The most important starting point is compassion – a core value of the NHS as a whole and its NHS staff. Sustaining the NHS as a culture of high-quality compassionate care requires compassionate leadership at every level and in interactions between all parts of the system – from national leaders to local teams. Compassionate leadership in practice means leaders listening with fascination to those they lead, arriving at a shared (rather than imposed) understanding of the challenges they face, empathising with and caring for them, and then taking action to help or support them. Such leadership will help us begin to address the problems the service faces because top down national solutions are not working. Meanwhile, patient care and staff health are being undermined.
But there are some myths that must be addressed to ensure people see the value of compassionate leadership. These are that compassionate leadership will mean:
- loss of commitment to purpose and high-quality performance
- tough performance management and conversations won’t be allowed or will be labelled as bullying
- always taking the easy, consensus way forward rather than putting patients and communities first
- not being able to challenge the status quo and make the radical changes our patients and communities need
- team work and system working will be controlled by whoever has the most power and is most ruthless.
Virtually all NHS staff are committed to providing high quality and compassionate care. They represent probably the most motivated and skilled workforce in the whole of industry. However, we impose on them a dominant command and control style that has the effect of silencing their voices, suppressing their ideas for new and better ways of delivering patient care and suffocating their intrinsic motivation and fundamental altruism. Released, their motivation and creativity will ensure commitment to purpose and performance. Their voices are needed to tell us how care can best be improved as the endless remote top-down plans often fail because they ignore the reality of day to day care.
Compassionate leadership means creating the conditions – through consistently listening, understanding, empathising and helping – to make it possible to have tough performance management and tough conversations when needed. Staff complain they only see their leaders when something goes wrong and that even if they do listen, nothing changes after the conversation. Compassionate leadership ensures a collective focus and a greater likelihood of collective responsibility for ensuring high-quality care.
At The King’s Fund’s annual leadership and management summit in July, the distinguished Harvard professor Amy C Edmondson will reflect on her work linking compassionate leadership with what she calls ‘psychological safety’ in health care teams. This helps staff feel safe to talk about their errors and near misses, to address concerns about work overload, to talk about worries over lack of competence, and to call out bullying, harassment and discrimination, all of which leads to health care team innovation and effectiveness, as Amy’s research demonstrates.
The only way to respond to the challenges that face us in the NHS is through radical innovation – transformational change. That can only come through releasing staff from the rigidities of bureaucracies, command and control hierarchies, and relentless top-down scrutiny and control. And the evidence from research is clear that compassionate leadership is the vital cultural element for innovation in organisations.
Compassionate leadership creates the conditions where the collective good – the needs of patients and communities and staff wellbeing and development – are prioritised over individual agendas, regardless of status, aggression, or undermining. Such leadership creates the conditions where it is possible to identify and challenge inappropriate use of power, hierarchy or control over resources that are inconsistent with the values and vision of our health services.
As Don Berwick, Prerana Issar (new Chief People Officer) and Sam Allen (CEO of Sussex Partnership Trust) commented in the recent King’s Fund online event, compassionate leadership requires courage. The courage to listen to tough messages from those we lead. The courage to explore their understanding of the challenges they face and to have our own interpretations challenged and rejected. The courage to feel how draining it is to work a 70-hour week, to not have time to go to the toilet on a shift, to have no access to food and drink on a night shift, or to be on the receiving end of violence or abuse from members of the public. And the courage to accept that practicing compassionate leadership will first and foremost address the most apparently intractable workplace challenges such as excessive workload, staff shortages and ever-increasing demand.
We hear some saying ‘let’s just talk about positive leadership rather than compassionate leadership’. But that’s a cop-out. Positive leadership means all things to all people. And it can be a fig leaf for pretending that problems don’t exist and then failing to address the endemic problems of bullying, harassment, discrimination, lack of equal opportunities and an increasingly beleaguered and damaged workforce. And it is meaningless – it doesn’t identify what the key leadership behaviours that constitute positivity are.
