The principles of patient-centred care are increasingly stressed as part of health care policy and practice. Explanations for why some practitioners seem more successful in achieving patient-centred care vary, but a possible role for individual differences in personality has been postulated. One of these, emotional intelligence (EI), is increasingly referred to in health care literature. This paper reviews the literature on EI in health care and poses a series of questions about the links between EI and patient-centred outcomes.
Papers concerning empirical examinations of EI in a variety of settings were identified to determine the evidence base for its increasing popularity. The review suggests that a substantial amount of further research is required before the value of EI as a useful concept can be substantiated.
Although work conceptualizing EI was underway in the early 1990s, popular interest in EI arose from Goleman’s ‘Emotional Intelligence: Why It Can Matter More Than IQ’, which suggested that life success depended more on the ability to understand and control emotions than on IQ.14 As is often the case with psychological constructs, the use of a variety of terms makes it difficult to agree on an overarching definition of EI, and it has been referred to as emotional literacy, the emotional quotient, personal intelligence, social intelligence and interpersonal intelligence.15 Perhaps one of the best and most circumspect definitions of EI is ‘a set of abilities (verbal and non-verbal) that enable a person to generate, recognize, express, understand and evaluate their own and others’ emotions in order to guide thinking and action and successfully cope with environmental demands and pressures.’16
Some view EI as a fixed and stable personality trait which is measured using self-report questionnaires of typical behaviour, others see it as a more dynamic personal quality measured using maximal performance measures which quantify actual performance. An example of this would be the difference between asking someone about their problem solving approach and giving them a problem to solve. A self-report format can be open to manipulation through learned or faked responses. However, the validity and reliability of these measures is more established than maximal performance measures, which are less open to faked responses but whose consensus scoring has been criticized for being subjective.
The fact that this conceptual distinction exists has generated much discussion on how best to measure EI and somewhat complicates the comparison of the few empirical studies that have been conducted. Matthews et al.17 have suggested that different measures of EI quantify different things, and in addition that the correspondence between different versions of scales demonstrates lower correlations than would be expected. Perez et al.18 have suggested that trait EI instruments measure emotional self-efficacy while ability measures of EI measure cognitive-emotional ability
EI IN HEALTH CARE
Whilst there has been a recent increase in the discussion of EI in health care literature, most of the references are based on unsubstantiated claims of the theoretical importance of EI and assume that EI is a quality that can be altered or improved. However, there is a small but growing empirical literature which suggests that there may be a role for EI in the health care setting.
If we are to determine whether there is a role for EI in health care, it must be rigorously evaluated where its value is hypothesized. The state of the current evidence base suggests that there are a number of questions which need to be posed before any conclusions as to the usefulness of this construct can be reached. Based on our understanding of the construct of EI and the way in which it has been employed in non-health settings, we addressed the strength of evidence for the relationship between EI and four areas which would seem to be important questions for health care.
How EI in health professionals might impact on patient-centred care, patient satisfaction and quality of care;
How EI might impact on issues of job satisfaction and performance;
Whether EI training for health professionals may impact on personal as well as patient-centred outcomes;
Whether measurement of EI should be part of the selection and recruitment process for health care professionals and students.
EI AND PATIENT CARE
Most complaints about doctors relate to poor communication, not clinical competence, and improving communication in health care is a current area of interest in policy and practice. Given the emphasis on insights into one’s own and others’ emotions that are described by models of EI, it might be offered as an explanation for why some practitioners appear to be better at delivering patient-centred care than others.35 Assessing and discriminating patient’s emotions could have an impact on the quality and accuracy of history taking and diagnosis. In addition, if clinicians are able to understand patients’ emotional reactions to prescribed treatments or lifestyle advice they may be better able to understand why some treatments are more or less acceptable to some patients. The ability to manage and read emotions would seem to be an important skill for any health professional and might potentially enhance patient-centred care, improve the quality of the professional-patient relationship, and increase patient levels of satisfaction with care and perhaps even concordance.
