Promoting kindness through media increases patient satisfaction in an emergency department: a simple intervention to uplift patients and lower stress

Abstract

Introduction

One of the compelling reasons for healthcare leaders to nurture a kinder organisational culture is that kindness buffers stress by creating connection. As stress affects both patients and staff and increases negativity, burnout, distrust and incivility, the impetus for fostering kindness is much greater than just being nice.

We have been deploying kindness media (KM)—short form videos depicting acts of kindness and caring—in healthcare. Seeing KM reduces stress and uplifts patients and staff in non-critical settings.

The emergency department (ED) is a particularly stressful environment. In the ED, patients’ personal stressors are amplified by wait times, anxiety and illness.

Objective

The goal of this observational study was to assess the impact of KM in a level 1 trauma ED. Two questions were addressed. Did KM affect how patients felt? Did viewing KM affect patient satisfaction with their care?

Methods

KM was displayed on waiting area televisions. Questions were added to the patient experience survey (Press Ganey (PG)) to assess if patients watched KM and, if yes, how it made them feel. We report PG topbox scores (percentage of responses as ‘very good’).

Results

3176 survey responses were included in the analysis. Of these, 361 patients (11%) reported that they had watched KM. Of the 361 patients, 54% reported feeling more positive.

In general, patients who watched KM had significantly higher top box scores across care-related questions stratified by waiting time satisfaction. For example, the top box percentage differences for ‘overall rating of care’ were 9%–27% higher in KM viewers (all p<0.001). Similar results were observed for multiple other questions, including ‘Likelihood to recommend our ED’ and ‘I was treated with respect and dignity’. KM partially offset the negative impact of waiting time.

Conclusions

Viewing KM in this ED is associated with a positive shift in patient perception of their care experience.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• It has been previously shown in healthcare that seeing acts of kindness and caring in media rapidly increased positive emotions (eg, happiness, calm, gratitude), decreased negative emotions like irritation and stress and promoted generosity. These findings in patients and staff are very consistent with multiple studies outside of the healthcare environment. That is, kindness media exerts positive effects on emotions and behaviour (including generosity).

WHAT THIS STUDY ADDS

• This study looks beyond the immediate emotional and behavioural reactions to the media; it shows for the first time that kindness media is associated with a positive shift in patients’ perspectives regarding their care. It also provides evidence of similar effects in other healthcare environments.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Positively shifting patient perspective, likely through lowering their stress, can enable better patient outcomes and impose less stress on staff. As kindness media needs no training and minimal staff involvement, it provides a low resource-requiring intervention to promote kindness (civility) and lower stress in healthcare. Future research projects will examine the impact on patient behaviours as well as staff satisfaction and outcomes.

Introduction

Much has been written regarding the importance of promoting kindness and compassion in healthcare.^1–4 These articles have rightly focused on practical, relevant and valuable recommendations for leaders to steer organisational systems and culture more towards ‘helping others do better’. By doing so, leaders can ‘prevent occupational distress and support professionals who are suffering from the emotional exhaustion and cynicism of burnout’.¹ Relieving staff stress will yield a better care experience for patients.

Yet leaders may be confronted with resource limitations to accomplish and sustain these goals. To complement these specific, kind actions, it is also desirable to regularly infuse a culture of kindness into the organisation. The goal is to be able to foster better decisions, actions and interactions based in feeling connected to others as part of a greater organisation that serves the members of its community, including patients and visitors.

Having patients and visitors be an active part of a kind organisation can also contribute to satisfaction with their care and the trust that they feel. As emotions and behaviours are highly contagious,^{5 6} it is predictable that patients have a part in enhancing staff well-being. It is easy to conceptualise a virtuous cycle between patients and staff that kindness can catalyse. And of course, this directly translates to greater patient loyalty and future revenues, aspects that leaders must pay attention to.^{7 8} Most importantly, when both patients and staff flourish, outcomes will improve.

We began examining the effects of kindness media (KM) several years ago in our clinical environment. The goal is to use the neuropsychology of seeing kindness to inspire connection, uplift patients and staff, and naturally foster kind behaviours without being too directive or critical. This approach has much appeal as it does not require staff training or time and can complement specific actions to improve staff and patient well-being.

KM are short videos portraying acts of kindness, caring, connection and love. Our overall goal is to uplift (and lower stress) for both patients and staff such that when they come together, the quality of their respective care experiences rises. A 2-min sample video can be seen here.

