CULTURE OF SEVA

 By: Arun Datta, COO, Seva At Home

In the Indian culture, the word ‘Seva’ connotes selfless, empathetic, trustworthy and respectful care provided mostly by the family members, to elderly and convalescent members of the family. It embodies within itself a level of empathetic care which only a close family member can provide. Even in difficult times, Seva creates a sense of warmth, joy and happiness in the family, wherever it is practised.
We at Seva At Home, wish to nurture a culture in the organisation which is infused with this ethos of Seva. We believe this can be achieved in an environment where there is no gap between professed and operant values, and where performing Seva can lead to personal and spiritual development.
The ‘Culture of Seva’ which we wish to nurture at Seva At Home is built of five pillars. These are:

1. Compassionate Seva
2. Trusted Seva
3. Respectful Seva
4. Joyful Seva
5. Art and Attitude of Seva

COMPASSIONATE SEVA:

Before commencing on establishing a culture which provides Compassionate Seva to the patients, it is necessary to clarify a few concepts about Empathy and Compassion, because both these terms are sometimes used interchangeably, though they are quite different. Empathy really is of three distinct kinds: Cognitive empathy which is the ability to understand another person’s perspective, Emotional empathy which is all about our ability to understand what someone else feels, and Empathic Concern, which gives us the ability to sense what another person needs from us.
After understanding and developing empathy, what is it then that triggers us to act and to take the next step? That is exactly where compassion steps in. Thus compassionate behaviour stems from empathy and requires display of empathy in our behaviour. If compassionate Seva is practiced in a healthcare setting, you take empathy a step forward and act on it to provide compassionate Seva! You feel the distress when you meet someone in distress and want to help! Compassion makes the difference between understanding and caring to give Seva!
What does one do to provide Compassionate Seva? Empathy can be developed. That’s the conclusion suggested by research conducted with physicians by Helen Riess, the director of the Empathy and Relational Science Program at Boston’s Massachusetts General Hospital. Those who are utterly at a loss may be able to prime emotional empathy essentially by faking it until they make it, Riess adds. If you act in a caring way—looking people in the eye and paying attention to their expressions, even when you don’t particularly want to—you may start to feel more engaged.
While Empathy can be taught, learnt, and practised, Compassion can however only be nurtured in the culture by valuing fellow human beings, whether they are Patients and their family members, employees including Clinicians, Vendors etc. Cultivating compassion broadly means extending compassion to employees, doctors, nurses, vendors, in short to everyone who walks in to Seva At Home. It must start with Partners, Providers and Employees because they are the ones who are at the frontline interacting with Patients, Families, Vendors etc. If these frontline Providers are treated dispassionately, they will simply not display compassion. Only option is to have a team of well treated, engaged, happy, compassionate Providers!

