Setting the scene – context and evidence for the need.
Research now shows that compassion enhances healthcare worker wellbeing, is a positive mind state and is an antidote to burnout. The term ‘compassion fatigue’ is considered to be incorrectly named. It is actually ‘empathic distress fatigue’ that leads to burnout.
A big driver behind compassion training is fMRI research showing the difference between compassion and empathy. Compassion is protective against burnout. Major USA research institutes developed compassion training courses in 2008 e.g., Stanford and Emory. Values-based healthcare is big in the USA. It’s inevitable that compassion training was going to come to Australia.
Compassion defined – compassion is a concerned response to another’s suffering combined with a desire to alleviate the suffering of the other. Compassion has been mentioned for centuries. It is considered a virtue across cultures and is the foundation of healthcare.
meet The educator – Dr Debbie Ling.
Dr Debbie Ling has over 20 years experience in healthcare working as a social worker at educator at Monash University. Debbie has been regularly presenting on compassion training to healthcare workers since 2017 and has a strong familiarity with target customer group i.e other healthcare professionals.
Debbie is a lecturer in the Department of Social Work at Monash University and key contributor to the Monash Centre for Consciousness and Contemplative Studies.
Debbie’s research focuses on compassion, common humanity and prosocial behaviour. Her PhD investigated the relationship between common humanity and compassion in healthcare. She developed, trialled and evaluated a compassion training intervention in 2017 which has attracted international interest. Debbie sits on the Australian Compassion Council, Charter for Compassion Australia. Debbie is also a social worker at Epworth HealthCare and in private practice.
meet The users – healthcare workers.
It’s a common problem for healthcare workers to get burnout – they need to know the difference between compassion and empathic distress. Demand for compassion training spiked up in 2020/2021 due to Turning Point event promoting Debbie’s compassion training workshop Australia-wide, which proved difficult to meet the demand.
Traditionally this healthcare worker cohort participated in face-to-face training, and besides one-way-broadcast-style webinars, they were unfamiliar with learning online (until COVID-19) – they came to our training with perceptions and potential misconceptions of a fully online learning experience.
This was Debbie’s inspiration to scale the training and partner with Monash Centre for Professional Development and Monash Online Education (CPD MOE) to design, develop and deliver the fully online training to healthcare workers around Australia.
The opportunity.
Compassion is known to benefit the patient, but research now shows that compassion is a positive state of mind, increasing the wellbeing of the giver and protecting against burnout – it’s crucial to train healthcare workers on how they might embed compassion in their professional and personal lives.
Debbie’s thinking was that it’s important for Monash to get in first and be the leader in Australia. Debbie had solid understanding of the healthcare market and competitors courses. Specific intention to create a course that could be commercially successful in both domestic and international markets.
The response – what we did.
As project lead and educational designer, I worked with Debbie, Professor Craig Hassed and Dr Richard Chambers from the Monash Centre for Consciousness and Contemplative Studies (M3CS) to produce a practical course for healthcare professionals and anyone working in community and social service roles.
The course was designed so that over the four weeks of the course, participants will learn strategies to enhance compassion, avoid empathic distress, improve their own wellbeing and create more caring and compassionate workplaces. Participants will need to commit around three hours per week to make their way through the course material and sample the compassion exercises.
The course’s explicit aim was to give healthcare workers bitesize tools and techniques they can then go away and practice – the course was designed especially to relate to an authentic healthcare workers experience. Its direct applicability really strengthened the course.
Our design principles.
Building on education design skillsets, a commitment to designing for everyone by observing Universal Design for Learning (UDL) and Web Content Accessibility Guidelines as well as taking inspiration from Designing better government information and services: a service design toolkit for government, eight core design principles guided the design of the course and participant experience – like the government toolkit, all principles were considered of equal importance.
working together – Rowan and Debbie.
The course design process was highly collaborative, where the storyboards, written copy, learning activity staging and sequencing were steadily refined over a series of iterations. Our focus was to design a course to help healthcare workers to apply their learning in practice was a crucial factor in the success of the course.
We thought of a “Fridge Magnet” approach which helped us focus discrete ideas and pull out easy take aways for participants e.g., 3 C’s and Five Moments of Compassion.
Throughout the course, carefully curated high quality related links were gently offered to participants where they could “Find out more”, if it was of interest to them. These were not just isolated links, but contained a brief explanation e.g., “Watch this 5 min youtube by world famous neuroscientist Tania Singer on the difference between compassion and empathy”. This extra-touch made it easy for participants to quickly identify the value of the resource.
When thinking of how to best present this learning, Debbie modelled specifically off Craig Hassed’s approach of still being the expert but being relatable, real and encouraging. This is a real shift away from the “academic on a pedestal” approach that can happen. Debbie also practiced being fluent in the line of logic so she could improvise comfortably on the videos and in interviews. Adopting this approach was crucial for establishing an appropriate tone for the course.
