Learning self-compassion through social connection at work: The experiences of healthcare professionals in a 6-week intervention

Abstract

Self-compassion has previously been shown to buffer healthcare professionals from burnout and other forms of mental distress, yet research is lacking on how self-compassion can be developed and integrated into the healthcare work environment. The purpose of this pilot study was to examine the potential precursors, mechanisms, and outcomes of change regarding how healthcare professionals learned self-compassion from attending a 6-week Self-Compassion for Healthcare Communities (SCHC) training. Social connections at work enhanced the trustworthiness of the program and helped participants learn to apply self-compassion within the healthcare context. Participants described practicing self-compassion with “small daily gifts” and by offering themselves “grace.” They felt their relationships with patients, coworkers, and family members had improved as a result of the emotion regulation and self-care skills they had gained. Findings suggest the SCHC program may address HCP burnout and empathy fatigue by providing tools that help individuals replenish their energy throughout the day and emotionally separate from others’ experiences of pain. Situating programs within healthcare settings may help to reinforce and contextualize self-compassion concepts and facilitate the implementation and benefits of these tools and skills.

Keywords

Resilience intervention thematic analysis self-compassion burnout healthcare professionals

Introduction

Burnout in healthcare

The work of pediatric healthcare professionals is multidimensional. Not only are social workers, nurses, physical therapists, and physicians required to possess an array of technical skills and knowledge to care for sick patients, their typical workday often involves interactions with patients, families, and coworkers that can be emotionally distressing. To add to the complexity of their job, practical and interpersonal tasks are carried out within organizations that may be understaffed, have high rates of turnover, and experience shifting policies regarding documentation and patient care funding (Hagmajer and Strekalova, 2019).

Because of the complex demands healthcare professionals (HCPs) confront at work, they are at greater risk of experiencing burnout in comparison to the general working population (40% v. 28%; Shanafelt et al., 2019). A recent synthesis of over 3000 studies on the topic demonstrated that between 35% and 60% of nurses, physicians, medical students, and residents experience symptoms of burnout (National Academies of Sciences, Engineering, & Medicine (NASEM), 2019). Additionally, several studies have indicated elevated rates of burnout among healthcare social workers (for a review, see Frieiro Padín et al., 2020). Burnout occurs when workload demands exceed workers’ emotional, cognitive, and physical resources (Bakker and Demerouti, 2017). The experience of burnout is characterized by reduced feelings of efficacy and satisfaction in one’s profession, emotional exhaustion, and becoming numb to the humanity of those with whom one works (i.e., depersonalization; Reith, 2018; Maslach and Jackson, 1981). Professionals who are burned out are at risk for a range of adverse health outcomes, such as heart disease, musculoskeletal pain, impaired immune function, and depressive symptoms (Salvagioni et al., 2017). The physical and mental consequences of burnout interfere with HCPs’ relationships, diminish overall quality of life, and impair work performance, contributing to lower quality of care (Salvagioni et al., 2017; Salyers et al., 2017). HCPs who are experiencing burnout are more likely to leave their profession, taking their valuable training and experience with them and leaving organizations even more short-staffed (West et al., 2018). Losing skilled and tenured employees due to burnout limits access to care, reduces clinical hours, and has been projected to cost $4.6 billion at the national level each year (Han et al., 2019).

Self-compassion interventions to reduce burnout

While the prevalence of burnout in healthcare is well-documented, less is known about how to effectively address the issue (NASEM, 2019). Recent studies suggest that self-compassion might be one way to protect HCPs against burnout (Bluth et al., 2021; Dev et al., 2020; Richardson et al., 2016). Self-compassion refers to treating oneself like a good friend when one feels inadequate or otherwise suffers (Neff, 2003). A self-compassionate way of being is defined by the presence of three compassionate responses (mindfulness, common humanity, and self-kindness) and the relative absence of three uncompassionate responses (over-identification, isolation, and self-judgment) to the self in moments of difficulty (Neff, 2016). Responding to personal limitations or hardships with an open, nonjudgmental perspective (i.e., mindfulness), with an understanding of one’s interconnectedness and shared human experience (i.e., common humanity), and with kind, caring support (i.e., self-kindness) exemplifies self-compassion. In contrast, viewing challenges with a narrow mindset (i.e., over-identification), creating distance and disconnecting from others (i.e., isolation), and harshly berating oneself (i.e., self-judgment) demonstrates a lack of self-compassion.

