Kind care: Medical & Recreational Cannabis Dispensary

Our Team – Kind Care Animal Hospital

Dr. Robin Livingston

Veterinarian

Dr. Livingston is a graduate of the University of Georgia Veterinary School and also did her undergraduate work there. She is a native of the D.C. area, but has resided in the North Myrtle Beach area since her high school days. She opened Kind Care Animal Hospital in June 1996. Dr. Livingston and her husband have 3 children.

Dr. Kim Stengel

Veterinarian

Dr. Stengel, a Myrtle Beach native, graduated with a BS in animal industries from Clemson University in 1992. She attended Tuskagee University School of Veterinary Medicine and received her DVM in 1997. She joined the Kind Care family in 1999. She completed the International Veterinary Acupuncture Society (IVAS) course in 2001 and is happy she can add this modality to help her patients. Dr. Stengel enjoys camping with her husband, Glenn, children (Jake and Abby), and their dog, Zeke.

Dr. Alison Carroll

Veterinarian

Dr. Carroll grew up in Richardson, Texas, near Dallas. She received her DVM from Texas A&M University Veterinary School in 2005. She has been coming to the Myrtle Beach area to visit her grandparents since she was a little girl and always loved the Grand Strand. Therefore, after she graduated veterinary school she moved down and joined the Kind Care family in June 2005. Dr. Carroll’s goal as a veterinarian is to treat all of her patients like she would her own pets and to the best of her ability. She loves all aspects of veterinary medicine, but particulrly enjoys internal medicine. In her spare time, Dr. Carroll enjoys reading and spending time with her husband, Bo, their two sons Mikey and Keegan, their daughter Kinsey, and their loving dog Ernie.

Dr. Mike Marino

Veterinarian

Dr. Mike was born and raised in Pennsylvania (GO EAGLES!). He attended West Chester University, where he earned a bachelor’s degree in biology with a concentration in microbiology in 1997. He then worked for several years in research, where he eventually met his wife, Carolyn. Dr. Mike felt God calling him in a different career path and in 2005 he was admitted into Kansas State University College of Veterinary Medicine. Dr. Mike and Carolyn married two months prior to school starting, and moved away from all of their friends and family. It was worth it in the end. Dr. Mike achieved his goal of becoming a veterinarian in 2009, and is looking forward to a long career in veterinary medicine. He joined the Kind Care family in July of 2015. He and his wife have two daughters, Bethany and Tiffany, and one son, Joshua. They also have three cats: Maggie, Stitch and Chewy and one dog: Loki.

Dr. Rachel Carey

Veterinarian

Dr. Carey is originally from Charleston, West Virginia. She has always wanted to live in a beach town, so after graduating the Virginia-Maryland College of Veterinary Medicine in May 2018, she moved to the Grand Strand. After completing her internship with Kind Care in early 2018, she knew she was in the right field and couldn’t wait to start seeing patients at Kind Care as a full-time DVM in June 2018. Dr. Carey is a cat lover, and enjoys spoiling her three at home. She has two domestic shorthair cats named Dale and Brennan (named after the movie Stepbrothers), and a Devon Rex named Tula. In her spare time, Dr. Carey enjoys going to the beach, reading, and going back up north for snowboarding.

Dr. Leslie Mucci

Veterinarian

Dr. Mucci joined Kind Care Animal Hospital as a relief veterinarian in 2015 and came on board as a part-time veterinarian in September 2019. She grew up in Greenville, South Carolina, attended undergrad at Clemson and then the College of Veterinary Medicine at Tuskegee University. She practiced veterinary medicine in Las Vegas, Nevada for 2 years and in Houston, Texas for 4 years before returning to the East Coast. She and her husband moved to Myrtle Beach, SC in 2015 and together enjoy Clemson football games, traveling, hiking, and surfing with their daughter. Her family pets include Tilly, a black labrador retriever mix, and Mojo, a gray domestic shorthair.

Dr. Adri Casagrande

Veterinarian

Dr. Adri was born and Ft. Lauderdale, Florida. Growing up, she split her time between the beach and the barn before heading to undergraduate training at the University of Finlay in Ohio. She then headed west and graduated from the University of Missouri College of Veterinary Medicine in 2015. After graduating vet school, she practiced at a small animal hospital in the upstate of South Carolina. Dr. Adri is happy to return to the beach and join the team at Kind Care. When she is not working, she enjoys watching E-sports, attending car shows, and caring for her large menagerie of pets.

Sam Maloni

Practice Manager

Sam Maloni, our practice manager, also a Horry County native, joined the Kind Care family in 2015. She earned her degree in communications from the College of Charleston and came to us with Veterinary management experience from a previous clinic. Her creativity and innovative ideas have been an excellent addition! She works hard to keep up with not only the schedules of all of our support staff but also the doctors, on top of creating interesting and interactive content for our Facebook page. She is always striving for excellence with her innovative ideas and ways of promoting the KCAH family. Sam enjoys photography, good books and traveling. She has three fur-children, Bentley, a Shih-Tzu mix, Shelby Ann, a Chocolate Labrador, and Eloise, a sassy calico.

Lauren DiTore

Assistant Manager

Lauren DiTore, our assistant manager, joined the Kind Care family in 2017. She is originally from Old Bridge, New Jersey and moved down to our area in 2015 to be closer to her family. She is excellent at getting to know clients and making sure they are happy with their experience. She comes to us with previous management experience in the dental field and wanted to apply her skills in the veterinary field. She enjoys spending time with her daughter, Ryleigh and her two pit bulls, Duke and Duchess. She likes beach days and binge watching Netflix!

Manage consent

Kindcare Pediatric Center

Why choose Kindcare Pediatrics for your child?

For over a decade, Kindcare Pediatrics has been one of the most respected names in pediatric care in New Jersey.
With two centrally located, state-of-the-art medical facilities, Kindcare Pediatric Center continues deliver high quality, comprehensive primary care to infants, children, and adolescents. We offer a wide array of services:

Emergency Care

Physical Exams

Vaccines

First-Aid

Lab Services

Welcome!

Our mission is to provide quality, comprehensive care to all pediatric patients that come through our doors, whether it’s for well or sick visits, simple or complex cases. We will give you individualized care to meet the specific needs of your child.

Our experienced staff of physicians and physician assistants deliver high quality, comprehensive primary care to infants, children, and adolescents.

Locations

63 Central Ave, Passaic, NJ 07055


424 River St, Paterson, NJ 07524

SCHEDULE PASSAIC

• Monday 9am – 8pm
• Tuesday 9am – 8pm
• Wednesday 9am – 8pm
• Thursday 9am – 8pm
• Friday 9am – 8pm
• Saturday 9am – 3pm

SCHEDULE PATERSON

• Friday 3pm – 7pm

Please note the times are subject to change depending on the day to day recommendations from sources such as the CDC. In addition we ask for a limit of one parent per patient so that we may better adhere to the social distancing recommendations

We have been featured by Univision!

Gobierno busca cambios en programa de almuerzos escolares y expertos advierten sobre los peligros

Las actuales reglas de nutrición escolar que requieran porciones considerables de frutas y vegetales y fueron impulsadas por la ex primera dama Michelle Obama, muy pronto podían ser retiradas. Esto daría paso al aumento de hamburguesas, pizzas y papas fritas en los planteles, advierten los críticos del plan. Esta pediatra que imparte programas de nutrición en el centro KindCare, dice que dejar elegir a los estudiantes sus alimentos no es recomendable. “Van a coger las papas, las galletas, los jugos en vez del agua, granos o algo así. Por supuesto ellos se van a ir a lo que es más dulce,” advierte la pediatra Mariana Boscán. “Nosotros aquí en nuestra oficina vemos niños de 10, 12 años ya con pre diabetes, aumento de la presión arterial y todo eso a largo plazo trae complicaciones de salud,” explica.

For the safety of everyone, please call the office, in advance, to schedule an appointment (even the same day) for your child. Do not bring your child to the office without speaking to the triage staff for the proper directives, especially when one of the following are present:

Our hours of operation are:

Monday thru Friday: 9 am to 8 pm

Saturday: 9 am to 3 pm

Please note the times are subject to change depending on the day to day recommendations from sources such as the CDC. In addition we ask for a limit of one parent per patient so that we may better adhere to the social distancing recommendations

TELEMEDICINE IS NOW AVALIABLE

For more information on coronavirus, please click here

Quick facts about our center

See what we provide for your child’s health

Certified doctors

Our physicians are board certified pediatricians and active members of the American Academy of Pediatrics

Quick visits

Same-day appointments.

24-hour phone triage support

Insurance accepted

Most insurance plans accepted. Please get in touch with us to see if we accept your insurance provider

Caring staff

Our experienced and caring office staff is always ready to help with the needs of your child

Convenient locations

For your convenience, we have great locations in Passaic and Paterson with easy access. See map

Patients history

We keep a comprehensive record of your visits

Planing a visit? Make a free appointment!

PATIENT PORTAL

CaringKind – The Heart of Alzheimer’s Caregiving

•  

  Join us!
  September 25 – Coney Island Boardwalk
  October 23 – Central Park

  Register or Learn More

• 阿茲海默症關愛服務步行籌款
  康尼島中央公園25日起相繼啟動

  資訊

• During the COVID-19 Outbreak,
  You Can Connect with CaringKind

  Call our Helpline 646-744-2900 or join our other programs virtually, or by phone.

  

  Tips & Resources

•  

  CaringKind’s podcast,

  Caregiver/Storyteller Wins
  National Award

  Read More &nbsp Podcast

Featured Webinars & Videos

• Memory Advocate Peers
• Become a Caregiver Champion
• CaringKind Live Streams
• Creative At-Home Activities
• Connect2Culture Webinar
  mini-series
• Pre-recorded Education Webinars
• Arts & Science of Caregiving

Memory Advocate Peers

Memory Advocate Peers is a support program that pairs newly diagnosed individuals with Mild Cognitive Impairment or dementia and their support partner, to a mentor – a trained volunteer, who has prior experience caring for someone living with dementia. Learn more

Creative At-Home Activities

Watch Nancy Hendley, Dementia Care Coach at CaringKind, share some ideas on helping to keep your loved one engaged and occupied. View All

Connect2Culture Webinar mini-series

Connect2culture’s partners have found ways to engage families with dementia virtually, by creating live streamed and self-guided activities and experiences online. View All

Pre-recorded Education Webinars

Fun Activities for the Person with Dementia. .and Finding Time for Yourself
To view this pre-recorded webinar, please register here.

