The Case for Compassion

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WHAT IS COMPASSIONATE CARE?

Compassion means not only understanding and feeling another’s suffering, but also taking action to help them.1,2 While empathy means feeling or cognitively understanding another’s emotions and perspectives, compassion goes further by motivating behaviors to reduce their distress.3,4,5,6

For our purposes, compassionate care means:

  • Recognizing and acknowledging a person’s suffering, distress, and concerns
  • Taking active steps to address both their physical and emotional needs
  • Providing genuine human connection throughout their healthcare journey

WHY DOES COMPASSIONATE CARE MATTER?

Healthcare is inherently complex, uncertain, and ever-changing, with rising rates of stress and burnout among healthcare workers (HCW) exacerbated by the COVID-19 pandemic. Yet one aspect of healthcare remains constant: patients and families want to receive compassion when they are vulnerable, ill and suffering, and that is what clinicians want to provide. Our nationally representative surveys reveal:

  • Both patients and clinicians believe compassion is vitally important to successful medical treatment and that good communication and emotional support can make a difference in whether a patient lives or dies.7,8
  • 85% of patients reported that compassion was very important to them.
  • Both patients and clinicians report that changes in the healthcare system are making it harder to receive and provide the kind of compassionate care and support they want.7,8

Compassion and the human connection are essential not only for our collective well-being, but also to improve health and organizational profitability.

HOW DOES COMPASSION WORK?

Research shows compassion activates neural reward networks, resulting in feelings of reward, pleasure, and connection.4,9 Simply put, compassion and the resulting helpful pro-social behaviors make us feel good. It infuses us with a sense of purpose, meaning and common humanity.10 In addition, positive emotions free up our thinking to be more creative and better problem solvers.  Compassion drives positive upward spirals in individuals and organizations, while burnout creates downward cycles.11

People who are burned out are in survival mode; their thinking is restricted to just getting through the day. Compassion, social connection and pro-social behaviors increase vagal tone, which counterbalances sympathetic nervous system activation and is associated with the reduction of stress hormones and perceived stress.12,13,14 Vagal tone and psychosocial well-being reciprocally and prospectively predict one another. Individuals with higher vagal tone deal better with stress.15

RECENT DATA HIGHLIGHTS THE SEVERITY AND COST OF BURNOUT FOR THE US HEALTHCARE SYSTEM.

PHYSICIAN BURNOUT:

45% in 2024 (down from 50-60% in recent years).75

NURSE BURNOUT:

60%, with 22% changing positions in the past 6 months.76, 77

Nurse burnout is associated with higher turnover rates for both nurses and physicians.62

This widespread burnout creates a cascading effect, increasing turnover and potentially compromising patient care quality. It’s a systemic issue that demands comprehensive organizational strategies to address workplace well-being. The cost of burnout and turnover is significant, as illustrated below:

PHYSICIAN TURNOVER COSTS:

  • Total U.S. annual cost: ~$4.6 billion78
  • Average replacement cost: $500,000-$1,000,00079
  • Hospitals lose revenue when a physician leaves; for example, a family medicine physician vacancy could include:80, 81
    • $130,000 on average lost monthly
    • 4.3 months on average to fill the position
    • Total potential loss: $559,000 (Losses could be much more for medical specialists)
    • Additional expenses including recruiting, interviewing, relocation costs and signing bonuses: $46,000+

NURSE TURNOVER COSTS:

  • Average replacement cost: $56,300
  • Hospitals lost $3.9-$5.8 million in nurse turnover (2023)82
  • Each 1% change in RN turnover saves/costs hospitals $262,500 annually6

The AMA has made an interactive calculator available to estimate the costs of turnover in an organization.79

Health workers’ poor mental health days have increased from 3.3 to 4.5 days per month (20182022).83 Fifty-one percent of physicians know a colleague who has considered, attempted, or died by suicide.84 Suicide rates among women physicians and nurses are almost twice that of the general population of women.85 Healthcare workers, especially support staff, RNs, and health techs, face significantly higher suicide risks.86

WHAT IS THE IMPACT ON PATIENTS, THEIR CARE TEAMS, AND THE HEALING RELATIONSHIP?