Self-compassion may be associated with reduced HCP burnout because it can help them manage the difficult emotions that arise when working with people experiencing pain (Raab, 2014). Studies have shown that those who are more self-compassionate are better able to regulate their negative emotions (Finlay-Jones et al., 2015), positively reframe difficult interpersonal situations (Leary et al., 2007), and adaptively cope with trauma (Munroe et al., 2021). Self-compassion is also associated with healthy behaviors, such as eating nutritious meals, exercising regularly, and getting adequate sleep, which could potentially help sustain HCPs physically and emotionally (Sirois et al., 2015). HCPs who are more self-compassionate tend to feel less exhausted in their profession and more engaged in their work (Babenko et al., 2019).

Despite the benefits of practicing self-compassion on HCPs’ well-being, many healthcare workplace environments fail to promote, model, or reinforce this healthy way of relating to oneself. Work demands often encroach on HCPs’ personal time to attend to their own needs (NASEM, 2019) and unhealthy interpersonal dynamics may reinforce self-criticism, such as the widespread problem of nurses bullying students in training (Henley et al., 2018). One way healthcare organizations can support HCPs’ development of adaptive emotion regulation strategies, such as self-compassion, is by investing in a culture that exhibits and encourages compassion to oneself and others.

A number of interventions have been offered in healthcare settings in this regard, including programs that offer mindfulness, meditation, and/or self-compassion training to cultivate more self-awareness and well-being. Such programs have contributed to significant reductions in burnout (Luken and Sammons, 2016), depression (Bluth et al., 2021), and secondary traumatic stress (Delaney, 2018), and significant increases in self-compassion (Beaumont et al., 2016; Wasson et al., 2020). Yet, formal practice may not be an appealing technique for some HCPs. Many HCPs often work 12-h shifts during the days or evenings, a schedule that may not allow for regular attendance at a lengthy intervention, nor the capacity to practice in one’s free time.

With these limitations of self-compassion interventions in mind, Self-Compassion for Healthcare Communities (SCHC; Neff et al., 2020) was developed to contextualize self-compassion and mindfulness tools for the healthcare work environment and to offer these tools in a short period of time (in six, one-hour sessions). SCHC is an adaptation of the Mindful Self-Compassion Program (MSC), an 8-week, 24-h, empirically validated self-compassion training program for the general population that requests participants practice self-compassion and mindfulness tools for 20–30 min a day (Neff and Germer, 2013). SCHC, in contrast, offers self-compassion practices that can be utilized quickly on the job. See Table 1 for a list of informal practices offered at each session. Bluth and colleagues (2021) switched to offering SCHC, rather than MSC, to certified nursing assistants (CNAs) to improve participation in their study. Findings from focus groups with CNAs in their study suggest that the length of SCHC made the programming more accessible and feasible (Bluth et al., 2021; Lathren et al., 2021).

Table 1.

Self-Compassion for Healthcare Communities practices by week.

Week One: What is self-compassion?	Exercises: How do I treat a friend? hand gestures; self-compassion bracelets
Week Two: Practicing self-compassion	Exercises: Soothing touch; self-compassion break; S.T.O.P; soles of the feet
Week Three: Discovering your compassionate voice	Exercise: Motivating ourselves with compassion
Week Four: Self-compassion and resilience	Exercise: Strategies for meeting difficult emotions
Week Five: Self-compassion and burnout	Exercise: Compassion with equanimity
Week Six: Making it count	Exercise: Setting an intention; self-compassion stone

Recent systematic reviews suggest that the implementation of brief interventions in healthcare settings generate improvements in HCP well-being, including reductions in stress and symptoms of burnout (Klein et al., 2020; Zhang et al., 2020). An initial evaluation of SCHC showed participants experienced improvements in self-compassion, compassion to others, and compassion satisfaction, and decreases in burnout, secondary traumatic stress, depression, and stress (Neff et al., 2020). These results were replicated in a group of nurses who took the training in 1 day (Franco and Christie, 2021) and a group of interdisciplinary healthcare professionals who participated in the training online at the beginning of the COVID-19 pandemic (Knox and Franco, 2022). Offering the training in a variety of accessible formats appears to support HCP well-being.

