Distilled Dignity: Organizational Compassion with Rachel Thienprayoon

In this distilled episode from season 1 of The Dignity Lab, Dr. Rachel Thienprayoon and host Dr. Jennifer Griggs discuss the importance of compassion and dignity in the workplace. Dr. Thienprayoon explains the concept of suffering and how it can be mitigated through organizational compassion. Dr. Thienprayoon also highlights the impact of toxic behavior and the need for compassionate leadership that responds to bullying and other behaviors. She emphasizes the connection between compassion and dignity and the role of both in creating a thriving workforce. The conversation concludes with a discussion on changing the narrative around productivity and the importance of self-care.

Guest Contact

• LinkedIn Profile

Episode Resources

• Unlocking Us with Brene Brown: Chris Germer
• Operationalizing Compassionate Connected Care: A path to improved workforce engagement and patient outcomes
• Experiences of Care: Reducing Suffering through Compassionate, Connected Care-Christy Dempsey
• More information about Christina Maslach

Exploring what it means to live and lead with dignity at work, in our families, in our communities, and in the world. What is dignity? How can we honor the dignity of others? And how can we repair and reclaim our dignity after harm? Tune in to hear stories about violations of dignity and ways in which we heal, forgive, and make choices about how we show up in a chaotic and fractured world. Hosted by physician and coach Jennifer Griggs.

For more information on the podcast, please visit www.thedignitylab.com.
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For additional free resources, including the periodic table of dignity elements, please visit https://jennifergriggs.com/resources/.

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Transcript

Jennifer

Welcome to The Dignity Lab. This week, we’re distilling my conversation with Dr. Rachel Theinprayoon, the Chief Clinical Wellness Office at Cincinnati Children's Hospital and a palliative care physician with training in oncology. This is a condensed version of our recording from Season 1. I hope you enjoy it.

In our conversation, Rachel defines compassion, suffering, and organizational suffering and compassion. She speaks to preventable causes of suffering, incompetent compassion, and the role of dignity at work.

Dr. Rachel Thienprayoon, welcome to the Dignity Lab.

Rachel

Good morning. Thank you.

Jennifer

Would you start by explaining what you mean with the word compassion?

Rachel

The sort of operational definition is, compassion means noticing that another person is suffering, then making an empathic connection to the suffering, so feeling something, caring about it, then acting to mitigate or to relieve the suffering. what distinguishes it from similar states of empathy or kindness is that it's a verb. It requires actually acting to relieve someone else's suffering. Chris Germer is a researcher. He said on a podcast, when asked, what is compassion? From the Buddhist tradition, compassion is when love meets suffering and remains love. And I think that's a really beautiful way to summarize it too.

Jennifer

And what do you mean by suffering?

Rachel

I think suffering is deeply personal and subjective. I like the work of Eric Cassell, who was a bioethicist, a physician, a writer, a big thinker. his definition of suffering evolved over those years to the one that I like, which is suffering is anything that threatens the intactness of the whole person. Jennifer 

Jennifer

What if we suffer when we see someone else’s pain, even the pain of an animal killed by the side of the road? Would you consider that suffering?

Rachel

I think it doesn't matter what I think. It matters what you think and what you feel. And I think it's such an interesting point, Jennifer, because for empaths who feel so much and who feel so deeply, it doesn't take much to threaten that, right, to penetrate whatever armor we have to try to keep us intact and whole. I have finite energy, I have finite emotional energy, and I have to choose to focus that, on my family, on my work, on myself, on the people I care about. And that doesn't mean I don't care about the suffering in the world. That doesn't mean that I don't do what I can but it does mean that I have to really be attuned to what I am bringing in to stay feeling like a whole person as often as I can.

Jennifer

What about your own experience, your own suffering? Have you been able to name your own suffering?

Rachel

Oh, wow. I think when the source of the suffering is personal, yes, of course. I'm a very self-aware person. Which can turn into rumination in a way that is unhealthy. So I go to therapy, I have a therapist, right? And when I'm really stewing or feeling like I'm stuck, that's a tool that I use. I have wonderful friends who were really wise people. Coaching helped me a lot to manage the work suffering and figuring out how to move through that into a healthier place. So I think I have found my tools, in addition to just basic self-care to try to be prophylactic and preventative and maintain a physical health. I go to bed early every day. Jennifer

Jennifer

So I'd love to have you talk about organizational compassion, and now that I think about it,  do we need to talk about organizational suffering first?