Home Care in the Time of COVID-19

To view this pre-recorded webinar, please register here.

CaringKind Live! Wednesdays at 1:00PM EST

We’re covering the news and speaking with Dr. Alisa Kauffman, who specializes in dentistry for people with Alzheimer’s and dementia. View all

Become a Caregiver Champion!

Help CaringKind by being our brand ambassadors – talking to your friends, family, and colleagues about the critical work that we do nonstop, every single day. Learn more

Loraine Halis Lecture on the Arts and Science of Caregiving

Dr. Tia Powell is Director of the Montefiore Einstein Center for Bioethics and the Einstein Cardozo Master of Science in Bioethics program, and a Professor of Epidemiology and Psychiatry at Albert Einstein College of Medicine. View more

Featured Programs

View All

Education

Caregiver & Professional Education

Our education programs help family and friends understand and navigate the challenges of Alzheimer’s disease and caregiving.

LEARN MORE

Dementia Consultations

Schedule a free consultation.

Our team of Dementia Specialists are dedicated to in-depth, personalized support. Appointments are required for in-person dementia consultations.

LEARN MORE

Connect2Culture

Connected to your city

Participate in the extraordinary cultural offerings available in and around New York City, especially designed for those living with dementia and their caregivers.

LEARN MORE

Wanderer’s Safety Program

Peace of mind when you need it most

Enroll with fellow New Yorkers who have the protection of this program and are returned home safely when they wander.

LEARN MORE

© Copyright 2022 CaringKind – The Heart of Alzheimer’s Caregiving

Leadership for careful and kind care

Article Text

Article menu

• Article
  Text
• Article
  info
• Citation
  Tools
• Share
• Rapid Responses
• Article
  metrics
• Alerts

PDF

Commentary

Leadership for careful and kind care

1. Dominique Allwood1,2,
2. Sreenivas Koka2,3,
3. Ryan Armbruster2,4,
4. Victor Montori2,5

1. ¹
   Department of Primary Care and Public Health, Imperial College London, London, UK
   
2. ²
   The Patient Revolution, Rochester, Minnesota, USA
   
3. ³
   School of Dentistry, The University of Mississippi Medical Center, Jackson, Mississippi, USA
   
4. ⁴
   Division of Health Policy and Management, University of Minnesota System, Minneapolis, Minnesota, USA
   
5. ⁵
   Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, Minnesota, USA
   

1. Correspondence to
   Dr Dominique Allwood, Department of Primary Care & Public Health, Imperial College London, London, UK; dominique. allwood1{at}nhs.net

http://dx.doi.org/10.1136/leader-2021-000451

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

• clinical leadership
• organisational effectiveness
• patient-centred care

The fundamental role of healthcare organisations ought to be to care for patients. The care of patients is a human activity by which people with the capacity to care notice and respond well, with compassion and competence, to people who seek this care.1 This article describes how, instead, healthcare has industrialised care; with care degraded, care has become transactional. It has overwhelmed the capacity of both the people called to care and those that receive care, and has rendered care unsustainable. 2 We propose that leaders can restore care by turning their organisations away from industrial healthcare and asserting their organisation’s purpose to enact careful and kind care. This article describes that turning away and invites healthcare leaders to pioneer it from within their organisations. First, we explain the pathologies of care and an alternative to them, and then what leaders might do to turn this new strategy into action.

The industrialisation of healthcare and the pathologies of care

The public expects healthcare organisations to enable care by supporting the work of people responding to the problematic situations of their patients. Yet, healthcare organisations respond to their external environment and to the policies and structures—austerity, greed, poverty—that condition the kind of healthcare that clinicians give and patients receive.3 4 Extrinsic motivators encoded in healthcare policies determine what is measured,5 how organisations are benchmarked and how organisations behave. 6 Organisations have prioritised improving their financial position and sustainability, monitoring performance, characterising flow, stemming demand and counting beds and appointment slots. Increasingly often, the core purpose of healthcare, to care, has become side lined or postponed as organisations focus on prioritising operational and financial goals and pursuing reputation-burnishing targets.

In adapting to these determinants of industrial care, pathologies of care have emerged. These pathologies include hurry, blur, cruelty and burden (figure 1). As fewer resources are available to care, healthcare learns to process patients, clinical interactions become transactional, and processes focus on ‘efficiency’. Patients receive hurried care as clinicians barely look up from notes or from the computer.7 Clinicians with limited time interrupt the patient and fail to notice the problematic human situation of this patient.8 Patients are seen as objects of care,9 but their situation remains nothing but a blur. Instead of cocreating a response specific to that patient’s situation,10 clinicians offer recommended care for patients like this.

Figure 1

Industrial versus careful and kind care.

Care plans become complex and burdensome as they are assembled in uncoordinated fashion from all of the therapies recommended for patients with this and that diagnosis; this is particularly true for people with multiple chronic conditions.11 Waiting, and the delegation of boring and unimportant administrative and medical errands to patients and caregivers, add to the work of being a patient, wasting scarce time, energy and attention of patients and caregivers.12 Nearly 40% of patients living with ongoing chronic conditions, one of the largest and growing groups seeking healthcare, report feeling overwhelmed by the demands of healthcare.13 When overwhelmed, patients and caregivers implement care plans with poor fidelity which reduces healthcare effectiveness and wastes precious resources.

As patients are processed through the system, professionals working in healthcare in general, and clinicians (We use the term ‘clinician’ to refer to any health care professional—eg, nurse, physician, pharmacist, therapist—with the privilege of the bedside and there to care for patients) in particular, lose sight of their role, become unable to respond with compassion towards each patient, and eventually turn into depersonalised cogs in the wheel.14 They must comply with standards and meet targets, metrics and overcome documentation requirements. Fear of violating standard operating procedures and narrowing role specialisation prevent these professionals from responding to the particular needs of the people seeking their care. Due to these cruelties, nearly 40% of clinicians report symptoms of burnout, with many leaving patient care, and others, perhaps more disconcerting, continuing in care roles.

An alternative: careful and kind care

There is an alternative to this unsustainable industrialisation of care. In our 2017 book, Why We Revolt, we called for a patient revolution, turning away from industrial healthcare towards careful and kind care.15 Here, the words careful—attentive concern, solicitude and error avoidance—and kind—exhibiting a gentle, sympathetic, or helpful nature relating to kindness and compasison16—acquire particular meaning when used to describe care. Careful care demands an evidence-based, safe and sensible response formulated to address the problematic situation of this patient not of patients like this. Careful care requires that clinicians see the whole patient, notice their problems in their biology and biography, and respond with compassion and competence by cocreating plans of care that make intellectual, emotional, and practical sense to each patient. Kind care involves humanity, recognising in each patient a member of the clinician’s kin, a fellow human, one of us rather than one of them. Kind care recognises that patients have limited attention, time and energy, and that they should use their limited resources to fulfil their lives and loves rather than to complete the homework that healthcare assigns to them.

We propose that elements of careful and kind care include elegance, high definition, responsiveness and minimally disruptive care (figure 1). Hurry is not avoided simply by creating longer consultation time slots; these may waste the time of patient and clinician and reduce access to care. Hurried conversations may come across as highly efficient but are not; effective care has its own rhythm. Rather than efficient, healthcare must be elegant: there ought to be no waste and no haste. Elegance involves protecting the ability of patients and clinicians to set the tempo of their interaction, a tempo that encourages noticing what is the matter and responding in a way that reflects what matters.17 This does not always require more time, which would reduce access to care. Rather smarter scheduling, elimination of distractions, and presence and participation from clinicians and patients can promote that each visit takes place in the tempo of care. 17

To respond well, clinicians must notice the patient’s human need and problematic situation in high definition, in all its relevant biology and biography. This cannot be fully represented by test results and diagnostic labels in the medical record. This is particularly critical for patients living with multiple chronic conditions. For these patients, the biology of diseases and treatments interact with each other and with the stressors of living. To cope, they must weave care plans with the demands of their daily routines. While guidelines recommend care that is considered safe and effective, these recommendations should be a starting point for the cocreation of feasible and sensible care plans for and with this patient.18 Healthcare professionals must be empowered to recognise when to apply or break rules, policies, role descriptions, and standard operating procedures to be responsive to the problems of this patient.19 This responsiveness requires a culture fostering safety and integrity and a supportive emotional environment for healthcare professionals to be at their best. Ultimately, care must be minimally disruptive, that is, treatment must pursue the goals and priorities of the patient while minimising the demands it places on the patient’s time, energy, and attention.20 21

A fundamental change: asserting that the core purpose of healthcare is to care

Healthcare organisations align with the external environment, responding to its policies, urgencies, and incentives. Organisations are motivated by how they and their leaders are evaluated, and their performance rewarded (ie, rewarded for operational efficiency rather than to respond well to their patients’ problems). Given these complexities, leaders may judge that acting in dissonance with these demands is neither possible nor sensible or too costly. Yet, healthcare organisations must play a pivotal role in leading change.

Leaders can choose to oppose, reinterpret and correct their organisation’s alignment19 by fostering careful and kind care. Leaders have led pioneering transformations such as electronic health records, open notes, continuous quality improvement, lean, or value-based healthcare despite facing barriers to their adoption and long before there were policies and incentives for such initiatives. Their actions contributed to subsequent policy reforms. From these lessons, leaders can draw the necessary courage to shift their gaze away from industrial healthcare and embrace bold experiments to shift policy and change to the culture needed to achieve careful and kind care.

We turn our focus now to that urgent shift in gaze. We believe that leaders should assert that the sole purpose of their organisations is to care. This means that organisations must support the work of those who make care possible so that they can optimally notice each patient’s problem and respond with compassion. Asserting this core purpose requires leaders to change both culture and strategy.

Culture

The organisational and leaders’ language plays a central role in placing the care of the patient as the organisation’s sole purpose. Language—the way the organisation expresses its culture through words, signs, symbols, and actions—both reflects and shapes the culture of the organisation. Preferring the language of care over the language of business will change how leaders and others in the organisation think and act. 15 Too often, leadership speech that emphasises administrative and financial urgencies and promotes value to the organisation or to payers, can end up treating patients, clinicians, and staff as workers or commodities, and caring as merely throughput.22 Only people can care, and yet people easily disappear behind ‘service lines’ and ‘population segments’.

