Empathy pays: the case for compassionate healthcare organisations

Organisations that support their staff and build compassionate cultures achieve better patient outcomes, lower costs and stronger performance, argues Professor Jeremy Howick at the University of Leicester.

A hospital that treats its staff well, maintains manageable workloads, fosters empathic leadership and creates an environment where people feel heard and valued: is that good management, or good medicine? The answer, it turns out, is both. And we can now measure it.

Research from England, Europe and the United States points to the same trend: empathy is not just a quality of individual clinicians. It is a characteristic of high-performing healthcare organisations.

To test whether empathy could be measured, we analysed data from 104 NHS hospital trusts in England, drawing on regulator (Care Quality Commission) ratings, staff surveys, workforce records and financial accounts.^[1] We then scored each trust from one to 10 across nine measures, including compassionate leadership, effective management teamwork, physical environment, sensible workload, adequate time, effective governance, practitioner empathy, fostering a culture of empathy and staff well-being.

We found that the average index score was 5.99, showing the need for wholesale improvement across the board (the highest scored 6.78; the lowest 4.88). The gap in empathy scores was associated with differences in patient safety, staff well-being and how much money was spent.

Trusts with the highest empathy scores had far better safety and care ratings than average trusts: nearly three-quarters of their sites were rated good or outstanding for safety, versus under half at average trusts. And four in five sites at higher-empathy trusts were rated good or outstanding for care, versus just over two-thirds at average trusts.

The financial signal is equally clear. Trusts with lower empathy scores spent £5.4m more on temporary staff and £760,000 more on external consultancy than higher-scoring trusts (see Figure). Staff working in more empathic organisations reported lower burnout, less sickness absence and better overall health. Supported and valued staff stay, whilst those who are not leave. This means employers must pay premium rates to fill vacancies. Empathy, in other words, is not a cost: it is a saving.

This index is built on NHS data. But the phenomenon it measures is global.

In the United States, researchers at Jefferson Medical College found that diabetic patients of the most empathic family physicians were significantly more likely to have well-controlled blood sugar and cholesterol levels than patients of lower-empathy physicians.^[1] In Italy, the same research group extended these findings to a larger population: 242 primary- care physicians and nearly 21,000 diabetic patients.^[2] Patients of the most empathic doctors had acute metabolic complication rates, including diabetic coma and ketoacidosis, of just 4.0 per 1,000 patients, compared with 6.5 to 7.1 per 1,000 for patients of less empathic physicians. One ten-year study of patients with type 2 diabetes in England found that those who rated their doctors and nurses as more empathic had a 40 to 50% lower risk of death over the following decade than those who gave them the lowest ratings.^[3] A 2024 systematic review published in the Annals of Internal Medicine, drawing on randomised trials from North America, Europe, Asia and Africa, confirmed the pattern: across diverse healthcare systems and cultures, empathy consistently improves patient outcomes.^[4],^[5]

The workforce evidence crosses national boundaries too. A study published in The Lancet in 2014 examined over 400,000 surgical patients across nine European countries.^[6] Each additional patient added to a nurse's workload increased the odds of that patient dying by 7%. Overloaded, unsupported staff cannot deliver the attentive care that keeps patients safe. Addressing this is not spending on welfare. It is investing in survival rates.

Beyond healthcare entirely, the Global Empathy Index ranked major international companies on empathic culture across ethics, leadership and employee experience.^[7], ^[8] It found that the top ten most empathic organisations generated 50% more earnings than the bottom ten and grew in market value more than twice as fast. The link between empathy and performance is not a peculiarity of any one sector, but a structural feature of how organisations function, whether they are delivering healthcare in Bologna, Bradford or Baltimore.

What unites these findings is a consistent signal: organisations that invest in the conditions for empathy outperform those that do not. Safer patients, healthier staff, lower costs. Empathy is, by any serious measure, one of the most cost-effective levers available to healthcare systems under pressure.

This has immediate implications for how systems are evaluated. Current performance frameworks prioritise clinical activity, waiting times and financial balance. They measure outputs, not cultures. Leaders should incorporate measures of organisational empathy into routine monitoring, giving themselves an actionable upstream indicator which predicts performance before harm occurs, rather than measuring it after the fact.

The practical priorities follow from the evidence: sustainable workloads, empathic leadership,^[9] investment in staff recognition and well-being. These are not luxuries to be funded when budgets allow. They are the infrastructure of a high-performing healthcare system, and the evidence consistently shows they pay for themselves.

Healthcare systems everywhere are searching for ways to do more with less. Sometimes the answer is not to spend more but to invest more wisely—in the cultures and conditions that allow clinical excellence to flourish. Being an empathic healthcare organisation is not an ethical aspiration. It is a financial strategy.

Views or opinions expressed are those of the author and any individuals cited, and do not necessarily reflect those of Economist Enterprise or any other member of The Economist Group.