Health Institutions Championing the Cause of Dignity

When a person has the need for healthcare in whatever form, it can be a very overwhelming, even frightening time, where the person may feel vulnerable, anxious, embarrassed, and that they lack control over what is happening to them. Dignity is important to every individual, irrespective of the situation in which they find themselves, including healthcare settings. Treating patients with dignity is an essential aspect of patient-centred care and patient engagement and satisfaction. Even small gestures of kindness, sensitivity, respect and compassion can have a meaningful effect on a person’s sense of dignity.

Dignity in healthcare involves respecting patients’ rights to make decisions about their own care, and respecting their autonomy. People are enabled to manage their own health and care when they can and to maintain their independence. Doing this helps to empower people to take an active role in their healthcare, which leads to better health outcomes, as patients who feel involved in their own healthcare are more likely to engage in their treatment and recovery.

Dignity in healthcare means creating an environment where healthcare recipients feel valued, informed, empowered and involved in their care planning and decision-making processes. Being treated with dignity and respect helps to create and develop trusting relationships between those providing healthcare and those receiving it. This can help to reduce any feelings of vulnerability, anxiety, or distress, leading to more positive healthcare experiences.

The NHS defines dignity in healthcare as “Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals”. The National Institute for Clinical Excellence (NICE) have publicly stated as a quality standard that “To have a good experience of NHS services people must be treated with empathy, dignity and respect.”

Dignity in healthcare is embedded in the care regulation framework and is defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10. The intention of this regulation is to make sure that people using the service are treated with respect and dignity at all times while they are receiving care and treatment, and the Care Quality Commission (CQC) can take regulatory action for breaches and/or non-compliance with this regulation.

Dignity also underpins professional training standards in the healthcare sector for both regulated and non-regulated staff. For example, standard 7 of the Care Certificate highlights the importance of privacy and dignity. It is important that privacy is respected in all healthcare settings so that people can maintain their dignity. Privacy is very important during personal care but also with regard to people’s personal space. Confidentiality is also a very important principle in the provision of healthcare services, as people’s confidentiality should be respected at all times and legal requirements about data protection must be met.

Many healthcare providers champion dignity in healthcare, and initiatives such as the Dignity in Care campaign launched in November 2006, aim to put dignity and respect at the heart of UK care services. As of 2024 the campaign has over 116,000 people registered as ‘Dignity Champions’; these are people within the sector who not only put dignity and respect at the heart of the care that they provide, but who also believe passionately that being treated with dignity is a basic human right, not an optional extra.

Dignity means working in a way that promotes respect, autonomy and compassion for individuals, and to achieve this, healthcare settings need to set clear standards for service delivery and staff performance. It also requires that they have in place policies and procedures that support the delivery of dignified and respectful healthcare. These standards, policies and procedures help an organisation to develop an organisational culture that prioritises dignity and respect throughout all its activities, not only with care recipients but also throughout employee relationships and dealing with the wider community.

In this article we will explore case studies of health institutions that have successfully implemented dignity-centred practices and policies, and that are making a significant impact on patient well-being.

Case Study 1 – The John Hopkins Hospital, USA

For more than 125 years, The Johns Hopkins Hospital has been a leader in the diagnosis and treatment of disease. Located in Baltimore, Maryland, USA, The Johns Hopkins Hospital was the top-ranked hospital, as well as 15 of its medical specialties. Two other Johns Hopkins Medicine member hospitals in Maryland and Washington, D.C., Sibley Memorial Hospital and Suburban Hospital, were also recognised in state and regional rankings.

The Johns Hopkins Hospital has been named an Honour Roll hospital on U.S. News & World Report’s 2024–25 Best Hospitals list. The U.S. News Honour Roll is composed of the 20 top-ranked hospitals in the nation among 4,500. This year’s Honour Roll is the second to not assign individual ranks to the top 20 hospitals.