1. Compassion improves patients’ physical and mental health

Compassionate care improves health outcomes of patients suffering from pain and trauma:

  • Reduced orthopedic post-operative pain and anxiety, leading to improved functional status and satisfaction.16
  • Improved patient perceptions of high-level trauma outcomes, with greater satisfaction reported at six months and even one year after hospital discharge.17
  • Better outcomes of treatment for back pain are associated with clinicians’ empathy and compassion compared to standard treatments alone:
    • Lower back pain intensity, reduced pain interference, and decreased back pain-related disability and fatigue.18
    • Improved health-related quality of life, with physician empathy and compassion linked to better outcomes than non-pharmacological treatments, opioid therapy, or lumbar spine surgery.18
    • Patients with chronic low back pain treated by physical therapists trained in compassionate communication experienced significantly more pain relief compared to standard physical therapy alone.19,20

Compassionate care improves cancer care outcomes:

  • A meta-analysis of 55 studies showed notable benefits, including enhanced health-related and emotional quality of life, greater communication involvement, reduced treatment regret, and increased trust and satisfaction with the treating physician.21
  • Patients with lung cancer experienced improved quality of life, improved mood, less depression and extended survival.22
  • Improved quality of life and mood reported in patients with gastro-intestinal cancer.23 Physicians’ compassion reduces diabetes complications, cardiovascular events, and mortality:
  • Physicians’ compassionate care of patients with hypercholesterolemia and diabetes was associated with improved control of these conditions, reduced the likelihood of serious diabetes complications, lower risk of cardiovascular events, and significantly lowered the risk of all-cause mortality.24,25,26

Physicians’ empathy and compassion improves immunologic responses:

  • In a study of patients with the common cold, compassion was associated with increased immune response and reduced viral-related symptoms.27
  • In a study of patients with Crohn’s disease, physicians’ compassionate care improved immunologic response, reduced anxiety, improved self-efficacy and sleep quality.28

Compassion improves medication adherence which enhances health outcomes.

  • Medication non-adherence in the U.S. costs the healthcare system billions annually through disease progression and worsening symptoms.29 Non-adherence to medications is complex and may be driven by patient, clinician and systemic factors (e.g. lack of understanding, complex regimens), communication issues, lack of insurance, and low income.
  • A key driver of medication adherence is provider communication skills – particularly accurate information delivery, active listening, empathy, trust-building, and collaborative problemsolving around adherence barriers.30
  • A Kaiser study of 9,377 patients found that poor provider ratings in patient involvement, treatment understanding, and trust-building correlated with 4-6% lower medication adherence rates (P < 0.05).31

Clinician empathy and compassion directly correlate with reduced patient depression, anxiety, and improved mood outcomes.

  • Clinical interventions focused on developing self-compassion and compassion for others show statistically significant benefits (p < .001) across multiple measures: compassion levels, mindfulness, psychological well-being, and reduced depression and anxiety.32
  • A landmark 1985 NIMH study showed that the psychiatrist’s impact matched or exceeded the benefits of antidepressant medication.33
  • Empathic responses to hospitalized patients’ negative emotions led to reduced anxiety and higher communication satisfaction scores, without increasing the duration of interactions.34

2. Compassion reduces unnecessary utilization of healthcare services

Low-value care persists in part due to systemic financial incentives that are misaligned with the quadruple aim (improved patient experience, population health, and well-being of healthcare workers and reduced costs of care), and due to physicians’ concerns about malpractice risk. Lowvalue care provides little or no benefit to patients and may cause harm while using expensive healthcare resources. Both low-value care and non-adherence drive up costs and increase the risk of patient harm. Ten to thirty percent of the $3 trillion spent annually on healthcare in the U.S. is estimated to be allocated to low-value care, potentially amounting to $900 billion. Unnecessary treatments increase costs, cause health complications, and delay more effective care.35 Compassionate, relationship-centered communication and care reduces unnecessary utilization of tests and services.

  • Physicians who use compassionate, relationship-centered communication skills (by eliciting understanding, validating the patient’s perspective, coming to a mutually shared understanding of the problem, etc.), use fewer healthcare resources, like diagnostic tests and referrals, to address the patient’s problem.36,37
  • Patients’ perceptions of reaching “common ground” with their physician directly correlates with reduced healthcare resource utilization.38
  • Physicians in outpatient settings who use compassionate, patient-centered communication skills may understand their patients’ medical issues and concerns and use fewer healthcare resources (e.g., referrals and tests) to address their patients’ problems.39,40
  • Patients’ perceptions of reaching common ground drives their experiences of patientcenteredness.38
 

3. Compassion enhances patient satisfaction and increases revenue

Patient experience ratings strongly influence hospital financial performance. Studies show a 5-point increase in hospital ratings leads to a 1% higher profit margin. Each 1% increase in “definitely recommend” ratings correlates with $1.07 million more in revenue.41 Better patient experience predicts higher revenue and lower costs in subsequent years, particularly in private hospitals.42

Hospitals rated “excellent” in patient experience consistently outperform those with lower ratings across 18 quality measures, including shorter emergency wait times. The strongest link to positive ratings comes from patient-nurse engagement, suggesting this relationship is key to both patient satisfaction and hospital performance.43

Compassionate, relationship-centered communication improves patient satisfaction.

