Empathy By Design

Healing the body
while caring for the mind

Imagine walking along the sidewalk on your way to work, and you see a homeless man jangling a cup with handful of change in it.

What do you do?

“The sympathy response would be to toss him a coin and feel a bit sorry for him,” said social philosopher Roman Krznaric. “The empathy response, in contrast, would be to really try to imagine what it might be like to be him—to sleep out rough on a cold winter's night, or to have people walk right past you without looking you in the eye.”

Research shows the capacity to put ourselves in someone else’s shoes is crucial to our ability to live among and relate to others. Studies show that empathy can especially make a difference in health care, notably among patients who suffer from chronic and/or life-threatening disease.

With this in mind, more providers and hospitals, including the Cleveland Clinic, whose ethos is based on caring for the patient’s mind, body and soul, are building empathy into the DNA of their operations—from staff hires to building design to team structure. Cleveland Clinic aims to be “a relationship-centered culture founded on the concept of empathy,” said Adrienne Boissy, MD, MA, Chief Experience Officer. This commitment to empathy is especially prominent in the new Cleveland Clinic Taussig Cancer Center, which has been designed and staffed with patient comfort and well-being at the forefront.

The science of empathy

Researchers looking at the roots of empathy—if and how it can be cultivated and what habits or life experiences affect one’s ability to show it—have found that this skill is based on a mix of physiological makeup, genetics and effort. Thirty years of medical literature point to the impact of communication on patient outcomes and satisfaction with their care experience, Boissy said.

“Historically, people thought empathy meant being nice to people or being friendly,” said Boissy, who explained that empathy is also about feeling what others are feeling; imagining what they might be feeling; fostering that sense of being connected to one another and acting on feelings of empathy.

Light is life.


In a 2013 study published in the Journal of Neuroscience, researchers found that humans naturally tend to be egocentric, but a part of our brains responsible for empathy and compassion identifies and corrects this.

The good news is that we can learn empathy, “just like we can learn to ride a bike or drive a car,” Krznaric said. “One of the most important starting points is what's known as ‘empathic listening.’ This involves not just being extremely attentive to what another person is saying to you, but also trying to focus on that person's feelings and needs, and giving them the opportunity to express those feelings and needs.”

“But it’s actually more
that you hire
somebody who can

relate to people and
who can
work as
a team.”

-Brian Bolwell, MD, chairman, Cleveland Clinic Taussig  Cancer   Institute

Why empathy matters in health care

Empathy has become an important topic in the health care sector, and is increasingly viewed as an essential skill for caregivers to build trust with patients and promote healing. Empathy is being taught at medical schools nationwide, and Cleveland Clinic trains all its caregivers on the value and tools of empathetic care.

The hospital has been a trailblazer in this area among health care systems nationwide, and was the first to add a chief patient experience officer to its executive leadership. Boissy heads a team of 100 caregivers who are dedicated to all aspects of the patient experience.

A conscious decision to incorporate empathy into care has not typically been the norm in cancer clinics, where science and research tend to be the primary focus. In addition to exceling in science and research, where Cleveland Clinic is a national leader, “it’s also important that you hire caregivers who can relate to people and who can work as a team,” said Brian Bolwell, MD, chairman of Cleveland Clinic Taussig Cancer Institute.

Research shows that empathetic care can result in improved patient outcomes. A 2012 study of primary care physicians and their diabetic patients found that of three groups of physicians with different levels of empathy, the most empathetic group had more patients with fewer diabetic complications.

“Empathy is essential to any healing or caring process,” Kzarnic said. “In the last few years we've seen a very welcome rise of interest in empathy in public health care, as hospitals and family medical services realize that patients need to feel as if their perspectives and experiences are really being taken into account—everything from how they are treated by a doctor or nurse to flexibility of visiting hours and post-operation aftercare.”

This ethos is at the heart of Cleveland Clinic, where pleasing, memorable artwork promotes a feeling of calm and helps patients navigate the sprawling clinic. A high level of emotional intelligence is also a crucial factor in hiring doctors and other employees to work at the Clinic. In fact, empathy is the governing principle behind the entire patient experience, from multi-disciplinary caregivers working together on each patient, to patient concierges—called “red coats”—who help patients find their way through the system of the Clinic.