However, these and other quantitative studies do not elucidate the processes through which healthcare professionals develop self-compassion as a result of attending an intervention. Given the limited state of research on brief self-compassion interventions conducted within pediatric healthcare settings, this qualitative pilot study explored potential mechanisms of change that explain how self-compassion interventions support HCPs. This pilot study is an extension of the initial larger study to examine the effectiveness of Self-Compassion for Healthcare Communities (SCHC) in the context of pediatric healthcare (Neff et al., 2020). Our qualitative investigation was designed to illuminate how SCHC helped participants develop a compassionate way of relating to themselves and how they implemented self-compassion practices in their everyday lives. In this pilot study, we collected retrospective, qualitative data from individuals who completed SCHC to develop preliminary hypotheses that illustrate the effectiveness of SCHC in promoting self-compassion and reducing burnout among HCPs.

Methods

Participants

Twenty-three participants in the SCHC study were asked to participate in a qualitative interview about their experience in the program. Thirteen were interested in participating in an interview, and nine had the availability to schedule an interview within the timeframe offered. On average, the nine participants in our sample had 10 years of experience in healthcare (range: 4.5–17). The average age of the sample was 35 (range: 28–44). Twenty-two percent (2/9) of participants identified as Latinx and 78% as White (7/9). All participants identified as female. One participant worked in administration, two were child life specialists, two were nurses, two were social workers/case managers, and two worked in rehabilitation therapy services. All participants worked in an urban, pediatric inpatient hospital setting. The hospital was chosen because it had an established SCHC program and was part of the original intervention study (Neff et al., 2020).

Intervention

SCHC is an adaptation of the empirically supported Mindful Self-Compassion program created by Neff and Germer (2013), modified to include examples specific to the healthcare context. While many training programs exist for healthcare professionals, this training deliberately considers the challenges of implementing these tools amid stressful experiences on the job. Healthcare professionals cannot typically leave the bedside to engage in meditation or even take 5 minutes to reflect. Alternatively, this program offers informal and brief exercises and clarifies how to use the tools in the midst of working with patients, families, and colleagues, allowing HCPs to cultivate compassion for self and others in the moment.

Informal practices include paying attention to the soles of one’s feet while walking between patient rooms or while experiencing the intense emotions of a patient. Attaching a badge card to one’s lanyard with directions for brief mindfulness and self-compassion practices provides an on-the-spot reference to use when needed while working. Breathing techniques and phrases that can be used inconspicuously during interactions with others, including colleagues, offers HCPs the opportunity to ground and realign their perspective. These practices are intended to help individuals manage the empathic distress that arises when working with others who are experiencing pain, while maintaining a compassionate connection with themselves and the other person. Small and large group discussions at each session are intended to reinforce the concept of common humanity—the recognition that difficult experiences in one’s personal and professional life are shared.

The intervention was conducted over 6 weeks and facilitated by two trained Mindful Self-Compassion teachers. Both were employed by the hospital that hosted the research, and one had 25 years of clinical, bedside experience. They are both authors of the current study. Each week the participants met for 1 hour during lunch. Lunch was provided at each session as a small incentive for participating. The general structure of the sessions was as follows: opening discussion regarding how last week’s tools were implemented throughout the week, introduction to the topic of the day, a guided practice, small and large group discussion, and closing. Between classes, homework assignments were not given, although participants were gently encouraged to use the tools they had learned in their day-to-day lives. See the table below for a brief overview of the tools covered each week:

Data collection

Participants were interviewed using a semi-structured guide. The interviewer had extensive training and experience in conducting interviews for qualitative analysis. The structured interview guide we developed had been previously utilized with another group of participants who had attended the training and was slightly modified for clarity and flow. Interview questions focused on participants’ initial motivation to attend the training, their experiences during the training, and the impact of the training after it was over (e.g., how they implemented self-compassion practices in their everyday lives). All interviews were recorded and then transcribed using the software Temi (Temi, 2020). Interviews ranged between 15 min and 45 min with an average length of 27 min.

