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Dear Chetan,

I enjoyed reading your post. I particularly took note of your comments on compassion. If we postulate that compassion would be a valuable characteristic in healthcare providers or policymakers, it begs three questions. The first is what is the root of compassionate in human beings. From an evolutionary biologist point of view the question is identical to or nearly so to the question of what is the root of altruism (Keltner, 2012).  Richard Dawkins, in the Selfish Gene, argues that human beings can act altruistically when they recognize those that they are helping as kin, or there is a realistic expectation of a quid pro quo (Dawkins, 2016). Furthermore, the degree of altruism varies, as with every other human characteristic, from one individual to the next. The second question is, since altruism is a variable human attribute, how can we select individuals who are more compassionate to serve as health care workers or policymakers. Unfortunately, to use physicians as an example, success has been more correlated with competitive traits rather than with a compassionate nature. (Weed, 2015). Regarding leaders in general, Bill George writes ““In the past two decades far too many leaders have been selected more for charisma than character, for style over substance, and for image rather than integrity” (George, 2016).  So, in keeping with Jim Collins conclusions in his book Good to Great,  if we want a team, whether policymakers or healthcare providers, to perform in a certain manner  we have to pay close attention to how we select it ( Collins, 2001). The third question is, if we want compassion and we select individuals who are likely to display it, then how do we make sure that we incentivize the desired behavior.  21 years ago, Stephen Kerr wrote a classic paper on the topic of incentives entitled on the folly of rewarding A, while hoping for B (Kerr, 1995).   As a practicing physician and as a healthcare leader I am well and personally familiar with the fact that the principal incentive for most healthcare workers in the United States is the bottom line rather than the degree of compassion associated with healthcare delivery.  Therefore, should we really be surprised that we are not getting the outcome we might desire? We could similarly ask if our policymakers are incentivized to be compassionate or are they incentivized to pander to the selfish desires of the stakeholders that hold influence over them. So what is the relevance of this discussion to Kingdon’s streams?  I would say that if we want the policy stream to incorporate our desire for there to be more compassion within our society and health care system, then we have to understand the roots of compassion, we have to select individuals who are compassionate, and we have to incentivize them to be compassionate.

Best

SG

Bibliography

Collins, J. C. (2001). Good to great: why some companies make the leap and others don't. New York, New York, USA: HarperBusiness.

Dawkins, R. (2016). The Selfish Gene: 40th Anniversary Edition (Oxford Landmark Science) 4th Edition. Oxford, United Kingdom: Oxford University Press.

George, B. (2016). Mindful Leadership: Compassion, contemplation and meditation develop effective leaders. Retrieved June 26, 2016, from Bill George: http://www.billgeorge.org/page/mindful-leadership-compassion-contemplation-and-meditation-develop-effective-leaders

Keltner, D. (2012, July). Dacher Keltner on the Evolutionary Roots of Compassion. Retrieved June 26, 2016, from Greater Good – the Science of a Meaningful Life: http://greatergood.berkeley.edu/gg_live/science_meaningful_life_videos/speaker/dacher_keltner/dacher_keltner_the_evolutionary_roots_of_compassion/

Kerr, S. (1995, February). On the folly of rewarding A, while hoping for B. The Academy of Management Executive, 9(1), 7 - 14.

Weed, M. A. (2015, September 22). Has Your Doctor’s Success Required More Competitiveness Than Compassion? Retrieved June 26, 2016, from Huffington Post: http://www.huffingtonpost.com/matthew-a-weed-phd/has-your-doctors-success-_b_8161376.html