Rachel

Oh yeah, okay, organizational suffering. Oh wow, that's not even a, that's not a concept that had even occurred to me. And I don't know how I missed it because I really, as a researcher and as a worker, I think about suffering on the individual level and at the unit level. And then I think about these salient sources of suffering in society like COVID or, you know.

In Cincinnati, five children are shot on the same day, and it's just a massive impact on the community. So I think there can be situations or events that occur that cause suffering at the level of the organization and society and the community. But for the most part, I think it happens at the level of the individual and at the level of the team in the unit. But...

Organizational compassion in the management space has been defined as creating a climate in which when normal human suffering comes into the workplace, someone notices and someone responds compassionately. So not necessarily from the top down, the whole organizational leadership structure is responding to this one person. But how do you create or cultivate a climate of noticing and responding in a way that is useful? 

One of the things that my research team has done is expand that definition for use in healthcare because healthcare is such a human field. Christina Dempsey was the chief nursing officer of Press Ganey. So Press Ganey has developed this compassion connected care model and Christina Dempsey talked about how being a patient has inherent sources of suffering because you're sick and that threatens your intactness as a whole person, but then the healthcare system brings in avoidable sources of suffering on top of that. And Dr. Dempsey has expanded this in a way that I think is really appropriate to include clinicians, that being a clinician means that you encounter deep sources of human suffering and trauma and that impacts us. But we also were brought into the work for meaning and purpose…the suffering on its own can give us a real sense of usefulness and helping others and being the vehicle of compassion for them. But then the system also brings in all these avoidable or preventative sources of suffering for all of us as well. And so that's why for health care, we've expanded the definition of organizational compassion to say that it's the continuous and ongoing identification, prevention, and mitigation of recurrent sources of suffering for clinicians. Because if you know that your system is causing your people to suffer, it's not enough just to notice and to respond. You must also prevent to take care of them in an appropriate way.

The EMR causes us to suffer. If we are spending all of our time at home writing our notes, because we couldn't get it all done during the day, that's an avoidable source of suffering, which maybe in the moment doesn't feel like suffering, but over time, I think does rise to the level of suffering.

I think a for-profit healthcare system causes many of us to suffer because what brings us into medicine is a desire to help people. And when we are unable to deliver the care to our patients that we know is right because an insurance company says, I'm not going to pay for that, that causes us to suffer. That threatens our intactness as whole people. And part of it has to do with the fact that our identities as clinicians and our identities as whole people are so deeply intertwined. And I think that's really beautiful. I don't think that that's all wrong. I think some of the ways in which we are taught that are unhealthy, but we're all striving for meaning and purpose in life. And so to find a profession that is deeply intertwined with who we are, I don't think is wrong. And I think it's actually pretty common. So, when I think about sources of suffering at the system level for clinicians, I think it plays out in big and small ways every day. 

Unaccountability for toxic behavior is a source of suffering because it may be that in the moment a bully is bullying a single person, but there are others who are witnessing and threatened by those actions and then the system is further threatened by a lack of response, appropriate response, right? So lots and lots of ways.

Jennifer

Is that organizational integrity or lack of when there's bullying that's not acted upon?

Rachel

Yes. I think so.

I mean, I guess it depends on who the organization says they are. If it's the, um, I don't know, like United Guild of misogynists, maybe not. I suppose there there's a potential that there is an organization that really likes toxic behavior, but generally I think it's a society, we accept that that's wrong and yet if we were holding people accountable. #MeToo would never have been required.

Jennifer

You’ve done some work on clinician experiences of compassion. Can you tell us about your research?

Rachel

Mm-hmm. So, the goal of my research right now is to develop a tool that measures how clinicians experience compassion in the workplace. So, it's a clinician-reported experience measure of compassion. And… we started by doing interviews with 21 or 22 pediatric hospice and palliative care clinicians from all over the country of different roles. The goal of this tool is to be used by all clinicians, not just clinicians in a single role. And we asked about sources of suffering and compassion in the workplace. And the themes that came out of those interviews were so fascinating. One of which, to answer your question, was what are the behaviors that clinicians see or desire in our leaders that exemplify compassion? And it was very clear over and over that a hypocrisy or a lack of congruence between stated organizational values and leadership behaviors is related to experiencing compassion or not in the workplace for clinicians.

Unwillingness to change was related to experiencing compassion or not, because people will know that improvements need to be made, will advocate for improvements, will be told, yeah, we'll go do that, and then nothing ever happens. And so that was experienced as a source of suffering when people see a problem and voice it and raise it up and nothing ever happens.