  • Research across 14 international studies demonstrates that compassionate communication by healthcare teams directly improves patient satisfaction. A comprehensive Cochrane Review confirms these findings, showing that patient-centered communication consistently enhances care satisfaction.44,45

Compassion practices for healthcare workers improves patient experience ratings.

  • Healthcare organizations implementing formal compassion practices (recognizing staff compassion, supporting caregiver stress management) show significantly higher HCAHPS ratings and patient recommendations.46
  • Clinic-level compassion practices correlate with:
    • Higher patient ratings of nursing care.
    • Lower nurse emotional exhaustion.
    • Increased nurse psychological vitality.
    • Better overall patient care experiences, likely mediated through improved nurse well-being.47

4. Provider compassion and well-being reduces adverse outcomes, medical errors and malpractice claims

Medical errors are ranked third by some researchers as a cause of death in the U.S., after heart disease and cancer.48 There are an estimated 251,000 annual deaths attributable to medical errors. Poor quality care leads to unnecessary suffering, persistent symptoms, sicker patients, more disabilities, higher costs, and lower confidence in the healthcare industry.49

Burnout, for which compassion is the antidote, is strongly associated with adverse outcomes.

  • Burnout, fatigue, and lower work unit safety grades were each independently associated with self-reported medical errors.50 Burnout is strongly associated with poor quality of care and medical errors, and doubled the number of patient safety incidents.51,52
  • A single point increase in physician depersonalization correlates with 45-50% higher odds of major medical errors within three months, revealing burnout’s profound and direct impact on patient safety.50,53
  • Research demonstrates that higher scores in personal accomplishment, emotional empathy, and cognitive empathy significantly reduce the likelihood of self-perceived medical errors. Each one-point increase in these measures corresponds to a 7-9% decrease in error probability over subsequent three-month periods.54
  • Medical error contributes to depression, and depression contributes to errors. Although less common than burnout, symptoms of depression and suicidality are strongly and bi-directionally associated with perceived medical errors.50This cycle emphasizes the critical importance of addressing both clinical performance and provider well-being as interconnected aspects of healthcare safety.
  • Employee engagement is significantly associated with improvement in patient safety outcomes, culture and errors/adverse events.55

These outcomes are not only uncompassionate, but preventable. In one study of a harm reduction intervention in a 24-hospital health system where 26% of patients had previously experienced harm, improvements were seen in costs and revenue.56

  • $108 million: Total cost reduction from health system harm reduction
  • $48 million: Variable cost savings
  • $18 million: Increase in contribution margin
  • 60,000: Inpatient care days saved

Compassion practices can reduce medical malpractice claims.

There were 11,440 medical malpractice claims in 2023, with $4.8 billion in settlement payouts. Of these, 1,300 claims were settled for payouts of more than $1 million.57 The cost of resolving the average malpractice claim outpaced inflation between 2014 – 2020, and loss costs due to extremely large verdicts (in excess of $10 million) have accelerated.58 

  • Adverse outcomes that result in malpractice claims may be driven by compassion failures on the part of the clinician, team and/or organization.
  • Most malpractice claims stem from a compassion deficit: poor communication, dismissing or devaluing patient and family perspectives, and perceptions of abandoning the patient.59,60

5. Compassion improves healthcare worker physical health and mental health, and reduces burnout

Burnout is an occupational syndrome that occurs when there is a mismatch between individual and organizational values and priorities, and when organizational demands exceed available resources. It is characterized by emotional exhaustion, depersonalization and cynicism, and lack of personal effectiveness, and is the result of systemic failures, not individual shortcomings.  Burnout is associated with poor patient safety and quality of care,51,52 medical errors,50,51,52,61,62 unprofessional behavior,63,64 low staff engagement and high turnover.62,65

Compassion and burnout have an inverse relationship. Data shows that burnout decreases as selfreported compassion increases, perhaps through the buffering effects of compassion on workrelated stress.8,66,67,68,69,70

Chronic work-related stress triggers sustained sympathetic nervous system hyperactivity and cascading stress hormone release, profoundly impacting both psychological and physical wellbeing. These physiological disruptions increase risks for multiple conditions: cardiovascular disease (including hypertension and atherosclerosis), compromised immune function, disrupted gut-brain axis regulation, systemic inflammation, and mental health disorders such as depression, panic disorders, and suicidal ideation.71

Compassion buffers the effects of work-related stress.

