Authors: Emma Stanton, Douglas Noble
Publication date: 17 nov 2010
Emma Stanton and Douglas Noble consider whether improving emotional intelligence enhances patient safety
Since Lord Darzi’s review of the NHS stated that health services perform better when clinicians are leading, opportunities for doctors to develop leadership skills have increased considerably. Many leadership courses focus on learning about the complicated architecture of the NHS and how to lead within such a structure. Although an understanding of the broader healthcare system is undoubtedly beneficial, further, and crucial, dimensions of leadership are self reflection and effective communication.
Although communication skills are now a central part of the undergraduate and postgraduate medical curriculums, patients continue to complain that their doctor or healthcare professional didn’t listen to them or seemed distracted. For example, we once observed a general practitioner, who, despite the patient articulating their problem succinctly and clearly, immediately responded with the question: “So tell me about the problem?” This is reminiscent of One Flew Over The Cuckoo’s Nest, where on consulting with McMurphy the psychiatrist fails to listen. Instead, he sits behind his desk, takes notes, avoids eye contact, and contributes the occasional condescending remark. This exemplifies what is meant by a lack of emotional intelligence. It not only damages the doctor-patient relationship, it also has potential to compromise patient safety. In McMurphy’s case this contributed to an institutional riot.
Safer care and emotional intelligence
It is widely agreed that determining intelligence quotient alone is insufficient to fully measure cognitive ability. Deeper, more nuanced measures are necessary. Emotional intelligence provides a framework for measuring and articulating the ability and capacity to identify and manage one’s own emotions as well as those of others.
Emotional intelligence is not a new concept. It originates from the phrase “social intelligence,” which was used in 1920 to describe the skills entailed in managing and understanding others.
Emotional intelligence can be described in a variety of ways. One well known way, which is receiving widespread media coverage, is described in Daniel Goleman’s best seller Emotional Intelligence: Why It Can Matter More Than IQ.
Goleman describes five core characteristics of emotional intelligence: self awareness; self regulation; motivation; empathy; and social skill. Goleman found that more than 90% of the difference between high performers and average performers in senior leadership resulted from emotional intelligence rather than cognitive ability safety (see table ). We ask whether a wider awareness of emotional intelligence could lead to improvements in patient.
In 2001, a patient was given vincristine spinally. Vincristine should never be given by that route, and the patient tragically died. Two doctors, both employees of the hospital trust for less than six months, had assumed unwarranted competency. Senior supervision was lacking.
The subsequent inquiry stated: “A newcomer assumes that he knows what the organisation is about, assumes others in the setting have the same idea, and practically never bothers to check out these assumptions.” Despite concerns by the less experienced doctor, the culture did not facilitate this concern being articulated.
Possessing sufficient self awareness and confidence to question clinical decisions is a necessary defence against medical error, rather than being a threat or challenge to authority. Self awareness relies on having a deep understanding of emotions; strengths and weaknesses; needs; and drives. Recognising that mood affects everyone’s performance and behaviour and knowing when to ask for help is paramount.
Unquestionably, healthcare can be frustrating. Patients or colleagues may be late, equipment might be unavailable, and unanticipated events are all too frequent. Clinicians are expected to remain calm, adapting to constant changes and disruption without panic or judgment. To do this, impulses must be controlled—for example, rushing to give a blood transfusion in an emergency without stopping to verify the patient’s identity.
People who manage their emotions might be considered to lack passion, whereas individuals with fiery temperaments may be considered charismatic. Self regulation is a skill, from the toolbox of emotional intelligence, that controls and challenges emotions. This involves reflection and thoughtfulness. Being in control of your feelings creates an environment of trust and openness that is palpable to others and vital to improving patient safety. Following a medical error, self regulation means resisting the urge to blame individuals, one of the main facets of the blame culture.
Leaders in both business and health care are frequently high achievers. High levels of motivation are often accompanied by an intense passion to work hard, beyond seeking money and status. Levels of motivation are often played out at appraisal. Clinicians who are highly motivated will often track their progress, whereas those with less motivation may have incomplete or absent records. An inner drive can be attractive, infectious, and effective at building a strong team.
Another dimension of emotional intelligence is empathy—the ability to understand and read the emotional make up of others. Doctors are rarely given feedback about how they make the patient feel emotionally during an appointment or admission. If doctors are excessively preoccupied with their own emotions, they may be unable to consider the feelings of others.
It is well documented that on psychiatry wards, the emotions of those present on the ward will be hugely affected by the suicide or self harm of a patient. Clinical leaders need to be able to react in an emotionally intelligent manner to such intensely emotional events and to bring the healthcare team together to share their feelings and reactions openly.
The final dimension of emotional intelligence is proficiency in managing relationships and building networks through social skill. Goleman suggests that social skill is the culmination of other dimensions of emotional intelligence. Individuals with a high level of social skill build bonds widely. Socially skilled individuals are able to move seamlessly across communities, hierarchies, and organisational boundaries. This makes social skill a core leadership competency. Within healthcare, it has the potential to enable the socially skilled healthcare professional to improve safety across primary and secondary care boundaries, and between the realms of mental and physical healthcare.
Innate or acquired?
Whether people can develop emotional intelligence bears similarities to the debate as to whether leadership skills are innate or acquired. In Outliers, Malcolm Gladwell suggests that the key to perceived genius is devoted practice. Although there is a likely genetic component to emotional intelligence, it has been shown to improve with age and practice.
As with leadership, emotional intelligence cannot be taught on a brief didactic course. Behavioural therapy demonstrates that change with lasting results requires positive reinforcement over time. People learn best through motivation, extended practice, and feedback.
Emotional intelligence is essential
Emotional intelligence has moved from “nice to have” to “need to have.” Improvement in patient safety requires healthcare professionals to evolve from emotional unawareness to emotional intelligence. This will not only benefit the professional, the healthcare team, and the wider organisation but, most importantly, has the potential to improve patient safety.
Competing interests: None declared.
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Emma Stanton specialist registrar in psychiatry
South London and Maudsley NHS Foundation Trust
Douglas Noble public health registrar NHS Tower Hamlets