When business language pervades the organisation, it manifests at the point of care where, jarringly, it is used to justify clinical actions as some care and some patients—such as those judged to be ‘high utilizers’—are considered wasteful, inefficient or low-value. Leaders should instead draw from the language of care. Although medicine and nursing have a long tradition of care, these disciplines have also evolved word habits that are uncaring, such as ‘noncompliance’, and objectify the patient, for example, ‘the diabetic’ or ‘bed 24’. Care, however, has a long cultural tradition with its own language. Rather than push out business speak from the boardroom and the back office to the point of care, leaders should imbue their organisation with a language consistent with the organisation’s purpose. They must draw words from the dictionary of care.

Stories written with the lexicon of care draw attention to the effect of policies on people and on their ability to care and vice versa. Stories can help uncover the efforts people must make to overcome organisational barriers to collaborate on behalf of a patient or to make meaningful human connections. Stories about existing pathologies of care and stories about the ability (or inability) of the organisation to foster careful and kind care can complement practice-based evidence. A core competency of caring and learning organisations is to tell these stories and learn from them, using them to drive improvements in care.1 23

Mission and strategy

Leaders judge clinical care on how clinicians and patients use resources, for the safety of their processes, and for their impact on organisational results, reputation and patient outcomes. Yet, when the primary aim is to care, an organisation should be judged by the extent it enacts and supports careful and kind care and its leaders should hold themselves accountable for achieving this result.

Because achieving careful and kind care demands collaboration and cocreation at all levels of the organisation,24 new forms of mutual accountability must be fostered at all levels. At the level of the organisation, leaders must focus their analyses primarily on the ability, at every level, of supporting, enabling and enacting careful and kind care. These analyses will draw from stories from the point of care and carefully selected metrics describing the care groups of patients have received. ‘Is this the most careful and kind response we can muster?’ and ‘did we offer careful and kind care today?’ are questions that clinicians and patients will ask leaders about their work, professionals will ask of each other at every level seeking to improve and innovate, and clinicians and patients will use to reflect together about their own joint achievements.

In industrial healthcare, leaders have become used to focusing on the organisation’s reliability, effectiveness, safety, profit and efficiency. In recalibrating to careful and kind care, leaders must become champions of the ‘other’ domains of quality: patient centeredness, timeliness (with elegance), and equity. Accountability should also address ‘the triple aim’25 26 but reframed to emphasise patient and staff well-being, care experience (eg, tempo, burden of treatment, satisfaction with responsiveness of care by clinicians and patients), and resource use (eg, appropriateness of place of care (online or in person, at clinic or at home, synchronous or asynchronous, unhurried conversations, engagement of community assets)).

Aligning the organisation’s strategy and policies and principles and practice to its purpose to care is an ongoing and multifaceted endeavour. For example, mutual accountability must start with sharing decision making equitably—with stakeholders in the administration and with ‘patients as partners’ who, together, define the outcome measures. Disseminated decision making requires a culture and systems that distribute autonomy, authority, and information. 27 As the purpose, the ‘why’ of the organisation, turns away from industrial healthcare and towards careful and kind care, leaders must also use the organisation’s evolving capabilities to innovate and improve their care processes. Industrial healthcare has developed these capabilities to address defects in reliability.28 Going further, these capabilities need deployment not just to improve organisational reliability but also to improve caring responsiveness. All this work and the resources needed to achieve it must reflect care as the purpose of the organisation, even as healthcare expands its mission to contribute to address the social determinants of health and improve population health.29

Translating strategy into action

Organisational leaders must develop and enable cultures, policies, practices, structures, processes, behaviours and motivators that make up the daily routines and operations at the level of teams and individuals to achieve care as the primary organisational purpose.

To enact these changes is no small feat and many leaders will understandably wonder where to start. We encourage leaders to identify examples of where they see the most industrial care and where they see careful and kind care already happening within their organisations. They can shine a light on these and in doing so encourage others to notice where these are occurring, draw learning from those, and identify opportunities for ‘bold experiments’ of change that affirm the purpose, advance the culture and realise the strategy of pursuing careful and kind care for all. Table 1 highlights areas that leaders could consider exploring in their endeavour.

Table 1

Realising the strategy

Organisational leaders also have a role in cultivating interdependencies and systems thinking. Simply addressing each pathology of care as a ‘defect’ subject of a targeted quality improvement effort, risks exacerbating other pathologies. Without transformative change towards a culture of care, an improvement in one area may lead to failure in another. For example, addressing blur and improving the ability of clinicians to see the patient in high definition by completion of comprehensive questionnaires ahead of an outpatient visit could lead instead to a burdensome practice for clinicians as they spend time reviewing the questionnaire answers, to hurried visits as less time is allocated to explore the patient’s situation in person since the task was delegated to the questionnaire, and to unresponsive care for patients since the true nature of the patient’s situation may have been missed by the questionnaire. A significant portion of the documentation that interrupts care and burdens the clinician, for example, can be delegated to a scribe. Subsequent gains in efficiency afforded by the scribe could be translated into either an increase in the number of patients seen or an increase in the proportion of unhurried consultations.30 Therefore, innovation and improvement to address the interrelated pathologies of industrial healthcare will be less impactful without a concomitant shift in the organisational purpose towards care.

Leaders have to realise that the call for careful and kind care that we have emphasised for patient care also applies to the organisation’s professionals and staff. Organisations cannot care, only people care. The transformation towards careful and kind care requires that organisations hire and retain people able, skilled and ready to care. Leaders can attract new healthcare professionals by fostering an organisation focused on care. This change in demand would signal to training entities what kind of professionals are needed, who should be admitted into training, and what kind of training they should receive.2 Powerfully, turning towards careful and kind care in practice will change the ‘hidden curriculum’,31 transmitting different language, values and norms that shape trainees’ attitudes and behaviours. Healthcare professionals fully adapted to industrial healthcare will need to be nurtured into forms of working that kindle their compassion and elevate their care competence. Problems in their work must be noticed in high definition and responded with competence and compassion, cocreating improvements that make sense to those who will live and work with their consequences. And leaders must realise the humanity of each of the professionals who work in the organisation, that their lives are not all focused on healthcare, and that other joys may very well lie outside the workplace. Beyond mutual respect, organisations must enable mutual care. Caring for and about each other, mutual care across and between leaders and staff, will beget careful and kind care for patients.

Conclusion—a call to leaders

Healthcare organisations must turn away from the efficient and sometimes cruel processing of patients according to standards of care for patients like them and towards cocreated, sensible, and minimally disruptive care for this patient. We suggest that leaders can pioneer a movement towards careful and kind care from within their organisations.

As we have outlined, leaders will need to assert care as the core purpose of healthcare and then work to align the critical enablers: culture and strategy. They must orient the caring and learning capabilities of their organisation to enact careful and kind care for all while holding each other accountable. ‘Is this the most careful and kind care we can muster?’ will spur curiosity, analysis, learning and continuous improvement and innovation.

Next steps

This article has outlined some initial and fundamental steps. Embryonic learning communities are developing to further some of these ideas,32 and we welcome others to contribute to this body of knowledge and practice. There are many issues requiring attention.

Professionals in leadership and administrative positions may need to develop additional leadership capabilities to advance their potential contribution to enable and foster careful and kind care. As leaders translate strategy into action, it is important to align tactics, for example, how best to improve reliability in organisational processes while paying attention to the effect of these protocols on care; hiring of people with the ability to notice and response sensibly and with integrity; how to ensure better capabilities to notice and respond through policies of diversity and inclusion in hiring and developing staff; how to align incentives and recognitions with the organisation’s core purpose. Examples of these tactics and case studies can bring additional clarity to the effort while enhancing the training of the next generation of leaders.

While a focus on care expands the relative importance of the different resources necessary for care, namely the intellectual and emotional availability of clinicians and time available to care, budgets play an oversized role as a determinant of industrial healthcare and as a potential barrier towards careful and kind care. Resources to sustain the organisation and advance its mission must be subject to careful stewardship.

We hope this article offers leaders the inspiration to undertake the journey towards achieving careful and kind care for all. Healthcare leaders, professionals and activists who use this article to take their first steps towards a culture of care are invited to share the lessons they learn from their experiments and contribute to a patient revolution.

Acknowledgments

The ideas discussed in this paper emerged from discussions among the authors and with the Patient Revolution Fellows. We are grateful for their ideas as well as for the thoughtful critique and feedback on earlier drafts of Göran Henriks, Juan Pablo Brito, Bob Klaber, and Nish Manek. The authors take responsibility for the final draft, that represents their own views and not the views of their employers.

References

1. ↵
   2. Montori VM
      ,
   3. Hargraves I
      ,
   4. McNellis RJ
      , et al

   . The care and learn model: a practice and research model for improving healthcare quality and outcomes. J Gen Intern Med 2019;34:154–8.doi:10.1007/s11606-018-4737-7
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/30430403
   

2. ↵
   2. Montori VM

   . Turning away from industrial health care toward careful and kind care. Acad Med 2019;94:768–70.doi:10.1097/ACM.0000000000002534
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/30475268
   

3. ↵
   2. Owens J
      ,
   3. Singh G
      ,
   4. Cribb A

   . Austerity and professionalism: being a good healthcare professional in bad conditions. Health Care Anal 2019;27:157–70.doi:10.1007/s10728-019-00372-y
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/31165964
   

4. ↵
   2. Mercer SW
      ,
   3. Guthrie B
      ,
   4. Furler J
      , et al

   . Multimorbidity and the inverse care law in primary care. BMJ 2012;344:e4152.doi:10.1136/bmj.e4152
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/22718915
   

5. ↵
   2. Kunneman M
      ,
   3. Montori VM
      ,
   4. Shah ND

   . Measurement with a wink. BMJ Qual Saf 2017;26:849–51.doi:10.1136/bmjqs-2017-006814
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/28733369
   

6. ↵
   2. Northcott D
      ,
   3. Llewellyn S

   . Benchmarking in UK health: a gap between policy and practice? Benchmarking 2005;12:419–35. doi:10.1108/14635770510619357
   

7. ↵
   2. Brown-Johnson C
      ,
   3. Schwartz R
      ,
   4. Maitra A
      , et al

   . What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ Open 2019;9:e030831.doi:10.1136/bmjopen-2019-030831
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/31685506
   

8. ↵
   2. Singh Ospina N
      ,
   3. Phillips KA
      ,
   4. Rodriguez-Gutierrez R
      , et al

   . Eliciting the patient’s Agenda- secondary analysis of recorded clinical encounters. J Gen Intern Med 2019;34:36–40.doi:10.1007/s11606-018-4540-5
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/29968051
   

9. ↵
   2. Dowrick C
      ,
   3. Heath I
      ,
   4. Hjörleifsson S
      , et al