As a part of the Johns Hopkins Health System, patients, visitors and staff of The Johns Hopkins Hospital have access to a vast network of clinical services and lab services. The hospital has a number of core values that underpin its patient-centred services to patients, which include:

• Dignity and Respect: They believe that an essential component of patient and family-centred care is listening to and honouring patient and family perspectives and choices. They constantly strive to incorporate patient and family knowledge, values, beliefs and cultural background into the planning and delivery of care.
• Information Sharing: Only through authentic and transparent dialogue can patients and families effectively participate in care and decision-making. Therefore, they believe healthcare practitioners should communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.
• Participation: They encourage patients and families to participate in care and decision-making at whichever level they choose.
• Collaboration: They invite patients, families, healthcare practitioners and hospital leaders to collaborate in policy and programme development and implementation, and evaluation of programmes ranging from healthcare facility design to professional education, as well as the delivery of care.

At The Johns Hopkins Hospital, there are eight patient and family advisory councils (PFACs) with over 200 members that include patients, family members and hospital staff. Each PFAC meets for two hours in the evening, typically once a month. These councils support the hospital’s commitment to partnering with patients, families and caregivers throughout their healthcare experience. The purpose and responsibilities of the PFACs are to:

• Promote respectful, effective partnerships between patients, families and clinicians.
• Increase understanding and cooperation between patients, families and staff.
• Transform the culture towards patient- and family-centred care.
• Improve quality, patient safety, and patient health outcomes.
• Establish a link between the hospital and the community at large.

The philosophy of patient- and family-centred care at The Johns Hopkins Hospital focuses on:

• Respect for patients’ values, preferences and needs.
• Coordination of care for more efficiency.
• Comfort and emotional support for mental health.
• Information, communication and education.
• Involvement of family and friends.

The Johns Hopkins Hospital code of conduct defines personal and professional standards of conduct and acceptable behaviour for all people while carrying out assigned responsibilities at The Johns Hopkins Hospital including its regulated sites.

The Johns Hopkins Hospital Patient Rights and Responsibilities clearly express that the patient voice matters to them and that they encourage patients to speak openly with their healthcare team whenever they have questions. They state that when patients are well informed, they are more empowered to take part in care decisions and treatment choices.

Johns Hopkins is committed to protecting health information. Their Notice of Privacy Practices explains how all members of the Johns Hopkins organisations safeguard privacy.

The above initiatives that focus on providing dignified and respectful patient-centred care at The John Hopkins Hospital have contributed towards their award-winning accolades for high-quality treatment and care. Patient- and family-centred care is a key focus for Johns Hopkins Medicine. Each hospital has teams devoted to the highest level of service excellence and patient satisfaction. All Johns Hopkins Medicine hospitals seek regular feedback directly from past patients and families through Patient and Family Advisory Councils. The Councils bring former patients and family members together with hospital leaders and staff to address patient experience needs and develop new ideas for improving patient care and communication.

A standardised national survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is mailed to some patients after discharge to provide their perspective of how they experienced care from the hospital. Patient responses are submitted to the Centres for Medicare and Medicaid Services, which publicly reports online at Care Compare the annual results from all U.S. hospitals including The John Hopkins Hospital.

Case Study 2 – NHS Lothian, Scotland

NHS Lothian provides a comprehensive range of primary, community-based and acute hospital services for the populations of Edinburgh, Midlothian, East Lothian and West Lothian, employing over 24,000 staff providing healthcare to over 800,000 people. The values and ways of working of NHS Lothian were developed by over 3,000 staff across NHS Lothian for the benefit of everyone working in the organisation and, most importantly, for the benefit of patients, and reflect their commitment to dignity-focused healthcare. These values and ways of working are:

• Care and Compassion
• Dignity and Respect
• Quality
• Teamwork
• Openness, Honesty and Responsibility

NHS Lothian consistently prioritises person-centred care, which focuses on treating patients as individuals with unique needs and preferences and places a strong emphasis on safeguarding human rights and ensuring that dignity is integral to all care practices. NHS Lothian is particularly noted for its dignified approach to end-of-life care.