In a previous study in a paediatric dental practice, KM displayed in a waiting room significantly uplifted both parents and staff and fostered happiness, calm and gratitude in comparison to children’s commercial programming. It lowered irritation in staff. Viewers of KM were also more generous, more often making a monetary donation to a needy family.⁹

The above field results are consistent with multiple academic studies that short inspiring videos depicting acts of kindness and caring (referred to as ‘prosocial’ media by psychologists) induce an emotion called elevation. Elevation ‘is a warm, uplifting feeling that people experience when they see unexpected acts of human goodness, kindness and compassion’.^10–13 A critical feature of elevation is that it creates a transcendent sense of feeling connected to others.¹¹ This is important as connection is a well-described stress buffer.¹⁴ Finally, participants exposed to KM are more generous, making donations of time or money.¹⁵

By fostering kindness and connection and lowering perceived stress in the healthcare environment, it is possible to positively shift both patient and staff experience. As stress negatively affects how both patients and staff think and behave (worsens decision-making, attention, incivility, negativity biases, etc.), interventions that reduce stress can significantly impact both the care experience and quality of care.^16–18

Figure 1 graphically integrates these various stressors and shows how they may affect patients in an ED environment. It is not surprising how the aggregate stress load can not only worsen a patient’s experience but also lead to patient aggressiveness and violence. Stress reduction, through fostering a warmer and kinder care environment, is an important aspect of elevating the care experience for both patients and staff.

Figure 1. Conceptualising the experience of patients arriving at the emergency department. Patients arrive at the hospital shouldering multiple burdens, including the anxiety of what is ailing them (A). In the emergency department waiting area, they are also exposed to more potential stressors, including wait time, media exposure, other patients and staff (B). As stress impedes cognitive function, creates a more negative outlook and can generate incivility to staff, it is important to help uplift patients and their families to alleviate stress as much as possible (C). Designed by D. Fryburg; Created by C. Roberto.

One of the places in a health system where providing a consistently high quality patient experience is particularly challenging is in the emergency department (ED). Patients enter the healthcare experience already shouldering their personal stressors like family and work issues. Even in less acute settings, patients are often weighed down by concern whether or not the provider is going to listen to them or find something wrong with them.¹⁵ In an ED, the patient’s anxieties are very often markedly heightened, as are those of family members, which partly explains patient and visitor aggressiveness.¹⁹ The incivility and aggressiveness from patients certainly impact the staff.

Stress in the ED can also be exacerbated by waiting, which often leads to lower patient satisfaction and sometimes to violence.^{20 21} Many may have delayed care experiences because of the number of other patients and relative severity of their problems. This is an important consideration in the evaluation of survey data as perceived, prolonged waiting time can negatively influence the assessment of care.²¹

The overarching goal of the present study was to determine the response to KM from patients in an ED waiting area. We wanted to address two questions. First, how did patients in this stressful setting respond to the media? And if this was positive, was there any relationship to their assessment of their care? That is, was seeing KM associated with a shift in patient perspective of their care?

Methods

The study was performed in the ED waiting area of Froedtert Hospital (Milwaukee, Wisconsin), a level 1 trauma centre and ED and the teaching hospital of The Medical College of Wisconsin. This waiting area has multiple televisions that prior to the study would display different cable television channels. At the beginning of the study period, three of the five televisions displayed KM and the others cable television. The videos displayed in the present study included an expanded portfolio of those used in an earlier randomised, comparator-controlled study.⁹ Patients were not given any instructions regarding what to watch. The media was simply playing in the background.

All patients were sent survey questions by email as usually undertaken by the hospital. Core questions (Press Ganey Emergency Department survey) regarding satisfaction with waiting time, courtesy of the providers, likelihood to recommend the ED, etc., were rated on a 5-point scale including ‘very poor’, ‘poor’, ‘fair’, ‘good’ and ‘very good’. Supplemental questions were included to establish if the patient watched television; if they saw KM; and if yes, how did the KM make them feel (online supplemental table 1).

The survey collection period for this study extended from June 2022 until May 2023. No clinical information (including acuity and waiting time in ED) is available for individual patients to maintain privacy. This project was reviewed and approved as a Quality Improvement project and exempted from IRB review per Froedtert Hospital procedures.

Data analyses

Patient characteristics were summarised using descriptive statistics (cell counts and percentages for categorical variables; n, mean and SD for numeric variables).

