Hospitals in England ranking highly for empathy ‘have better patient outcomes’

Research suggests NHS trusts with higher empathy ratings also benefit financially and have improved staff wellbeing

Patients and staff fare better at hospitals that rank highly on empathy, research suggests, with institutions also benefiting financially by spending less on agency staff, locums and consultants.

The finding comes from the first study to rate NHS trusts in England according to an empathy score that is drawn from information on the organisation’s culture, leadership behaviour and practitioner empathy, among other factors.

The report found that even modest increases in a trust’s overall empathy score were associated with widespread benefits, such as a better chance of the trust holding a “good” or “outstanding” rating for effectiveness and patient safety by the Care Quality Commission, the health and social care services regulator.

Small improvements in empathy were also linked to better staff wellbeing, with higher scoring trusts reporting less burnout and absenteeism than those that scored lower. Expenditure on agency staff and external consultants was also lower in trusts with higher empathy ratings, the researchers found.

“More empathic organisations have better patient outcomes, staff wellbeing and financial bottom lines,” said Prof Jeremy Howick at the University of Leicester, the study’s lead author. “Empathy helps patients because they feel listened to. If you’re not listening to the patient, or they don’t feel able to share all their symptoms, you won’t understand what they are going through and you cannot make an accurate diagnosis.”

The study comes days after the BBC revealed details of the brutal treatment women received at the maternity unit run by Nottingham university hospitals NHS trust, the focus of the largest maternity inquiry in NHS history.

Senior midwives were found to have advised others not to be “too kind”, while one patient was so firmly discouraged from coming in to hospital that when she did arrive, her baby was dead. On a whiteboard at the unit, the letters “FOH” appeared next to the names of several heavily pregnant women, shorthand for “fuck off home.”

“There’s a problem with lack of empathy leading to avoidable harm,” Howick said. “I wouldn’t want to generalise, but there is a problem and it needs to be improved.”

Howick and his colleagues drew on publicly available data such as CQC ratings, NHS staff surveys and financial accounts to rank trusts on nine different areas of empathy. The staff surveys, for example, provided information on whether trusts had a culture of empathy and whether staff felt recognised and rewarded.

The average NHS trust empathy score was six on a scale from one to 10. For every 2.5% increase, the researchers saw a 76% greater chance of the CQC rating a trust good or excellent for patient safety, and a 46% increase in being rated good or excellent for effectiveness. Trusts that scored highest for empathy spent hundreds of thousands of pounds less on agency staff and consultants.

The research has been submitted to BMC Health Services Research, but the results are provisional because the work has yet to be peer reviewed.

While the study draws a link between empathy, patient care and staff wellbeing, it cannot prove that increasing empathy drives the benefits. Patients and staff are likely to do better at well-run trusts where empathy has more chance of thriving.

However, Howick believes there is good reason to think empathy helps. Previous research has shown that empathy can reduce pain, depression and anxiety, and improve patient satisfaction and quality of life. “Our study doesn’t establish causation, but if you look at the evidence in the round, it’s reasonable to assert that it’s likely to be causal,” he said.

While the study does not list the worst performers, the top trusts for empathy included Cumbria, Northumberland, Tyne and Wear NHS foundation trust, Pennine Care NHS foundation trust and Birmingham Women’s and Children’s NHS foundation trust.

Prof Jeffrey Braithwaite, who studies health systems at Macquarie University in Sydney, Australia, said increasing empathy may well improve patient outcomes, and did not have much downside. “The danger is that empathy becomes another slogan on a poster or another online training module,” he said. “The real gains will come when NHS trusts redesign clinical work itself. This means staffing, workload, teamwork, psychological safety and responsiveness to patients. Wouldn’t that make empathy more likely rather than merely hoped for?”