Compassionate leadership requires huge courage, resilience and belief – it requires a commitment by you as a leader (and all staff should be considered leaders in the NHS) to be the best that you can be. It begins with self-compassion so that by attending to yourself, understanding the challenges you face in your own work (and life more generally), empathising or caring for yourself, and then taking wise action to help yourself, you are able to stay close to the core values that give our lives and work meaning – compassion, wisdom, courage, justice – we are able to have deeper, more authentic and more effective interactions with all those we work with and offer care for. Putting such leadership into action demonstrates not the myths, but the magic of compassionate leadership.
A Compassionate Leader is present, always willing to listen and will encouraging her employees to speak out share their ideas and views
Kindness is everything i know its an old cliché but treat people how you want to be treated, a smile can go along way you never know what someone else is going through what kind of day they may be having, it no good as a manager leader going in shouting when something is going wrong , ask what is happening as if you can help.
If your staff are happy and feel supported well valued then so will the residents.
Compassionate leadership is often misunderstood /misapplied.
I have seen managers, self-labeled as compassionate, but the human qualities which define a leader as compassionate were missing or present in homeopathic doses(zero empathy/zero courage/lack of commitment/no contact with reality).
NHS should create small autonomies to each department, each hospital, creating the premises to self-found and self-manage resources and generate profit, and at the end of the year to receive new financial resources based on the pertinent audits.
I find it frustrating at times to talk about clinical rationale with people who lack common sense...a prime example - think that a hip replacement can't be done to 45 years old individual under NHS because is too young!!!, but they reserve it for old age, enrolling that young individual into a cascade of prescriptions for pain management, transforming the individual without consent into an addict to opioid!!!
Clinicians should have the power to justify a medical act and take responsibilities at the end of the year and present results with positive impact to budget - directly, indirectly - by improving health outcomes and life qualities- they support a productive individual to reduce their work absence, increasing productivity and creating a good and healthy life.
This type of vision should be encouraged to create a safer and healthier society.
Compassionate leadership begins with self care and being able to be authentic as a leader in your own space. If you are not feeling psychological safe in your leadership stance how can you promote safety from top down for your employees.
I fear you miss the point compassion is essential leadership behaviour needed to make tough decisions and choose appropriate actions of innovation and transformation. Leaders not able to recognise this will continue to fall back on the tools and techniques that created the systemic issues we face today
Not the most useful comment as you don't givee an alternative view. Surely it's hard to argue with compassion? Confront reality? That is exactly what the authors are doing...
Wholeheartedly agree with compassionate leadership. It is another essential characteristics of an effective leader in healthcare. If Leaders are to model the way, then this is the way. It is who you are as a leader that has the greatest impact, therefore, authenticity, integrity and wholehearted leadership is essential. To become an effectual leader takes time, hours of reflection and trusted colleagues that are willing to highlight your blind spots.
How, what radical change?
Let’s face the truth, performance initiatives, quality control, compassionate care are all buzz words that rarely deliver what is needed at the front line. I work at the face to face level with the public and I am sick and tired of the obfuscation and years of silencing staff who can see ways to manage better than politicians and cutting budget motivated managers. Money is wasted every day going through self invented hoops to keep the boxes ticked instead of actually doing the job you are trained to do. I love innovation and scientific changes that could be used to alleviate the workload but instead of that is now used to ask staff to do more to keep up. We are not robots. We do cost money and yet not that much in the scheme of things. Mistakes are made because we are human not due to a lack of compassion. Compassion a buzz word used to accuse staff of the things that they have no control over. Systemic failures due to all the siphoned off funding that we spend sending people to external providers motivated to make profit not better care. At the moment we have the worst of both worlds not the best in either. Staff have turned to defensive practice which switches off their desire to provide compassionate care. If you are constantly worrying about the possibility that your performance is under scrutiny by those who are not trained in your profession how on earth are you actually able to practice effectively at all. Not all practitioners want to be managers but at least those who do could be brought back into the decision making picture to guide and help those managers who just don’t see what practitioners do.
'Compassionate leadership requires huge courage, resilience and belief... to be the best that you can be. It begins with self-compassion...' then extend to those around you. It is important not to personalise interactions and think people are getting at you. Wisdom in the Workplace is what we advocate.