Only one study directly examined the impact of EI in practitioners on outcomes relevant to patient care, and it reported only a limited relationship between physician EI and patient satisfaction.36 They administered an EI measure to 30 residents in an academic family medicine department. Only the EI sub-scale of happiness in the residents showed any relationship to satisfaction in the patients they treated.
EI AND JOB SATISFACTION AND PERFORMANCE
Given that EI is hypothesized to be important in recognizing and processing our own as well as other people’s emotions, higher EI could impact positively on job satisfaction and performance. For example, there can be tensions from many spheres of practice—from the macro (organizational) to the micro (patient/colleague)—which can produce feelings of frustration and anger. Being better equipped to recognize and manage such feelings may allow practitioners to experience fewer incidents of job related stress. Health care practitioners who are disillusioned, over-stressed or burned out are unlikely to be able to deliver good quality care and communicate well with patients.
Three studies have examined relationships between EI, work stress and burnout in health care professionals. One reports the added value of considering the EI of subjects in connection with levels of stress. They described a link between EI and burnout in nurses measured at two different points in time.37 In a similar study of work stress, no direct relationship between EI and work stress was identified, but nurses with more job experience had higher levels of EI.38 In the third study, low EI was associated with higher perceived stress in dental students.39
While the above studies have begun to examine relationships between EI and stress and burnout in individuals, such problems occur within the context of the health care organization. A wider approach to this area may need to examine the organizational culture in which health care is delivered and whether an organization can operate in an emotionally intelligent way to reduce stress and burnout. There is a body of literature which discusses EI at the level of the organization. However, as with the individual-focused research, there is no definitive evidence linking EI to organizational performance
There is an increasing interest in the construct of EI. The construct has certain face validity and despite little empirical work is proving attractive in many areas, including health care, where the search for abilities and characteristics which can improve the patient-centred qualities of health care professionals and ways in which we can improve training goes on. However, on the basis of the literature we have reviewed it would seem a pity if EI were to be accepted as unquestioningly in health care as it has been in other settings.
The construct of EI is not without its critics and problems. There are difficulties in agreement over its conceptualization—whether it is a dynamic quality which can be trained or improved, or a more fixed personality trait. There is little published empirical work and much of the data that are collected are held in proprietary databases which are not available for independent scrutiny. All of these problems make comparison of the few studies available difficult, and critics of EI suggest that these problems are sufficiently serious to make the construct of EI irrelevant and unusable; however, there are others who, whilst recognizing the problems, nevertheless feel the construct has sufficient promise to merit further attention but call for careful scientific study and caution the claims for its use until further work is done. It would seem premature to discount EI as a useful tool for health care settings completely, but it does require a rigorous examination before any real claims about its utility can be made.
While these limitations may seem damning to the construct of EI and its future use, similar debates have taken and still take place in the measurement of many psychological constructs, including standard intelligence (IQ) and many other measures of ability and personality, and EI is therefore not unique in having such criticisms levelled at it. For example, some may argue that empathy is a skill which can be developed and is one of the aims of medical school curricula which stress patient-centred care. Others may suggest that empathy is inherent in personality and a core characteristic of a person which is unresponsive to training and education. In reality, the likelihood is that for both empathy and EI the truth may lie somewhere in the middle, with contributions from personality, the culture of the health care organizational environment and personal life experience.
R Soc Med. 2007 Aug; 100(8): 368–374.doi: 10.1258/jrsm.100.8.368
Emotional Intelligence and Patient Centred Care
Rasalkhaimah, ras, al, khaimah, dubai, university, salford, manchester, @hishamsafadi, hisham, safadi, European, medical, center, business, entrepreneur, startup, economy, money, motivation, education, Leadership, Transactional, analysis, emotional, intelligence, organisations, development, innovative, technology, care, health, investor, investment, production, shark, tank, sharktank, USA, UK, London, group, european, canada, india, china, japan, KSA, projectmanagement, datascience, bigdata, IOT, internetofthings, cloud