That was, I didn't ask, is that suffering? But when we asked about compassion, that theme came up over and over that a source of compassion at the organizational level is willingness to grow and change. So I think there are salient sources of suffering in society, not necessarily for everybody, but they go deep enough for some that also require compassionate response at the organizational level.

Jennifer

And to go back to your definition of compassion, it starts with noticing.

Rachel

Noticing, yeah.

The definition of compassion has historically been defined by the actor. Did you notice? Did you care? Did you try? And not by the person who's experiencing compassion, which is a shift that our research is making, but it's also something that's being discussed in the positive organizational scholarship space too. And so I was at the Positive Organizational Scholarship meeting at the University of Michigan in June of 2022. And I spoke right after one of my heroes in this space named Ace Simpson, who's an organizational compassion researcher from the UK. And he put up this beautiful slide of the NHS during COVID. And so every night, you know, in the UK, people would go outside and clap and thank the caregivers who were headed into the hospital. And there was backlash because the people who worked for the NHS said, we don't need your applause. We need a living wage. We need our rent paid and we need to be able to buy food. And he said, technically the behavior of the public was compassion, they noticed suffering and the care and they responded, but it was experienced as incompetent compassion. That's not what we need, what we actually need is this other thing. And so, you know, as I was exchanging emails with people on my team this morning.

And so to provide… compassion that is competent and useful requires deeply knowing another person and sometimes asking, “What is it that can help you right now? And so that's another way that I'm like struggling and growing and thinking a lot as a leader in this space is showing up just enough sometimes. If I show up with the wrong attempt, the burden of that is great because it can actually make people suffering worse to offer the wrong compassion in the moment. And so it's not as straightforward as it seems, and it's not as easy as it seems.

Jennifer

This is where the impact and intent is so important. We can have this intent to show compassion and be kind, but if it misses the mark, it's, it's really a violation of, of exactly what we're trying to aim for.

So Rachel, there are a lot of things that people have heard both before and after COVID, things like burnout, things like moral injury, things like empathic distress. What is your take on these concepts?

Rachel

I think that they're all related. burnout is a syndrome characterized by three dimensions, emotional exhaustion, low professional accomplishment, and a sense of depersonalization for the people around you. And the way that I think about burnout is if the people around me are just in survival mode.

You know, when I interact with a colleague and they're in this space of every small threat gets this overreaction, I start to wonder where they're hitting on these burnout scales. It feels absolutely terrible to know that you are not at your best and to not be able to see a way out easily is incredibly difficult. And then we have empathic distress. Moral injury. Moral distress is thought of as that, that feeling when you know the right thing to do for your patient, but you're helpless to see that happen. And so much of that has to do with the hierarchy and medicine. And so the way this plays out sometimes in pediatrics, right, is a bedside nurse will say, well, I just believe this child is suffering and it's time for us to let him go kind of and the parents aren't ready yet. But if you really, if you go deep, right, tell me how they're suffering. Well, we're managing their pain. They're totally unconscious, right? Any physical suffering they could have, we are mitigating to the best of our ability.

What I think that they haven't been given words to say is, this situation is threatening the intactness of that whole person, and I am bearing witness to it, and my intactness is threatened. And… one set of words that we have to describe that sense is moral distress. And I think moral injury can include all of that, but can also just be, toxic person is not being held accountable for their behavior. I am witnessing something that I know to be wrong and I'm helpless to change that, perhaps not specific to patient care, but to other people's behavior. 

Jennifer

I asked Rachel about the praise of people, especially doctors, who work long hours, even at the expense of their health, their families, and their other interests.

Rachel

Yes, because what that's saying is we're going to grade and judge you by how hard you work, how much you're physically here, how little you take care of yourself. That's our value set, is we come last and you come last. And I understand that there's a sense of nobility in that I trained, it's sort of close to the beginning of work hours restrictions, but like 80 hours a week is still a lot of hours to work. It's still far too xxx.

And not just the hours, but what you have to give up. If you're on service, and you're an intern, and somebody dies, you're unlikely to be released to go to that funeral if you're physically sick, like you're taught to come to work. And I trained during the, here's your IV, drag your IV. I never did this myself. But I had friends who did, who came in and worked ER shifts with gastroenteritis. They'd sit and get a bag of fluids and then go work. Like that's how we were trained. So it's not just the duty hours. It's what we're telling people is important to us and it's not their physical or mental or emotional health or their identities as whole people who are brothers, sisters, daughters, mothers, grandchildren. You are one thing. You are a doctor and you will live here. And that's still, I think, real.