TRUSTED SEVA

Like we dealt with Compassionate Seva, we shall start again by clarifying few concepts. What do we understand by the term ‘Trust’?
The first thought that comes to mind is of ‘Competence’, i.e. for anyone to be trusted he or she has to be competent. Advice or guidance from any individual becomes acceptable only when we assume the individual to be competent.
The second thought that come to mind is of the ‘Context’ in which we are interacting. While a competent driver may be trusted to drive a car well, can he be trusted also to prescribe medicines to us?
The third thought in mind is of ‘Openness and Honesty’. Does the person that you are interacting with come across as open and honest, or do you get the feeling that he is hiding something important? Do you get the feeling that there is a catch somewhere which is being hidden from you, and the person that you are dealing with has an ace up his sleeve!
The fourth thought that comes to the mind is of ‘consistency’. Are you dealing with someone who is changing his stance quite often? Is his behaviour consistent with advice? I remember once being in the hospital room with someone in the family, when this senior physician walked in and instead of coming towards the patient headed straight for the washroom! He stopped at the washroom door and closed the door, which was open though the washroom was not in use. What followed was ten minutes of impressive hygiene lesson by him, of how washrooms can be a major source of infection. Next day though the same physician walked in, again unfortunately at a time when the washroom door was open. This time though he did not even look at the door, just did his usual checks and walked out, without bothering about the open washroom door!
The fifth thought that comes to mind when you think of Trust, is ‘Concern for others’. Have you met people who volunteer to do anything often? Are they the ones who are willing to donate for a cause? Do they listen to others without bragging about themselves, and make the conversation about others and not about themselves?
Ever wondered why is Trust so important in healthcare settings? The poor patient has, most of the time, no control on what is being prescribed, what prices are being charged, has no control on outcomes and does not know if he will be able to live life the way he is used to, and in fact sometimes does not even know if he is going to walk out alive! Just imagine if such a patient is in a setting where he feels he cannot trust those who are providing Seva!
Warren Buffet is credited to have said, “Trust is like the air that we breath, when trust is present no one notices it, and when it is absent everyone notices it.” Some other noticeable quotes are, “Trust is like the glue which keeps everything together and keeps people motivated” and “Trust is most powerful tool, hardest to create and it is fragile”.
How does one create Trust within the culture of Seva At Home? Let us go through our initial thoughts on Trust, when we said that trust requires, Competence, Context, Openness and Honesty, Consistency and Concern for others.
I have heard a lot of Healthcare organisations saying ‘Competence’ is of utmost importance to them, and the same set of organisations turn around and build the most opaque performance management systems, almost non-existent criteria for recruitment, giving last priority to learning and development. At Seva At Home we are working to implement strict international standards to ensure competence is evaluated, recognised and rewarded. We are transparent enough to provide all our patients the evaluation and anecdotal data of our caregivers, as evaluated by their patients themselves.
Trust in ‘Context’ of healthcare requires us to be right the first time. Healthcare service is not replaceable, not repeatable, cannot be mechanised, and cannot be copied and does not give us a second chance. We have to be right the first time that we provide care!
‘Openness and Honesty’ gets ingrained in the culture when people are friendly, there are tested channels of communication, there is good amount of transparency in various activities, fewer instances of cloak-and-dagger encounters, lesser political groups and coteries.
‘Consistency’ is all about practicing time and again over a long period of time, what we preach. Any differences between stated and operational values of the organisation, deal a body blow to establishment of Trust in the culture. If there are any stated values about patients, about employees, about vendors, about establishment, adhering to those stated values by itself generates Trust.
‘Concern for others’ can only be demonstrated through our behaviours of volunteering, donating, listening without evaluating, and making conversations about others, rather than about ourselves.
Trust begins with competence and reliability. People need to know that we are experts in our field, we are skilled, we are continuously updating our knowledge, and we are reliable enough to do what we are capable of! Hence creating systems which strengthen Competence and its communication to the world are important tools.

