Providing emotional care for patients in a technology-driven health system

“They made me feel genuinely cared for. They listened, made eye contact with me, conveyed warmth and understanding in their voice and repeated back to me what I was saying.” — Sophia, about her visit to a chronic pain clinic, from a “care moment” prepared by the Patient Experience department of Alberta Health Services.

Mounting concern that health professional/patient interactions are often less than therapeutic has led to many initiatives aimed at finding ways to put the care back into the health care system.

In Canada, one such initiative is the creation of the Patient Experience department of Alberta Health Services.

Established in 2009 as part of AHS’s health care quality and improvement division, it produces easy-to-use tools and conducts workshops across the spectrum—from hospitals to long term care facilities, home care organizations and emergency medical services—aimed at improving patients’ experiences in the system.

A key way to do this (and one focus of the department’s work) is to better provide emotional support to patients. The current international push for more patient engagement and for patient-centred care generally acknowledges the  importance of  patient emotional support.

Ways to improve provider/patient relationships

The AHS Patient Experience department consults with the Patients Association of Canada, which in turn endorses the practical wisdom tools AHS has created and promotes them on its website.

The tools are two-pagers. Staff boil down extensive research into easy-to-understand guidelines about ways to improve patients’ experiences. These include actions such as introducing yourself, practising active listening, sitting or standing by the patient’s side.

 “Health care professionals at the front line have been so busy for so long,” says Willow Brocke, the department’s director of the patient engagement.

Providers say they feel like an extension of technology

 “The volume of work, the speed, the expectations, and the increase in what’s possible with life saving technologies—it’s a pressure cooker. People tell us they’re feeling like an extension of technology. At a humanistic level, there is a sense of lost meaning.”

Sholom Glouberman, president of the Patients Association of Canada, calls this instrumentalism. “The instruments have got so powerful that doctors don’t talk to patients, they order tests.”

A recent blog post in the New York Times (titled For New Doctors, 8 Minutes Per Patient) described how, increasingly, doctors cull electronic medical records for information about a patient: “When finally in a room with patients, they try to speed up their work again, but by limiting or eliminating altogether gestures like sitting down to talk, posing open-ended questions, encouraging family discussions or even fully introducing themselves.”

Relationships with patients are vulnerable “in profound ways”

Dr. Jim Kitchens, a clinician-teacher at St. Michael’s Hospital in Toronto, says the increasingly fast pace of health care means that the doctor/patient relationship is vulnerable “in profound ways that are hard to articulate.”

He adds that although it’s accepted that listening to a patients’ medical history story is important for the purpose of making a diagnosis, “we may not fully appreciate the importance to patients of having been heard . . . real healing may be delayed or denied until that happens.”

Importantly, patient emotional support—and hence patient satisfaction—is linked to better clinical outcomes, note the Canadian authors of the recent Health Quarterly article, Understanding the Patients’ Perspective of Emotional Support to Significantly Improve Overall Patient Satisfaction.

The task: to maintain a caring disposition while working with new technologies

“We need to teach providers how to maintain a caring disposition amongst all this new technology,” says Keith Adamson, lead author of the Health Quarterly article.

Care delivery is often focused on the what, and not the how, the article argues.But the provider patient transaction is still fundamentally one between human beings,” he adds.

To try to understand what constitutes emotional support from the patient point of view, Adamson and co-authors conducted lengthy interviews with a random selection of 25 patients who were being discharged from a large community hospital in Toronto.

In the hospital’s regular key indicator reports, overall patient satisfaction scores were quite static. “We wanted to dig deeper, to see what we could do to improve scores—to be aspirational, not just content with static numbers.”

Co-author Jatinder Bains notes there was some concern that “the patients would be afraid to talk about the experiences, that they would think it would jeopardize their future care. But most were quite willing.”

Ways to provide emotional support: from basic to advanced levels

Their findings led them to construct, for health care practitioners, a template of “key actions related to the different levels of emotional support”—actions that are very similar to those outlined in several of the two-pagers from the Alberta group.