Jennifer

The nobility of it becomes self-reinforcing and it becomes coercive in a way. I remember rounding very late at night on patients who would say, oh, Dr. So-and-so is such a good doctor. He's always here. And it becomes that you then wanna be that person because you want to be a good doctor when they're equated.

Rachel

There is so much tension between how patients define a good doctor and how we manage being whole human beings that I don't have an easy answer to. I think the answer is actually in teamwork in these are my doctors, not that is my doctor. Some people who I think are tremendously wonderful physicians are pretty porous in their boundaries with their patients. And that's their way and that's their life. And who am I? Except to say it's very hard to partner with people like that. And I think that there's a risk of getting out on a limb with these families and having no one to help support you if you need to go to a wedding or take a trip. So there's real tension in that dynamic of being a good doctor and what patients and families want and also allowing us to have whole lives.

Jennifer

Okay, so Rachel, I'm going to ask you, if I can, to bring to mind somebody we might call a toxic leader or somebody who has power over other people. And we often use the word toxic or a bully, and we know that person is suffering. We know hurt people hurt people, whether it's in their childhood or multi-generational trauma or their own training. How do we balance compassion for an individual actor and then for the whole ecosystem, if you will?

Rachel

A person can be behaving badly because they are hurting, and that doesn't mean that we have to tolerate their behavior because they are causing suffering in other people. And that suffering matters as much as the suffering of the individual person. So I think there's this idea that compassion is unbounded, that it means putting up with something that you think is wrong out of kindness.So when I think about toxic behaviors in the workplace, the root of it may be suffering, but that doesn't mean that it's acceptable. And that doesn't mean that compassionate leadership tolerates it or accepts it. I think we should help people try to become better actors and, you know, better colleagues, better leaders, especially if they're suffering. But I think that we're also assuming a reason for toxic behavior here. And that's really not, it's not necessarily true. Some people are just toxic because it helps them maintain power, suffering or not, that's just unacceptable. And so the way that compassionate leadership shows up in that space is to absolutely not tolerate it, to try to help them get help, but also remove them from harming other people.

And I think too, right, if you are observing unusual behaviors in a colleague, that is likely to be a person who needs help, who is suffering, who needs that suffering attended to. That's one thing. If a person has a long history of being misogynistic and a bully and displaying unacceptable behaviors and never being held accountable, that's not necessarily the same thing.

Jennifer

And then it feels like the whole system gets contaminated.

Rachel

It doesn't just feel that way, it does get contaminated. It's like ink in a well, right? Like it just takes one drop. But the ripples, the impact of this on cultures of systems and microsystems is deep. And that's where I think moral injury becomes real.

Jennifer

I think you're right. So that person would need to be reined in and it's funny because it can be insidious, right? It can be so insidious at the beginning, especially where people are like, did he really say that? Did she really do that? You know, that sort of, it's so outrageous that it's hard to believe. Shocking and then unbelievable. So abusers, we know, will often do things that are so outrageous that the victims are not believed.

Rachel

Yeah, I've had personal situations like that where in the moment, it's so outrageous. You're just trying to end the conversation. And like, how do I show up with it? It's not even just showing up with integrity because it's hard to like be in your body in those moments. You're in shock. You're just so confused and it's bizarre but profoundly, profoundly painful in the long term and it violates our dignity. And we talk about how you reclaim your dignity and sometimes it feels as though that wound is never gonna heal. Even if it's got a scar, that scar is pretty thin and still underneath, you know, it's bleeding a little bit all the time.

Jennifer

So what is the relationship between compassion and dignity? 

Rachel

Yeah. I'm so glad you asked this question because this is the most surprising thing that came out of the research to me. In the management literature about compassion, there's nothing written historically about dignity. And so in our interviews, when we asked people about how they experienced compassion in the workplace, they talked about just feeling valued. Do I feel valued for the work that I'm contributing to this place? Do I feel valued as a human being? And we had, you know, in qualitative research, you make these like buckets of themes, and you sit back and look at it and try to figure out what is this? And it took me a really long time. We were calling it feeling valued and I finally arrived at this is just dignity. This is just having your dignity honored in the workplace. Jennifer

And there are so many facets of dignity, right? There's inclusion and safety, psychological safety, there's being heard and seen, there's fairness. Yes.Rachel

Yes, yes. Feeling acknowledged, feeling respected, yes, yes.

Yes, you know, in the management space, when they think about engagement and positive workplace voice, do I have an influence in the decisions that are made as a profound driver of engagement?