Data analysis

Data were analyzed using qualitative content analysis. The goal of content analysis is to distill qualitative information into meaningful concepts or categories, providing insight into patterns and processes of the data under investigation (Elo & Kyngas, 2008). Cho and Lee (2014) explain that content analysis involves the following steps: selecting the unit of analysis (e.g., transcript and observations), initial open coding of the data, creating codes from data, coding the data, revising the codes, and developing categories and themes.

We structured our data analysis around pre-generated research questions regarding participants’ experience before, during, and after their training, but used an inductive approach to generate themes from the data in each question category (Graneheim et al., 2017). After transcription, each interview was openly coded line by line using the software NVivo (released in March 2020). After coding each interview for concepts related to the interview questions, categories were developed that represented common responses across interviews. Then, each interview was coded for these common categories. As Cho and Lee (2014) indicate the coding process was iterative and involved going back and forth multiple times between interviews to narrow down categories. Themes that portrayed the core essence of the answers to each interview question were developed, tying the various categories together for interpretation (Graneheim et al., 2017).

Ethics and trustworthiness

This study was approved by the Seton Institutional Review Board (SIRB), study #CR-19–161. All participants signed a consent form prior to participating. The research team applied several strategies to facilitate the trustworthiness, or qualitative rigor, of the study’s results. Thematic saturation is a measure of qualitative power, or the adequacy of the study’s sample size. Saturation is achieved when no new categories emerged from the analysis of the data (Saunders et al., 2018). As a pilot study, saturation was not assessed. However, as part of our analytic process, we documented the range of themes across participants in the sample (e.g., how many times a theme emerged, see Table 2). Moreover, to ensure that the categories and themes were valid representations of the data collected, member checks, in which participants read the categories and themes and provided feedback on the authors’ interpretations, were conducted with two participants. Both participants felt the categories and themes accurately represented their experience.

Results

Our findings suggest that learning self-compassion is a relational process that includes both precursors to change, as well as mechanisms of change (Table 2). As a relational process, self-compassion emerged through a connection with other people, the intervention, and the healthcare environment, and Figure 1 illustrates how HCPs developed self-compassion following the completion of SCHC. Intervention outcomes (practicing self-compassion; improved interpersonal interactions) stemmed from experiences that happened prior to enrollment in the intervention (trust in the intervention and experiences of burnout), in addition to mechanisms of change that happened during and after the intervention (social connection and self-compassion contextualized for the healthcare environment). In the following paragraphs, we will present direct quotes from SCHC participants and refer to them as HCP# (e.g., HCP1 and HCP2) to preserve their anonymity.

Figure 1.

Precursors, mechanisms, and outcomes of learning self-compassion in a 6-week intervention for healthcare professionals.

Table 2.

Themes and categories related to precursors, mechanisms, and outcomes of change.

	Themes	Categories
Precursors to change	Trust in intervention	Colleague referral (6)
	Experience of burnout	Tools to use on the job (5)
		Want to address or avoid burnout (4)
Mechanisms of change	Social connection Self-compassion contextualized for healthcare environment	Connecting with other HCPs (8) Learning how to apply self-compassion at work (4)
Outcome of change	Practicing self-compassion	Self-compassion is:Giving myself grace (5)
		Self-awareness (3)
		I Practice self-compassion with:
		Small daily gifts (5)
		Mindfulness (4)
	Improved interpersonal interaction	Self-compassion facilitates:
		Communication with others (6)
		Boundary setting (5)

Precursors to change: Trust in the intervention & experiences of burnout

HCPs revealed that their motivation to enroll in the intervention stemmed from their trust in its helpfulness as well as their experience of burnout. Referrals from previous participants and an understanding that the training was designed to meet the distinct needs of people working in healthcare cultivated a sense of trust in the intervention’s utility and pertinence. Six out of nine HCPs had been referred by a colleague who had previously taken the 6-week course. HCP5 indicated that her motivation to attend was influenced by “word of mouth because there have been other people in my clinic that have taken this particular training and said that they found it helpful.”

