Understanding Compassion in Ethiopian Health Care Organizations: A Case Study Examining Health System Reform, Institutional, Employee, and Patient Perspectives in a Post-COVID-19 Context

Abstract Background Health system reforms in Ethiopia focus on a motivated, competent, compassionate, and respectful health workforce and person-centred care. Despite a strong national policy commitment, the consistent delivery of compassionate care remains challenging due to organizational factors such as heavy workloads, limited resources, inadequate supportive supervision, and the ongoing impacts of the COVID-19 pandemic. Understanding how compassion is shaped by organizational contexts in real-world health care settings can provide valuable insights to inform improvement efforts. The goal of this study was to explore how compassion was demonstrated and experienced within an Ethiopian health care organization following the COVID-19 pandemic. Methods A case study of an Ethiopian health care organization was conducted using multiple data sources, including policy and organizational documents, surveys with patients and employees, and interviews and focus group discussions (FGDs) with employees (health care providers, leaders/managers, and support staff). Documents were analyzed using content analysis, surveys using descriptive statistics, and interviews and FGDs using reflexive thematic analysis. Results were subsequently integrated to triangulate findings. Results Thirty-five documents were analyzed, surveys were completed by 141 employees and 293 patients, and 35 employees participated in interviews or FGDs. Document review indicated that compassion was embedded across system, organizational, and professional levels; however, survey results suggested that compassion within the organization was perceived as moderate, with limited presence of supports and recognition programs. At an individual level, both health care providers and leaders/managers reported high levels of self-perceived compassion competence, and patients reported moderately positive experiences of compassionate care from health care providers. Interview and FGD findings highlighted personal and professional motivations for compassion, the importance of communication and connection in person-centered care, supportive organizational structures that facilitate compassion, and systemic pressures, including workload and COVID-19-related strain, that hinder compassionate practice. Conclusions While the Ethiopian national policy provides a framework to support compassionate practices, numerous implementation barriers persist at the organizational level. In addition to system-level policy, strengthening compassionate leadership and providing training initiatives and recognition programs, as well as safe working environments, may help sustain compassion in post-pandemic health care settings.