empathy will be appropriate for patient care situations. In other aspects of healthcare leadership, the appropriateness of expressed empathy becomes contextually-based and needs to be balanced with other core values of an organization. For healthcare leaders, the interface (and potential for tension) in employer-employee relations is perhaps best described as balancing accountability vs. the need for respect and compassion (though not necessarily empathy). Fairness and justice toward any given employee should be paramount, remembering how the leader would want to be treated, him or herself, in a similar situation, and also with recognition of how other employees will perceive the leader’s actions.
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