Compassion and innovation in the NHS

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One of the most extraordinary characteristics of humans as a species is our capacity to innovate in response to challenges. But the right conditions have to be in place for innovation to bubble up.

Earlier this year, in Caring to change, we set out the cultural conditions needed for innovation to take place in NHS organisations. These included the need for a lived, inspiring vision that emphasises the importance of innovation and improvement; autonomy or freedom for staff to develop and implement new and improved ways of doing things – and a commitment to giving staff the skills they need to do this; collective, rather than command-and-control, leadership; and strong and unequivocal support from leaders as innovators address the challenges they face.

Innovative organisations also have positive approaches to inclusion and participation, high-quality teamworking and an ethos of optimism, cohesion, co-operation, support and collaboration across boundaries, with a strong commitment to ensuring high-quality care for the communities they serve. 

Caring to change looked at the link between compassionate leadership and innovation, and based on our review of the international research it is clear that compassionate leadership stimulates innovation by enhancing the intrinsic motivation of NHS staff and reinforcing their fundamental altruism. It also promotes a culture of learning, where risk-taking (within safe boundaries) is encouraged and where there is an acceptance that not all innovation will be successful – an orientation diametrically opposite to cultures characterised by blame, fear and bullying. 

The research evidence shows that compassion also creates psychological safety, such that staff feel more confident in speaking out about errors, problems and uncertainties. They feel more empowered and supported to develop and implement ideas for new and improved ways of delivering services. And they are likely to work more co-operatively and collaboratively in compassionate cultures, in climates characterised by cohesion, optimism and efficacy. 

All well and good, but how do we actually achieve this in organisations? For the past two years The King’s Fund and the Center for Creative Leadership have been working with NHS Improvement to develop a programme to support trusts in developing leadership strategies to deliver cultures of high-quality, continually improving and compassionate care. The programme has three phases: a discovery stage that examines the existing culture and leadership of organisations; a design stage that involves developing a comprehensive and sophisticated leadership strategy; and a final implementation stage. The first output from this project was a series of tools to diagnose a trust’s current culture, the second is an evidence-based programme that includes all the building blocks for developing a leadership strategy that spans recruitment and talent management, leadership development for those in key roles, and leadership behaviours for all staff. The programme includes more than 50 elements, such as developing compassionate leadership, leading for innovation, and building team-based working.

Based on a co-design process involving three trusts (Northumbria, Central Manchester and East London Foundation Trust) and evidence from the NHS and international research, the comprehensive programme enables trusts to assess their existing cultures and leadership and then to design an integrated strategy that will deliver compassionate, collective and inclusive leadership necessary for innovation and high-quality care. 

The programme also draws on pioneering work by Lancashire Care NHS Foundation Trust and Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, and on the good practice of many other trusts across the country. A vibrant community of practice is also working to advance knowledge of how to refine the considerable content that constitutes the guidance. 

We know what’s required to meet the challenges facing the NHS – high levels of innovation within and between organisations. Now the key is for leaders in every organisation to make it happen by recognising that innovation takes courage, persistence and confidence. The prize is a significant one – high-quality, continually improving and compassionate care that ensures the health and wellbeing of communities and an increasingly caring society. 

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