NHS Lothian has implemented dignity in care campaigns that focus on raising awareness and training staff to ensure dignity is consistently respected in healthcare settings. These campaigns educate staff on the importance of patient respect, communication, privacy, and maintaining patients’ sense of control over their healthcare decisions. Healthcare professionals receive regular training on how to communicate with empathy, protect patient privacy, and provide care that respects individual values and cultural backgrounds.

These training programmes are designed to underpin the value that dignity should be maintained in all interactions with patients, regardless of their condition or circumstances. There is also a dedicated Quality website for staff working within NHS Lothian and/or Health and Social Care who want to learn about or undertake quality improvement work within their service. NHS Lothian has also introduced dignity champions to ensure that respect is integrated across all care settings, from hospitals to community services.

NHS Lothian is committed to ensuring that patient privacy is respected at all times and prioritises protecting the dignity of patients by safeguarding their personal and medical privacy. They also have a number of policies and procedures created to prioritise dignity and respect including a Patient Engagement Policy which outlines roles and responsibilities for dignity-centred patient care.

NHS Lothian recognises and celebrates individuals or teams who go above and beyond to provide high-quality care with an array of awards that help to foster a stronger sense of purpose to improve the overall quality of care. Connections is NHS Lothian’s regular newspaper, keeping staff, patients and many others in touch with what’s going on throughout the huge and diverse organisation. The newspaper is an important way to publicise campaigns, such as dignity in care, hospital hygiene, child protection etc.

NHS Lothian is dedicated to putting patients, their families, carers and workforce at the centre of all they do, and this is reflected in their Patient Experience Strategic Plan 2023–2028. They define a positive patient experience as “ensuring people are receiving care or treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way, having information to make choices, to feel confident and in control, are spoken with and listened to as an equal and being treated with honesty, respect and dignity”.

NHS Lothian has implemented systems to gather and act on patient feedback more effectively. Patients are encouraged to share their experiences through surveys and feedback forms, and the insights gained are used to drive improvements in care delivery. The emphasis on compassion in care delivery has been recognised through various patient satisfaction surveys. Patients report feeling more supported and respected, with improved communication and a greater sense of involvement in their care decisions.

Below are some extracts of stories posted on Care Opinion during 2022–2023 about care at NHS Lothian:

“The critical thing for me, that helped what could have been a really traumatic birth be actually fine was the staff. At all times I felt respected, listened to and cared for, in particular by my two midwives (shift change!). The doctor who finally delivered my son was also incredible. We had a follow up appointment a few weeks later with him where he explained what had happened and why which also made a huge difference to how I felt about the birth.”

“One nurse for holding our daughter’s hands and chatting to her and me on way to theatre (I think she made special arrangements to be there for the sake of continuity of care for her). She went the extra mile talking to me and she also later popped back to enquire about her.”

“We were treated with absolute kindness and patience during a worrying time and all our questions were answered. We were listened to and helped and although we could see how busy the department was, the staff couldn’t have done more for us. Heartfelt thank you to everybody!”

Case Study 3 – St Christopher’s Hospice, UK

Dame Cicely Saunders founded St Christopher’s Hospice in 1967. The first patient was admitted on 13 July 1967 and the official opening followed shortly after on 24 July 1967, and ever since the hospice has been a centre of innovation and insight. Located in Sydenham, London, St Christopher’s Hospice supports adults with a life-limiting condition and their carers in the London Boroughs of Bromley, Southwark, Lewisham, Lambeth and Croydon.

It has 38 beds and provides world-class palliative and end-of-life hospice care for adults including inpatient care, outpatient clinics and community services to everyone who needs it. It has a main inpatient and outpatient base in Sydenham, with some staff working from a Bromley site. The service also has a large community branch to provide specialist care in the community, caring for people in their own homes.

The St Christopher’s Hospice vision is of a world in which all dying people and those close to them have access to equitable care and support when and wherever they need it. They operate on the core principle that each person’s life and individuality should be honoured and respected, particularly at the end of life. Their ambitions are to:

• Tackle inequalities
• Fulfil a national and global leadership role
• Create a sustainable business model
• Equip the future workforce
• Tackle ethical issues

These ambitions are defined in their 2023–26 strategy summary.