   . Recovering the self: a manifesto for primary care. Br J Gen Pract 2016;66:582–3.doi:10.3399/bjgp16X687901
   pmid:http://www.ncbi.nlm.nih.gov/pubmed/27789507
   

10. ↵
    2. Hargraves IG
       ,
    3. Montori VM
       ,
    4. Brito JP
       , et al

    . Purposeful SDM: a problem-based approach to caring for patients with shared decision making. Patient Educ Couns 2019;102:1786–92.doi:10.1016/j.pec.2019.07.020
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/31353170
    

11. ↵
    2. Tran V-T
       ,
    3. Barnes C
       ,
    4. Montori VM
       , et al

    . Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. BMC Med 2015;13:115.doi:10.1186/s12916-015-0356-x
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/25971838
    

12. ↵
    2. May CR
       ,
    3. Eton DT
       ,
    4. Boehmer K
       , et al

    . Rethinking the patient: using burden of treatment theory to understand the changing dynamics of illness. BMC Health Serv Res 2014;14:281.doi:10.1186/1472-6963-14-281
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/24969758
    

13. ↵
    2. Tran V-T
       ,
    3. Montori VM
       ,
    4. Ravaud P

    . Is my patient Overwhelmed?: determining thresholds for acceptable burden of treatment using data from the compare e-Cohort. Mayo Clin Proc 2020;95:504–12.doi:10.1016/j.mayocp.2019.09.004
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/31619365
    

14. ↵
    2. West CP
       ,
    3. Dyrbye LN
       ,
    4. Shanafelt TD

    . Physician burnout: contributors, consequences and solutions. J Intern Med 2018;283:516–29.doi:10.1111/joim.12752
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/29505159
    

15. ↵
    2. Montori V

    . Why we Revolt: a patient revolution for careful and kind care. Rochester, MN, USA: Patient Revolution, 2017.

16. ↵
    2. Vogus TJ
       ,
    3. McClelland LE

    . Actions, style and practices: how leaders ensure compassionate care delivery. BMJ Leader 2020;4:48–52.doi:10.1136/leader-2020-000235
    

17. ↵
    2. Kebede S

    . Ask patients “What matters to you?” rather than “What’s the matter?”. BMJ 2016;354:i4045.doi:10.1136/bmj.i4045
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/27449399
    

18. ↵
    2. Montori VM
       ,
    3. Brito JP
       ,
    4. Ting HH

    . Patient-centered and practical application of new high cholesterol guidelines to prevent cardiovascular disease. JAMA 2014;311:465–6.doi:10.1001/jama.2014.110
    pmid:http://www.ncbi.nlm. nih.gov/pubmed/24496532
    

19. ↵
    2. Berwick DM
       ,
    3. Loehrer S
       ,
    4. Gunther-Murphy C

    . Breaking the rules for better care. JAMA 2017;317:2161–2.doi:10.1001/jama.2017.4703
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/28448652
    

20. ↵
    2. Mair FS
       ,
    3. May CR

    . Thinking about the burden of treatment. BMJ 2014;349:g6680.doi:10.1136/bmj.g6680
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/25385748
    

21. ↵
    2. May C
       ,
    3. Montori VM
       ,
    4. Mair FS

    . We need minimally disruptive medicine. BMJ 2009;339:b2803.doi:10.1136/bmj.b2803
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/19671932
    

22. ↵
    2. Groenewoud AS
       ,
    3. Westert GP
       ,
    4. Kremer JAM

    . Value based competition in health care’s ethical drawbacks and the need for a values-driven approach. BMC Health Serv Res 2019;19:256.doi:10.1186/s12913-019-4081-6
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/31029136
    

23. ↵
    2. Maddox TM
       ,
    3. Albert NM
       ,
    4. Borden WB
       , et al

    . The learning healthcare system and cardiovascular care: a scientific statement from the American heart association. Circulation 2017;135:e826–57.doi:10.1161/CIR.0000000000000480
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/28254835
    

24. ↵
    2. Batalden M
       ,
    3. Batalden P
       ,
    4. Margolis P
       , et al

    . Coproduction of healthcare service. BMJ Qual Saf 2016;25:509–17.doi:10.1136/bmjqs-2015-004315
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/26376674
    

25. ↵
    2. Berwick DM
       ,
    3. Nolan TW
       ,
    4. Whittington J

    . The triple aim: care, health, and cost. Health Aff 2008;27:759–69.doi:10.1377/hlthaff.27.3.759
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/18474969
    

26. ↵
    2. Bodenheimer T
       ,
    3. Sinsky C

    . From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014;12:573–6.doi:10.1370/afm.1713
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/25384822
    

27. ↵
    2. Laloux F

    . Reinventing organizations. A guide to creating organizations inspired by the next stage of human consciousness. Nelson Parker, 2014.

28. ↵
    1. NHS Improvement

    . Building capacity and capability for improvement: embedding qualtiy improvement skills in NHS providers, 2017.

29. ↵
    2. Maani N
       ,
    3. Galea S

    . Physicians and social determinants of Health-Reply. JAMA 2020;324:1217.doi:10.1001/jama.2020.12115
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/32960236
    

30. ↵
    2. Gottlieb M
       ,
    3. Palter J
       ,
    4. Westrick J
       , et al

    . Effect of medical Scribes on throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis. Ann Emerg Med 2021;77:180–9.doi:10.1016/j.annemergmed.2020.07.031
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/32868143
    

31. ↵
    2. Hafferty FW
       ,
    3. Gaufberg EH
       ,
    4. O’Donnell JF

    . The role of the hidden curriculum in “on doctoring” courses. AMA J Ethics 2015;17:130–9.doi:10.1001/virtualmentor.2015.17.02.medu1-1502
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/25676226
    

32. ↵
    2. Marshall M
       ,
    3. Cornwell J
       ,
    4. Collins A
       , et al

    . Rethinking medicine. BMJ 2018;363:k4987.doi:10.1136/bmj.k4987
    pmid:http://www.ncbi.nlm.nih.gov/pubmed/30545822
    

Footnotes

• Twitter @DrDominiqueAllw

• Contributors DA and VM conceived the idea for the paper and wrote the original draft. All four authors (DA, SK, RA, VM) were involved in drafting and editing the work and all give approval of the version published and agreement to be accountable for all aspects of the work. This work reflects the views of the individual authors and not their affiliated organisations.

• Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests None declared.

• Provenance and peer review Not commissioned; externally peer reviewed.

• Author note Twitter: @vmontori @DrDominiqueAllw @patientrev

Read the full text or download the PDF:

Subscribe

Log in using your username and password

For personal accounts OR managers of institutional accounts

Username *

Password *

Forgot your log in details?Register a new account?

Forgot your user name or password?

Senior Home Care St.

George UT

Main Content

Helping Seniors Stay At Home

Our Registered Nurse creates a care plan to determine your exact home care needs

Request a Free Nurse Assessment

A consultation will help you understand how we can help you maintain your independence

Request a Free Consultation

Call Us For A Free Consultation 435-275-1656

Caregivers

Our Caregivers are trained extensively in all aspects of In-Home Care.

Company

Kind Hearts Senior Care was established in 2012. Since that time, Kind Hearts has been providing world class care to Southern Utah.

Family Portal

The Family Portal allows family members to receive daily updates about their loved ones most recent shift.

Resources

Our Management Team has access to hundreds of resources in the local market that are free of cost.

Transition Home

Our Transitional Services help you transition back into your home after a stay at the Hospital or a Skilled Nursing Facility.

24 hr. management

Our team is on call 24 hours a day, seven days a week.

Want To Learn More About Our Services?

Call 435-275-1656

Highest Rated Senior Care Agency in St. George, UT

Phenomenal care. Holistic approach to individual and family needs. High hiring standards for caregiver staff.

I’ve loved working with the staff at Kind Hearts Senior Care. They are as dependable of a group that I’ve found in Healthcare. Very thorough and very responsive. Barry & Colleen have always been super helpful and timely with anything I’ve ever needed their assistance on. I would most definitely trust Kind Hearts to take care of any of my loved ones.

Awesome company! Very easy to work with, with smooth transitions. They are quick to set up a consultation with you, answer your questions and are simply great at putting your mind at ease. Very loving and caring company! Thankful to have them in our community!

I think kind hearts is an amazing company and totally recommend them!!! They are affordable and so professional.

The home health and hospice agency I work for has seen many patients of ours be so compassionately and wonderfully served by Kind Hearts. I love to refer patients to them. They respond immediately whenever I contact them. They are the best!

I work with Kind Hearts frequently. They are a pleasure to work with. They are truly focused in providing excellent care to their clients! I would highly recommend them to anyone!

Couldnt ask for a better Personal Care company! Barry and his team always give the best of care. ..I highly suggest them!

I have the opportunity of working here, and I can say that the ownership, the management, and the Caregivers here are all incredible! I am so happy that I have such excellent people all around me here at Kind Hearts! They continue to go above and beyond to help our patients.

Logan and I have been assisting many families together with their care needs and how to fund the expense of that care.
I am honored to have my association and friendship with Logan and Kind Hearts Senior Care.

Kind Hearts Senior Care have been so kind and great to work with. Would highly recommend to anyone!

Logan and Shellee Aitken run a great company and I would recommend them to anyone looking for home-care in Southern Utah. One of the best in the area!! The staff is also very helpful and easy to work with and response time is FAST!

Kind hearts senior care has been caring for my dad for over a year now and Logan and his staff have gone above and beyond what I ever expected. When my dad moved to St George from Las Vegas we could not find anyone who accepted his insurance covering his illness as a result of working at the Nevada test site. Logan went out of his way and jumped through several hoops of government paperwork and many hours of extra time dedicated to my dad in order to get approved and provide service for my dad. Once approved his care has been wonderful, my dad is happy so that makes me happy.

Kind Hearts has been so great to work with and they have some of the best caregivers in town. I would recommend them to anyone. It has been nothing but a pleasure to work alongside and provide care with Kind Hearts. I know whenever I need additional help. I can always call Logan and get the answers/care I need. Great company and even better service!

We did lots of research and were thrilled when we found our “angel” at Kind Hearts Senior Care. They listened to our needs, and matched the perfect staff to work with our Dad. We will never forget the kindness shown to us by Laurie. She became a part of our family. Logan listened, and met our needs.