The 5-category patient satisfaction variables (‘very poor’, ‘poor’ ‘fair’, ‘good’ or ‘very good’) were analysed using a two-way logistic regression model that included saw KM (yes or no). The logistic regression model also included age, gender and race as covariates.

The dichotomised patient satisfaction variables were further analysed with a similar logistic regression model where KM was analysed as: did not see KM, saw KM and responded positively and saw KM but did not respond positively. As this study was exploratory in nature, no adjustment for multiple comparisons was planned or implemented. No imputations of missing data were used; only observed data were analysed. P values <0.05 were considered statistically significant. All analyses were conducted using R V.4.3.3 (R Foundation for Statistical Computing, Vienna, Austria; <https://www.r-project.org/>).

Due to differences in waiting time satisfaction between groups, we stratified five-category and dichotomised patient satisfaction responses by three waiting time satisfaction strata: ‘very poor/poor’; ‘fair’ and ‘good/very good’. Full distributions of stratified responses are included for completeness (online supplemental tables 2 and 3) and are the basis for statistical comparisons.

We chose to focus the results on top box scores, that is, the percentage of patients responding in the most favourable category (ie, response of ‘very good’) to each survey question as that is the prevailing practice among hospital leaders. However, we have included the entire distribution of responses for two of the questions in the main body of the paper and for all of the other questions in the online supplemental file.

Qualitative statements regarding the effects of kindness media

To complement the results from the ED study, we have included in the results section qualitative and unsolicited observations from other healthcare settings regarding how KM have affected patients and staff.

Patient and public involvement in study planning

No patient was involved in the study planning process.

Results

A total of 3176 patients who were 18 years of age and older who had visited the ED and returned a survey were included in the analysis. Of the 3176 patients, 361 (11.4% of total) patients reported that they saw KM. The mean age was similar across viewing groups; the overall mean (SD) was 53.1 (17.8). Table 1 summarises the gender and racial demographics by viewing group. A larger proportion of females than males saw the media (12.8% vs 8.3%, p<0.002). There were no racial differences across the viewing populations.

Table 1. Demographic summary for media viewing groups.

Demographic variable	No kindness media	Kindness media
Age
Gender
Female	1791 (64%)	263 (73%)
Male	1024 (36%)	96 (27%)
Race
Black	798 (28%)	115 (32%)
White	1785 (63%)	226 (62%)
Other*	223 (8%)	18 (5%)

^*Includes patients of both Asian American and Hispanic heritage; they are included in one group as there were very few in the KM category. (%) indicates the percentage of patients within that group, No KM v Saw KM.

Of the 361 patients who saw the KM, in the days to weeks after their emergency room visit, 198 (54%) recalled that it made them feel positively. The remainder reported feeling the same (42%) or less positive (3%).

Given that a large percentage of patients who recalled seeing the media noted that it made them feel more positively, we conducted an exploratory analysis to determine if seeing the media affected how KM viewers perceived their care experience.

Data were initially separated into two groups: those patients who watched KM and those that did not. What we noticed from this first level analysis was that those who did not see the KM reported waiting time satisfaction top box percentages of 57%, in contrast to those that saw KM, of 30% (p<0.001).

Despite this large difference in waiting time satisfaction, the Yes KM group in 16 of the 20 care-related questions (eg, courtesy of the nurses; courtesy of the doctors; likelihood to recommend ED, etc.) had top box percentages numerically greater than or equal to the No KM group. In general, these were either borderline statistically significantly or not statistically significantly different. For completeness, top box scores for all questions in this analysis are included in online supplemental table 2.

Given the imbalance in waiting time satisfaction, we stratified the responses by waiting time rating to better directly compare patient responses. The distribution of responses regarding ‘overall rating of care’ and the ‘likelihood to recommend’ is summarised in table 2. As can be seen for ‘overall rating of care’, within each stratum of waiting time, those patients who saw KM had a shift in the percentages of responses towards the right (higher ratings of ~9 to 22 top box percentage points). These distributions were significantly different from one another.

Table 2. Summary of all percentage responses stratified by waiting room satisfaction score for overall rating of care and likelihod to recommend questions. Comparisons are for whether or not patient saw kindness media by waiting time satisfaction strata. Analyses are from logistic regression model adjusted for age, gender and race.