St. Christopher’s Hospice has been well known for its holistic and dignity-centred approach to palliative care since its foundation in 1967. In 2022 they unveiled a revised model of the Rehabilitation in Palliative Care, at its heart is the all-important notion of helping individuals retain or rebuild their personhood, nearly always at risk when someone is coping with the consequences of advancing and life-threatening illness. Their identity and well-being is often eroded as their needs for care increase. This model seeks to redress this by focusing on the question of what matters most to them, confident that attention to this helps protect their quality of life.

At St. Christopher’s Hospice, care is tailored to meet the unique needs, preferences and wishes of each patient. This includes discussing treatment options, pain management preferences, and emotional and spiritual needs. Patients are involved in every aspect of their care planning, ensuring their autonomy and dignity are maintained. Their holistic care model ensures that patients feel supported in every aspect of their well-being, which is critical to preserving dignity, especially at the end of life.

All staff at St. Christopher’s receive extensive training in palliative care and the importance of maintaining dignity throughout the care process. This includes communication skills, compassionate care techniques, and understanding the emotional needs of patients and families. They are trained to navigate complex ethical decisions with the patient’s dignity at the forefront. Staff are also trained to have sensitive discussions about end-of-life decisions, allowing patients to express their fears, wishes and hopes, and open, compassionate conversations about death and dying are actively encouraged, helping patients to feel respected and dignified when receiving end-of-life care.

End-of-life care at St Christopher’s actively encourages families and loved ones to be involved in care discussions, and provides support to them during their loved one’s end-of-life care. This care and support also extends after their loved one’s death. Their bereavement services include counselling and grief support groups, helping families and loved ones process their loss in a dignified and supported way.

St Christopher’s has a dedicated Wellbeing and Complementary Therapy Team that offers a range of services at both its Sydenham and Caritas sites in Orpington. Complementary Therapies are used alongside conventional medical practices; they are traditionally natural practices that often involve therapeutic touch and include:

• Acupuncture – this is a treatment derived from Traditional Chinese Medicine. It is the practice of inserting fine needles just under the surface of the skin at certain points of the body with the intention of alleviating any number of symptoms.
• Aromatherapy – this is the practice of using essential oils to massage into the skin during a treatment or to add to a diffuser.
• Massage Therapy – this is the use of therapeutic touch to specific areas of the body, either on the skin or through clothes, depending on the preference of the individual.
• Reflexology – this is most commonly performed on the feet, but can also be offered on the hands or face. It is based on the concept that the body is mapped on either the feet, hands or face. Therapists use light pressure and reflexes of the feet are either stimulated or sedated, using different techniques, to promote relaxation and possibly ease a number of symptoms.
• Therapeutic Touch – this is a very gentle treatment whereby the Complementary Therapist places their hands on different areas of the body. The individual receiving the treatment may feel warmth coming from the hands of the therapist. Therapeutic Touch is a soothing treatment that can promote relaxation, stress reduction, pain reduction, improved sleep and an improved sense of well-being.

The Psychological and Spiritual Care team at St Christopher’s offers space for compassionate, contemplative care and reflection, through therapeutic, psychological, emotional, religious, pastoral and spiritual support. They offer one-to-one support as well as the following groups:

• Singing for Breathlessness
• Creative Bereavement
• Mindfulness Based Art Therapy

St Christopher’s Hospice is rated outstanding by the Care Quality Commission (CQC). In October 2024, Sky News showcased the innovative work of St Christopher’s Hospice as part of an article and film exploring palliative care in the UK and was broadcast as the Assisted Dying Bill was introduced into Parliament. St. Christopher’s is renowned for its pioneering research in the field of palliative care, which continues to shape global standards for dignified end-of-life care.

St Christopher’s features a number of patient, family, volunteer and staff stories on its website. These stories offer a poignant insight into the positive effect that the care and support provided by St Christopher’s Hospice has on all the people that it touches and highlights the importance of prioritising dignity and respect in care.

