HUMANIZATION OF CARE: Innovative strategies for more empathetic healthcare
New techniques for putting the patient at the center, crossing hospital boundaries with empathy, listening and innovative approaches.
In previous articles published with Spaghetti Boost, we have explored topics such as redesigning care spaces, providing general definitions, and presenting international best practices. We have also delved into the use of artistic landmarks as a strategy to facilitate orientation within healthcare facilities. Lastly, we referenced data and scientific evidence demonstrating how these initiatives can contribute to improving the physical and psychological well-being of those who frequent these structures, whether daily or for brief periods.
The goal of this new article is to explore a term frequently mentioned in the media and at scientific and public conferences: the humanization of care. This concept can be seen as an "umbrella" term encompassing numerous aspects and design applications. It represents a set of practices and approaches aimed at making the care process more attuned to the needs and dignity of individuals, integrating psychological, social, and relational dimensions with traditional clinical interventions.1
The humanization of care is a concept often invoked, but what does it truly entail? The visual representation below summarizes the fundamental principles of this still-evolving field, characterized by a hybrid identity and non-linear trajectories. Humanization of care seeks to redefine approaches to health by transcending the traditional notion of the patient as a mere "clinical case" and instead recognizing them as a person with a story, emotions, hopes, and relationships that must be considered integral to the care process.
The integration of the humanization of care into Italian healthcare policies was formalized with the "Health Pact" 2014–20162, which established the need for structural, organizational, and training interventions to improve the quality of care through patient-centered practices. Specifically, AGENAS3 developed evaluation tools to measure the degree of humanization in healthcare facilities, involving citizens and local communities to monitor four key areas: care processes, physical accessibility and comfort, transparency of information, and the quality of relationships4.
The common thread connecting the various attempts and initiatives in this field is the holistic well-being of the individual. This includes attention not only to physical spaces and the working conditions of healthcare personnel but also to the integration of innovative therapeutic strategies. For example, social prescribing or positive distraction serve as complementary interventions to improve patients’ quality of life, while medical humanities introduce a novel pedagogical approach in training future doctors, promoting narrative medicine as a tool for more profound and complete anamnesis.
Humanities, such as visual arts, occupy a central role in this context, as exposure to culture has been shown to have positive effects on the immune system and, consequently, on the efficacy of therapies and the quality of work life5. This combination of words—humanization of care—is grounded in an essential principle: breaking down the rigid separation between so-called hard sciences and soft sciences in favor of an integrated approach that considers the individual in their entirety, combining technical expertise with humanistic sensitivity6.
The humanization of care thus represents a continuous journey toward a model of assistance that values the individual not just as a patient but as a human being in their full complexity.
The following is a conceptual map aimed at identifying all best practices encompassed within the concept of humanization of care. This representation offers an overview of the main strategies and interventions designed to make healthcare more attentive to the needs and dignity of individuals. It integrates approaches that consider not only the clinical aspect but also the psychological, social, and environmental dimensions of the care process.
Patient-Doctor Relationship
This refers to the professional and interpersonal bond established between the patient and the physician during the care process. It is fundamental to the success and choice of treatment, relying on trust, effective communication, and mutual respect.
A case study with a positive impact involved interventions in oncological palliative care at a British hospital. The study examined the effectiveness of conversations about "advance care directives" between healthcare personnel and patients with advanced cancer. Results showed that a patient-centered communicative approach, characterized by open dialogue about care preferences and the patient’s perception of quality of life, led to better clinical outcomes and psychological well-being.
Data collection revealed a reduction in the use of unwanted aggressive treatments and improved symptom and pain management. These outcomes were measured using standardized evaluation tools that confirmed the effectiveness of communication strategies focused on patients' needs and values. The study emphasized the importance of training medical staff in empathic communication techniques to foster more personalized and patient-oriented care7.
Medical Humanities and Narrative Medicine
Medical Humanities incorporate humanistic disciplines like philosophy, literature, and art into medicine to enhance understanding of human suffering. Narrative Medicine, a component of this field, employs storytelling to better comprehend patient experiences and improve clinical practice.
At King’s College Hospital in London, a project demonstrated the effectiveness of these strategies. The initiative involved patients with complex chronic conditions, using narration as a tool to enhance medical history collection and therapeutic relationships. Through structured storytelling sessions, patients shared their illness experiences with physicians and healthcare staff. This approach provided more detailed and nuanced information about patients’ clinical histories, improving understanding of their emotional and social needs.The data collected showed significant improvement in patient satisfaction with care and increased engagement in therapeutic decisions. Additionally, storytelling helped physicians develop greater empathy and understanding of patients’ lived experiences, fostering a more compassionate clinical approach. Evidence from the study suggests that integrating Medical Humanities into clinical practices can improve doctor-patient communication and health outcomes, promoting a more person-centered care model8.
