How fostering empathy and psychological safety makes healthcare safer: An interview with Carolyn Cleveland

Summary

Carolyn Cleveland has delivered training on empathy and compassion to healthcare organisations for many years. In this interview, she describes how she came to develop her training approach and outlines how creating a psychologically space environment for individuals to engage with the practice of empathy contributes to safer organisational cultures.

About the Author

Carolyn Cleveland is founder of C&C Empathy Training Ltd and works with healthcare providers, coroner’s officers, lawyers and other public organisations. Her training helps people recognise and utilise their empathy, compassion and emotional awareness, to support psychological safety, patient safety, civility, resilience and wellbeing for all. Coming from a background of counselling and having experienced the loss of her child, Carolyn promotes deep exploration of topics for long term development, where emotions, light-heartedness and robust information can all sit hand in hand.

Questions & Answers

Hi Carolyn, please can you tell us a bit about yourself and your work?

My name is Carolyn Cleveland and I’m the founder of C&C Empathy Training, an NHS-approved training provider under the National Framework. I work with healthcare providers, legal firms and other organisations to help them recognise and foster empathy and apply this in their communication, leadership and treatment of complaints and incidents. I do this through training, conferences and in an advisory capacity.

Why is empathy important in delivering healthcare and how does it link to patient safety?

Empathy is a cornerstone of compassionate communication, professional curiosity, kindness and psychological safety. Emotional awareness and wellbeing are key factors in my approach to working with professionals and people who are in a vulnerable position.

Empathy and emotional awareness have a very strong impact on patient safety—they enable us to recognise the systems and factors at play and the vulnerabilities and emotional experiences that come with being human. They are crucial in understanding context and communicating with care. When empathy and emotional awareness are not present and incivility takes hold, our cognitive processes struggle to operate at their best. Examples of this include feeling invisible or that our thoughts and feelings are of no value, being spoken down to and having processes that overwhelm us emotionally. These experiences all have an impact on our ability to hear, understand, communicate and raise concerns. Having empathy present in patient care, colleague-to-colleague interactions or when dealing with complaints and incidents, fosters a strong foundation to expand viewpoints and recognise compassionate actions. It enables people to do their best. 

How did you come to deliver compassion and empathy training?

My journey into delivering training on this topic and setting up my company was in gestation for a long time. Let me take you back to 1992. I was 22 when my good friend died from a delayed diagnosis of cancer. Her four-year-old daughter Sophie was left in my care. At that time, I already knew the importance of empathy, but I also knew that there were no magic words or answers. I needed to work out how to offer Sophie the emotional support her feelings required, and the actions needed.

Over the next 11 years, Sophie became emotionally my first child. In subsequent years, I had three other children and undertook my counselling and psychology training, specialising in loss and fear. In 2003, at 15 years old, Sophie sadly died herself in a patient safety incident in hospital. Failings in healthcare had impacted on this young girl’s life twice. This left me and the rest of my young family traumatised and with many unanswered questions from the week I had spent in hospital with Sophie, raising concerns. 

After Sophie’s death, the complaints process I went through lacked empathy, compassion and emotional awareness. The hospital even used my biological status as reason not to examine what had happened. At this point, I knew from my own academic background the importance of communicating with care. It made me question the psychological safety within the hospital for families and loved ones, as well as staff, who wanted to raise concerns.

In 2006, I started speaking at conferences, but I always knew I wanted to provide staff and organisations with the opportunity to dig deeper into communication and emotional care in a psychologically safe environment. In 2015 I set up C&C Empathy Training to support staff and organisations to understand the emotional component in themselves and others, in all sorts of situations. It was important to me that I brought together the academic aspect, real lived experience and my personality to create training that was robust but experiential, deep but light-hearted.

I set out to address the duty of candour and preventing psychological harm by promoting compassionate engagement and involvement. My work has evolved over the years, to include resilience and civility and my courses are now recognised as approved training under the National Framework. I also offer courses around the wider systems-thinking approach related to the Patient Safety Incident Response Framework (PSIRF). But a core theme always remains: providing immersive training that goes beyond the theoretical and is authentic, reasoned and credible. The training always provides compassion as well as challenge for those attending and recognises the link between emotional intelligence and personal wellbeing, and how we communicate and act with others.

How can healthcare organisations change their culture to encompass compassion and empathy?

This question delves into the very heart of human interaction and organisational dynamics. Establishing a culture of compassion and empathy within healthcare organisations is a multifaceted endeavour, one that demands concerted effort and a profound understanding of human nature. In my experience, facilitating this transformation begins with embracing curiosity and nurturing emotional intelligence and awareness. It entails taking compassionate action and remaining receptive to change and continuous learning. It also involves prioritising the wellbeing of both staff and patients.

When I was confronted with challenges beyond my control—Sophie’s natural mum dying and the subsequent loss of Sophie—I realised the potency of focusing on what was possible. I recognised that I possessed two symbolic hands: one for extending empathy and compassion to others and another for nurturing my own emotional wellbeing through self-awareness and self-compassion. It became evident to me that both were indispensable. Promoting a culture where staff members feel valued and supported, starting from the top, is paramount. This includes fostering psychological safety and acknowledging the complex nature of individuals—staff members are more than their job titles, just as patients are more than their conditions. They bring with them lives, fears, hopes, dreams and vulnerabilities.

By cultivating an environment where empathy is not only encouraged but ingrained in the organisational ethos, healthcare organisations can genuinely enhance the quality of care they provide and the wellbeing of their staff and patients alike.

What impact does empathy training have on individuals and organisations?

Over the years, I've had the privilege of working with professionals from various levels and sectors, witnessing first hand the transformative effects of empathy training on both individuals and organisations.

Through my training sessions, participants are given the opportunity to delve into their own experiences, challenges and biases in a safe and supportive environment. As they engage in reflective exercises and discussions, they gain a deeper understanding of the importance of empathy in their roles and interactions. 

One of the most rewarding aspects of this work is witnessing the remarkable feedback from participants, often years later, expressing how the training has stayed with them and positively impacted both their professional and personal lives. It's incredibly gratifying to hear how participants have applied the principles of empathy in their daily interactions, even in the most challenging work environments. They often share how they feel they are expanding their minds and improving their practice, and promoting this internally with colleagues. It is immensely rewarding to witness. 

These experiences underscore the profound impact of the training in fostering empathy, understanding and connection within individuals and organisations. It's not uncommon for participants to arrive at the sessions feeling burnt out and questioning the necessity of empathy training. However, they often leave with a renewed sense of energy, a deeper appreciation for their innate empathic abilities and a reflective understanding of why they may have underutilised these skills in the past. Moreover, they express a genuine desire to continue developing these abilities.

By prioritising empathy development, organisations can cultivate healthier, more inclusive environments where individuals flourish and make positive contributions to their patients, colleagues and organisational culture.