A Primer on Kindness: A practical guide on how to give and receive more kindness in healthcare

by Dr. Lorraine A. Dickey

Founder & CEO

The Narrative Initiative LLC

Tedx Talk: A Formula for Kindness


Introduction

I've worked as a physician for over 30 years, and I've been a patient for over 20 years. If my experience as a patient has taught me anything about practicing medicine it's this: patients are human and they will forgive me for a lot, but they will never forgive me for treating them unkindly.


So, why it is hard to be kind? And how can we quickly and efficiently use the time we have with our patients to demonstrate that "I hear you", "I respect you", "I deserve your trust", and leave them feeling they've been treated kindly?


Actually I don't think it's hard to be kind. But I do think it can be tricky. Kindness is fundamentally qualitative in nature. What I believe feels kind to me isn't the same as what you believe feels kind to you.


In teaching the fundamentals of kindness to healthcare professionals for the past 5 years I've learned this: our healthcare ears are trained and tuned to hear quantitative language yet patients speak a qualitative language, the language of story. While we as providers have learned to properly signal when we hear meaningful data, we miss opportunities to acknowledge the adjectives, metaphors, and tones of the patient's story. And THAT'S where the magic happens. That's the stuff that when it's reflected back to me makes me feel like I was heard. And more importantly, acknowledging this qualitative "stuff' about my story helps me walk away from the experience feeling cared for which a critical element of my feeling like I was treated with kindness. It matters whether I walk away feeling like care was done "with" me or whether it was done "to" me. It influences whether I will come back, whether I will recommend a provider or organization, and how I fill out that survey. Make no mistake...Kindness still matters.


This primer includes:

This guide is designed for:

  • Healthcare providers so they can add these practical tools to their caregiving toolbox and intentionally bring kindness to their next interaction with a patient, a family member, or a colleague

  • Patients who need to seek care so they can advocate for a kinder healthcare experience for themselves

  • All of us to use in our personal lives with family and friends.


You can make the experience of healthcare feel kinder.



The Platinum Rule

I now believe there is a fundamental flaw in the way I've thought about kindness and in how I was taught to be kind as a child. I was taught to "Follow the Golden Rule," right? Treat others as you want to be treated. But this only works when those around us hold similar values and where we are closely aligned in what we believe kindness looks like and feels like. The truth of the matter is that we are a heterogeneous society and we hold heterogeneous beliefs on all kinds of issues. Why should kindness be any different? Several years ago on a trip to Australia I was introduced to something called "The Platinum Rule" that proposes we treat others as THEY want to be treated. Harvey Max Chochinov recently wrote a wonderful article about this. And I have come to appreciate that in the experience of healthcare platinum beats gold every time.

The Platinum Rule: Treat others as they want to be treated.

In this primer I examine what I've come to call Kindness 1.0, Kindness 2.0, and Kindness 3.0. I've found using this terminology useful in establishing a common framework for examining kindness. Once we have a common framework it's easier to understand why doing what we think is kind may not actually feel kind to the receiver of our intended kindness.


Kindness 1.0: The Components of a Kind Act

An intended act of kindness, physical or spoken, has 4 components: the agent, the intention, the act and the ask. The Golden Rule requires the first 3 of these components but the Platinum Rule requires all four.


1. The Agent: You or me

2. The Intention: The intention of the agent is to be kind, to act in a kind fashion

3. The Act: Either a physical act or one that is spoken

4. The Ask: This is the key to having your intended act of kindness actually be received as a kind act. This requires a component of self-awareness and a nanosecond of mindfulness. By asking "can I open that door for you?" a few things happen almost instantaneously.

  • You recognize the person you are offering to help is a whole person with the ability to act in the best interest of himself or herself.

  • Because they are whole, s/he can either accept or decline your offer. The choice is theirs and either option is perfectly fine.

  • By accepting your offer, or opting in, s/he has signaled that your offer and action holds value for him/her. Your values overlap. So completing the act is acceptable and is viewed as kind the perspective of the receiver.

Kindness is a team sport.

Have you ever had an intended act of kindness backfire? Take this situation for example:


I am walking into a store and the person in front of me is in a wheelchair reaching to for the door. She appears to be having trouble. I see there is a need and I believe I can help. So, I reach over and open the door. Imagine my surprise when she turns to me and says, 'Thanks but I've only been in this wheelchair a few weeks and I have to learn how to do this for myself."


The perception of the receiver of your intended kindness matters.

Here is where the Platinum Rule reigns supreme.


I could have made this interaction less awkward if I had remembered to ask before I acted. "Would you like me to get the door for you?" If she had declined, no harm done. If she had accepted then our values would have overlapped. My intention to be kind would be met with acceptance of my kind act. Then we both win. Remember, kindness is a team sport. It takes both an agent of kindness and a receiver of the kind act. It's more than just being nice. The proactive component of asking makes all the difference.


A nanosecond of heightened awareness and mindfulness:

Remembering to ask before acting kindly can make all the difference in how your action is received.