Biophilia
The concept of biophilia, when applied in healthcare, involves integrating natural elements into care environments to improve the physical and psychological well-being of patients and staff.9 The Khoo Teck Puat Hospital in Singapore is an exemplary case of hospital design inspired by biophilia. The hospital features expansive green spaces, vertical gardens, natural views from patient rooms, and outdoor pathways that facilitate direct contact with nature.
Architectural design at Khoo Teck Puat Hospital demonstrated tangible positive effects: inpatients reported reduced stress levels and higher satisfaction with the care environment. Healthcare staff also benefited, experiencing decreased psychological fatigue and work-related stress—critical factors in a high-intensity hospital setting. These benefits are supported by data showing increased efficiency, reduced absenteeism, and a more positive care experience for patients.10
Culture as Integrated Therapy
The concept of "culture as integrated therapy"11 has been successfully implemented by the Don Gnocchi Foundation in Italy, which has developed programs incorporating art, music, and other cultural forms into therapeutic processes. This approach aims to promote not only clinical care but also the emotional and psychological well-being of patients through aesthetic experiences and active participation in cultural activities.
The foundation introduced art workshops, concerts, and expressive therapy sessions to stimulate creativity and engagement, supporting recovery while reducing anxiety and stress. Studies on these programs showed positive effects on various well-being indicators: patients reported reduced stress levels and improved mood, which positively influenced recovery times and treatment efficacy. Healthcare staff observed increased patient cooperation and an overall improvement in the therapeutic environment, facilitated by an approach that sees culture as an integral part of care.12
Animal-Assisted Therapy (AAT)
Animal-Assisted Therapy (AAT) leverages interactions with animals to improve the physical, emotional, and social well-being of individuals with various health conditions, particularly in mental health and neurodivergence contexts. A significant example is Green Chimneys, a foundation in the United States that uses AAT programs to support children and adolescents with autism spectrum disorders, ADHD, and other emotional and behavioral challenges. Through daily interactions with animals such as dogs and horses, participants showed improvements in social skills, reduced anxiety, and better emotional regulation. Studies on these programs revealed that contact with animals fosters a sense of safety and enhances socialization, serving as an effective complement to traditional treatments and significantly improving patients' quality of life.13
An additional compelling case involves Charles University in Prague, which implemented an innovative AAT approach in response to collective trauma following a December 2023 shooting. A pony was brought to the faculty of arts to provide comfort to students and staff, creating a moment of emotional connection and psychological support. This intervention demonstrated how the presence of an animal can alleviate acute stress symptoms, boost morale, and foster a reassuring and cohesive environment, confirming the therapeutic potential of AAT even in crisis situations.
To dive deeper into the definition and effects of social prescribing, the importance of healing environments, and the effectiveness of positive distraction in improving the patient experience, as well as the topic of professionalism and the well-being of healthcare staff, we invite you to watch the dedicated reels on the Instagram page of Spaghetti Boost.
As a doctoral researcher in Medical Humanities, I have chosen to focus my research journey on oncology, a specialization that unfortunately continues to show a steady increase in cases and requires particular attention not only to clinical therapies but also to the human and emotional support of patients.In this context, a manifesto dedicated to the humanization of cancer care14 has been developed, emphasizing the importance of adopting practices that go beyond mere medical treatment, enhancing the overall well-being of the person in care. Oncology is characterized by significant therapeutic advances, as evidenced by the improvements observed in cancer survival rates in Italy15. However, the introduction of innovative biological drugs, while highly effective clinically, presents new challenges in terms of economic sustainability for healthcare systems.In this context, the need emerges to adopt a holistic and multidimensional approach to managing cancer patients16. The biopsychosocial clinical model promotes a comprehensive evaluation of the individual, integrating biological, psychological, cognitive, and relational factors to personalize therapeutic plans and provide more complete responses to the patient’s multidimensional needs.Similarly, the concept of “humanization of care” emphasizes the importance of considering not only strictly clinical aspects but also psychological, emotional, spiritual, relational, and social dimensions. This involves the active involvement of the patient in shared decision-making and the implementation of empowerment strategies to improve therapeutic adherence and quality of life.
All these best practices can be adapted to every medical specialization, with the necessary attention to personalizing them for patients, caregivers, and, most importantly, the healthcare personnel involved.
But what can be done concretely to promote the humanization of care?
Drawing inspiration from musical terminology, which divides the phases of a concert into pre-production, production, live, and post-mortem, this framework can also be applied to healthcare. Currently, we are in a transition phase between production and live: the scientific community is aware of the importance of these issues and intends to adopt such practices, but further impetus is needed to turn ideas into concrete actions.