I have had the privilege of working for Kind Hearts for 3 years now. I Love each of the Seniors I’ve been able to care for. They truly become family. The best part is they get to stay in their home where they are familiar & comfortable. This is a very caring, honest company. You can trust your loved ones to get the best possible care at Kind Hearts Senior Care.♥️

Perfect! Quick and easy and helped my moms move go very smooth. Even helped set things up. Thanks

I love working with Logan. He is always Johnny on the spot. I am the D/C planner for a SNF in St. George and I have refered several patients to his services and every time that I do a follow up call to the patient, they give Kind Hearts rave reviews. Thank you Logan and staff for providing excellent care for my residents once at home.

I have been lucky to work closely with Kind Hearts. They are response to their clients and offer great care. They are a wonderful part of this community! I recommend them:)

I work at Coral Desert Rehab, a local Skilled Nursing Facility, in St. George Utah. We have had the pleasure of working with Logan and his team at Kind Hearts. They provide excellent service to their patients, and play a vital role in the community for Seniors who need help at home due medical conditions and chronic illness. I highly recommend this agency and the services they provided.

I recommend this company. I offer a free service helping individuals find assisted living communities in St George Utah, sometimes moving into a community is not the best fit. Logan and Kind Hearts Senior Care is a great option for the individual who wants to stay home in his or her own environment. I feel confident referring individuals to them and know that they will take care of you. Another great thing is that he can help individuals apply for Aid and Attendance VA Benefits which will sometimes cover a significant amount of long term care expenses.

I am really impressed by the kind way in which Roland (the owner) and his wife (Leslie) treat the seniors! They are very sensitive to the needs of the elderly, and are also very helpful in helping you to understand what is needed/required in the care at home. They are very honest and upfront on everything, which I appreciate. I am very happy with the gentle way they approach this sensitive issue and love the genuine way I am treated – as well as the seniors. I recommend Kind Heart Senior Care to anyone who is looking to be treated with the utmost respect and kindness! Roland & Leslie are a pleasure to work with!

‹

›

Our Partners

OUR CAREGIVERS

Kind Hearts Senior Care is devoted to providing the most professional, reliable and friendly caregivers in the industry. Our caregivers provide assistance with such activities as errands, transportation to doctors, medication reminders, housekeeping, laundry, grooming, dressing, bath safety monitoring, and more. All services and schedules are tailored to the needs of the client, and our caregivers are available for hourly, daily, weekly, overnight, 24-hour or live-in assignments. Our wonderful aides truly have a passion for providing care – and they are OUR employees, thoroughly interviewed, screened and background-checked (state and national), trained and oriented, bonded and insured. We have rigorous hiring practices in which all applicants go through tests and screenings focusing on skills, experience, attitudes and placement into homes.

Continue Reading

WHY HOME CARE?

There is growing public demand for health care services that are available to the public in their own homes. The reasons have to do with tradition, with technology, and with cost effectiveness.

Home care is the oldest form of healthcare – and it is also the “newest”. Modern technology has developed to the point where many services that are available in the hospital can be provided at home. There is significant evidence that it is less costly than other forms of care, and that it is the most satisfying form of health care available to the American public. It is an idea whose time has come.

Continue Reading

ABOUT US

Our mission at Kind Hearts Senior Care is to give seniors the respect and compassion they deserve by providing them with kind and professional care so they can stay in the homes they love. We will do this by hiring the best caregivers, giving them the best training, putting in place the best systems, and holding ourselves accountable for implementing these systems.

Continue Reading

Get To Know Us

Kind Hearts Senior Care has been providing Home Care to St. George, Utah for years. Which also includes Home Care in Hurricane, Sun River, Kanab, Enterprise, Bloomington, and Cedar City.

If you or your loved one wants to continue to live at home we’ll help you find peace of mind with the help you need.

Kind Hearts Senior Care is the premier non-medical agency providing Home Care to St. George, Utah. We provide a wide range of in-home care services. Our personalized and affordable services are available 7 days a week and can range from 3 hours a week to 24/7 live-in care or anything in between. Our services include: companionship, light housekeeping, meal planning and cooking, transportation, help dressing, showering, walking, and more.

We have local kind, mature caregivers who are experienced, trained, bonded insured and supervised. Our caregivers have training in care for Seniors with Alzheimer’s, Parkinson’s, Dementia, and Strokes. Our caregivers let the client take charge and provide as much of their own care as possible, with assistance if needed. Our goal is to make our clients happy by doing things “their way” and letting our clients control the direction of their own care as much as possible.

Unlike many other agencies our Caregivers are experienced at caregiving as well as at housekeeping, cooking, shopping, and in being good companions to seniors. We advertise for, and hire, people who Love Seniors. In fact we call our caregivers KIND HEARTS, and that is what we are looking for when we hire, someone with a Kind Heart. This is a part of the reason we have many Caregivers who have been with us for years.

The Kind Care Bundle: A Curriculum to Teach Medical Students the Behaviors of Kind, Compassionate Care

MedEdPORTAL. 2021; 17: 11141.

Published online 2021 Apr 14. doi: 10.15766/mep_2374-8265.11141

, MD¹ and , MD^2,∗

Author information Article notes Copyright and License information Disclaimer

Supplementary Materials

Introduction

Patients’ hospital experiences can be adversely affected by clinicians’ negative behaviors. Simple positive behaviors, however, can have a dramatic impact on patient-clinician relationships. Medical students starting clinical training are ideal educational targets for learning good behavioral habits that promote kind, compassionate care.

Methods

We developed the Kind Care Bundle, a collection of concrete verbal and nonverbal behaviors for showing compassion in patient interactions. The curriculum was taught in 3-hour small-group interactive sessions to first-year students. Students reflected on personal experiences of compassionate care and role-played the use of the Kind Care Bundle. In pairs, students interviewed patients about their experiences of kind, compassionate care while practicing the Kind Care Bundle. Students completed a postsession evaluation with Likert scales and free-text responses.

Results

Thirty-seven of 40 students (92%) completed postsession evaluation forms. Session organization was considered excellent (27 of 37 students, 73%) or very good (nine of 37, 27%). Session relevance was rated as excellent by 30 of 37 students (81%) and very good by six of 37 students (16%). Students believed the bundle filled an educational gap. Qualitative themes included appreciation of concrete behaviors in the bundle, importance of empathy, and opportunity to reflect on one’s own experience of compassion.

Discussion

Students appreciated learning about specific behaviors for improving patient interactions. Targeting preclinical medical students has the potential to promote kinder and more compassionate patient interactions during subsequent clinical training. The long-term impact on students’ behavior and on their personal and professional development requires further study.

Keywords: Professionalism, Humanism, Compassionate Care, Person-Centered Care, Communication Skills, Reflection/Narrative Medicine, Well-Being/Mental Health, Burnout

By the end of this activity, learners will be able to:

• 1.

  Reflect on their own personal experiences of kind and compassionate care, as well as examples of kind and compassionate care observed in the clinical setting.

• 2.

  Identify specific verbal and nonverbal behaviors associated with compassionate care and understand the components of the Kind Care Bundle.

• 3.

  Practice the Three E’s during a patient encounter and interview a patient about their experiences of kind and compassionate care in the hospital.

• 4.

  Reflect on the experience of providing and discussing kind and compassionate care and identify opportunities to incorporate this into their clinical practice in the future.

Patient experiences during hospitalizations may be adversely affected by clinician behaviors of brusqueness, overformality, or ignoring patients’ and families’ cues to ask for more time.¹ A few interventions have been shown to improve patients’ experiences, namely, sitting down during encounters² and, to variable success, performing new patient rounds at the patient’s bedside.³ These interventions, however, have been inconsistently adopted. At some academic hospitals, patient experience departments have been developed to try to address this gap,⁴ which is now tied to hospital performance and quality-based reimbursement through measures such as Hospital Consumer Assessment of Healthcare Providers and Systems survey scores.⁵

Unhelpful behaviors in practicing clinicians are often learned and adopted during medical training through observation and mimicry of senior mentors and near-peers in the clinical setting. This hidden curriculum permeates the education medical students and residents receive as they progress in their training. ⁶ Even in early medical education—during students’ first exposure to history taking and physical exam skills—traditional teaching approaches often explicitly stress thoroughness and accuracy but not warmth and kindness. Attitudes and behaviors demonstrating compassion and respect, found in abundance among first-year medical students,⁷ are inconsistently reinforced through training and may even be devalued in the clinical arena in exchange for efficiency. This devaluing of early idealistic traits of compassion may play a role in the high levels of feelings of depersonalization and burnout reported by both medical students⁸ and clinicians⁹ and in the increasing levels of cynicism and erosion of empathy in each successive year of medical training.¹⁰ There is some encouraging news. Acts of kindness and empathy can be taught,¹¹ and compassion may improve both student wellness and clinical care.¹² In the face of a crisis of burnout among students⁸ and physicians,¹³ focusing on compassion may offer a way forward. ¹⁴

A person-centered and engaged bedside encounter, augmented with a bundle of specific behaviors stressing etiquette, respect, kindness, and compassion as essential components, may significantly increase both patient satisfaction with care and clinician satisfaction with the caregiving experience.¹⁵ We created the Kind Care Bundle of specific behaviors promoting kind, compassionate care and developed a curriculum to teach it to first-year preclinical medical students. Our intention was to target students prior to their formal clinical teaching in order to establish good habits of kind, compassionate care and to signal universal principles applicable to every single patient encounter. The Kind Care Curriculum addressed knowledge, skills, and attitudes: By having students examine their own experiences and speak with patients about kind and compassionate care, our intention was to promote empathy and shift attitudes. By providing students with a bundle of specific language and concrete behaviors for patient interactions, we aimed to close gaps in knowledge and skills regarding compassionate care.

In a review of the literature and similar topic areas in MedEdPORTAL, we found examples of effective curricula promoting humanism and professionalism in residents^16,17 and fellows,¹⁸ as well as a creative simulation-based curriculum promoting empathy in anesthesiology residents.¹⁹ Indeed, there is a strong need for curricula that promote empathy, kindness, and compassionate care, as residents indicate they often do not have opportunity to discuss empathy or receive formal communication skills training following the first two years of medical school.¹⁹ One critique is that all of these curricula target clinical providers at the resident and fellow levels. Thus, the curricula target individuals already in clinical training rather than instilling knowledge and skills for compassionate care earlier in undergraduate medical education. Among studies of medical students specifically, such as those using professionalism flash cards during clerkships²⁰ and reflective narratives²¹ to build empathy, most curricula target advanced clerkship students rather than preclinical ones. Also, the studies reviewed here utilize educational methods such as written case-based learning,¹⁷ simulation,¹⁸ and reflective writing,²² but none provide opportunities to work with patients directly. One curriculum involves training residents to lead family goals of care discussions,¹⁶ while another, developed by Kesselheim and colleagues, uses case vignettes to highlight challenges in humanism and professionalism and promote discussion among residents¹⁷ and fellows.¹⁸ In a simulation-based curriculum, anesthesiology residents role-play being a patient requiring an emergent C-section in order to build skills in empathy.¹⁹ While reflective practice promotes empathy²³ and reinforces learning,²⁴ these curricula do not offer concrete skills that can be learned to practice kind, compassionate care. In our review, we did not find a curriculum teaching concrete, simple behaviors that could be utilized in addition to communication strategies to demonstrate empathy in every patient encounter.

