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Compassion, Wellbeing, & Connection to Purpose Improves Health Care

    Shireen Mansouri, MD | January 11, 2024

    I’m sitting in an auditorium of over a 1,000 people on the last day of the Institute for Healthcare Improvement (IHI) Forum being led through a Metta (loving-kindness) meditation by IHI’s President Emeritus Don Berwick, M.D.

    May I feel safe and protected.
    May I feel happy.
    May I feel healthy.
    May I feel at ease and at peace.

    I felt beyond grateful to get to share in this profound experience.

    For over a decade, I have admired the work of the IHI and Don Berwick. Initially, as medical director for my organization, I appreciated their focus on improvement science — the idea that there are evidence-based ways to achieve quality improvement.


    Over time, as I studied compassion cultivation and saw the positive benefits in my medical practice (for both myself and my patients). I began to resonate with IHI’s challenge to the medical profession to change the question we ask patients from “What is the matter with you?,” to asking, “What matters to you?”.


    Additionally, I appreciated the Joy in Work Framework and inclusion of practitioner wellbeing to expand the Triple Aim ( improved experience in care, population health, and per capita cost) into the Quadruple Aim.

    Wellbeing for Health Professionals & Patient Outcomes

    Because of all of the reasons above and more, I was excited to learn that the Compassion Institute (CI) Health Team decided to attend the IHI Forum as an exhibitor in December 2023. We were honored to interact with the hundreds of people who came by our booth. Some sought us out intentionally, while others were simply curious as to what an organization with the word “compassion” in their name was all about.


    We heard stories of what health professionals are doing in their own organizations. We heard heart-wrenching stories of moral injury. We heard from almost all attendees we met about the need for more compassion in health care.

    What reverberated loud-and-clear — not only from the attendees, but also from the sessions — was there’s a critical need for health care workers to be well in order to achieve optimal patient experiences and outcomes.

    Recognizing the Universality of Suffering & Connecting to Purpose

    What surprised me most, however, was the alignment of IHI’s current thinking with the elements of compassion cultivation. During their respective keynote addresses, both Dr. Berwick and Dr. Kedar Mate (the current CEO and president of IHI) highlighted the universality of suffering, the need to connect to our purpose, and the importance of recognizing how we are interdependent as well as the the essential need for kindness and compassion.

    Dr. Mate started his keynote by acknowledging that there will always be challenges. They may change year to year, but their presence is guaranteed. He described how these challenges can evolve into a connection to purpose which then leads to joy.


    This capacity to transform a challenge into meaning and joy is of course at the heart of compassion cultivation. So often in our society, and in medicine, we delude ourselves into thinking that suffering can be banished. It was refreshing to hear an acknowledgment of the universality of suffering, and that this can be transmuted on the path of improvement.

    Ikigai & Purpose
    To Drive Improvement

    Dr. Mate also presented the Japanese concept of Ikigai — a combination of what you are good at, what you enjoy, what the world needs, and what you can be paid to do. He acknowledged that he went down a “rabbit hole” of research on the benefits of connecting to purpose — including more engagement at work, more resilience, increased compassion for patients, and even an overall mortality benefit. He challenged us all to reflect and connect with our purpose, as it relates to our Ikigai.

    Dr. Berwick echoed these ideas when he described a connection to purpose being the engine behind the “how” that drives improvement. The “how” being the core tenets of improvement — including having a shared purpose, recognizing our interconnectedness, and that it matters how we treat each other.

    How Does Proximity
    Impact Kindness?

    Additionally, Berwick asked why people can show kindness when suffering is in front of them, but much less so when it’s at a distance. He described experiences that he and his wife had over the last year where he observed the “endless kindness” of people. He then noted the paradox of this level of kindness when in the presence of suffering that was proximal. However, this was not the case when distance was a factor. He shared, “In other places and on other scales we see nothing but conflict, nothing but separateness, nothing but fear, fences, other …for existential human crises we fall apart.”

    This is one of the core questions we need to hold if we are to move towards a more caring and inclusive world. How do we extend and enlarge this circle of caring beyond what is proximal to us? Or alternatively, how do we bring a larger number of beings into proximity?


    As Bryan Stevenson, Executive Director of the Equal Justice Initiative and former IHI keynote speaker, has said, “If you are willing to get closer to people who are suffering you will find the power to change the world.”


    Dr. Berwick articulated part of the problem beautifully when he said, “Our fault is naming the enemy as each other, instead of suffering.”
    He then ended his talk by saying, “The older I get the more I think that if kindness cannot work at the core, nothing else will come to save us”.

    Compassion Cultivation
    & Provider Wellness

    As I reflect on his words, I realize that what I feel is an affirmation that this work is important. Working to cultivate compassion as a route to provider wellness in health care can seem like a luxury, a “nice to have.”

    To experience this overwhelming message that kindness, empathy, and compassion are in fact at the very root of what is needed to move forward in this world helps me reaffirm my own purpose, my own Ikigai.

    May all beings feel safe and protected.
    May all beings feel happy.
    May all beings feel healthy.
    May all beings feel at ease and at peace.