In addition, many of those who had similar experiences and interests (e.g., yoga, meditation, and counseling) perceived the SCHC program to be unique in its emphasis on using techniques in one’s daily work tasks and believed that the intervention would help them cultivate useful and relevant skills. HCP7 was working with a therapist outside of work but saw in the SCHC program “the special tie to working in healthcare. Because some of the stuff in counseling, it’s not realistic to do in the middle of the workday.” HCP5 shared her expectation to learn tools that could be used in “real time...when you’re...feeling activated but still have to do the work that you need to do in order to help patients.”

Additionally, experiences of burnout were crucial to cultivating a desire for change. In regard to recognizing symptoms of burnout, HCP8 conveyed this feeling in detail:

It’s a paralysis, like I’m stuck… The feeling of burning out is having no energy... When I go home, not being able to care for my baby or myself or my husband and my husband’s saying, ‘it feels like you’re giving all of who you are to work and not to us at home.’

Mechanism of change: Social connection

When reflecting on their experience during the intervention, eight out of nine participants identified the importance of connecting with other healthcare professionals during the sessions. Social connection helped participants develop common humanity, or a recognition that they were not alone in the difficulties they faced at work, a key component of self-compassion.

HCP4 expressed the value of opportunities for group discussion in each session: “I think it makes you feel like you’re not as alone when you hear others and you say, ‘Oh yeah, I have that very same thought or I have that very same experience.’” Similarly, HCP3 noted:

I really liked that it was interdisciplinary and I got to hear from child life nurses and doctors about how they’re...struggling too, and realizing that this goes across like all levels...we’re all struggling...in our own way. So I think that was very validating.

HCP1 reflected on how attending the training with other HCPs with whom she normally did not interact broadened her sense of community within her workplace: “There’s a lot of people who work here and I’ve never seen [their] face before or I see [their] face all the time…and now we have this deeper connection [because] we went through this thing together.”

Mechanism of change: Self-compassion contextualized for the healthcare environment

Participants elaborated on how learning self-compassion practices and concepts in the context of their work environment helped them understand how to practice self-compassion in their daily lives. HCP2 shared, “I go to yoga...and have these conversations outside of here, but it’s different applying it here. And I feel like the tools I learned before this training are helpful to me ...but...weren’t enough.” HCP7 expressed that having a reason to practice self-compassion at work while attending the training helped her understand how to use self-compassion practices after the training ended:

The class went through a time where one of my patients that was doing really, really well and then all of a sudden was not [doing well]. And so a lot of the stuff really applied in real world time, and then [I] thought of how it would continue to apply afterwards.

In many cases, the social connection they had developed with fellow HCPs and the facilitators during the training aided their understanding of how to employ self-compassion at work. HCP1 discussed how she gained an “accountability partner” from attending the course with a coworker in her department. At work, the coworker would reflect back to her when she was being self-critical. Interactions with the facilitator also helped HCPs incorporate the material into their work context and manage emotional challenges. HCP2 explained how one practice, “compassion with equanimity,” led to her feeling a lot of emotional discomfort. The practice is designed to address empathetic distress through a breathing exercise. It involves imagining being in the presence of someone that one cares about who is in pain and using the rhythm of breathing to send compassion on the exhale and receive self-compassion on the inhale. While breathing in this way, participants also listen to a series of phrases to help establish emotional boundaries (e.g., “I am not the cause of this person’s suffering”). For HCP2, when attempting to visualize someone to offer compassion to, “immediately it was like every kid I’d seen so far that day popped into my head.” After that session, she reached out to a facilitator who reframed the object of the practice: “I’m not responsible for this hospital’s lack of resources...that conversation was so helpful, and I still think about it every day.”