RESPECTFUL SEVA
Respectful Seva works both ways i.e. not only the patients to be treated with respect but all Providers should also be treated with professional respect. Let us start with some rights of the Patients that should be understood and practised to provide respectful Seva!
The first right of the Patients that should be treated with respect is the ‘Right for information’. Providers are required to provide adequate information about the Seva that they are equipped to provide. If the patient is not in a state to understand this, the Provider is required to provide the information to the family members who are participating in the Seva process.
Apart from this, patients have the right to know the identity and professional status of every Provider who is providing Seva. Information regarding costs of Care needs to be provided.
The second right that needs to be respected is that Patients or their family members who are participating in Seva have the right to access the original documents and reports generated in the Seva giving process. These may be hard copies of the documents or electronically generated reports on our app.
The third right of the patient that should be respected, applies to those situations where the Seva Provider, a qualified Nurse or a Doctor, carries out any invasive procedure at home. They may do so only after the patient has been explained the risks and consequences of the procedure and a consent form has been signed by the patient or by a family member.
The fourth right that needs to be respected utmost in Home healthcare situations is the right to dignity, privacy and confidentiality. Perhaps while giving Seva at home, a Seva Provider is likely to receive more personal and private information than even while the patient is admitted in a hospital. A Seva Provider at home may need to disrobe a patient often to help in bathing, may need to help the patient defecate or urinate, may have to help cleaning post defecation or urination, and in all these situations, respecting a patients privacy and dignity is of utmost importance. This right to respect a patient’s dignity becomes all the more important when the Seva Provider and the Patient are not of the same gender!
Fifth and perhaps the most important right that needs to be respected is that every patient of Seva At home is entitled to safe and quality care according to standards adopted by Seva At Home. These standards define Access to Healthcare at home, an assessment of Patient’s needs, providing access through Seva partners to Clinicians and diagnostic services, Patients’ rights and responsibilities, Rights of the Seva providers etc.
While patients who are at the receiving end of these services have their rights, but the Seva providers have their rights too that need to be respected. All Seva providers, whether they are Nurses, Nursing Assistants, Para Medical Care providers or Clinicians and Doctors, are professionals working according to the tenets of their professions, providing Seva to the patients. They are expected to provide only such Seva that their profession provides for, and only such Seva that they have been trained to provide.
In healthcare at home, instances when such professionals are expected to do beyond their calling are numerous. While we at Seva At Home do not discourage our Seva Providers to help the patient or their families beyond what is expected of them, however we believe making demands on such Seva Providers to perform tasks not ordinarily expected of them, may amount to disrespect to their professional status.
JOYFULL SEVA
Before we proceed to nurture a culture of Joy and Happiness in Seva At Home, let us try and understand the connection between Joy, Happiness and Health. At Seva At Home, we wish to look beyond physical health, and promote emotional stability, clarity in thinking, and the ability to embrace a continuing sense of spirituality. We believe it is possible to create joy and happiness by a combination of physical, emotional and spiritual health.
We will create happiness at Seva At Home in patients, by not only providing services which ensure their physical health, but by giving additional emotional and spiritual help by engaging with counsellors, mental health specialists, spiritual guides etc.
We will strive to create happiness amongst patients under Seva At Home’s care by not trying to change them, accepting them as they are and assuming that they are right in their own perspective. Any debates with patients over their opinions, their judgement, their preferences etc. is likely to create unhappiness. The only exception can be in terms of medical advice, which we should strive to implement without exception.
We will work with our partners, providers, employees to create happiness at their work places. These efforts will increase employee visibility, employee engagement, and by empowering employees to increase their social influence to become brand ambassadors on social media. It is important to us to carry our associates on a journey in which they achieve inner peace by providing service to those who need us.
ART AND ATTITUDE OF SEVA
The Art of providing service requires us to understand that even if we provide one experience of extra ordinary service to our patients, they will never settle for any thing less.
Our Attitude of Seva, or our inclination to do our best while providing Seva is driven by our own levels of contentment, by our inclination to seek help when we need it, and our levels of humility which allow us to express regrets, as and when we do not come up to the expectations of our patients.

If our levels of personal contentment are driven by recognition, money, power, or relationships, it may be fleeting and may change our levels of contentment depending on how much money do we have, or how much influence we have on others. On the other hand, contentment due to a satisfied and smiling patient is everlasting.
If our attitude does not allow us to seek help, when we need help, it may interfere with our ability to serve others. We are not born perfect and may at times require emotional, or intellectual help. Expressing such need openly and seeking help when required, increases our ability to serve others, increases our intellectual integrity, sheds the know all attitude. We are no longer then prisoners of perfection.
Humility and our ability to express regrets allows us to understand where we have gone wrong. Expressing regret is in fact the first step towards improving the quality of service. Expressing regret also saves us from a ego trip and take us on an integrity trip!
We at ‘Seva At Home’ are confident of working to nurture the ‘Culture of Seva’ and more specifically Compassionate Seva, Trusted Seva, Respectful Seva, Joyful Seva, and practise the Art and Attitude of Seva!