Background
The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout ...are high. Most research to date has focused on individual‐level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians’ ability to express compassion and well‐being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals.
Methods
More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross‐sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement.
Results
Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = −0.006, 95% CI −0.01, −0.00, p < 0.001 and f 2 = 0.05) but not competence (p = 0.24), lower job satisfaction (B = –0.20, 95% CI –0.23, –0.17, p < 0.001 and f 2 = 0.14), higher burnout (B = 0.02, 95% CI 0.01, 0.03, p < 0.001 and f 2 = 0.06), absenteeism (B = 0.004, 95% CI 0.00, 0.01, p = 0.01 and f 2 = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI 0.00, 0.03, p = 0.04 and f 2 = 0.004).
Conclusions
Working in value‐discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems‐level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well‐being outcomes.
Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers ...appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.
A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa - Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.
Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the 'taken for granted' power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming 'competent' in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.
A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.
Objectives
To experimentally investigate whether more urgent patient presentations elicit greater compassion from health care professionals than less urgent, facilitating future research and thinking ...to address systemic barriers to compassion in health care.
Design
This is a pre‐registered online study with an experimental, within‐subjects repeated‐measure study design. Two clinical vignettes that systematically varied the urgency of patient presentation were utilized. Both vignettes depicted a patient with difficult behaviours typically associated with lower compassion.
Methods
Health care professionals (doctors, nurses and allied health practitioners) recruited from all 20 District Health Boards across Aotearoa/New Zealand completed two vignettes in a counterbalanced order. Paired‐sample t‐tests were used to test the effect of the presentation urgency on indices of compassion.
Results
A total of 939 participants completed the vignettes (20% doctors, 47%, nurses and 33% allied health professionals). As expected, participants reported greater care and motivation to help the more urgent patient. However, the more urgent patient was also perceived as less difficult, and exploratory analyses showed that perceived patient difficulty was associated with lower caring and motivation to help, particularly in the less urgent patient.
Conclusions
This is the first work to experimentally test the relationship between the urgency of patient presentation and compassion in health care. Although the association between urgency and difficulty is complex, our findings are consonant with evolutionary views in which urgent distress elicits greater compassion. A system‐wide orientation towards efficiency and urgency may exacerbate this ‘bias’ which must be addressed to ensure more equitable compassion in health care.
New Zealand research on inequities in children's developmental health outcomes is sparse. We aimed to describe the prevalence, clustering, and socio-environmental associations of developmental health ...in preschool-aged children. A latent profile analysis was performed using data from child participants of Growing Up in New Zealand at age 4.5-years to identify profiles of developmental health status. Seven measures were included in the latent profile analysis, representing four domains of developmental health: 'physical', 'motor', 'socioemotional and behavioural', and 'communication and learning'. Multinominal logistic regression was used to investigate socio-environmental associations of latent profile membership. Six latent profiles were identified (N = 6109), including three healthy/flourishing profiles: 'healthy' (52.6% of the sample), 'early social skills flourishing' (14.5%), and 'early learning skills flourishing' (4.0%); and three suboptimal profiles: 'early learning skills difficulties' (19.5%), 'physical health difficulties' (5.6%), and 'developmental difficulties cluster' (3.7%). Children experiencing socioeconomic disadvantage, of Māori or Pacific ethnicity, and with unmet healthcare needs had increased odds of being classified to suboptimal developmental health profiles. In this large, diverse cohort, one-in-four children were classified as having suboptimal developmental health. Addressing inequities in developmental health is crucial to improving health over the life course.