Outcome of change: Practicing self-compassion

Participants described practicing self-compassion by treating themselves with “grace,” offering themselves “small daily gifts” of physical and emotional care, and being more self-aware. Five of the nine participants depicted self-compassion as giving themselves permission to be imperfect. HCP5 remarked: “What...I learned the most is allowing myself...that grace to be human and that you can’t always do it all. So accepting... That I did the very best that I could in that moment.” Many others echoed how self-compassion helped them to accept their own limits, as opposed to saying, “I should’ve done this...and really getting down on myself,” as HCP8 mentioned. Giving themselves grace within the specific context of work also emerged in participants’ reflections. For instance, HCP6 explained how since the end of the intervention she now responds differently to herself if she does not complete all her work tasks on time by remembering, “It’s okay to [say]...you probably needed this little space where you weren’t constantly going and as efficient as possible.” Furthermore, brief mindfulness strategies allowed HCPs to practice self-compassion in their everyday life. HCP4 defined self-compassion as “being more aware of your inner dialog, and then maybe that awareness causes you to change the way your inner dialog is speaking to yourself in a way that could be more kind.” Breathing and body-awareness practices were used in the context of stressful situations at work and at home. Participants provided details about how they practice mindfulness by labeling and accepting their emotions, in contrast to trying to change them. HCP1 revealed how this technique has been helpful to her: “The practice of acknowledging what [emotion] it is...and not trying to fix it or judge it...That’s a statement that’s very final-- I’m feeling sad right now and that’s it.”

After participating in SCHC, HCPs in our study reported practicing self-compassion in small ways that help them maintain their energy. HCP5 described practicing self-compassion as “giv[ing] yourself these little gifts throughout the day because you’re worthy of them.” Other participants’ gifts to themselves were expressed as simple ways they care for their physical and emotional needs throughout the day, such as eating lunch instead of working through their break, drinking a bottle of water, or asking for a break after working a difficult case. In the fast-paced environment of healthcare, these seemingly ordinary acts of caring for the self were extraordinary changes for several participants. As HCP1 reflected, “I’m thinking about my needs on a regular basis, which although basic, is huge compared to where I was before the class, where I could go through a whole day and not even get through my water bottle.”

HCP4 shared her small gifts to herself were short exercises she could do to meet difficult emotions, “something that wouldn’t take very long but could immediately sort of change the dynamic of how I was feeling.” HCP2 felt that finding little opportunities for breaks have helped to maintain her productivity: “I can recharge every day. It’s okay to...ask a coworker…[to] cover my phone for 30 minutes...It’s not me being weak. It's so that I can be good at my job for the rest of the day.”

Outcome of change: Improved interpersonal interactions

The majority of HCPs (6 out of 9) felt the tools they learned in the course have facilitated more effective interactions with their patients, coworkers, and family. As participants became more compassionate towards themselves, they reflected on communicating more skillfully with their coworkers and family and emotionally separating themselves from others’ suffering. Participants recounted being less reactive during challenging encounters with patients and their families and acting more authentic when sharing their feelings and opinions with coworkers. Additionally, HCPs articulated how they were better able to separate their emotions and needs from those around them as a result of the training, enabling them to state their opinions or ask for what they need from others. HCP5 relayed how she uses a practice called “soles of the feet” when working with patients who are emotionally activated: “[I] just kind of feel the ground underneath me and really be conscious of my feet...It really helps me actually hear the patient better than trying to be reactive to what they’re saying.”

In regard to coworker interactions, a number of participants reflected on being better able to understand their colleagues’ perspectives. HCP1 clarified how a phrase she learned in the training, “everyone is on their own life journey” and “the idea of acknowledging that people have their own things that they bring to the table” has helped her empathize with decisions made by management with which she does not agree.

Similarly, HCP2 found learning to name her emotions helpful for communicating her opinion, while continuing to keep her coworkers’ perspectives in mind:

Normally I approach things from ‘I just don't want this person to be mad at me…’ But that's not constructive, especially in this setting, when we're going from procedure to procedure, and I want the next one to go better. I have to figure out how to express what I think and what I feel about it, while also being professional and being concerned for your feelings.