The basic level includes practices such as introducing yourself, showing “manners and politeness to create a friendly environment,” maintaining eye contact, and ensuring a clean physical environment.

Advanced levels of emotional support include sitting with patients and “providing opportunities for them to feel accompanied in their struggles,” directly answering questions, making the patient feel special, and making supportive gestures such as, when appropriate, holding the patient’s hand.

Not everyone will be capable or interested in providing support at the advanced level, but everyone in health care should practice basic level skills, Adamson says.

In the 2012 Health Affairs article, Developing Physician Communication Skills for Patient-Centered Care, lead author Wendy Levinson notes that the US Institute of Medicine noted that patient centred care is characterized by (among other attributes) emotional support for patients.

“We end up seeing things only through our own eyes”

“We get so good at the task,” Carol Manson-McLeod, a nurse and head of emergency services for the Edmonton Zone of Alberta Health Services said, “that we end up seeing things only through our own eyes.”

Manson-McLeod said her staff had a wake up call last summer after a physician arranged for a former patient to tell her story. The patient had spent two nights in an emergency ward and was subsequently shunted around several different hospital departments.

“The care tasks were carried out, but compassion and caring was completely lacking. We listened to her story and it was quite distressing.”

The patient experience department was subsequently invited to hold a series of eight workshops for emergency ward staff at two large Edmonton area hospitals. Staff were paid for their time attending the workshops, which each had between 30 and 40 participants.

The importance of hearing positive stories from patients

The workshops always feature patients. “It’s most powerful when we have patients come and present in person, but we also have videos, and one paragraph stories that illustrate a time when we got it right,” says Jennifer Rees, executive director of the AHS Patient Experience department

Because health care workers hear enough stories about inadequate care, the patient stories presented in workshops always concern positive interactions with hospital staff—what worked well, what made a difference.

For example, a woman whose husband died in the emergency department “told the workshop how cared for she felt” by the social worker who met with her after her husband’s death, Manson-McLeod said.

The workshops, which staff reported were the “best ever”, led to tangible changes, she says. “For example, one of the triage nurses was just complaining to me about patients, how they butt in, and then one of the other nurses interrupted to say, “you have to look at it from the patient’s point of view.””

Manson-McLeod says that some people fear that taking time to interact with patients will add to their workload.

“It doesn’t add to the work flow. In my experience, it enhances my work. It makes me feels more valued as a health care provider.”

The comments section is closed.

  • Kimberley MacKinnon says:

    Great article! I recently had surgery and a two night stay in the Lethbridge Regional Hospital, Lethbridge, Alberta. I felt very cared for by my physician, the O.R team as well as the nursing staff. I had lots of time with my nurses who gave me ample opportunity to ask questions and just chat.

  • Rolene Barrett says:

    Thank You for writing beliefs I hold to be the truth and the means to promote confidence in healing!
    Medical care Givers who become patients will soon realize the mental and emotional confidence is a major component of healing for all! Give your patients the same personal interaction as you would to your loved ones. People are not words in a book nor are they machines without feelings. I learned valuable life lessons from a play produced by the CCS, based on the real diary of a teenage boy who wrote in secret about the people, medical and friends, strangers, and family who entered his life in the hospital during the months preceding his death. It was discovered by his parents after he died. What an eye opener for all!

  • Kira says:

    As a person who is relatively young (37) & has spent a lot of time dealing with the medical community, I can tell you a little more time & attention on the human side would be greatly appreciated.
    I understand they have a job to do & it’s one that takes a toll, but what seems to get lost is the fact that patients are struggling too.
    Patients (excluding those who are misusing or using the wrong resources) are already dealing with stressful, complex issues. They are required to repeat the same information over & over again, while they struggle to find treatment that works.
    In my experience I’ve learned that I can talk but there is no guarantee that I’m being heard. I want to be spoken to, not at or about. Medical professionals may be experts in their field, but the patients knows their body & can actually contribute to their treatment & care. Patients have to listen constantly, I don’t know why it’s so difficult for doctors & nurses to do the same.
    I don’t think that is too much to ask for. The reality is patients have to entrust the most precious thing their well being & when things go wrong they alone bare the consequences. When their trust is rocked it makes every future encounter more difficult for both sides.

