The Adventures in Caring Foundation

Karen Fox has had an incredible journey that has taken her from a diagnosis of cancer all the way through the creation and management of the Adventures in Caring Foundation, an internationally recognized program that teaches healthcare professionals of all types how to deliver exceptional care through compassion.

She and her husband Simon, who are based in Santa Barbara, California, believe that successful healthcare lifts the spirit and involves consistently delivering compassion, hope, joy, and encouragement to each patient's bedside. For the past 24 years, the Foxes and their all-volunteer team have done just this, making more than one million patient visits in the process. They have a goal of sharing what it takes to cultivate compassion, in a way that makes it stick.

Beginnings

It started in 1983 when Fox, a medical assistant and office administrator, received test results that indicated that the cancer she had experienced a few years ago may have returned. "I wanted to turn my own darkness into light and try to help others. So I decided to dress up as a Raggedy Ann doll, and visit other cancer patients at a Santa Barbara hospital."

The very first patient Fox visited had throat cancer. The patient's two sisters, who had invited Raggedy Ann to visit, explained that he hadn't spoken for eight months. She took a deep breath and stepped into a miracle.

"Hi, it's Raggedy Ann," she whispered, not wanting to wake him if he were sleeping. "Would you like a visitor today?" Looking up to see if he had heard correctly, he began to smile, and nodded his consent. Fox told him her story: This was her first day volunteering as Raggedy Ann, she was nervous, and she hoped that her visit would give her the courage to continue. Then, with a full heart, and at a loss for other words, she said to him, "I love you." His eyes gleamed, and a tear rolled down his cheek. Contact was made.

As Fox walked out of the room, she heard a faint, gravelly voice call out to her: "I love you too, Raggedy Ann!"

This was confirmation; she was on the right path. "Well, you've got me God!" Fox prayed. Then, in awe of what she had just experienced, she continued on her rounds.

She has taken her Raggedy Ann visiting program to hospitals and healthcare facilities all around the country. In 1991, her program was recognized by President Bush for outstanding community service.

Twenty-four years later, her mission continues. Now, under the Raggedy Ann and Raggedy Andy mop-top wigs are mostly undergraduate students who are pursuing careers in healthcare. By volunteering with Adventures in Caring, these young men and women, who will become tomorrow's physicians, pharmacists, dentists, nurses, and allied health professionals, learn the art of listening to patients at the very beginning of their careers.

The Many Merits of Compassion

Every year there is stronger evidence that patients are never very satisfied with the quality of their care – unless they experience compassion. And Fox points out that people rarely complete their medical regimen correctly – unless they experience compassion.

"Not only that," she says, "The economic benefits of compassion are startling. It's not just the patients and their families who suffer from a lack of compassion. It also harms staff retention and morale, and the culture and performance of a medical organization as a whole."

Tremendous time is wasted every day in high-tech healthcare units doing old-fashioned damage control for staff whose heartless communication has upset patients and families.

"The director of a Level 1 trauma center told me that he simply doesn't hire people who can't connect with patients or their families," Fox related, "He told me, 'We're so busy now, no one has time to do damage control for the jerks who won't relate.'"

It's been shown that patients almost never file malpractice lawsuits if they experience compassion. In his book Blink, Malcolm Gladwell describes how you can predict which surgeons will be sued just by listening to them for two minutes. It's the ones with the condescending tone of voice.

"I've been trying for two years to get it through the heads of the young bucks who drive our ambulances, not to treat the patients like cargo," a nurse educator told me. "They would just roll their eyes and say, 'We're just not touchy-feely guys' – until they saw real examples of compassion in The Medicine of Compassion video. Their scant response: 'Oh, yeah, sure – that's what you mean? OK – we can do that.' From then on, everything was different."

And it's not really hard. "I remember seeing an elderly lady just come alive, right in front of me, simply because I smiled and asked her where she was from," Fox says, "I watched an eight-year-old boy abort a panic attack in a highly agitated, 80-year-old lady with dementia in just five minutes using only body language. We have these skills at such a young age – it's a shame that we forget to use them."

Teaching Compassion

The question of how to teach compassion remains a mystery to most organizations. The Foxes have fine-tuned innovative patient care programs and taught compassion over the past 24 years. They've created a methodology that is now being used in thousands of hospitals, hospices, care giving ministries, nursing schools, and medical schools across the country.

Here is a summary of some of their most important ideas for teaching compassion in healthcare:

ATTENTION: Notice the signs, signals, and clues that tell you what is important to the patient, so that they experience feeling heard.

ACKNOWLEDGMENT: Let patients know that you noticed, to show that you appreciate them as a unique individual, so that they feel respected and validated, and keep their dignity.

AFFECTION: Use the human touch of warmth, comfort, humor, and kindness, so that they feel connected with their caregiver, and are included as an equal partner in the healing process.

ACCEPTANCE: Embrace people and situations just as they are, without judgment, so that they experience a sense of peace, and feel safe enough to change and heal.

The Four A's of Compassion can be used to deliver compassion anywhere, anytime, no matter what mood people are in.

The fundamental paradox of teaching compassion is that compassion is not about oneself. It's about others. "We need to care enough to pay attention to what is most important to the people in our care. We are all acutely aware of what is important to us, but the art of practicing compassion begins by paying attention to what is important to others," explains Fox.

"It's not about your performance, your ability, your needs, your ambitions. It's not about what you should do, say, think, or feel. It's about what others need and what others feel," she says. "But, in the process of taking an interest in someone else's life, we gain a greater satisfaction in our own."

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