Learning to be self-compassionate seemed to motivate HCPs to create better boundaries between themselves, their patients, and their coworkers. In creating these boundaries, many of our participants explained how they were taking care of their own emotional and physical needs in the midst of their caregiving duties at work and at home. The word “separate” was used frequently to demonstrate the process of boundary setting. HCP7 commented on how, “[the course] helped me take a step back... how can I safely separate myself so I don’t get so emotionally drained every single day that I’m here?” HCP5 portrayed what it is like for her to practice setting boundaries with her family at home:

Before [the course] I ...had a really hard time trying not to solve everybody’s problems at home while also trying to solve everybody’s problems at work...this self-compassion piece helped me say, [to my family] ‘how much of that can you do for yourself?’

In particular, the course helped HCPs set emotional boundaries between themselves and the pain they observed in their patients. For example, participating in SCHC provided tools to help HCP8 better distinguish her own experience from that of her patients: “I feel what they’re feeling, and I can attribute a circumstance in my life [to what] they’re going [through]... I think [self-compassion] helped me create healthier boundaries.”

Discussion

Our findings suggest that learning self-compassion within the context of healthcare and experiencing social connection throughout the intervention facilitate the application and benefits of self-compassion for HCPs. Participants who completed the 6-week SCHC training began to practice self-compassion in the form of offering themselves grace, being more self-aware, and providing themselves with small daily gifts of physical and emotional care. The heightened ability to be compassionate towards themselves contributed to HCPs’ improved interpersonal interactions in their personal and professional lives.

There is a substantive body of research that supports the effectiveness of self-compassion interventions for promoting psychosocial outcomes in the general population (Ferrari et al., 2019) and, for HCPs specifically, improving psychological well-being and experiences of stress and burnout (e.g., Bluth et al., 2021; Delaney, 2018). In addition, researchers have demonstrated a pathway between self-compassion and reduced stress and burnout via greater emotion regulation (Finlay-Jones et al., 2015). A key question for researchers, however, is how self-compassion develops in the first place. Identifying mechanisms of change is critical to advancing knowledge of how intervention processes contribute to treatment outcomes (Kazdin, 2009). Our results indicate that the development of self-compassion is a relational process that is influenced by both social connection and the social setting.

Prior to the beginning of the intervention, relationships with colleagues had already influenced HCPs’ willingness and motivation to attend SCHC by enhancing their perception of the program’s trustworthiness and value. Social connection also facilitated how participants were able to learn and apply self-compassion. Learning in a group setting and sharing difficult emotions with colleagues helped participants experience common humanity, a core element of self-compassion. Opportunities to practice self-compassion were reinforced by coworkers, facilitators, and patients, which further integrated self-compassion into the work environment and enhanced the salience of applying self-compassion skills on the job.

Although SCHC focuses on developing a compassionate relationship with oneself, it is apparent from participant responses that becoming kinder to oneself may be more possible within the context of a supportive community environment. This finding is aligned with other research that demonstrates healthy, high-quality relationships with colleagues can mitigate individual stress (Ulrich et al., 2019). Organizational support in healthcare settings may be an especially important factor to motivate HCPs to participate in self-compassion training (Byron et al., 2015; NASEM, 2019). When HCPs feel that they and their wellness are valued by their organization, they experience better health outcomes (Melnyk et al., 2021) and lower burnout (Prasad et al., 2021). By situating self-compassion practices within their work setting, participants in SCHC may be better able to regulate their emotions, or, in HCP4’s words, “change the dynamic” of how they are feeling, leading to reduced stress and burnout overtime. Developing these skills at work may strengthen HCPs’ ability to recall and apply self-compassion exercises because the relevant context may make opportunities to practice more salient (Bergman et al., 2015).

While the word “grace” never appeared in the content of the curriculum, it was a concept over half of our participants used to translate how they practice self-compassion within their work environment. Providing themselves grace may be a way for HCPs to mitigate perfectionism, a common cause of feeling burned out (for a review see, Hill and Curran, 2016). Extending oneself grace may similarly help individuals who feel as though their efforts to achieve goals at work are fruitless, a symptom of burnout (Cocker and Joss, 2016). Indeed, prior research indicates that individuals who have more self-compassion are less likely to be self-critical perfectionists, reducing their chances of experiencing burnout and depression (Richardson et al., 2018) and are more likely to feel competent (Neff et al., 2005).

