I’ve spent the last few weeks working on a grant proposal to support compassion in healthcare. I’ve been reading and thinking a lot about compassion – both what it looks like and how to teach it. I’ve also been musing about the idea of kindness. Could something so old-fashioned and prosaic hold promise for improving care in the increasingly high-tech universe of medicine?

In an article, “On kindness,” medical educator John Launer reflects on the big impact of small acts of kindness on people dealing with illness or vulnerability. Like Launer, I teach communication skills to healthcare providers. As he points out, those of us who teach these skills spend a lot of time talking about listening, non-verbal cues, and empathy. While these are all important, we tend to focus on behavioural strategies, and less on human values. We rarely use terms like “wisdom” or “kindness” in our curriculum. He raises an interesting question: How would being explicit about those values change how we think about giving and receiving care? He also highlights the importance of institutional kindness – creating an environment that encourages and values such actions.

Around the same time that I came across Launer’s article, I found Laura Pinger and Lisa Flook’s What if schools taught kindness for twice a week for 20 minutes. This article is about a school-based program that taught kindergarten students about kindness. They used stories and practices to help the kids cultivate mindfulness, regulate their emotions, and pay attention to the needs of others. They focused on both extending help to others and acknowledging the kindness extended by other people. They posted a “kindness garden” on the classroom wall to make visible acts of friendship between the kids. “The idea is that friendship is like a seed — it needs to be nurtured and taken care of in order to grow.”

Pinger and Flook reinforce the idea that even small changes create a ripple effect. Fundamentally, the school-based program emphasizes the quality of attention we turn towards others in moments of distress or need:

For example, what quality of attention do we bring when we interact with our kids? Do we give them our full attention — eye contact, kneeling down to speak with them, asking questions — or are we distracted? By modeling behavior, and through our interactions, we show them what it’s like to be seen and heard and to be compassionate with others.

All of this made me think about the Roots of Empathy (ROE) program I taught several years ago to a group of Grade 6 students who were struggling with life challenges and limited resources. In the ROE program, an infant and their parent visit a classroom every few weeks. The ROE instructor encourages students to observe the baby’s development and name the baby’s feelings. In this context, the baby is the “teacher,” and the instructor uses the children’s ideas to help them reflect on their own feelings and those of others.

I can still remember the kid’s excitement when the baby and her mother arrived in the classroom, and how they rushed to greet and try to help them. All of the kids wanted to touch the baby and be close to her. Even the most disengaged or “difficult” students were drawn to the baby and seemed to respond to our lessons on empathy. While the program couldn’t begin to resolve all the issues these kids faced, it gave them the message that small acts of kindness make a difference.

When I mentioned this blog posting to someone recently they remarked, “Kindness in healthcare is a rare thing. The whole environment doesn’t really lend itself to acts of kindness.” It made me think about the value of kindness in healthcare settings, and how the environment might actively discourage it. What quality of attention do we bring to our interactions with patients? Are we distracted? Do we give them our full attention — even during our brief moments of contact?

While it’s hard to argue against kindness for its own sake, there are higher stakes for healthcare. James Rody, MD, the Director of the Center for Compassion and Altruism from Stanford University, writes about the relationship between kindness and healing:

It is amazing what difference a physician’s attitude can have on a patient. A positive emotional state allows one to more fully connect, decreases anxiety and leads to a faster recovery. There is even evidence that when a patient listens to less than a minute of compassionate communication from a physician they feel less anxious. Researchers have mapped reduced anxiety and increased positive emotion to biological and immunological responses in the body.

Rody believes that kindness isn’t just good for patients.  He draws from emerging neuroscience research that acts of kindness stimulates the reward circuits in our brains, so giving and receiving kindness has a positive effect on healthcare providers as well.

While there’s a big gap between kindergarten students and health care providers, I’m wondering if the lessons we need to learn are not that different. Maybe we need to  institute “kindness gardens” on the walls of our hospitals to remind us of the importance of small acts of kindness towards others and hope they will grow.