  • Mark Roseman says:

    Good effort, but especially for an organization like AHS, this is truly an example of lipstick on the pig.

    What gets measured gets improved, and what little metrics are taken by the bloated levels of management involve $ and paperwork, not emotional needs of patients. Morale of front-line employees is horrid due to the organizational culture and abuse they suffer from higher up, so they are tired, jaded, and sick of banging their head against the walls. So unless those root causes are addressed, the front-line staff are in no position to improve on this front.

    Groups like these may make for good PR and a good story to tell, but at the end of the day, that’s all they’re able to deliver on. And that is a real shame. Not least for the well-meaning people who are part of those efforts, and the front-line staff who wish they were able to deliver more human levels of care.

    • Melynda Bryant says:

      Yes, it has to be a natural effortless response. It cannot be measured or taught. Adding surveys to ask the patient to determine how the care should be given is not caring. It is following a flow sheet and being a puppet in a position to make it look like caring. I want genuine caring for patients. Not an administrative task to report.

  • Lara says:

    %featured%On one hand, I am glad that this type of dialogue is coming to the forefront as we have reached a place where it is clearly required. On the other hand, I am also sad that it is necessary.%featured% In some minds, it’s a complicated issue. At its core however, it is a basic and common sense concept that human beings should be treated as such, particularly when they are emotionally and physically vulnerable. How is it that we have come to a place where we have to invest a copious amount of our precious resources to teach people how to treat each other with respect and dignity? We pat ourselves on the back for our ‘foreward thinking views and initiatives’, when we really should be shocked and uncomfortable that things have spiralled this far out of control. At least we can be thankful that some organizations and individuals are attempting to put the focus back where it belongs – on the patient as a human being.

  • Laith Bustani says:

    Thank you for this article. It is on a topic that is close to my heart. %featured%I agree with your conclusion that setting the stage for more effective, more human, interactions is one of the most important things we can do to improve healthcare.%featured%

    As a physician, I can vouch that most of my colleagues chose their profession, not to make money, or gain social status, but to aspire to cure the sick and help those in need. Those actions are tremendously rewarding in of themselves.

    Yet more and more, we find ourselves pulled away from patients. Time motion studies show physicians working in hospitals around the developed world spending an average of 66% of the time chasing down information and attending to administrative tasks. This leaves only 19% of their time to be in direct contact with the patient. I have all too often seen brilliant minds and honest souls leave the profession prematurely due to escalating pressure to do more with less time until the very joy that compelled them to sacrifice for society is drained. The average length of engagement of physicians practicing inpatient care across Ontario in 2011 was around 5 years.

    The surge of possibilities born of exponentially expanding technologies must be recognized as distinct from our lumbering, yet infinitely more elegant physiology. The social heritage by which we have evolved to commune most effectively without distraction, in an unhurried and timeless act of listening, feeling, and engaging. With our patients. With each other.

  • Barb says:

    %featured%Congratulations Alberta Health Services!! I hope your ideas are contagious. %featured%Here is a great resource on experience-based co-design.

    • Melynda Bryant says:

      I so agree. Part of the stress of nursing is the inability to provide that extra Care for the patient. Staffing does not allow for the emotional care of patients.


Robert Bear


Dr. Robert Bear is a former Professor of Medicine at the University of Toronto and the author of Sorrow’s Reward, a novel set in a dialysis unit.  He blogs on health care at

Ann Silversides


Ann is a journalist and specializes in health policy, writing and editing for a variety of health research institutes, associations and labour unions.

Andreas Laupacis

Editor-in-chief Emeritus

Andreas founded Healthy Debate in 2011. He is currently the editor-in-chief of the Canadian Medical Association Journal (CMAJ)

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