Our curriculum has the advantage of offering a bundle of verbal and nonverbal behaviors that can be used universally in all patient encounters. The curriculum is also different in that it targets first-year medical students at the earliest stage of their training before they have begun their clinical experiences. Finally, our intervention follows an experiential learning approach and involves an opportunity for medical students to interact with patients directly to build empathy and practice new language and behaviors for kind, compassionate care.

Development of the Kind Care Bundle

We developed a bundle of concrete verbal and nonverbal behaviors for showing attention, consideration, and compassion in patient interactions, naming it the Kind Care Bundle (Appendix A). The bundle consisted of specific behaviors that could be incorporated into any patient encounter, organized into the Three E’s, namely, entry into a patient’s room, the encounter with the patient, and exit from the room.

The Kind Care Bundle was developed using behaviors informed by evidence-based practices² as well as best practices from our own experience, such as offering an extra blanket, bringing water or other items to the bedside, and readjusting the patient’s position to ensure comfort at the conclusion of an inpatient visit. Following its development, the Kind Care Bundle was reviewed both by clinicians and by patients and families. The bundle and pilot design were presented at a meeting of the Center for Educational Innovation and Scholarship at Massachusetts General Hospital (MGH) in Boston, Massachusetts, and reviewed by medical education research colleagues. The Kind Care Bundle was presented to the Patient and Family Advisory Council at MGH in June 2018 and modified based on feedback from patient and family representatives to ensure it captured the patient experience.

The Kind Care Curriculum

We then developed a 3-hour curriculum with the goals of introducing students to the Kind Care Bundle, allowing them an opportunity to practice the bundle in real time, and helping them reflect on their own personal experiences and those of patients with kind and compassionate care. Guided by adult learning theory²⁵ and Kolb’s experiential learning cycle,²⁶ we designed the session to include an experiential component and structured reflection in order to influence a change in students’ knowledge, skills, and attitudes.

Setting and Participants

We delivered this curriculum over five morning sessions at MGH in August-September 2018. Participants were 40 first-year students at Harvard Medical School, assigned to groups of eight to 10 students per session. The educational session was incorporated into the transition-to-clerkships course, which immediately preceded the start of clinical clerkships. The sessions were facilitated by author Cynthia M. Cooper. No prior knowledge or experience was necessary for the students. No prior knowledge was necessary for facilitators other than reviewing materials in the facilitator guide (Appendix B).

Session Outline

Before the session

Prior to each session, the facilitator identified hospitalized inpatients who were willing and able to participate in an interview about their experience in the hospital and their definition of compassionate care. Typically, one patient was selected for each pair of students. The facilitator obtained verbal consent from patients (generally on the medical service) and wrote down the patients’ room numbers, including approximately two to three backup options in case one of the patients was no longer available or willing to participate. Patients were informed that students would come later in the day to complete a 30- to 45-minute interview. Patients were also told that this was voluntary, that they could withdraw their participation at any time, and that the students were not part of their formal medical team.

As prework, we asked students to read an article entitled “Etiquette-Based Medicine”¹ ahead of the session. We also asked students to wear white coats and professional dress in the session as they would be meeting patients.

During the session

All teaching notes for the facilitator, including appropriate timing for the session are included in Appendix B. The first hour was spent in a small-group-size classroom (eight to 10 students) with a large whiteboard. The facilitator began the session by prompting students to discuss the prework article. The facilitator then asked students to break into small groups of two to three and pair-share (i.e., share their experiences in pairs) about a time in their lives when they felt particularly cared for. We encouraged students to specifically think through verbal and nonverbal ways that caring and compassion were conveyed at that time. The facilitator next brought the group back together and facilitated a discussion of these experiences, capturing common themes on the whiteboard. Then, students were asked to share any clinical experiences in which they had observed compassionate care. The facilitator pointed out similarities between the experiences of being cared for themselves and of seeing compassionate care on the wards and helped students to develop common definitions of compassionate care.

Next, the facilitator introduced the Kind Care Bundle (Appendix A) and discussed the Three E’s format of entry, encounter, and exit. The facilitator demonstrated the application of the Three E’s to the group with one student volunteer acting as a patient (alternatively, two students might be asked to role-play an encounter, with the group discussing what went well in the encounter and what could be improved). The students were then divided into pairs and each pair went to the bedsides of the recruited patients to interview these individuals about their care experience using specific question prompts and to practice the behaviors of the Kind Care Bundle. Students were instructed to introduce themselves to the patients, apply the skills of the Kind Care Bundle, and work through the guiding interview questions (Appendix C). Students worked in pairs, taking turns asking patients questions and jotting down notes. Approximately 1 hour was allocated for students to find their patient’s room, interview the patient, and return to the group setting.

In the final hour of the session, after the patient interviews had been completed, students returned to the classroom, where they were guided by the facilitator in debriefing their experiences. Following questions in the guide (Appendix B), the facilitator asked students what they had learned from their patients about how they perceived caring and compassionate care. Students also reflected on their experience using the Kind Care Bundle in their interaction with the patient in addition to the usual patient-bedside experience. To close the session, every student was asked to share one thing they had learned and one thing they would like to incorporate into their care going forward.

After the session

Following this debrief, students were allocated 10 minutes to complete the end-of-session evaluation (Appendix D) and give any feedback they had on the bundle or the curriculum.

Session Evaluation

We surveyed students at the end of the session to assess their personal interest in compassionate patient care, whether they felt there was value to this as a topic of medical education, and when they thought the curriculum should be taught to students. We also asked students to rate their satisfaction with the session and their likelihood of using the Kind Care Bundle again in the future.

We developed the postsession survey de novo for this pilot project, based on our specific objectives. We had two intentions for this survey. The first was to assess students’ reactions to the session in terms of its value, organization, and clarity. Second, we were interested in students’ suggestions for improvement given the pilot nature of the session and our aim to improve the experience iteratively for future students. The survey included both quantitative Likert scales and open-ended qualitative responses. The survey was administered on paper by the session leader (Cynthia Cooper), who left the students alone to complete it anonymously. Surveys were collected at each session but not analyzed until after the completion of all five sessions.

Data Analysis

Surveys were voluntary and anonymized with no identifiable information. We summarized quantitative data in Microsoft Excel and tabulated results from the survey for workshop organization and relevance. We also determined students’ level of interest in the topic and intention to use the bundle again in the future.

We analyzed qualitative data from the free responses using Microsoft Word. Using mixed inductive-deductive qualitative content analysis,²⁷ Cynthia M. Cooper organized qualitative responses into key themes. Themes were derived deductively from our objectives and hypothesis about how the session could influence medical students and also arose inductively from the data.²⁸ Key themes were combined into major categories reviewed by Galina Gheihman and agreed upon by consensus.²⁹ Our analytical approach was exploratory rather than theory-driven given the pilot nature of this study.

Ethical Approval

Ethical approval was obtained from the Harvard Medical School Academy, which reviewed the proposal and approved the study. The study was deemed quality improvement and waived from formal institutional review board evaluation.

Thirty-seven of 40 participating first-year students (93%) completed the voluntary evaluation survey.

Session organization was evaluated as excellent by 27 of the 37 respondents (73%) and as very good by nine of them (27%). Session relevance was rated as excellent by 30 of the respondents (81%) and as very good by six (16%). Personal interest in the topic was rated as high by 24 of the respondents (65%) and as moderate by nine of them (24%). The majority of students either strongly agreed (28 of 37, 76%) or agreed (five of 37, 14%) that the curriculum should be taught to all first-year medical students.

Students reported that the bundle filled an educational gap. Some of the major qualitative themes included (1) an appreciation of the sessions’ emphasis on concrete behaviors, (2) the importance of practicing the bundle and the guiding questions, and (3) the personal impact of reflecting on one’s own experience of compassion. The lists all the key themes and includes supportive quotations for each theme.

Table.

Key Themes and Representative Quotations From Participants’ (N = 37) Free-Text Responses Evaluating the Kind Care Bundle

Open in a separate window

A majority of students reported that they could imagine using the Kind Care Bundle in their future clinical clerkships almost always (30 of 37, 81%). Students’ motivations for using the bundle again in the future included (1) impact on patient experience, (2) clinical success, (3) fulfilling professional ideals, and (4) self-care. Students did not suggest any major changes to the curriculum, and the pilot was not significantly altered between sessions.

We developed the Kind Care Bundle—a collection of concrete verbal and nonverbal behaviors for showing compassion in patient interactions—and taught it to preclinical medical students as part of the Kind Care Curriculum. This curriculum invited students to reflect on personal experiences of compassionate care, recall examples observed in the clinical setting, and interview hospitalized patients about their experiences with compassionate care. We also taught students a bundle of concrete verbal and nonverbal behaviors they had the opportunity to try out during the session. Students rated the experience as well organized and highly relevant to their current and future training. They believed the bundle filled an educational gap and helped them to reconnect to the importance of empathy and compassion in medical care, as well as to practice concrete behaviors for showing kindness to patients.

While medical educators implicitly value the importance of professionalism and kindness in patient interactions, rarely are compassionate behaviors explicitly discussed, formally taught,¹¹ or evaluated in medical school³⁰ or subsequent clinical training.³¹ The Kind Care Curriculum offers an innovative educational activity that prompts students to draw on their own experiences of compassionate care, teaches and reinforces compassionate instincts by providing a bundle of concrete behaviors to improve student-patient interactions, and gives students an opportunity both to test-drive this bundle during a patient encounter and to reflect on the experience.