Investigates and reports on the quantitative association between self-reported experience of racial/ethnic discrimination and health within a New Zealand setting. Draws upon systematic review methods ...used in previous reviews set within an international scope in order to provide an overview for New Zealand on the range of health indicators that racism has been linked to and the consistency and strength of these associations. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Reports the findings of a literature review investigating the barriers and facilitators of access to hospital services for Māori. Source: National Library of New Zealand Te Puna Matauranga o ...Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Provides an overview of existing frameworks that can be used to develop thinking and positioning in relation to the Treaty of Waitangi and responsiveness to Māori in the field of health research. ...Describes an equity-based approach to responsiveness to Māori and highlights four key areas that require careful consideration, namely : (1) relevance to Māori; (2) Māori as participants; (3) promoting the Māori voice, and; (4) human tissue. Argues for greater engagement with responsiveness to Māori activities as part of a commitment to achieving equitable health outcomes. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
ObjectivesDespite significant international interest in the economic impacts of health inequities, few studies have quantified the costs associated with unfair and preventable ethnic/racial health ...inequities. This Indigenous-led study is the first to investigate health inequities between Māori and non-Māori adults in New Zealand (NZ) and estimate the economic costs associated with these differences.DesignRetrospective cohort analysis. Quantitative epidemiological methods and ‘cost-of-illness’ (COI) methodology were employed, within a Kaupapa Māori theoretical framework.SettingData for 2003–2014 were obtained from national data collections held by NZ government agencies, including hospitalisations, mortality, outpatient and primary care consultations, laboratory and pharmaceutical usage and accident claims.ParticipantsAll adults in NZ aged 15 years and above who had engagement with the health system between 2003 and 2014 (deidentified).Primary and secondary outcome measuresRates of ‘potentially avoidable’ hospitalisations and mortality as well as ‘excess or underutilisation’ of healthcare were calculated, as the difference between actual rates for Māori and the rate expected if Māori had the same rates as non-Māori. These differences were then quantified using COI methodology to estimate the financial cost of ethnic inequities.ResultsIn this conservative estimate, health inequities between Māori and non-Māori adults cost NZ$863.3 million per year. Direct costs of NZ$39.9 million per year included costs from ambulatory sensitive hospitalisations and outpatient care, with cost savings from underutilisation of primary care. Indirect costs of NZ$823.4 million per year came from years of life lost and lost wages.ConclusionsIndigenous adult health inequities in NZ create significant direct and indirect costs. The ‘cost of doing nothing’ is predominantly borne by Indigenous communities and society. The net cost of adult health inequities to the government conceals substantial savings to the government from underutilisation of primary care and accident/injury care.
ObjectivesChildren’s exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is ...unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association.DesignCross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 child–primary caregiver dyads; 2011/2012: n=4420 dyads).Main outcome measuresChildren’s unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child’s medical centre.ResultsThe prevalence of reporting ‘any’ experience of racism was higher among caregivers of indigenous Māori and Asian children (30.0% for both groups in 2006/2007) compared with European/Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child’s healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child’s medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose–response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 1 report of racism, OR=1.89, 95% CI 1.34 to 2.67; 2+ reports of racism, OR=3.06, 95% CI 1.27 to 7.37). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation.ConclusionsVicarious racism is a serious health problem in New Zealand disproportionately affecting Māori and Asian children and significantly impacting children’s healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation.
This retrospective observational study used a Kaupapa Māori framework to investigate ED admissions into 18/20 District Health Boards in Aotearoa New Zealand (2006–2012). Despite some ED process ...measures being positive for Māori, for example arrival to assessment time and access block, others showed no difference, for example self‐discharge. Despite this, Māori mortality and ED re‐presentation were higher than non‐Māori. Our findings reinforce the need to investigate health professional bias and institutional racism within an acute care context.
Objective
There is increasing evidence that EDs may not operate equitably for all patients, with Indigenous and minoritised ethnicity patients experiencing longer wait times for assessment, differential pain management and less evaluation and treatment of acute conditions.
Methods
This retrospective observational study used a Kaupapa Māori framework to investigate ED admissions into 18/20 District Health Boards in Aotearoa New Zealand (2006–2012). Key pre‐admission variable was ethnicity (Māori:non‐Māori), and outcome variables included: ED self‐discharge; ED arrival to assessment time; hospital re‐admission within 72 h; ED re‐presentation within 72 h; ED length of stay; ward length of stay; access block and mortality (in ED or within 10 days of ED departure). Generalised linear regression models controlled for year of presentation, sex, age, deprivation, triage category and comorbidity.
Results
Despite some ED process measures favouring Māori, for example arrival to assessment time (mean difference −2.14 min; 95% confidence interval CI −2.42 to −1.86) and access block (odds ratio OR 0.89, 95% CI 0.87–0.91), others showed no difference, for example self‐discharge (OR 0.98, 95% CI 0.97–1.00). Despite this, Māori mortality (OR 1.60, 95% CI 1.50–1.71) and ED re‐presentation (OR 1.11, 95% CI 1.09–1.12) were higher than non‐Māori.
Conclusion
To our knowledge, this is the most comprehensive investigation of acute outcomes by ethnicity to date in New Zealand. We found ED mortality inequities that are unlikely to be explained by ED process measures or comorbidities. Our findings reinforce the need to investigate health professional bias and institutional racism within an acute care context.
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