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Excellence in Human Understanding Award—How a palliative-medicine director “operationalizes compassion”

Empathic care is a goal for every healthcare provider. On a harried hospital floor, it can sometimes be more aspiration than reality—but some providers manage not only to bring empathy to every encounter, but also to galvanize the compassion of an entire staff.

It’s these transformative individuals whom NRC Health recognizes with its Excellence in Human Understanding Award. This article is one of a series celebrating the achievements of healthcare workers who have an outsized impact on patient care.

One of this year’s nominees is Sonia Malhotra, MD, the Director of Palliative Medicine and Supportive Care at University Medical Center (UMCNO), a safety net teaching hospital in New Orleans that is a partner in the LCMC health system based in New Orleans.

Dr. Malhotra’s energetic pursuit of a better Palliative-Care experience has profoundly elevated UMCNO’s serious illness and end-of-life care, and has inspired widespread institutional change within UMCNO. Below are three crucial talents Dr. Malhotra brings to her work—and what other healthcare organizations might learn from her example.

Building coalitions for productive change

Reforming institutions is hard, and it’s never done by one person alone. Against the headwinds of the status quo, would-be changemakers must rally the enthusiasm of their colleagues, or else see their initiatives come to nothing. Fortunately for UMCNO—and for the community’s patients—building coalitions of support is one of Dr. Malhotra’s particular gifts.

This was especially evident in the wake of the COVID-19 pandemic. Like most other hospitals across the country, UMCNO was quick to restrict visitor access to inpatient coronavirus cases. But Dr. Malhotra, with her background in Palliative Care, knew how devastating such restrictions would be for patients and their families.

Dr. Malhotra believed it was unconscionable to deprive families of contact with their loved ones. So, when COVID-19 arrived in New Orleans in early March 2020, Dr. Malhotra got to work. Her goal was to ensure that no patient would suffer alone.

“As soon as our first COVID patient rolled in, I was meeting with our ICU medical directors, our ER medical directors, everyone possible, to figure out how to establish daily care and visitation guidelines,” Dr. Malhotra says.

What emerged from these conversations was a series of solutions enabling patients and their families to stay connected. These included weekly video-chat sessions (conducted via iPads), text-based notifications on patients’ conditions, and, in the most serious cases, daily phone calls from Palliative Medicine providers.

None of this would have come together without Dr. Malhotra’s concerted efforts to reach across the organization.

“Without such a truly multidisciplinary coalition, I’m not sure our visitor initiative would have taken off nor would we have been able to work so closely together across departments for optimal patient care,” she says.

An innovation mindset

Sometimes, profound insights can emerge from applying previous lessons in a new context. This takes a certain nimbleness and flexibility of mind—which is precisely what Dr. Malhotra brings to her work.

During the developing pandemic, COVID-19 mortalities quickly mounted in the New Orleans area, leaving many bereft families in UMCNO’s charge. Thanks to her experience in Palliative Care, Dr. Malhotra observed some important opportunities to offer comfort for grieving relatives.

Her first idea was a simple one: comfort groceries.

Before the coronavirus outbreak, UMCNO would frequently give bags full of snacks and activities to visitors of terminally ill patients, to help them stand vigil at the beside. In the era of social distancing, this gesture was no longer possible.

Dr. Malhotra proposed modifying the program. Instead of a small gift at the bedside, UMCNO would instead send a carton of basic groceries to family members’ homes.

“It’s our way of saying, ‘We’re thinking about you, and we care about you and your well-being’,” Dr. Malhotra says. “It’s how we can step in and assist with the grieving process.”

Family members naturally appreciated the gesture. But it was Dr. Malhotra’s other grieving initiative that likely helped them the most: a complimentary 12-month bereavement-counseling program.

“Our bereavement program is the one thing I’m most proud of,” Dr. Malhotra says. “And I’m especially proud to say that we will likely expand it beyond just COVID-19.”

This was an opt-in program for family members who struggled with losing a family member to COVID-19, or for those who screened positive for a complicated pattern of grief. Participants would engage in every other month, hour-long check-ins with UMCNO Palliative Medicine social workers, who would help them ease back into life after such a profound loss. Family members could choose to receive further services in a bereavement counseling clinic.

“Often I tell family members, ‘Your loved one would want us to check in on you,’” Dr. Malhotra says. “I truly believe that, and that’s one of the most important things that we’ve been able to provide.”

Coaching for compassion

Finally, perhaps the most important of Dr. Malhotra’s recent contributions has been her ability to help other providers develop their skills.

She wanted to help ensure that, for the most serious cases, UMCNO’s serious illness and end-of-life planning conversations would be consistently helpful. To do that, she knew she had to destigmatize the struggles that can arise in these difficult moments.

Having serious illness and end-of-life conversations is something that comes naturally to some providers. For others, it’s an uncomfortable position to be in, and one they would rather avoid. But, Dr. Malhotra argues, no matter where a clinician starts from, there’s always room to improve.

“It’s important to acknowledge that not everyone is a gifted communicator,” she says. “It’s a skill, just like putting in a central line or performing an intubation. It’s something you have to learn.

To that end, she started the Serious Illness Conversation Project, with the goal of teaching clinicians how to have productive serious and end-of-life conversations with their patients and family members.

“This isn’t just their clinical wishes, or care planning,” Dr. Malhotra says. “It’s not just a medical conversation. It also includes their hopes, their fears, their expectations. So, we can give them the most meaningful serious and end-of-life experience possible.”

UMCNO staff quickly discovered that, far from being simply a nerve-wracking moment, these conversations also stood to be immensely comforting—to staff and patients’ family members alike. The simple act of having a thoughtful conversation is an emotional salve in situations of extreme duress.

“It helps family members learn what to expect, and it helps us avoid any guessing when it comes to our patients’ treatment,” Dr. Malhotra says of the project. “And one of the things we’ve seen is that if teams are ready to have these conversations, it really decreases their moral distress and improves their willingness to come back to work.”

Operationalizing empathy

Each of these talents represents a tremendous achievement on Dr. Malhotra’s part. But what, ultimately, earned her a nomination for the Excellence in Human Understanding Award? In a word: empathy.

Dr. Peter DeBlieux is UMCNO’s Chief Experience Officer, and the person who recommended Dr. Malhotra for the award. About his colleague’s service, he has this to say:

“Empathy is a feeling; compassion is putting action behind that feeling. And [Dr. Malhotra] is a master at that. Whether it’s comforting patients, comforting family members, or comforting team members, she’s just a rock star. She operationalizes empathy across the entire organization.”

Dr. DeBlieux has captured perfectly the essence of a health system’s work, as well as what makes Dr. Malhotra such an extraordinary practitioner.

Congratulations to Dr. Malhotra and UMCNO, for embodying the spirit of real, human care.