As HCPs became more skilled in taking care of their emotional and physical needs, many reported an effect on their professional and personal relationships with patients, colleagues, and family members. The SCHC participants we interviewed reported creating boundaries between their own and others’ emotional experiences. Self-compassion training may decrease secondary traumatic stress through imparting skills that allow HCPs to “separate” from patients’ and families’ needs while still maintaining a caring connection towards them. The capacity to emotionally separate from patients protects HCPs from the side effects of empathizing with others in pain (e.g., empathy fatigue) (Duarte et al., 2016) and is associated with reductions in secondary traumatic stress (Badger et al., 2008).

Each of these are examples of proactive ways to practice self-kindness that may help HCPs recharge during and throughout their workday, in contrast to reactive self-care that occurs when individuals are already overwhelmed or exhausted (Andrews et al., 2020). Through applying the skills of emotion regulation and offering themselves grace, HCPs improved their interactions with colleagues, patients, and their own families. HCPs described meeting their difficult emotions with compassionate awareness through brief, in-the-moment practices such as focusing on the soles of the feet, which allowed them to be more present in their patient interactions.

Strengths and limitations

Published research on self-compassion is almost exclusively focused on quantitative findings. Our qualitative analysis enhances the study of self-compassion by presenting a more detailed perspective of participants’ knowledge and practice. For example, participants in this study named salient features about self-compassion with novel language not included in the standard SCHC curriculum (e.g., giving themselves grace and small daily gifts). HCPs also discussed benefitting from learning tools they could use on the job, rather than something they had to wait to do after work. In a population vulnerable to burnout and on the frontline of a global pandemic, such insights about how HCPs conceptualize and practice self-compassion in their day-to-day work lives may inform tailored interventions to better support them.

Caution should be taken in regard to generalizing these findings to a broader population of healthcare professionals. First, the viewpoints represented here are those of nine individuals who self-selected to participate in interviews out of a group of 23 participants who self-selected to sign up for the training. Moreover, our nine participants were in roles that can require more intimate emotional relationships with patients (e.g., social workers and nurses), potentially making their interests and responses different from other healthcare occupations. Second, the sample was relatively homogenous—all participants were female, and the majority were White.

Recommendations for future research

It is important to further examine how self-compassion is conceptualized and practiced by a diverse group of healthcare professionals in a range of healthcare contexts. Future research should include interviews with larger samples of HCPs to represent the varied experiences of learning and practicing self-compassion within the healthcare setting. Other studies could compare HCPs who learned self-compassion with coworkers to HCPs who learned self-compassion with people outside of their healthcare organization to understand how participant workplace context impacts the quality and value of social connection. Additionally, a longitudinal study could provide insight into how long self-compassion skills are retained when taught in the workplace and determine whether some healthcare institutions are more conducive to sustaining HCPs’ self-compassion than others. Finally, future research could use the findings from this study to create interview questions for HCPs to continue to clarify how this supportive resource can be applied in the unique conditions of healthcare.

Conclusion

The importance of relationships in this study emerged throughout all parts of the interview, suggesting social connection and context are important to consider when implementing SCHC and similar training programs to reduce burnout and improve HCP well-being. The program’s effectiveness was likely influenced by the workplace setting in which the training was accepted, experienced, and reinforced by and for participants. While SCHC presumably targets an individual-level protective factor against burnout (i.e., self-compassion), it seems that interpersonal relationships and organizational support bolstered individuals’ ability to care for themselves more consistently.

The findings from this study can inform healthcare policy, practices, and protocols to create conditions for HCP well-being. By addressing the factors that participants named as influential to their well-being, such as learning tools for emotion regulation and separation, healthcare communities can integrate pertinent skills into professional development training. An environment that normalizes difficult emotions and prioritizes employee self-care may generate a resilient healthcare culture through supporting HCPs’ emotional and physical health. Hospitals should consider creating protocols for how to navigate stressful patient or colleague interactions that reinforce healthy boundaries and the importance of offering oneself grace. With these shifts, healthcare organizations may begin to extinguish some of the conditions of burnout and foster health and well-being on a collective level.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Marissa C Knox

Lauren E Gulbas

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