Five myths of compassionate leadership

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The NHS is facing a crisis in staffing with large gaps in the nursing and medical workforces in both primary and secondary care. Recruitment is proving ever more difficult, absenteeism is high and staff are leaving or retiring early. There is no magic solution in sight. Part of the reason is the sustained work overload staff face, which has been increasing over time. This leads to high levels of staff stress (50 per cent higher than in the working population as a whole), harming the physical and mental health of staff across the NHS. It is an unsustainable position which demands a wise and powerful response.

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.

The endless remote top-down plans often fail because they ignore the reality of day to day 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.

The only way to respond to the challenges that face us in the NHS is through radical innovation – transformational change.

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. 

Comments

Dr Carolyn Edd…

Position
Was a GP for 25years. Now Traditional Acupuncture,
Organisation
www.cyclesofchange.com
Comment date
30 May 2019

There is a fantastic Consultant Anaesthetist, Robin Young in NZ, who was campaigning for compassionate healthcare. Lots of resources.
So thrilled this is being discussed!

andrew j campbell

Position
frelance,
Organisation
co-create
Comment date
31 May 2019

In 1998 i started to work with an organization at Oxford who at that time was using Learning Organization ideas (Peter Senge et al) that used ideas of compassion among others (E.g. Maturana). My brother was a co-founder of what was by then (late 1990's) a 1 billion turnover business, dedicated to quality. 'Command and Control' was among several of the top issues to deal with. Surveying the entire culture 'at work' today, 21 years later, it's evident that little has changed beyond well-meaning Op-eds and 'positive, idealistic' ambitions toward a 'change for the better.' It has become a business unto itself, perpetuating third and second rate interveners in 'systems' leading to few if any qualitative outcomes for those of the front line, and those who support them.
Just my tuppence worth :)

R

Comment date
31 May 2019

Compassion is what you provide to your pet who needs to be put down.
"The only way to respond to the challenges that face us in the NHS is through radical innovation – transformational change."
This is a self interested, management consultants view of the world.
Do me a favour and apply a little less "self-compassion" .
Confront reality.

Mr R W Ebley

Position
Retired Civil Servant,
Organisation
Retired
Comment date
31 May 2019

The NHS needs good management and this will be achieved if they adopt and then maintain ISO standards
It's not an overnight fix and it's not a bikini clad solution but it will sort out the problems in time
Thank you

Richard Spicer

Position
Retired NHS Consultant Surgeon,
Organisation
University of Bristol
Comment date
31 May 2019

But you must admit that " That can only come through releasing staff from the rigidities of bureaucracies, command and control hierarchies, and relentless top-down scrutiny and control." rings very true. That means more clinical staff, fewer managers and that politicians should back off and allow clinicians to get on with their job. That is what confronting reality should be.

Simon Diggins

Position
Business Development Manager,
Organisation
South London and Maudsley NHS Trust
Comment date
03 June 2019

Looking after your staff who, in turn, look after patients and the communities we serve, should be common sense and may not need a label, though 'Compassionate Leadership' does as well as any; our Army officers' version is 'Serve to Lead'. But good leadership, without an effective organisation or structure, is largely ineffective, though probably more pleasant, than bad leadership in a poor structure.

It is disappointing though that a retired Consultant apparently sees no value in management structure, 'just let us get on with our job..'; it is a common cry and frankly, total nonsense. The role of managers is to support clinicians so that they can do their job: to argue for resources; to respond to commissioners, local authorities, NHS, and non-NHS, structures, politicians and the public; in short, to provide a structured framework for a reasoned debate about priorities, current performance and future requirements. No doubt, clinicains could do that, but it would be at the expense of their clinical function; is that what the retired consultant wants?

Perhaps the real answer to this question is to ensure that clinicians, nurses and managerial staff are trained together, have a common understanding of what the problem is, 'the recognised picture' so to speak, and then, together, devise options and agree a plan to resolve them. Into that context, 'Compassionate Leadership', in whatever format, has its place as the again, 'recognised' style of leadership.

Tracy Wharvell

Position
Program Director,
Organisation
Pulse UK
Comment date
10 June 2019

'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.

Wendy

Position
Psychologist,
Organisation
NHS
Comment date
14 June 2019

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.

Mick Forsham

Organisation
HR Specialist
Comment date
15 June 2019

How, what radical change?

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