’Overall rating of care’
Waiting time satisfaction strata	Kindness media	N	Very poor	Poor	Fair	Good	Very good	P value
Very poor/poor	No	394	26.1	14.9	21.1	22.3	15.6
	Yes	119	16.1	11.3	19.7	27.6	25.4	0.001
Fair	No	291	9.1	7.4	15.3	28.9	39.4
	Yes	64	3.8	3.5	8.4	22.4	61.9	<0.001
Good/very good	No	2042	2.2	2.0	5.2	16.2	74.3
	Yes	168	1.3	1.2	3.2	10.8	83.5	0.008

‘Likelihood to recommend’
Waiting time satisfaction strata	Kindness media	N	Very poor	Poor	Fair	Good	Very good	P value
Very poor/poor	No	392	40.8	14.9	17.5	16	10.8
	Yes	121	32.8	14.3	18.8	19.4	14.7	0.066
Fair	No	290	13.1	8.5	15.8	26.9	35.7
	Yes	63	4.1	3.1	7.2	19.2	66.4	<0.001
Good/very good	No	2037	2.9	2.3	3.5	15.7	73.7
	Yes	169	1.8	1.5	3.6	11.4	81.7	0.023

Similar conclusions apply to the responses from ‘likelihood to recommend’ question. At the lowest waiting time satisfaction stratum (very poor/poor), the top box percentage in KM viewers is higher, although the difference is not significant (p=0.066).

Figure 2 summarises the top box percentages as organised by waiting time strata and if they viewed KM. As there are 20 questions in the patient experience ED survey, we selected several key questions to display in the main body of the paper (entire survey responses with full distributions in online supplemental table 3). The selected questions included:

Figure 2. Graphic comparison of top box percentages for selected questions. Data are separated into no KM vs KM by waiting time strata. Numbers above each bar are the top box percentage in that bar. Numbers in () at the bottom of each bar reflect the patient survey response #s. Levels of significance are derived from comparisons of the entire distributions adjusting for age, gender and race : *p<0.05; **p<0.001 vs no KM within each waiting time strata. KM, kindness media.

• Courtesy of the nurses.

• Courtesy of the doctors.

• How well the doctors took the time to listen to you.

• Staff treated you with respect and dignity.

• Likelihood of recommending our ED.

• Overall rating of care.

For those patients that reported seeing KM, in almost every waiting time strata, their top box percentages were numerically and statistically significantly higher than the No KM group (figure 2).

The ‘very poor/poor’ and ‘fair’ strata KM, in general, displays the largest differences to No KM with up to ~30% increases in top box percentages. Yet even in the ‘good/very good’ stratum, the responses of patients who observed had numerically and statistically greater top box percentages ranging from 8% to 11%. The same conclusions can be made for the other questions (please see online supplemental table 3).

As detailed in table 2, figure 2 also provides insight into the association between waiting time satisfaction, per se, and top box percentages for the No KM group. At each step rise in waiting time satisfaction, there are progressive increases in top box percentages. These differences are marked, ranging from top box percentages as low as 11%–27% in very poor/poor up to 74%–81% in good/very good. This pattern was observed for every care-related question (please see online supplemental table 3).

Influence of feeling more positive after watching kindness media

With the understanding that simply seeing KM, irrespective of the response to it, significantly improved how patients perceived their care experience, we examined how having a positive response affects satisfaction scores. In addition, if people felt the same, did that suggest that they might not have had an effect?

This analysis is shown in table 3. In addition to the waiting time satisfaction strata, there are three media viewing groups: no KM; KM but felt the same or less positively; and KM, felt more positively.

Table 3. Top box percentages segregated by waiting time satisfaction and media responses.

Differentiate by waiting time score	See kindness media (KM)?	N	Courtesy of the nurses	Courtesy of the doctors	How well the doctors took the time to listen to you	Staff treated you with respect and dignity	Likelihood of recommending our emergency department	Overall rating of care
Very poor/poor	No	381	27	28	27	25	11	15
	Yes, same	74	45	36	32	33**	10	19
	Yes positive	41	61**	66**	65**	53**	24**	40**
Fair	No	289	51	50	49	47	36	39
	Yes, same	33	65	76*	75*	68*	54*	54
	Yes positive	32	91**	94**	86**	88**	80**	70**
Good/very good	No	2039	81	81	77	78	74	74
	Yes, same	48	81	78	74	80	64	69
	Yes positive	121	93**	93**	93**	93**	90**	91**

Analysis of key patient experience questions subdivided by no KM, KM with same or less positive response or KM with positive response. Patients who reported a positive response to KM had numerically and statistically high assessments of their care experience. Even if patients had no reportable increase in positive feelings, patients had numerically and statistically significantly greater responses, especially in the ‘fair’ waiting time satisfaction stratum.