In this educational intervention, we targeted students prior to their formal clinical training in order to establish good habits of compassionate care. Many students noted that they would use the Kind Care Bundle again in their upcoming interactions with patients and felt that it offered a universal approach for treating all patients with compassion. We wanted not only to give students the knowledge why this was important but also to start modifying their attitudes and equip them with skills for kind, compassionate care. Thus, the curriculum offered opportunities for reflection on students’ own prior experiences,¹⁸ as well as on the impact of using the bundle with patients. Students’ free responses indicated they were connecting with values of empathy, professional fulfillment, and personal well-being as a result of the personal reflection prompted during the session.¹⁹ Furthermore, we wanted students to develop concrete skills to utilize. The session provided an opportunity for students to observe the bundle in action (in the role-play in the first hour), to practice engaging in the behaviors (with patients in the second hour), and to reflect on this experience, thereby connecting their new learning with its impact on patients. The curriculum’s combination of knowledge, skills-based practice, and reflection^25,26 was highly rated by preclinical students and may have use in other trainee populations, clinical settings, and institutions.

We learned several additional lessons from our experience with the implementation of this pilot curriculum. First, learners may be reluctant to reflect on past experiences of vulnerability and compassion in front of their peers. To create a safe psychological space, it may be necessary for the session leader to have personal narratives of compassionate care at the ready to share at the start of the session. In our implementations, the facilitator thought ahead of time about examples to mention and drew upon them if the students were reluctant to share. We also found that students were more forthcoming in the larger group if they first had a chance to interact in a smaller, intimate setting. We asked students to share their thoughts with a partner prior to opening the discussion to the larger group for this reason. For the brainstorming related to Educational Objective 2 (i.e., when learners were recalling their clinical experiences with compassionate care), we found that the facilitator could organize the whiteboard in real time into columns of verbal and nonverbal behaviors corresponding to the Three E’s of entrance, encounter, and exit. This allowed a smooth transition from group brainstorming to the introduction of the Kind Care Bundle that followed. A central component of the success of this intervention is the opportunity for students to interview patients. We found that selecting patients ahead of time was necessary. Patients were chosen from among the general medical floors at the hospital, were informed about the session, and provided consent. This made it easier for first-year students to visit with them subsequently and facilitated deeper discussion. The richness of individual patients’ responses to the guiding questions varied significantly. A brief introduction to the aims of the session during patient recruitment enhanced patients’ subsequent comfort and willingness to share openly with learners. Through the course of the five sessions, learners identified additional behaviors for demonstrating care, ranging from finding a patient’s remote control to adjusting the shades on a bedside window. Future iterations of the Kind Care Curriculum could be adapted to include these caring behaviors.

Limitations of this pilot study include the small sample size, limited scope of the evaluation, and restriction to a single clinical site and medical school. Despite a small sample, we had a high response rate and received feedback from almost the entire cohort of participants. It is unclear whether these results generalize to other clinical sites at our institution, other medical schools, or other trainee populations (e.g., residents and fellows). Both the generalizability of this intervention and its longer-term impact on students’ behaviors and patient interactions require further study. A strength is that the session was mandatory for all students rather than elective, limiting the potential bias of interested students self-selecting into receiving the curriculum. We did not validate our survey formally to ensure students’ accurate interpretations of our questions. Future studies can help validate our survey tool or be repeated using validated survey instruments measuring empathy in medicine. ³²

Patients recruited for the sessions were a convenience sample of medicine inpatients chosen for being English speaking, oriented, conversant, and willing to participate. A broader sampling of patients could have altered students’ experiences; patients not meeting these criteria might have different experiences of compassionate care. We did not formally survey patient participants about their experiences with students’ use of the bundle. Informal interviews indicated that patients appreciated the opportunity to speak with students and share their experiences.

This pilot initiative was proof-of-concept that preclinical medical students could learn and appreciate a bundle of concrete behaviors for demonstrating kind, compassionate care at the bedside. Further study could involve the effect of this intervention on students’ well-being,¹² on their sense of connectedness with patients, on the persistence of their sense of compassion over time, and, ultimately, on patients’ care experiences. We believe emphasizing kindness and compassionate care in trainees can augment patients’ experience of care. This in turn may help reconnect students with the values that brought them to medicine, reducing burnout and bolstering career satisfaction and joy in work among trainees and practicing clinicians alike.³³ Indeed, teaching kindness in the clinical setting could have a reverberating and reinforcing effect, promoting kindness in all types of interactions across a medical school or other clinical institution,³⁴ as well as empathy and wellness.

Next steps for this project include completing follow-up longitudinal surveys to determine the durability of the curriculum and students’ use of the Kind Care Bundle over time in their clinical training. We are also expanding the pilot to all preclinical students at the medical school and will be able to assess its reproducibility within other clinical settings at our institution. Future work could include adapting the intervention to populations at different levels of clinical training (e. g., residents, fellows, and attending physicians) and at other institutions.

1. Kind Care Bundle.docx

2. Facilitator Guide.docx

3. Guiding Interview Questions.docx

4. Evaluation Survey.docx

Click here to view.^{(173K, zip)}

All appendices are peer reviewed as integral parts of the Original Publication.

Drs. Cynthia M. Cooper and Galina Gheihman contributed equally to this work and are co-primary authors.

The original idea for this pilot was presented at a meeting of the Center for Educational Innovation and Scholarship at Massachusetts General Hospital—we thank our colleagues for this discussion and their contributions. The Patient and Family Advisory Council at Massachusetts General Hospital also provided valuable feedback on the design of the Kind Care Bundle and this study. We acknowledge and thank Dr. Arabella Simpkin Begin for her mentorship and advising throughout the development of the project and for her review of earlier versions of the manuscript.

None to report.

None to report.

Cooper CM, Gheihman G. Teaching the “Kind Care Bundle” to medical students—a transition towards compassionate care. Poster presented at: Harvard Medical School Academy Medical Education Day; December 11, 2018; Boston, MA.

Gheihman G, Cooper CM. Teaching the “Kind Care Bundle” to medical students—a transition towards compassionate care. Poster presented at: 79th Annual Soma Weiss Medical Student Research Day; March 12, 2019; Boston, MA.

The Harvard Medical School Academy approved this study.

1. Kahn MW. Etiquette-based medicine. N Engl J Med. 2008;358(19):1988–1989. 10.1056/NEJMp0801863 [PubMed] [CrossRef] [Google Scholar]

2. Swayden KJ, Anderson KK, Connelly LM, Moran JS, McMahon JK, Arnold PM. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ Couns. 2012;86(2):166–171. 10.1016/j.pec.2011.05.024 [PubMed] [CrossRef] [Google Scholar]

3. Lichstein PR, Atkinson HH. Patient-centered bedside rounds and the clinical examination. Med Clin North Am. 2018;102(3):509–519. 10.1016/j.mcna.2017.12.012 [PubMed] [CrossRef] [Google Scholar]

4. Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–781. 10.1056/NEJMp1109283 [PubMed] [CrossRef] [Google Scholar]

5. Mann RK, Siddiqui Z, Kurbanova N, Qayyum R. Effect of HCAHPS reporting on patient satisfaction with physician communication. J Hosp Med. 2016;11(2):105–110. 10.1002/jhm.2490 [PubMed] [CrossRef] [Google Scholar]

6. Hundert EM, Hafferty F, Christakis D. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71(6):624–642. 10.1097/00001888-199606000-00014 [PubMed] [CrossRef] [Google Scholar]

7. Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ. 2004;38(5):522–534. 10.1046/j.1365-2929.2004.01820.x [PubMed] [CrossRef] [Google Scholar]

8. Dyrbye LN, Massie FS, Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173–1180. 10.1001/jama.2010.1318 [PubMed] [CrossRef] [Google Scholar]

9. Dyrbye LN, Shanafelt TD, Sinsky CA, et al. Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. National Academy of Medicine. July 5, 2017. Accessed May 25, 2018. 10.31478/201707b [CrossRef] [Google Scholar]

10. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–1191. 10.1097/ACM.0b013e3181b17e55 [PubMed] [CrossRef] [Google Scholar]

11. Patel S, Pelletier-Bui A, Smith S, et al. Curricula for empathy and compassion training in medical education: a systematic review. PLoS One. 2019;14(8):e0221412. 10.1371/journal.pone.0221412 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

12. Weingartner LA, Sawning S, Shaw MA, Klein JB. Compassion cultivation training promotes medical student wellness and enhanced clinical care. BMC Med Educ. 2019;19:139. 10.1186/s12909-019-1546-6 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

13. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385. 10.1001/archinternmed.2012.3199 [PubMed] [CrossRef] [Google Scholar]

14. Trzeciak S, Roberts BW, Mazzarelli AJ. Compassionomics: hypothesis and experimental approach. Med Hypotheses. 2017;107:92–97. 10.1016/j.mehy.2017.08.015 [PubMed] [CrossRef] [Google Scholar]

15. Schwenk TL. Physician well-being and the regenerative power of caring. JAMA. 2018;319(15):1543–1544. 10.1001/jama.2018.1539 [PubMed] [CrossRef] [Google Scholar]

16. Rock L, Gadmer N, Arnold R, et al. Critical care communication skills training for internal medicine residents. MedEdPORTAL. 2015;11:10212. 10.15766/mep_2374-8265.10212 [CrossRef] [Google Scholar]

17. Kesselheim J, Garvey K, Sectish T, Vinci R. Fostering humanism and professionalism in pediatric residency training. MedEdPORTAL. 2010;6:7906. 10.15766/mep_2374-8265.7906 [CrossRef] [Google Scholar]

18. Kesselheim J, Atlas M, Adams D, et al. Humanism and professionalism for pediatric hematology-oncology fellows (HP-PHO). MedEdPORTAL. 2013;9:9607. 10.15766/mep_2374-8265.9607 [CrossRef] [Google Scholar]

19. Bauchat J, Park C, Santos J, Anderson L. Simulation-based empathetic communication curriculum. MedEdPORTAL. 2016;12:10336. 10.15766/mep_2374-8265.10336 [CrossRef] [Google Scholar]

20. Seymour P, Watt M, MacKenzie M, Gallea M. Professional Competencies ToolKit: using flash cards to teach reflective practice to medical students in clinical clerkship. MedEdPORTAL. 2018;14:10750. 10.15766/mep_2374-8265.10750 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

21. Glod SA, Richard D, Gordon P, et al. A curriculum for clerkship students to foster professionalism through reflective practice and identity formation. MedEdPORTAL. 2016;12:10416. 10.15766/mep_2374-8265.10416 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

22. Wagner L, Roth L. Reflective narrative exercise. MedEdPORTAL. 2015;11:10238. 10.15766/mep_2374-8265.10238 [CrossRef] [Google Scholar]