Lessons Learned from Leading Institutions

Healthcare institutions that excel in providing excellent dignified and respectful healthcare and support share a number of commonalities that enable them to create a culture of dignity within their settings.

Across these institutions, respect for human dignity is a guiding principle which is embedded in the institution’s vision and values. Dignity is prioritised in every interaction between patients, their families, and healthcare professionals, and between healthcare colleagues at all levels of the setting. Respect for dignity is visible in all interactions and practices with all stakeholders.

Leadership teams lead by example, and prioritise dignity in all decision-making. They provide adequate resources and support for training and continuous professional development, particularly in topics such as cultural sensitivity, compassionate communication, and person-centred care for all staff, and recognise and celebrate good working performance and practices.

When staff are trained and feel confident and competent to deliver person-centred dignified care, it enhances employee engagement ensuring their commitment to a culture that promotes dignity and respect in all its activities.

When patients feel valued and are treated with dignity and respect, it helps to reduce any anxiety, fear and discomfort that they may be experiencing as a result of having to undertake healthcare. Feeling heard and respected about personal preferences, values and feelings enhances their sense of control, builds trust, and contributes to a sense of security and comfort, improving a patient’s overall well-being.

A culture of dignified and respectful care promotes inclusivity, making healthcare accessible and respectful to people from all backgrounds, regardless of their race, gender, disability or socio-economic status, ensuring that each patient is treated fairly and without discrimination. This helps to create a more positive work environment for healthcare professionals, delivering higher job satisfaction, which in turn results in lower work-related stress, and better staff retention levels.

When a culture of dignified and respectful care is prioritised by healthcare organisations such as those highlighted in the case studies above, it ensures that the healthcare provider is not only meeting the standards set out by the various regulatory bodies such as the CQC, but that they are also complying with their statutory legal duties such as those set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Implementing a culture of dignity in healthcare is not without its challenges and barriers, and these can range from issues such as limited resources, busy schedules and staff shortages, to inadequate training resources, and organisational cultural issues such as silo working and resistance to change.

Overcoming these challenges needs strong leadership and commitment from senior management to prioritise initiatives such as training and continuous professional development (CPD). Management needs to provide both time and financial resources to ensure that all staff, irrespective of level and role, can participate in training to provide them with the skills, knowledge and understanding to be able to deliver dignified, respectful patient-centred care. Training should not be constrained to one-off events; it should encompass ongoing CPD and reinforcement to keep staff updated on best practices in dignity-centred care.

Healthcare leadership should also ensure that they create and implement robust policies and procedures to support a culture of dignified and respectful patient-centred care. Policies play a crucial role in supporting dignity in healthcare by providing a structured framework that guides healthcare institutions, professionals and staff to respect and uphold the rights, autonomy and individuality of patients. These policies include, but are not limited to:

• Staff training and development policies
• Equality, diversity and inclusion policies
• Safeguarding policies
• Health and safety policies
• Privacy and confidentiality policies
• Codes of conduct
• Complaints policies
• Communications policies
• Patient engagement policies

In all the case studies highlighted above, leadership teams prioritised their commitment to dignity in care by embedding the concept into the values and ambitions of their organisation. They created cultures supported by robust policies where training and development is prioritised and quality care is recognised and celebrated.

Recommendations for Other Health Institutions

Any healthcare institution wanting to champion dignity in care must begin to embed the concept into every aspect of the organisation’s activities, placing the patient experience at the heart of everything they do, learning from feedback to improve care and to collaborate on plans for future services.

Organisational values and objectives should reflect this commitment to create a clear vision for the organisation, its staff, patients and families and for the wider community. As part of the business planning process, organisations should allocate adequate finance and resources to bring about this vision. Organisational policies and procedures should also be reviewed and updated to reflect the emphasis on dignified and respectful patient-centred care.

Creating communication channels for patients and staff to voice their opinions and suggestions is a great way to engage both service users and service providers. A great example of this is the Patient and Family Advisory Councils at the John Hopkins Hospital. The Connections newspaper at NHS Lothian keeps staff and patients informed about service and quality initiatives, highlighting how NHS Lothian is implementing its dignity in care values.