*p<0.05; **p<0.001

’Yes, same’ includes the small proportion of patients (3%) who reported feeling less positive.

As can be seen in table 3, in the two lower waiting time satisfaction strata, patients who reported feeling the same or less positively in general had numerically higher top box percentages. Especially in the ‘fair’ waiting time satisfaction category, which showed many statistically significant shifts, ranging from 8% to 26%. No differences were observed in the good/very good waiting satisfaction stratum.

For those patients who recalled feeling positively after watching the media, large, significant differences in top box percentages were observed in all of the waiting time strata, especially ‘fair’. Even for the ‘good/very good’ stratum, seeing KM and feeling positively about it was associated with top box percentages of 90% or more for these key questions. Top box percentages for all questions can be found in online supplemental table 4.

Other observations from the emergency department (ED) data

We also examined individual demographic groups to see if there was a preferential response. There was no evidence for that: patients of different ages, race and gender appeared to respond similarly (data not shown).

Qualitative statements regarding kindness media in healthcare

To complement the above population level observations, we have included unsolicited observations from two other healthcare settings using KM. One is in a general dentist’s office; the other is a surgical floor from a professor of anaesthesiology in an academic medical centre. These are relayed verbatim as shared with Envision Kindness.

From a general dentist displaying the media for about 1 year:

I’ve noticed a general sense of calmness in our waiting area since we started showing the videos. Patients seem to be more relaxed and exhibit less visible anxiety about their appointments. There’s a noticeable shift in the atmosphere, with the environment feeling more tranquil and positive.

While these are more subjective observations, the change in the waiting room’s ambiance is undeniable, and the programming has been a valuable addition to our practice, enhancing patient experience and contributing to a more positive and compassionate atmosphere.

The dentist’s observation is confirmed by patient feedback from the same practice, including:

Watching these acts of kindness is a breath of fresh air. It’s a gentle reminder of the good in the world, right before my dental appointment, which honestly helps me relax more than expected.

From a professor of anaesthesiology: KM was placed in the hallway on the surgical unit on which he is an attending so that staff could see it.

In our months of displaying the kindness media, I received several compliments from the staff about the positive effect the images and videos had on them. Some saw it as a ‘quick pick me up’, while others spoke about how it affected their mood throughout the day. The impact the media has had on our floor has been palpable, and we aim to continue to use it in the future!

Discussion

This observational study of more than 3000 patients in a level 1 trauma ED suggests that watching KM affected their perception of their care, resulting in higher satisfaction scores on almost all of the questions in the Press Ganey questionnaire. This positive shift in perspective is also evidenced by how watching KM also appeared to offset the negative impact of lower waiting time satisfaction. The results from the ED are supported by qualitative observations from other healthcare settings.

Altogether, the results suggest that it is possible to shift a patient’s perspective through display of the media, a very low resource-requiring programme. This shift can be looked at as one of the central aspects of care: to lower stress and provide comfort for the patient, which in turn can generate trust and better outcomes.

For the Press Ganey survey, hospital leaders are also provided with comparative data from other hospitals with a level 1 trauma ED to gain perspective on their organisation’s ranking. Based on previous Froedtert Hospital ED’s top box percentages for ‘Likelihood to recommend the ED’, we estimate that a 6% change in top box percentage would yield a shift of 20 points in percentile rank in the level 1 trauma ED comparison group.

Given that the magnitude of the differences observed across media viewing groups for the KM group is generally larger than 6%, it is conceivable that larger shifts in top box percentage and percentile rank are achievable when applied to a larger portion of the ED patient population (and greater fraction of viewers).

Although top box percentage is the predominant metric used by hospitals, it is worthwhile noting the changes in the other responses from very poor to good related to KM. We have provided these data as they show an associated diminution in the worst categories such as very poor and poor. In the pursuit of having as many patients as possible have a better experience, from our perspective, shifting someone from ‘very poor’ to ‘fair’ is a laudable goal even though it is not in the top rated ‘very good’.