23. Chen I, Forbes C. Reflective writing and its impact on empathy in medical education: systematic review. J Educ Eval Health Prof. 2014;11:20. 10.3352/jeehp.2014.11.20 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

24. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2009;14(4):595–621. 10.1007/s10459-007-9090-2 [PubMed] [CrossRef] [Google Scholar]

25. Taylor DCM, Hamdy H. Adult learning theories: implications for learning and teaching in medical education: AMEE Guide no. 83. Med Teach. 2013;35(11):e1561–e1572. 10.3109/0142159X.2013.828153 [PubMed] [CrossRef] [Google Scholar]

26. Kolb DA, Fry RE. Toward an Applied Theory of Experiential Learning. MIT Alfred P. Sloan School of Management; 1974.

27. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. 10.1186/1471-2288-13-117 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

28. Strauss A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage Publications; 1990. [Google Scholar]

29. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288. 10.1177/1049732305276687 [PubMed] [CrossRef] [Google Scholar]

30. Launer J. On kindness. Postgrad Med J. 2008;84(998):671–672. 10.1136/pgmj.2008.076729 [CrossRef] [Google Scholar]

31. Pavlic A, Liu D, Baker K, et al. Behind the curtain: the nurses’ voice in assessment of residents in the emergency department. West J Emerg Med. 2019;20(1):23–28. 10.5811/westjem.2018.10.39821 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

32. Hemmerdinger JM, Stoddart SDR, Lilford RJ. A systematic review of tests of empathy in medicine. BMC Med Educ. 2007;7:24. 10.1186/1472-6920-7-24 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

33. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272–2281. 10.1016/S0140-6736(16)31279-X [PubMed] [CrossRef] [Google Scholar]

34. Suchman AL, Williamson PR, Litzelman DK, et al.; Relationship-Centered Care Initiative Discovery Team. Toward an informal curriculum that teaches professionalism. J Gen Intern Med. 2004;19(5):501–504. 10.1111/j.1525-1497.2004.30157.x [PMC free article] [PubMed] [CrossRef] [Google Scholar]

GOOD ZABOTA.RF – a project to develop the creative abilities of children

Translate page

“GOOD CARE. RF” is a non-commercial project to develop creative abilities and teach labor skills to children, as well as to provide social and psychological assistance to children in difficult life situations.

The GOOD CARE.RF project has existed since 1999 and is currently being implemented by public organizations – ANO Art Studio Violet Summer and ANO Center for Social Initiatives Energy of Life with the active assistance of partners, sponsors and volunteers.

Project goal:
to develop in children the desire and skills to take care of themselves and others, as well as the desire for a successful independent life.

Objectives of the project:
1. Social adaptation of children aimed at success in studies, work and creating a family;
2. Intellectual development of children, promoting the identification and development of talents;
3. Teaching children about peaceful and kind emotional relationships;
4. Formation in children of the desire and skills for socially useful work, as well as instilling an interest in a healthy lifestyle.

The tasks of the project are solved by the following methods and tools:

– creative interactive author’s meetings,
– concerts, holidays and festivals and competitions,
– master classes, seminars, trainings,
– as well as training with children and teachers of various cultural and educational activities.

Our team also implements other charitable, social and cultural projects.

We organize cultural and mass events for children and adults, master classes, seminars and creative meetings, holidays, concerts, festivals of the city, regional and regional levels, and also take part in competitions, forums and festivals of various levels and directions.

Our news and events

10 of 125

Congratulations to the pupils of orphanages in Russia on the holiday “Children’s Day – June 1” in 2022 as part of the GOODZABOTA.RF project

I would like to thank all the partners and volunteers who took part in the congratulations of children from orphanages in Russia on the holiday “Children’s Day – June 1”.

This time we congratulated the children and employees of orphanages with congratulatory letters and attached video greetings, and everything turned out to be sincere and sincere.

I invite everyone to join our project GOODZABOTA.RF and give and receive good things together.

All the best.

June 1, 2022, 12:05

• dobrayazabota.rf,
• violet-summer.rf,
• glory dal,
• lara dal,
• lara and glory dal,
• all the best,
• June 1,

Event for children on April 21, 2022 within the framework of the GOOD CARE.RF project for students of the MAOU “School No. 18 for students with disabilities” in Perm

Our next event was wonderful – the author’s online educational interactive meeting – in the form of a video bridge between Sochi and Perm – a concert on the topic of interest in a healthy and peaceful lifestyle for children and youth for students of the school for children with developmental disabilities – MAOU “School No. 18 for students with disabilities” Perm

I thank all the participants for the organization and preparation, and especially the school teacher Ekaterina Sukhanova.

I invite you to our project GOOD CARE. The RF of all who like to give and receive good things – because together it is easier and more pleasant to do this.

All the best.

April 21, 2022, 10:20

• kind care,
• purple summer,
• Slava Dal,
• Alexander Sobolev,
• good care . rf

Creative online learning – master – class from students of the Moscow Institute of Culture for children from the orphanage in Barnaul

Educational master class and performance of a cheerful author’s song “School rock – n – roll” in ONLINE format within the framework of the GOODZABOTA.RF project for pupils of the orphanage in Volzhsky

At the invitation of the Russian Orthodox Church, an author’s educational interactive meeting was held for children.

Due to technical and other difficulties, there was a delay in posting our events on the site.

We continue to publish our news with a delay, adhering to the chronology of the seasons and we would appreciate your understanding.

In this photo, we are with children after our author’s educational interactive meeting – a concert, held by us at the invitation of the Russian Orthodox Church.

It was an interesting experience and unusual energy.

My assistant, musician Oleg Zubtsov and I were worried.

Everything went well – the children listened with pleasure and answered questions, we enthusiastically communicated all together and made discoveries for ourselves, gaining new knowledge and vivid emotional experience of communication in an unusual environment.

After the event, the children were awarded our commemorative medals – who for ATTENTION, who for the BEST ANSWER, and who for COURAGE,

At the end of the meeting, the inviting party arranged a friendly tea party, which made us even more friends.

I express my deep gratitude to everyone who shares and supports our important work of helping children.

Sincerely yours, the author of the project Slava Dal.

Online event – author’s creative interactive meeting – producer and art – psychologist Slava Dal for pupils of the orphanage in Gornozavodsk.

CLICK ON THE PHOTO ABOVE TO SEE THE ENTIRE IMAGE.

In connection with the quarantine announced in the country, children from orphanages found themselves in social and emotional isolation.

We managed to accept this challenge and quickly master the options for social assistance to children in a remote Internet format.

And for the first time in 15 years we created events within the framework of our GOOD CARE project. RF On April 2, 2020, in the orphanage in the city of Gornozavodsk, with which we have long-term business, creative and warm friendly relations, we held an interactive creative workshop. multimedia author’s meeting.

The head of the orphanage, Tatyana Borisovna, suggested that we reveal to children the topic of shaping the desire and ability of children to take care of themselves and their neighbor, harmoniously combining their rights and obligations in relation to others.

The meeting turned out to be interesting and exciting, both for children and teachers and organizers.

I express my sincere gratitude to the staff of the orphanage in Gornozavodsk for the quick response and help in organizing events in a new format for us.

We invite media volunteers, hand-made craftswomen, experts and trainers, artists and musicians, and everyone who can hold an online event and a creative master class for children to join us.

Call +79128818929 MTS, Viber, Vats Ap, Telegram.

Slava Dal.

FEEDBACK ABOUT THE MEETING AT THE CHILDREN’S HOME, GORNOZAVODSK.

Art Director of ANO “Art Studio” Violet Summer”.

Dear Slava Dal!
We are happy to be convinced again and again that there are many talented people! And even happier that they are not just colleagues, but also our friends !

Thank you for the fire of emotions and impressions for the new format of communication)))

Everything was great, singing live, fire!!!

Thank you for your ideas, for your tricks, for your humor and good mood)))
Yulia Nikolaevna Vologdina, social work specialist at the orphanage in Gornozavodsk.

April 2, 2020, 10:00

• violet summer,
• good care.,
• Orphanage Gornozavodsk,
• online meetings and concerts,
• Slava Dal,
• remote events in orphanages,
• we invite media volunteers,
• media volunteers,
• purple summer ask the internet

Shrovetide – SEEING OFF WINTER MARCH 1, 202 IN THE CHILDREN’S CENTER

March 1, 2020, 12:43

• WELCOME,
• PURPLE SUMMER,
• Slava Dal,
• Good Care,
• HOLIDAYS,
• CONGRATULATIONS,
• MASTER – CLASSES,
• MEDIA VOLUNTEERS,
• WE INVITE MEDIA VOLUNTEERS,
• SPONSORS INVITED,
• WE INVITE VOLUNTEERS,
• CHARITY PROJECT

An event with the participation of our volunteers in the recreation center of the village.

Frola.

Download in one archive

We are glad that we managed to take part in the festive event – a big anniversary reporting concert – the anniversary of our longtime friend and participant in our festivals and concerts, arranger and director of our songs and events, longtime creative partner and just wonderful A man named Igor Meshchurov. The event took place in the Palace of Culture of the village. Frola.

April 1, 2020, 12:08

• good care,
• purple summer,
• Maslenitsa,
• Slava Dal,
• holidays,
• congratulations,
• good deeds,
• kind care,
• purplesummer

Master class “Soft toy” in the social rehabilitation center

Read more

SRCN Rainbow, master class “Christmas tree toys”

Read more

Video

Creative master classes in Dobryanka

School rock and roll. Author Slava Dal

Day of the City of Sochi – Art Studio “Purple Summer”

Children’s Help Center, Department No. 2, Perm

Purple Summer – 10 years. Unpress-Perm report.

Project “Purple Summer” at the Festival “White Nights in Perm 2014”

Orphanage in Solikamsk. Video review of the computer science teacher about the master class Good care

Letter of thanks from the SRTSN Kungur

Business and charity. Live broadcast with Slava Dal

Making BOUQUETS FROM CANDIES with the participants of the Good Care project

About business trust in public organizations

“How to avoid child aggression at school” – psychologist’s recommendations

Photo gallery

good work – Traducción al español – ejemplos ruso

Su búsqueda puede llevar a ejemplos con expresiones vulgares.

Su búsqueda puede llevar a ejemplos con expresiones coloquiales.

Otros resultados

That’s what they call old, good job clerk.

Bueno, esa es la gerencia de los viejos tiempos.

And I would certainly recommend to the Chairs not to weaken this good work in the expectation that in the course of extensive discussions we can find a way to a breakthrough.