We know participants that take our professional development courses are incredibly busy and time poor. Understanding this informs the way we design the course and shape its content – we made it flexible.
Downloadable materials and end of week summaries, which in this course we called ‘the essentials’ are designed to be printable and ready to use as a quick reference, much like a “fridge magnet” or “post-it note” stuck on your monitor that’s immediately available when you need it.
Learn with others.
The course is designed to be social. That’s why we encourage talking in class! With this social aspect in mind and the potential for varied responses to some of the compassion exercises, we’ve designed for opportunities for participant reflection and discussion – we gently invited participants to “Tell us how you went” and “Reflect and connect” with others.
This social interaction is further supported with more intensive educator engagement via text-based discussion forums as well as freshly minted feedback videos produced in response to participant activity and discussion throughout the week.
In the fourth and final week of the course, participants are invited to attend a live Q&A event with the course educators – that’s coming up next week. These helped the course feel more human and along with text-based instructions in the course, the videos help guide the participants journey through the course.
These varying modalities enable participants to ask clarifying questions and get feedback from other participants and the course educators, which is crucial – when you’re practising a new skill you want to know if you’re doing it right.
Again, thinking about our cohort we intentionally designed the course to have a modern feel. We wanted the participants learning experience to be calm, warm and welcoming.
Bite size learning sequences.
Each week of the course is carefully chunked and sequenced to make it easy for participants to identify where they are in the course, navigate to where they want, and also track their progress – this enables them to dip in and out of their learning as needed and then easily pick up where they left off.
We’ve designed for the learning to action-based and practical, encouraging participants and inviting them to actively engage in the READ, WATCH and DO.
Mixing up the modalities.
Text-based content is often the most used method for delivering content in many learning experiences. In our course, we used text as well as diagrams and images to communicate key concepts to participants e.g., how compassion and empathic distress are different.
Using formatting to create emphasis and increase scannability of content is important to user experience, engagement and learning – examples of this in our approach is to use heading levels, short sentences, bold, call-outs and pull quotes to highlight key point, or even tabulated formatting when showing data-style content, and more.
Audio-based compassion exercises would another crucial component – course participants were encouraged to practise the exercise, and then if comfortable share their experience with others in a discussion.
Like many other courses, we used video to deliver content. Our videos generally featured Debbie presenting by herself, but also with course contributors Craig Hassed and Richard Chambers – videos featuring more than one presenter had a conversational and reflective style.
The use of video isn’t reduced only to pre-prepared and pre-recorded content that contributes to the course material. Video is also used in response to participant activity and plays a critical role in enabling educators and the course team to provide feedback to participants throughout the delivery of the course.
The affordances of video enable instructors to convey detailed and elaborate feedback as well as encouragement and praise to learners more so than written commentary (Henderson and Phillips, 2015) – there’s been a positive learner response to video-based feedback from the course educators, which is fantastic.
Give it a go.
Because this course is all about developing skills that can then be applied to a professional practice, there are many opportunities to practise compassion exercises as listening and reflective activities.
These exercise often feature invitations for participants to “Give it a go” and to then tell us and other participants how they went – this is through guided discussion and reflection.
Participants are gently encouraged to contribute by reading and replying to discussions started by other participants, making sure they provide constructive feedback and commentary. These discussions are also managed by the course educator Debbie – these responses make the course extremely personal, attentive and intimate, much like a community of learners.
Things that went well.
Compassion training for healthcare workers was a success and ran five times throughout 2022 with our support. It was also awarded the 2022 MNHS Dean’s Awards for Excellence in Education in the category of ‘Excellence in Education – Industry and Community Education Programs (Team)’. In 2023, there are plans to run the course again in various iterations, this time without our support – Debbie is going it alone.
Course participants let us know about their experience in the comments of the course, which were overwhelmingly positive. Many participants have commented how practical and useful the course is.
We’ve also noticed how the course is opening up a lot of other opportunities e.g. requests to Debbie to meet with hospital leadership, present at hospital grand rounds, consult at policy level re: embedding compassion in healthcare at systems level etc, which is fantastic.
Things that didn’t go SO well.
Multifactor authentication (MFA) authentication was rolled out university-wide at the same time as the first run of the compassion training. Combine poor IT rollout with a wonky grace period and a cohort unfamiliar with configuring their devices or starting the course and then returning to their learning after the grace period led to diminished experiences for participants and unanswered helpdesk requests to reset accounts.
EPILOGUE.
In 2020, Monash Centre for Professional Development and Monash Online Education was disbanded. All professional development courses and associated source, working and deployed files were handed over to their respective faculties/centres of excellence – the thinking was that the completed course could be adopted and adapted and continue to be offered.
The compassion training was handed over to Monash Centre for Consciousness and Contemplative Studies (M3CS) and is now one of their many professional development programs.