An important question to ask is why did the patients who saw KM have lower perceived waiting time satisfaction yet higher satisfaction regarding their care? The answer to this cannot be fully resolved in this study because we do not have the actual wait times of individual patients nor the acuity of their medical problems. It is hypothesised that those patients had a longer waiting time perhaps when the emergency room was very busy and that the acuity of their medical conditions was lower. Perhaps the arrangement of seating and the televisions that were displaying KM (ie, line of sight) or other reasons (eg, less cellphone use), these patients may have had more time and/or a more direct view of the KM.

By stratifying for waiting time satisfaction, we tried to balance the impact of waiting time across the two groups. This enabled visualisation of the associated effect of both waiting time satisfaction and KM on assessment of the care experience. In those patients who did not see KM, worse waiting time satisfaction was associated with significant decreases in care satisfaction. This observation aligns with multiple studies on perceived waiting time and care experience ratings by patients.^{20 21}

As an observational field study, no control was exerted over if, and for how long, patients watched KM. Patients were not guided to specific seating nor were they advised to watch the KM. We did not randomise patients to specific media groups. Although not a randomised trial, it is highly encouraging that these differences were observed despite the lack of experimental control. The results suggest that with more directed instruction to patients and using all of the televisions, we could amplify the effect.

Yet these observations also require consideration of an alternative hypothesis—that people who chose to watch the media were naturally more optimistic and therefore that their care satisfaction scores reflected their personalities. In this alternative, the media helped select those who were more likely to rate their care experience higher.

Observations from multiple other studies, however, suggest that is not the case. Most importantly, the results described in the current study are the application of what has been known in multiple academic studies from different investigators. Seeing kindness, either in person or through media, is known to be a kindness prime.²² When studied (usually using media), with a high degree of consistency, kindness primes elicited elevation, relaxation, a sense of feeling connected to others and generosity.^{10 11 23} Watching a 2-min clip in a laboratory depicting an act of caring induces very similar effects to what we observed in the field.⁹ That this response occurs very rapidly supports the idea that it is an automatic or subconscious response.

We had observed similar responses to the academic studies in a patient focus group study in which 15 Wisconsin adults were invited to give feedback about the media. Using the single 2-min video shared above (‘Why Do Hugs Feel So Good?’), the majority of these participants reported decreases in irritation, anxiety, stress and sadness. They also reported feeling happier, calmer, more connected to others and more cared for. A summary of the percentages of patients reporting emotional changes is shown in figure 3. There was also evidence of greater optimism in 40% of participants (not shown).

Figure 3. Changes in emotion after watching a single, 2-min kindness video. Percentages indicate % of focus panel members reporting a change.

Aligned with the idea of decreasing the self-other gap and promoting feeling connected to others, different investigators have also shown that media depicting kindness affects the willingness to donate time or money to members of another race or increase perceived humanisation of others.^{24 25} This aspect of the media has much relevance to health equity and inclusion and implicit biases. Similarly to our work in healthcare, KM in laboratory studies has also been shown to decrease stress, leading the investigators to suggest using the media as a daily prescription for attenuating stress (in general).²⁶

Reinforcing the psychological studies on the impact of KM is evidence for activation of reward centres, endorphin and oxytocin release, blood pressure lowering and vagal nerve activation, all considered salutary changes.^{27 28} That is, there are physiological benefits, too.

In contrast, negative media like the news can rapidly induce anxiety and stress.^{29 30} For these reasons, if the news is displayed in your waiting areas (including breaking news reports), you should consider removing it as it is likely working against the goal of instilling a calm and caring environment. It is noteworthy (and consistent with the present results) that seeing kindness can counterbalance the negative impact of the news.³¹ Please consider that even seemingly innocuous programming might be a stressor through envy, etc.

Limitations

The major limitation of this study is that it is an observational study and not a randomised, controlled trial to more firmly ascribe causality. An additional limitation is that we rely on patient recall of seeing the media. Finally, the fraction of patients watching the media is comparatively small and could present a selection bias. Despite these limitations, in concert with the totality of the known effects of KM, it is likely that the observed effects to uplift patients and shift their perspective on their care are causally related.

Conclusions

It is possible to utilise the neuropsychology of kindness and connection to help uplift patients and lower their stress. By doing so, we can also help staff who must manage patient stress in addition to their own. What makes this approach attractive is that it is a passive intervention (watching a television) that also requires little resource (especially staff time), needs no training and exerts its effects rapidly.

Future studies will extend these observations in randomised, controlled trials including how KM may affect patient and visitor aggression as well as staff satisfaction and burnout.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.