Kerbauy et al. describe the deployment of a communication skills training course at the Fleury Group. The Training was based upon the Communicate with H.E.A.R.T. program developed and used at Cleveland Clinic, and the authors focused upon START with Heart-an upfront customer service class-to determine if it might serve as a means to provide culture change to improve the experience for their patients. The authors evaluated the training by using interviews with leaders at Fleury, and by

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... observations, as they describe in their article entitled "Communicating with HEART around the globe-does empathy transcend culture?" (1). As employees of the Cleveland Clinic, we have participated in Communicate with H.E.A.R.T. classes and have seen the positive influence this training has had on the culture at the Cleveland Clinic. We are pleased to see it being used and evaluated in a different healthcare system in Brazil. The fundamentals of S.T.A.R.T. with Heart, which include: smiling, engaging with the patient on a personal level, active listening, establishing a positive rapport and thanking the patient for their time, speaks to the core necessity of human beings to engage on an interpersonal level regardless of culture. "6 Things you need to know about Empathy" by Peg Streep (2), states "Research shows that most people think of empathy as intuitive..." however, "The best way to think about