And the way that showed up for us was related to dignity and related to experiencing compassion. So when I speak up on rounds in my herd, and you know, right, like the interviews were done in palliative pediatric palliative care clinicians, and we are often devalued, actively devalued members of the team and our presence can threaten teams who don't really understand what we do or why we're there and they assume that they assume terrible things about us to be honest.

Our space is to understand the goals and values of the family and advocate for those and bring those back to the team and try to help align the plan with the family's unique goals and values. So not just assuming that we know what's best for them. Most of the time the team has asked and there's good alignment, but sometimes families don't feel safe to voice that with their teams or families may be moving towards feeling as though their child is suffering more than they are having quality. And so they may be moving along a path towards stopping and the team's not ready yet. And when we are the people who sit in between those spaces that does feel threatening to the clinicians who love this child and are invested in the child and perhaps believe that the definition of a good nurse or a good physician is fully aligned with continuing this plan that we're all, you know, all in on.

So all of that to say it was a really interesting space to do these interviews because we didn't have the most powerful people in the hospital answering our questions. And so they said how they feel valued, how they are respected, how their voice is heard is related to suffering and compassion.

Jennifer

So how does an organization's mission and its responsibility to people we call stakeholders, right? So let's say it's a board or shareholders. How does that work alongside compassion for people who work in that organization?

Rachel

Mm-hmm. I don't think it's always clear, you know, the goal of an organization is supposed to be to create value for its stakeholders. And in the for-profit space, I think that quickly becomes distilled into making money for the shareholders. And depending on the values of the board and the leadership, caring for the employees may or may not be part of it.

And taking better care of your employees results in a more productive workforce, which can help you meet your capitalistic goals as well. You know, I think it's much cleaner, like, a pediatric not-for-profit hospital where care for human beings is our mission. We are here to take care of children and their families and not just children. We take care of adults, too. But being a compassionate organization that cares for our folks directly impacts how we care for patients and their families. We know how deep and profound that relationship is between happy, engaged, healthy frontline clinicians, not just the frontline clinicians, everybody in the whole place, right? And patient experience and outcomes and safety. It's all related.

Jennifer

So it sounds compelling to make an argument that if an organization wants to be successful, that it has to meet the compassion needs, ask what those needs are, act on it, follow through, be consistent, have organizational integrity in order for the organization to thrive, and we don't always see that in the marketplace.

Rachel

Yeah, if I could just write that down and publish that, that would be great. I think you said it really beautifully. 

Jennifer

What’s something that’s surprised you about organizational compassion?

Rachel

Value, feeling valued and dignity definitely caught me off guard and surprised me. That was a big surprise. We did not expect that relationship to come out as clearly and as strongly as it did. But the other thing that continues to sort of tickle me and please me and make me grateful is when I talk about this in front of clinicians, when I talk about our experiences in terms of suffering instead of just burnout.

I watch and it's profound in person. I watched the audience just like sit up and light up and feel seen and and I honor their dignity by talking about this in a way that resonates and feels real and that's always 

Jennifer 

What's one wish you would have for our listeners?

Rachel

Oh, yes. You know, I work in a place that I think is emblematic of not just the Midwest, but American work culture, which is, and this is, I am guilty of this. I learned this lesson very early in my life, and that is productivity is self-worth, right?

So if I could encourage all of us to do one thing, it is to change the story we tell ourselves about ourselves in a way that cannot immediately be reduced to a productivity measure. It's soul work. It's really hard work. And it's a journey. It's not a destination. There are some days that I think I do okay at it. There are a lot of days that I don't. But if we can just give ourselves a little bit more kindness and grace, that becomes the root of making a better world.

Jennifer

Dr. Rachel Thienprayoon, thank you so much for being on the Dignity Lab.

Rachel

Thank you for having me.

Jennifer

I hope you enjoyed listening again, or discovering again, my conversation with Dr. Rachel Thienprayoon. With this conversation, I was reminded of how important it is to understand what it is people need when they’re suffering. Noticing their suffering, while important, is not sufficient to meet the bar for compassion. We need to respond to their suffering. It’s important to avoid what Rachel refers to as “incompetent compassion,” in which our response misses the mark. If this is the first time you’ve listened, what did you hear in our conversation that struck you? And if you’re revisiting from Season 1, what is something new you heard?

We love to hear from you. You can contact us through our website, www.thedignity.com. There you’ll also find downloadable resources as well as our other episodes. We’ll be back next week with another dose of dignity on gossiping with dignity.