Table Of ContentAN
EPIDEMIC
OF
EMPATHY
IN
HEALTHCARE
How to Deliver Compassionate,
Connected Patient Care That
Creates a Competitive Advantage
Thomas H. Lee, MD
New York ChiCago SaN FraNCiSCo atheNS
LoNdoN Madrid MexiCo CitY MiLaN
New deLhi SiNgapore SYdNeY toroNto
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For Soheyla
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Contents
acknowledgments vii
introduction 1
Chapter
1 the problem 11
Chapter
2 the imperative 35
Chapter
3 the response: empathy 53
Chapter
4 Measurement 85
Chapter
5 Social Capital and Social Network
Science Come of age 123
Chapter
6 Changing Behavior and
Creating the epidemic 155
Chapter
7 ten key Steps toward higher-Value
empathic healthcare 187
Notes 195
index 203
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acknowledgments
If an epidemic of empathy is an idea whose time
has come, it is because of the timeliness of the conver-
gence of a series of ideas from various key colleagues. I
hope this acknowledgment of their deep influence on
this book will also serve as an abbreviated syllabus for
readers who might want to go more deeply into some
of the themes I have woven together. Individually
and collectively, the work of these colleagues provides
important insights into healthcare’s current state and
where healthcare should go.
For insight into the nature of strategy in a com-
petitive healthcare marketplace, there is no better place
to begin than with the work of Michael E. Porter, my
colleague, coauthor, and friend from Harvard Business
School. Over the last few decades, Michael has defined
the meaning of strategy for business in general. His
work on healthcare has helped clarify why an over-
arching strategic goal is important for every orga-
nization and why that goal should be to create value
for patients, determine what multidisciplinary teams
should look like, and decide what kind of information
and incentives those teams need to drive improvement.
For insight into the nature of the overall healthcare
marketplace and the dynamics related to real competi-
tion (as well as efforts to frustrate competition), I turn
vii
viii Acknowledgments
to Leemore Dafny, a Kellogg School economist who is perhaps
best known for her work on payer and provider consolidation, illus-
trating how it leads to weaker competition and higher prices. Like
many clinicians, I have long been leery of thinking about healthcare
as a marketplace, anticipating potentially perverse consequences
if patients have to act like consumers and try to make trade-offs
between quality and price. But no model of paying for healthcare
is perfect, and all those models can have a range of adverse effects.
Dafny and some of her economics colleagues inspire confidence
that competition in a value-driven market has great potential to
drive improvements in quality and efficiency, especially if providers
embrace competition and learn to trust market forces. All stake-
holders, including providers, will trust market forces more if pro-
viders are actively engaged market participants by, for example,
being transparent with their quality data. Porter’s and Dafny’s work
tell us what we have to do and why we have to do it.
But how to get that work done? University of Chicago sociol-
ogist Ronald Burt’s book on social capital Brokerage and Closure:
An Introduction to Social Capital is one that I have given to virtu-
ally every colleague working directly with me in managing health-
care delivery. It provides a clear and useful structure for learning
(increasing variation in what is done by brokering ideas) and then
converging on best practices (closure). Social capital is at least as
important as financial capital to the ability of healthcare provid-
ers to compete in the era ahead, and corporate boards should give it
the lion’s share of their attention.
No one’s name appears more often in this book than that of
Nicholas Christakis, the Yale social network scientist whom I met
when he was launching his extraordinary work at Harvard. From
Nicholas, I have learned how epidemics of values and emotions
can spread from person to person to person and how to think of a
group of people as an organism. If the work of Porter, Dafny, and
Acknowledgments ix
Burt defines the big picture, Christakis characterizes the nature of
the work to be done closer to the ground.
Then there is the work that is not included in this book and is
conspicuous by its absence. By that, I mean the nuts-and-bolts details
of the kinds of programs and actions that can improve patients’ expe-
riences. For those details, I refer readers to the work of my colleague
Jim Merlino, former chief experience officer of Cleveland Clinic and
author of the widely praised bestselling book Service Fanatics: How to
Build Superior Patient Experience the Cleveland Clinic Way.
I also have been deeply influenced by my colleagues at Press
Ganey, most notably Deirdre Mylod, who was the first and the
most persistent in saying that the reduction of suffering should be
the performance goal to be measured and managed, and Christy
Dempsey, our chief nursing officer, who defined compassionate
connected care as the way to reduce suffering. Pat Ryan became the
CEO of the company in 2012 and made these goals the focus of
Press Ganey even before talking to me about joining.
I allude throughout the book to the work and wisdom of many
colleagues on the provider side. (I won’t single out any to minimize
the risk of slighting others.) I do, however, want to thank Beverly
Merz and Gregg Dipietro for their help in preparing this manu-
script and Casey Ebro at McGraw-Hill for having the confidence
that we could produce the book in a rather short time frame and
the great editing and interpersonal skills that made that happen.
Finally, the very idea of this book was that of my wife, Soheyla
Gharib, MD. She suggested it one day over breakfast and did not
complain when weekends and evenings were then lost to it. She’s
a wonderful physician, and I often think of how I would not want
to do anything in my medical practice that would disappoint her.
She provides the norm. In this and many other ways, the influ-
ence of our relationship on my work is a demonstration of Nicholas
Christakis’s ideas about social networks in action.
