April 4, 2018

Blog: Integration of compassion-based practices to improve health outcomes for patients and frontline health workers in a clinic setting in Jordan

Region: Global Empowering and engaging people and communities, Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors, Creating an enabling environment

This blog was authored by Dr. Susan Parrish-Sprowl; Adjunct Clinical Professor, Global Health Communicate Center, Indiana University, Indianapolis, Indiana USA.


Providing healthcare in humanitarian settings is challenging. In addition to physical illnesses and injuries, patients often have serious ongoing stressors even as they struggle with the effects of trauma and loss associated with the precipitating event(s). As in other resource-scarce settings, organizations providing health services to these patients often have limited financial resources and a shortage of specialized personnel in the context of an uncertain environment. 

The clinic we worked with was staffed by motivated, caring health workers who were often overwhelmed by the demands of the work. The health workers lacked sufficient knowledge, training, and resources to effectively deal with so many patients in emotional distress.  This frequently resulted in frustrating interactions that negatively impacted the quality of care for the patients and demoralized the health workers, who struggled with burnout and compassion fatigue.

The “Communication for Whole Health” (CWH) perspective used in this project is a compassionate care approach to improving quality in health service delivery based on the recognition that communication is bioactive. Research shows that how we interact with one another shapes and is shaped by our biology[1].  Linking this finding to an understanding of the interdependence between physical, mental, and social health has profound implications for thinking about how our social environment can be managed to influence health outcomes. Using our CWH approach, adapted to the context, we worked with staff to shift the communication ecology[2] of the clinic from a “culture of reactivity”[3] that impairs mental, physical and social health, to a “culture of receptivity”3 that calms the body, facilitates understanding of health information, and encourages treatment adherence. 

The goal was to promote the intentional use of the social environment to improve the health and well-being of patients and staff.

Interventions based on the CWH approach included changing aspects of the physical clinic environment to make it more inviting. Training was provided to ALL staff on the effects of traumatic experience and how it can impact a person’s behavior.  In addition, the health workers were taught important self-regulation skills, including how to recognize their internal reactivity in stressful situations (i.e. activation of the sympathetic nervous system’s fight, flight, freeze, or faint response), and how to modify their breathing to activate the calming parasympathetic nervous system.  Over a 13-month period, this training and follow-up coaching helped the health workers to better understand patients, engage them with compassion and, with the use of conversation management skills, reduce patient distress and reactivity.

This approach empowered frontline health workers to understand their environments and  reactive encounters, and to use their newly acquired skills to better manage their own response and support one another. This approach enabled the health workers to provide better quality care and empower patients. As health workers became more skilled at interacting in a calming way, they were able to work with patients to problem-solve health challenges and improve treatment adherence.

One key outcome of this approach was education of patients by health workers  to better manage stress, improve relationships, and help other family members develop skills that are essential for whole health across the lifespan. One health worker commented that, “I just didn’t KNOW any of this before…I think EVERYONE should learn it.”  This was an attitude expressed throughout the clinic.  

The CWH approach, adapted to the context, can address important but often overlooked needs of patients and frontline workers in resource-scarce healthcare settings. It should be considered as a potential intervention framework for improving quality through compassionate care.



Compassion-Based Care:

Is an empowering perspective that can drive positive behavior change for patients and frontline health workers;

Is both a way of thinking and a set of skills that can be learned and practiced by ALL facility staff;

Requires commitment and ongoing support at multiple systemic levels for sustainability;

Will be a higher priority when funders and decision-makers understand that its value is transformative, not merely additive. By capitalizing on the dynamic synergy that emerges from this empowering way of being in relationship throughout a health system, there is potential for new solutions to challenging problems that can transform healthcare delivery and improve outcomes in unexpected ways.


Susan Parrish-Sprowl is a psychotherapist, healthcare consultant, and clinical professor with the Global Health Communication Center at Indiana University in the U.S. She partners with stakeholders worldwide to improve well-being by focusing on how the quality of our social interactions impact health.   


[1] See, for example, Louis Cozolino, The Neuroscience of Human Relationships (New York: W.W. Norton & Company, 2014)

[2] Communication Ecology refers to the patterns, processes, and content/messages that constitute the environment within which people function in a particular context. From our physical surroundings, to how and what we say and do both face-to-face and via media, this web of meaning-making shapes and is shaped by our physical sensations, thoughts, emotions, and actions.

[3] These neuroscience-informed intervention concepts draw from Stephen Porges’ Polyvagal Theory and the interdisciplinary field of Interpersonal Neurobiology (IPNB) pioneered by Daniel Siegel.  See WHO: Understanding and Managing Fear - Training for humanitarian workers in emergencies to watch Dan Siegel explain why the concepts of receptivity and reactivity are important in the context of community engagement.  


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