Program Leaders’ and Educators’ Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study

Figures & data

Table 1. Thematic framework.

Category	Theme	Sub-theme
Origins, Foundational Principles and Purpose	Origins & Foundational Principles: Leaders, Learners and Government Initiatives	Leader identified need
		Learner identified need
		Governmental identified need
	Purpose: Developing Compassion to Others, a Compassionate Self, and Compassionate Leaders	Leadership training to create conditions where compassion can flourish
		Nurturing healthcare providers’ innate capacity for compassion for the primary benefit of self
		Nurturing healthcare providers’ innate capacity for compassion for the primary benefit of others
Curricular Content	Mindfulness Meditation Theory and Techniques: Integrating Mindfulness into Compassion Training
	Intrapersonal Theories and Knowledge to Help Foster Compassion: Cultivating Self Kindness to Cultivate Compassion
	Interpersonal Theories and Knowledge to Help Foster Compassion: Interpersonal Skills to Establish a Compassionate Connection
Methods of Teaching and Learning	Meditation Practice: Contemplating Compassion
	Experiential Learning: Self-reflection and Creative Techniques to Enhance Compassion
	Patient Narratives and Case-based Learning: Patients as Teachers of Compassion
	Group Learning: Learning and Listening from Others
	Clinical Skills Development and Evidence-based Learning: Embedding Learning in the Practice Setting
	Compassion Toolkits: Supplemental Learning Resources to Sustain Learning
Trainer Qualities: Guide to the Side & Embodied Teaching	Teaching Skills: Guide on the Side
	Embody Compassion: Exemplifying Compassion in the Character of the Trainer
	Contemplative and Self-care Practice: Knowing and Caring for Oneself
	Empirical Knowledge and Clinical Experience: Knowing the Organizational Culture and Practice Setting
Challenges and Facilitators of Compassion Training Programs	Learning Challenges: Background, Values, Expectations, Personal Issues, and Misperceptions of Compassion Aptitude	Misconceptions about the purpose and content of the course
		The expert mind: learners preconceived compassion competence
		Unmotivated learners & personal issues
	Facilitators: Situating Training Programs for Success – Successful Compassion Training Programs are Supportive, Situated, Individualized, and Accessible to Learners	Pre-orientation training and commitment to change: creating and sustaining the conditions for compassion to flourish
		Assess individual learner needs in order to tailor training
		A desire to learn & supportive learning community
		Accessible learning
Evaluation and Impact of Compassion Training: How is Training Assessed and Who Determines Impact?	Measuring Success & Missing Measures: Learner Reported Outcomes and the Need to Integrate Patient Reported Outcomes	Missing metrics: the need for patient reported compassion as a training outcome measure
		Learner outcomes and self-assessments as measures of success
	Impacts: Reported Outcomes	Perceived patient impact
		Improved HCP personal and professional wellbeing
		Perceived impact on clinical practice
		The ripple effect: organizational impact

Table 2. Recommendations for the development of a compassion training program.

Organizational commitment is required to create a culture of compassion, sustain compassion, and provide compassion training needs Compassion training programs should be adaptable across organizations and engage multi-disciplinary healthcare staff, with all iterations underpinned by a core framework The organizational model must acknowledge the importance of effective leadership to create a ripple effect Curricula content should consider compassion as the construct of interest and include an assessment of what patients want from learners in terms of experiencing compassion Training must include a clinical-skills based component to equip learners with the behaviors, skills and attitudes needed in providing compassion in patient care The program should incorporate a mix of experiential, online and in-person teaching Facilitators must embody compassion, including a co-facilitator grounded in clinical practice and the organizational culture A learners’ needs assessment should be conducted prior to training The program must be evaluated with valid and reliable measures, including a patient-reported measure of compassion