Healthcare organisations wishing to implement dignity in care don’t need to reinvent the wheel, as they can review best practices from healthcare providers that have already successfully implemented the initiative. For example, sources of best practice and guidance can be found on the CQC website and on the NHS England website. The National Institute for Clinical Excellence (NICE) also provides examples of best practice and guidelines.

Proposed updates to NHS Constitution for England will prioritise putting patients and their families, carers and advocates at the heart of decision-making, and strengthening links between NHS services, and will be published following consultation.

In most healthcare settings that have been successful in implementing dignity in care, the introduction and training of dignity champions has been key to ensuring that dignity and respect is integrated across all care settings, from hospitals to community services. Dignity champions have been proved to play a critical role in promoting and maintaining dignity in healthcare settings. They act as advocates for dignity-centred care by promoting the key principles such as respect, privacy, autonomy and empathy within healthcare environments. They work to ensure that these principles are embedded in everyday care practices.

Because they have been fully trained, they are able to identify any potential issues or areas where dignity may be compromised, such as in communication, personal care or decision-making processes, and they can offer constructive feedback to staff and management to help improve the quality of care.

Dignity champions are an invaluable resource as they can help to identify, organise and facilitate training sessions for healthcare staff on dignity-related topics. They can also act as mentors or coaching support for colleagues, offering guidance, and helping others improve their approach to patient care. The experience of dignity champions can guide improvements in the physical environment, communication processes, and care protocols as well as help to inform policy and practices.

Dignity champions help to gather and disseminate best practice by networking with other dignity champions across healthcare service providers throughout the UK, and even overseas. This sharing of ideas, successes and challenges helps to collectively improve healthcare practices nationwide.

Healthcare settings serve a wide range of patients with diverse cultural, emotional and physical needs. It is therefore imperative that a culture of quality and continuous improvement sits alongside dignity in patient-centred care. Practice and policies need to evolve to reflect the current and future needs of the communities the healthcare setting serves and innovations in areas such as technology need to be integrated to improve patients’ experiences and outcomes.

Quality audits, patient and staff feedback and other evaluation measures should be viewed as positive tools to help identify what is working well and needs to be built upon, and what needs to be improved. Ongoing evaluation and improvement are essential to ensuring that dignity remains at the heart of healthcare provision.  

Conclusion

Dignity in healthcare is not a new concept; in fact, dignity has been a core element of UK care standards for many years. The NHS Constitution and Care Quality Commission (CQC) both emphasise the importance of treating patients with dignity and respect and professional bodies such as the General Medical Council (GMC) and Nursing and Midwifery Council (NMC) continue to emphasise dignity in their codes of conduct.

As medical technology advances and care delivery becomes more complex, the principle of dignity continues to evolve. However, the basic principles still remain the foundation of dignity in care, and these are:

• Respect for the Individual
• Promoting Autonomy and Independence
• Privacy and Confidentiality
• Compassion and Empathy
• Communication
• Inclusivity and Equality
• Social Inclusion
• Partnership

These principles are fundamental to ensuring that patients feel valued, respected and comfortable in every aspect of their care, ensuring that care is aligned with their needs and wishes, and when they are, the patient’s outcomes tend to be more positive. Patients who feel dignified and respected are more likely to follow medical advice and adhere to prescribed treatments. This cooperation is crucial for managing chronic conditions, preventing complications and promoting recovery.

Staff who practise the principles of dignity in care in their everyday working activities tend to obtain greater job satisfaction, engagement and a sense of achievement. Healthcare organisations that become renowned for their dignified and respectful patient-centred care can retain valuable staff and are able to attract top-quality staff at all levels as they have an enhanced reputation.

Embedding dignity into everyday healthcare practices promotes continuous improvement in healthcare, which encourages trust, improves patient well-being, enhances health outcomes, reduces legal risks, and promotes a positive healthcare environment.