Implementing a Culture of Caring in Health Care

By Rose O. Sherman, EdD, RN, FAAN

Most nurse leaders readily acknowledge that the current healthcare environment is the most challenging of their careers. There are many unknowns as we move into an era of health reform that will fundamentally change the way that we deliver care. It can be hard to stay grounded in the midst of complexity and chaos. Yet, some principles of our work should be timeless including a value system that is grounded in caring. Staff look to their leaders to build cultures that give meaning to their work. Implementing a culture of caring takes intentional leadership. It is not a given even in healthcare environments where most would agree that it is what patients expect to experience from their caregivers.

In a recently released book, Health Care System Transformation for Nursing and Health Care Leaders, authors Anne Boykin, Savina Schoenhofer and Kathleen Valentine present a values-based model – the Dance of Caring Persons – that can be used to guide organizations in a transformation to caring cultures. The dance symbolizes the valuing and appreciation of each person in a way that is person- centered and caring-focused. The dance includes a circle of many different dancers. Each person is understood to be caring and living their commitment to the mission of the organization in unique and special ways. There are no positions of power, but rather awareness that everyone brings their own valuable and unique contribution to the whole. There is recognition of the importance of exquisite teamwork in health care.

Many nursing departments have implemented theoretical frameworks to guide their nursing practice. A weakness in most models, even those that are caring-based, is that the focus is limited to nursing practice. Although nurses make a unique contribution to the patient experience, they don’t work alone. The implementation of a culture of caring needs to be at the organizational level. Many health care organizations lack an explicit value system that highlights caring as a core value. There are considerable efforts by hospitals today placed on improving HCAHPS scores (patient satisfaction) to avoid reimbursement penalties. Yet, there is a lack of recognition that these scores are only representations of what really matters to patients in their experience – the value of caring. The authors propose that the Dance of Caring Persons can be used as a values-based unifying framework to transform health systems in the 21st century.

The implementation of the Dance of Caring Persons involves major transformational change. In their work, the authors provide guidance for moving through phases in the change process. They also present experiences of organizations who have made the transformation. The following 5 phases are not linear but each encompasses work that must be done at the organizational level to move the commitment to change:

Create awareness
Build knowledge and articulate expectations
Prepare first adopters, increase the desire for change
Enable and motivate all users
Build proficiency and reinforce skill

An essential component to the implementation of the Dance of Caring Persons is the use of story. Health care is unlike any other product or service. The experience that a patient has is highly dependent on the values, desires and beliefs of everyone encountered on the journey. Every employee in the organization has stories that connect them to patient experiences. These need to be shared so they can be valued as part of the dance. This may mean that traditional ideas about power, hierarchy and communication need to be revisited.

Although we think about caring as the essence of healthcare, the importance can get easily lost in the realities of practice today. The implementation of a culturing of caring involves fundamental organizational change. The Dance of Caring Persons model presented in this book provides leaders with a framework on how to do this.

Read to Lead

Boykin, A., Schoenhofer, S. & Valentine, K. (2013). Health care system transformation for nursing and healthcare leaders: Implementing a culture of caring. New York: Springer Publishing.

Nursing as Caring Website http://www.nursingascaring.com

Website Anne Boykin Institute for the Advancement of Caring