“We wanted it to be a
shop for
patients and have as

much as we could in the
-Brian Bolwell, MD, chairman, Cleveland Clinic
Taussig Cancer Institute

Inside Cleveland Clinic Cancer Center

This “patient-first” philosophy extends to the Clinic’s new Cancer Center, which has been built and designed with empathy in mind—limiting the time it takes to undergo treatment and ensuring physical comfort and mental well-being, as much as possible.

“Patients with cancer are scared more than any other diagnosis,” Bolwell said. “It’s life-changing…shatters your world…and nothing else can hold a candle to it. It’s impossible to get away from. It dominates your thoughts. It’s hard for anyone to get it unless they have walked in your shoes.”

On average nationally, a newly diagnosed cancer patient begins treatment in 44 days. Bolwell and the architects at William Rawn Associates, the Boston-based firm tasked with the project, aimed to change that time frame, working with the Clinic’s facilities team, caregivers within the Cancer Center, construction crews and patients and their families, who were consulted on everything from lighting to furniture.

“We wanted it to be a one-stop shop for patients and have as much as we could in the building,” Bolwell said. For a cancer patient, “one thing that changes is the definition of time. Time matters now. Time is a big deal. If I have six months to live, waiting 30 minutes to check in is not acceptable.”

Instead of traveling from building to building to see an oncologist, surgeon and radiologist, for example, patients at the Cancer Center will spend the day in an area of the building organized by cancer type, and rest in a single exam room as various members of their care team come in and out for appointments.

The benefit of this overall approach to patients is less time spent moving from place to place. The benefit to the care team is better communication with colleagues, which in turn streamlines the patient stay.

“Breast cancer almost more than any other cancer is a multi-disciplinary effort,” said Stephen Grobmyer, MD, section head of surgical oncology and co-director of the breast cancer program at Cleveland Clinic. “Most patients will encounter or need the expertise of a wide variety of clinicians. Often there is a decision to be made to start with surgery or start with chemotherapy, and sometimes it’s not black and white and it comes down to a dialogue between the medical oncologist, the surgeon and the patient and their family. Having everyone there at the same time makes that very easy to do. Things can be done very quickly. Tests can be ordered, labs can be drawn.”

Building with empathy

One reason the new Cancer Center may be so infused with empathy is that the people who designed and constructed the building kept the patient experience front of mind. During construction, the Center’s construction workers created a ribbon wall with each ribbon commemorating a loved one or family member who had cancer.

During the development stage, architects and doctors visited other cancer centers, and met with existing and former patients to hear their thoughts and experiences. After learning how much natural light affects patients’ state of mind, architects designed floor to ceiling windows on both sides of the building, adding corridors and skylights to let daylight in throughout—into chemotherapy rooms, large open lobbies and basement radiation rooms.

Efficiency was also a factor in the design of the building’s cantilevered entrance. Since most cancer patients spend a full day at the Clinic receiving treatment from their team of caregivers, many arrive at 9 am. To ease congestion, William Rawn designed a 30-foot-deep awning that extends over three lanes of traffic, allowing ease of movement for patients—often in wheelchairs or frail and ailing—and their caregivers in inclement weather or during peak times. Valets are also on hand for those who do not wish to park their cars after dropoff.

That attention to time and patient support continues in the lobby area, which patients enter again upon checkout. Here on the first floor, patients have blood drawn at the start of the day. There is also a wig boutique, an art therapy room, a meditation room and a retail pharmacy. These resources provide convenience while acknowledging the whole patient—body, mind and soul.

“Cleveland Clinic is world-class medical attention defined,” said Jeff Husney, a Cleveland Clinic patient who underwent treatment for head and neck cancer nine years ago and now sits on the hospital’s Volunteer Patient Advisory Council. “But what it also stands for is always being on the frontline of new technology, always being concerned about patient and family care. The new building embodies that spirit.”

Cleveland Clinic Taussig Cancer Center