The Compassion Pause Connects Caregivers in OR

System Update | March 2025

Before the first incision in the operating room, Juan Moldes, MD, draws his team in for a few moments to center their focus on the human being before them.

Juan Moldes, MD

You are human, too. You have a lot going on in your life – we all do. But for the next few hours, you are here, and this patient on the table is all that matters.

That’s the message that Dr. Moldes delivers to the team before every surgical procedure. Known as a Compassion Pause, this shared experience in the operating rooms at UH Cleveland Medical Center are having a transformative experience for those who witness them.

It starts while Dr. Moldes is scrubbing, alone with his thoughts, to cleanse his mind as he does his hands. Then, in the OR, following the standard Safety Time Out, Dr. Moldes draws the attention of the whole team – anesthesiology, nurses, first assists, techs and residents – to the person on the table.

“Take a deep breath and have conscious awareness of this important moment,” he said recently in one Prentiss OR. “Be fully present and leave outside the OR all the thoughts that are not related to this patient. Focus on the job we have to alleviate the suffering of this patient and this family.

“Be committed to our purpose to be here,” Dr. Moldes continued. “With our courage as surgeons and caregivers, we are here as a team with wisdom and knowledge to help them. Take a deep breath, and we can start the surgery.”

As a pediatric urologist, his patients are already under anesthesia in OR. The Compassion Pause is for the benefit of the surgical team. But in Mather OR, before surgeries on adults, the urologist who recruited Dr. Moldes to UH is including his adult patients in his pause.

Lee Ponsky, MD, FACS, Chairman of the UH Urology Institute, Leo and Charlotte Goldberg Chair in Advanced Surgical Therapies and Senior Distinguished Physician, asks his patients what they do for a living, if they have a spouse or children, where they live. With his hand gently resting on their arm, he listens thoughtfully to their answers and follows up with more questions. Plumbers, teachers, union laborers, lawyers, grandmothers, physicians – most are surprised to be asked more than their date of birth and confirming the type of surgery about to be performed on them.  

“It was one of the best experiences of my life,” said one patient of Dr. Ponsky’s, who shared his testimonial in a video shared at the 2025 System Surgical Summit. “In such a stressful situation, I felt the best I’ve ever felt in any medical situation. It’s all about the idea that somebody took the time to say, ‘I get the anxiety you’re going through.’”

Dr. Ponsky tells his patients that he knows it can be intimidating being naked on a table in an operating room before a room full of strangers. But while they are in his team’s hands, they are all that matters.

“We all have things in our lives going on, but we have a commitment to you, the patient – and while you are here, you are our full priority,” said Dr. Ponsky, who holds the Leo and Charlotte Goldberg Chair in Advanced Surgical Therapies and is a Master Clinician in Urologic Oncology. “We acknowledge that vulnerability.”

Dr. Moldes was at the pinnacle of his 30-year career in Argentina when he was recruited to UH. He was performing the most advanced surgeries, including transplantation, at Hospital Italiano de Buenos Aires, the largest and most complex private hospital in Argentina. He’d spent a decade as chief of pediatric urology there and completed a healthcare management master’s program.

Yet still, something was missing.

“People would imagine in a position like that you would feel complete, but in the last five years or so, I felt there was something missing in the connection of what we are as human beings and what we do as surgeons,” said Dr. Moldes, who was already practicing meditation and exploring mindfulness and compassion.

Pedro Lopez, MD (L) and Juan Moldes, MD

When his close friend, Pedro Jose Lopez, MD, was interviewing with Dr. Ponsky to be chief of pediatric urology at UH Rainbow Babies & Children's Hospital, he learned there may be an opportunity for him in Cleveland also. Dr. Moldes brought to UH an expertise in complex reconstructive bladder and kidney surgeries, including endoscopic, laparoscopic or robotic techniques as well as transplant. 

He also introduced this new focus on compassion inside the ORs at UH.

“It’s completely the opposite of how we learn to be surgeons, where your feelings are not allowed in the OR,” Dr. Moldes said. “I feel here at University Hospitals that I can open this connection that I was looking for, for so long, having the consciousness that we are human beings working with human beings. I really felt this is the place to do this.”

Dr. Ponsky was intrigued by this clinician’s professional experience and wisdom to explore the fundamentals of why people become physicians in the first place. He wanted to bring compassion to the forefront again.

“Doctors before medical school are impassioned about the idealism of being a doctor and helping humanity. But that gets lost in the focus on learning anatomy and pathology and how to take care of patients,” Dr. Ponsky says. “Surgeons get hyper-focused on learning safety and techniques and mastering the technical aspects, and sometimes that compassion takes a back seat for a period of time.

“This really allows us to focus on the experience of our patients and our providers. Dr. Moldes is basically reminding everybody why they became doctors.”

The Compassion Pause is completely voluntary, but surgeons who try it are met with overwhelmingly positive feedback. Dana Obery, MD, a second-year urology resident, has been in awe of the response it has elicited from surgical patients.

This pause creates a more collaborative environment in the OR, Dr. Obery said. With so many pre-operative tasks to complete, and everyone from techs and first assists to circulating nurses and anesthesiologist having their defined roles, it offers a brilliant chance for the team to focus as one, he adds.

“This pause is such a simple idea, and yet it really has caused an energy that is much needed in OR culture,” Dr. Obery said. “It has provided such a breath of fresh air during the cases I’ve been a part of, as you have a sense of calm as a result of this pause, and it creates a unique focus in the room.”

Dr. Moldes developed the concept after taking a Mindfulness-Based Stress Reduction course created at University of Massachusetts and Compassion Cultivation Training designed at Stanford University. Then he worked with two international trainers in mindfulness and compassion on creating four essential elements for a Compassion Pause in the OR, which he introduced at UH:

1. Conscious awareness to be fully present
2. Commitment to purpose, that remind us that one of our goals as providers is to alleviate the suffering of our patients. 
3. Courage and wisdom to make hard decisions in difficult situations
4. Caring connection to build a safe environment in the OR where everyone feels valued

The concept is spreading beyond urology. Cristian Baeza, MD, Surgical Director of the Structural Valve Center and Co-Director of the Aortic Disease Center at UH Harrington Heart & Vascular Institute, has been surprised by the response he’s received from his patients.

Telling an open-heart surgery patient that for the next four to five hours, nobody in the OR will be thinking about anything but them and making them better has been met with tears.

During post-op rounding, one cardiac surgery patient told Dr. Baeza through tears that this pause eased his anxiety about having a major surgery. The patient said he knew that no matter the outcome, the team was intent on doing their best. And he even shares the sentiment in the office, providing extra assurance to his patients.

“When you tell somebody they need open-heart surgery, it’s a big moment,” said Dr. Baeza, a UH Distinguished Physician who spent 20 years leading thoracic and cardiovascular surgical programs at two prestigious hospitals in his home country of Chile before joining UH. “People feel very anxious, and sometimes they start crying in the office. When I tell them there is a team of more than 10 people who have trained years for this moment, and they’re going to know your name and why you’re here, and they are going to take care of you, it calms them down.”

Dr. Ponsky believes the Compassion Pause, something so simple yet profound, will continue to ripple throughout the organization. Dr. Moldes has already published a piece about it in the Journal of Pediatric Urology.

“Dr. Moldes is a special individual,” Dr. Ponsky said. “The lessons he’s teaching us are so critical.”