  • Programs like the Schwartz Rounds® create structured opportunities for healthcare workers to build connections and process work-related stress collectively. These dedicated spaces for sharing experiences and emotional reflection have been shown to reduce burnout and improve team cohesion. To learn more visit org/ schwartz-rounds
  • Meaningful relationships and social connections decrease disease-related morbidity and mortality. The health risks of social isolation rival those of smoking, excessive alcohol use, and obesity, highlighting the critical importance of fostering supportive professional relationships.72
  • Helping others actively improves the provider’s own well-being. Healthcare workers who engage in pro-social activities report better mental health, enhanced sense of purpose, and greater resilience against burnout, while building stronger connections with colleagues and patients.73
 

6. Compassion facilitates high functioning teams

Compassion facilitates psychological safety and caring in teams.

Psychological safety is “[feeling] permission for candor.”87 Empathy and compassion are key facilitators of psychologically safe environments, as they enable individuals to understand and appreciate others’ perspectives and create spaces in which people feel comfortable sharing ideas and concerns without fear of judgment or criticism. Leaders who demonstrate empathy and compassion set the tone for a psychologically safe workplace by actively listening, validating emotions, and showing concern for their team members.

Outcomes of psychological safety include improved team performance and organizational effectiveness,88 including:

  • Mitigates interpersonal risks inherent in learning in hierarchies and is strongly associated with team learning.
  • Upward communication can be a vital force in helping contemporary organizations learn and succeed; by speaking up to those who occupy positions to authorize actions, employees can help challenge the status quo, identify problems or opportunities for improvement, and offer ideas to improve their organizations’ well-being.
  • Nurses’ perceptions of team caring strongly predicts their perceptions of organizational compassion,8 demonstrating how team dynamics shape institutional culture. This relationship highlights the critical role of supportive team environments in building compassionate organizations.

Compassion facilitates relational collaboration and teamwork.

Compassionate, interprofessional teamwork generates gains in collaborative care, continuity of actions, and improvement in relations. It also saves time, promotes continual learning, and reduces ideological, organizational and relational barriers. This requires communication and sharing of workspaces to ensure frequent contact, the appreciation and knowledge of different practices and professional roles, and shared leadership to deal with conflicts and tensions.89

Outcomes of relational dimensions of team care include:90

  • Meaning in work
  • Bolstered resilience which acts as a buffer against stressful work conditions
  • Collective empathy for colleagues that fosters compassionate connections with patients
  • Improved team and organizational performance

Relational coordination of care is characterized by shared knowledge, shared goals, mutual respect and frequent, timely, accurate communication across health care providers. Outcomes of relational coordination of care include:

  • Improved quality of care, reduced postoperative pain, and decreased lengths of hospital stay.91
  • Greater job satisfaction (A 1-point increase in relational coordination nearly quadrupled odds of being satisfied with their job (OR = 3.92, p < .001) and decreased odds of burnout by 64% (OR = 0.36, p < .001).91

7. Organizational compassion improves healthcare worker engagement

Organizational compassion can be defined as “the proactive, systematic, and continuous identification, alleviation, and prevention of all sources of workplace suffering.”92

Compassion for healthcare workers improves their engagement, as well as the organization’s financial health.

  • Benefits of organizational compassion include accelerating post-traumatic healing, strengthening trust, and enhancing employee engagement (motivation, pride, job satisfaction, and organizational commitment).93,94,95,96
  • Employees’ perceptions of organizational compassion are a strong predictor of engagement and turnover.97
  • Outcomes associated with employee engagement in a meta-analysis of 112,312 business units found teams scoring at the top quartile versus lowest quartile had:98,99
    • 10% higher customer loyalty
    • 23% higher profitability
    • 19% higher sales
    • 18% – 43% lower annualized turnover
    • Reduced absenteeism and long-term sick leave 100

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