A gradual and consistent phase of awareness-raising is essential. Physicians, after the experience of the COVID-19 pandemic, have personally experienced the role of patients or caregivers, gaining new awareness of the challenges related to the humanization of care.17
Concrete actions can include:
- Raising awareness among civil society about the importance of a human approach to medicine: Programs such as the international conference organized by the International Association for Music & Medicine (IAMM), held annually in Berlin, explore the therapeutic role of arts and music in healthcare. Topics include the potential of artistic interventions in the emotional and psychological healing of patients and the importance of cultural sensitivity in healthcare. In Italy, the Festival delle Medical Humanities organized by the Alessandria University Hospital is an annual event that aims to promote a more human understanding of medical care, integrating artistic and cultural elements to strengthen relationships between doctors, patients, and the community.
- Promoting discussion tables between academics and healthcare professionals: Initiatives such as those by the Center for Arts and Wellbeing at Edge Hill University in Ormskirk facilitate meetings between healthcare experts and artists. In Italy, the CCW – Cultural Welfare Center in Turin has initiated working groups to discuss integrating the arts into healthcare practices, fostering the exchange of ideas between academics and professionals.
- Organizing artistic residencies: An example is the Arts Health Research Intensive by the Social Biobehavioural Research Group (SBRG) in the United Kingdom, which organizes residencies to bring together healthcare professionals and scholars from around the world. Similarly, the University of Trento organizes the PsyHuman “Psychology and the Humanities” International School, 4th Edition: Multidisciplinary Approaches to Individual and Community Well-being.
- Developing interdisciplinary workshops and think tanks: Events such as the Conference on the Humanization of Care in Siena provide opportunities for dialogue among experts in healthcare, art, and the humanities. Alternatively, the Think Tank Cultura è Salute organized by the “Giovanni Paolo II” Foundation in Italy promotes interdisciplinary discussions to integrate culture and creativity into healthcare practices, reinforcing the role of arts and humanities in care pathways.
- Disseminating knowledge and research through writing and publication of articles: Communicating scientific discoveries and best practices is crucial to raising awareness of the importance of a human approach to medicine. Journals such as Arts & Health publish articles and studies on the topic. In Italy, the journal Salute e Società explores the relationship between culture, art, and health, contributing to spreading knowledge and research in the field of humanized care.
These initiatives encourage dialogue and the design of sustainable interventions that can improve the quality of care. For an in-depth exploration of these themes, the book Arts in Health: Designing and Researching Interventions18 provides useful insights for integrating the arts into health processes.
These joint efforts to promote a holistic and humanized approach to oncology care lay the groundwork for a healthcare system that does not merely treat but genuinely cares for people. As Eric Cassell, a pioneer in humanistic medicine, states: Suffering is an experience that involves people as a whole, not just their bodies, and it arises from challenges that threaten the integrity of the person as a complex social and psychological entity.19 This perspective invites us to consider each patient in their entirety, recognizing the importance of integrating emotional and relational aspects into clinical practice.
Cover Image: Keith Haring murals, The NYC Health + Hospital, New York
SOURCES
1 Vergara-Escobar, O. J., Henao-Castaño, Á. M., & Gómez-Ramírez, O. J. (2021). Humanization of health assistance: Concept analysis. Revista Ciencia y Cuidado, 18(3), 74-85. https://doi.org/10.22463/17949831.2791.
2 The "Patto per la Salute" 2014-2016 was promoted and signed by the Ministry of Health and the Italian Regions, represented by the Conference of Regions and Autonomous Provinces. This agreement, signed in July 2014, aimed to ensure the sustainability of the National Health Service (SSN), improving the efficiency and quality of healthcare services and optimizing available resources. The "Patto per la Salute" included several strategic interventions, such as rationalizing healthcare spending, updating the Essential Levels of Assistance (LEA), promoting technological and organizational innovation, and fostering greater balance between Regions in terms of healthcare provision and quality.
3 AGENAS is the acronym for the National Agency for Regional Health Services. This public agency operates under the supervision of the Ministry of Health and supports the Italian Regions and the Ministry in the planning, evaluation, and improvement of healthcare services. AGENAS carries out monitoring, analysis, and consultancy activities to ensure the efficiency and effectiveness of the National Health Service (SSN) and promote continuous improvement in the quality of healthcare services provided to citizens.
4 Agenzia Nazionale per i Servizi Sanitari Regionali. (2022). Umanizzazione ospedaliera. AGENAS. https://www.agenas.gov.it/aree-tematiche/qualita-e-sicurezza/empowerment-del-cittadino/umanizzazione-ospedale.
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14 The "Manifesto for the Humanization of Care in Oncology" was drafted by the Working Group for the Humanization of Care in Oncology. This document was presented during the conference "Caring for the Person with Cancer," organized by AIO, AIOM, FAVO, and other entities in the oncology sector.
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She is a cultural designer and doctoral candidate in Medical Humanities and Welfare Polices. Her common thread is caring for people's wellbeing, whether it is behind a stage with Grato Cuore, Rosetum Jazzfestival, a professorship at the Mohole School or research to rethink the design of healthcare environments through artistic interventions. With Spaghetti Boost he will address various topics on the combination of art and sanctity in international and national contexts, proposing how to concretely innovate it.