Kindness 2.0: Kindness by Omission

Let me set the scene: Steve and I are out to dinner with some friends we haven't seen in a while. Steve tells a story I've heard a hundred times and I'm pretty sure our friends have too. My options are 1) to interrupt him to save him from what I think is embarrassment or 2) to intentionally do nothing. I'm going to argue that option 2 or "intentionally doing nothing" is actually really doing something. It's a kindness by omission.


In a kind act by omission we still have the 3 main components of a kind act: the agent with the intention to act kindly. However, instead of asking for permission to act I instead choose to make an omission. I make the conscious choice to give myself permission to not act. The catch here is that when a kindness by omission goes well the receiver of the kindness may never even know it even happened. But you do! Pat yourself on the back. You've just been kind by omission.


In our Narrative Kindness work we have developed a texting option for kindness by omission for those of us who use cellphones. Pioneered by Douglas Dickey, a pilot with American Airlines and my husband of over 35 years, this simple texting option lets you acknowledge someone with a kind text of omission.

Sample of a kind text of omission


Try this out by texting this to yourself or a friend. Four easy steps:


1. Open your texting application.

2. Select someone to receive the text.

3. In the message don't write anything and simply hit "Return" 3 times.

4. Send the text



So, when you receive a text that you feel was unkind or perhaps you want to respond with a less than kind remark, you now have the option of responding to that text with a kind act of omission, or a kind text of omission.

At the end of a rough day when I can't name a single kind thing that happened I can still tell myself there is a chance I was on the receiving end of a kindness by omission. I just never noticed it. And I can find some comfort in that.

Kindness 3.0: Agents of Kindness

Make no mistake...it can be tricky to be an agent of kindness in our age. There are good reasons we may opt out of putting ourselves out there. Some people even think kindness is for losers. Yet there are people who seem naturally kind and there are also some of us could use a little encouragement. Here are some good reasons we decline to act kindly, consciously or unconsciously.

  • Incompetence: maybe I don't think I have what is needed to act kindly in the moment

  • Insecurity: recognizing the need of another naturally open up recognition of vulnerability in ourselves

  • Inconvenience: I just don't have the time right now

  • Inner bias: I can't be an agent of kindness because I can't see your point of view due to my own personal conscious or unconscious bias

The 2022 Gathering of Kindness USA* brought community and healthcare representatives together to talk about the challenges to kindness in healthcare, and to develop some work arounds when we are challenged to be agents of kindness. Consider these:

  • Immersion: when you become immersed in the other's perspective it becomes easier to see the other as someone just like you. Immersion can happen physically by taking a trip to another country. Or it can happen momentarily when you listen to the story of another on a subject you both care about and when you find you have something in common. Immersion can help us feel more competent, less insecure and help us manage our inner biases.

  • Curiosity: This is an essential component in a practice of mindfulness. Leaving open the possibility of a different ending to a story we think we already know allows curiosity to take the lead. We want our children to be curious. Curiosity is a trait we generally admire in others. And curiosity may well help us overcome our insecurities and inner biases to be better agents of kindness.

Conclusion

Congratulations! You've just added new kindness tools to your care giving and care receiving toolbox!

  • As a healthcare provider you can now make the experience of those you care for, your colleagues AND your own experience of working in healthcare feel kinder

  • As a patient you can now advocate for yourself for a kinder healthcare experience

You've now learned

  • The Platinum Rule beats The Golden Rule in the experience of healthcare

  • There are 4 components to any intended act of kindness that you want to have accepted: The Agent, The Intention, The Act, and The Ask. The most important one is taking a nanosecond to be mindful and ask permission to act kindly.

  • Kind acts of omission happen all around us everyday even though we are not aware of them. And it's possible to respond to a text with a kind text of omission

  • There are real challenges to being an agent of kindness. Curiosity and a willingness to be immersed in another's story are some real-world workarounds.

Now, my challenge to you is to give this a try! Start today by asking for permission to act kindly from a friend or family member. See how this is different that just being nice. Text a sample kind act of omission to yourself, or keep it in mind to respond to a text in the future. And be curious for a moment while listening to the story of another so that maybe...for just a moment...you can see the world from their perspective.

Together we can make healthcare feel kinder

The journey of a lifetime starts with the first step. It's impossible for me to change the winds of healthcare or adjust how our healthcare systems run. But with each small individual act of kindness I can change how I feel about giving care and how those I care for feel about receiving care. Join me on this journey. Together...WE CAN make healthcare feel kinder.


*The Gathering of Kindness USA is an annual event that brings together community members and healthcare professionals to have a meaningful conversation about the challenges to kindness in the experience of healthcare and ways to overcome these challenges. GOK USA is a multimedia presentation sponsored by The Narrative Initiative.



To contact Dr. Lorraine Dickey or The Narrative Initiative:

Email: Ldickey@TheNarrativeInitiative.com or visit our website www.TheNarrativeInitiative.com


The mission of The Narrative Initiative (TNI) is to make the experience of healthcare feel better for those who chose to give care and those who need to receive it. TNI facilitates small and large group narrative sessions with our innovative and award-winning Write-Read-Reflect Narrative Exchange Method and certifies professionals as TNI Narrative Facilitators.


Contact us to learn more, request a workshop, or chat about bringing A Gathering of Kindness USA event to your organization.


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