Innovative “Compassion Pause” Spreading from UH Rainbow to All of University Hospitals

Innovations in Pediatrics | Summer 2025

Pediatric urologist Juan Moldes, MD, delivers a message to the team before every procedure: “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.”

Juan Moldes, MD

Known as a “Compassion Pause,” this simple yet profound concept is transforming the operating room experience for staff at University Hospitals Cleveland Medical Center and UH Rainbow Babies & Children’s.

It starts while Dr. Moldes is scrubbing, alone with his thoughts, to cleanse his mind as he does his hands.

Then, 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.

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

Dr. Moldes and colleagues published “Surgery with compassion: A potential shift in surgical paradigms” in the Journal of Pediatric Urology earlier this year:

Dr. Moldes was at the pinnacle of his 30-year career in Argentina when he was recruited to UH Rainbow. 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.

“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.

When his close friend, PJ Lopez, MD, was interviewing to be Chief of Pediatric Urology at UH Rainbow, he learned there may be an opportunity for him in Cleveland. Dr. Moldes brought to UH Rainbow an expertise in complex reconstructive bladder and kidney surgeries, including endoscopic, laparoscopic and 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.”

Now the “compassion pause” is spreading to adult patients. Lee Ponsky, MD, Director of the UH Urology Institute and who is holder of the Leo and Charlotte Goldberg Chair in Advanced Surgical Therapies and is a Master Clinician in Urologic Oncology, asks his patients what they do for a living, if they have a spouse or children, where they live. 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.

“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 said. “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.”

Contributing Expert:
Juan Moldes, MD
Pediatric Urologist
UH Rainbow Babies & Children’s Hospital