Covid-19: why compassionate leadership matters in a crisis

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— Michael Rosen, These are the hands: poems from the heart of the NHS1

These are the hands of health and care staff who dedicate their lives to caring for others. And who are now committed to caring for their communities during a grave global crisis, risking their own health and wellbeing. Last night, millions of people across the United Kingdom took part in a national applause of thanks for health workers and carers helping in the fight against Covid-19 (coronavirus). The collective gratitude and respect for the work of health and care workers was emotional and uplifting at a time of global crisis.

No country has the resources to deal with this crisis in the way they would wish. Last week, the Chancellor of the Exchequer, Rishi Sunak, said, 'we will be judged by our capacity for compassion and individual acts of kindness'. All health systems have to find creative responses – to innovate, spread knowledge and collaborate. How should those who lead health and care services respond? Certainly with compassion at the heart of their leadership.

'Connection and compassion are certain, unchanging and provide a safe refuge in the face of this onslaught on health and care systems and our wider communities'

This moment of crisis is also an opportunity to collectively improve the leadership culture across the NHS. It is vital that, as the NHS responds to Covid-19 challenges, leaders and managers model and promote compassion in an enduring way including self-compassion. Connection and compassion are certain, unchanging and provide a safe refuge in the face of this onslaught on health and care systems and our wider communities. Compassionate leadership is the most potent way people can deal with what feels frightening and overwhelming and leaders need to focus compassion on all those who provide health and care services whatever their role or grade.

The Covid-19 pandemic is placing huge pressure on the ability of the NHS to deliver safe, high-quality care. This means leaders have to sharpen their focus on meeting the core needs of staff, ensuring their wellbeing and sustained motivation to help them deal with this rapidly changing situation. In a crisis, managing emergency response and recovery is based around the concepts of command, control and co-ordination, alongside the need for clear structures and guidance. However, this can come with an understandable reversion to a style of leadership that goes beyond what is necessary, instead overly directing people. This risks alienating the very staff that need to be engaged and motivated.

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The Covid-19 situation is full of uncertainties. Leaders are struggling to find the right solutions as the context changes almost hour by hour. Now more than ever, leaders need to draw upon all available resources, most particularly their people, utilising the collective intelligence of experience and knowledge while adapting and revising solutions as the situation unfolds.

NHS staff are highly skilled and motivated. They have great wisdom, experience and profound values of compassion. They can all be leaders if the right conditions exist for them to be able to do what they know to be the right thing. Unleashing their collective wisdom requires compassionate leadership. That means paying attention to all staff, truly listening to them and being present with them. It means truly understanding the challenges they face, rather than seeking to impose understanding. Empathising with them, feeling their fears, stresses, uncertainties, anxieties and exhaustion, provides the motivation to always ask the question ‘how can I help you?’, the most important task of leadership. Compassion should also be guided by appreciating and meeting the core ‘ABC’ of human needs at work.

A: autonomy and control

People instinctively want to have control and not feel coerced or directed, particularly when under huge pressures in a crisis. Staff must have voice and influence over decisions that affect their delivery of care and their own workplace environments. They need to be trusted to make the best decision they can. Taking away autonomy in a high- demand situation creates stress. Ensuring autonomy and control means listening to staff every day and taking account of their knowledge, skills and experience to make crucial decisions.

Control also means being able to take regular breaks from the inevitably high workload to ensure staff do not make mistakes, get sick or patient care suffers. Staff need access to food and drink to meet their basic biological needs and they need time to care for their health and wellbeing.

The key role of leaders is to provide the resources and clear away obstacles to fulfilling these needs on the path to successful management of the pandemic. Leaders also need to be honest when resources are in limited supply and involve staff openly and honestly in both assessing the impact and risks involved and in making difficult decisions.

B: belonging

Belonging is fundamental to human wellbeing and the need to belong is greater during a crisis. Everyone can feel frightened and overwhelmed in the situation we now face. We cope by feeling supported, loved, cared for and building a sense of belonging as part of a larger, caring whole. And our immediate work group, team, department is critical. Not only must leaders ensure a positive, caring and supportive climate but also encourage and enable sustained multidisciplinary team-working where everyone is clear about each other’s roles.

This means everyone being a member of a ‘home team’ (preferably multidisciplinary) that provides support, enables a shared focus on the task and provides the medium for collective learning and innovation. Such team-working leads to better care, better staff wellbeing and more innovation. And working flexibly, supportively and collectively across boundaries is the way forward in this crisis and for the future. This can only be successful in the context of a compassionate and collective organisational culture.

C: competence

All staff desperately want to deliver high-quality care during this pandemic. Leaders will need to enable and support staff to work effectively during what will be a very testing and prolonged period. Work overload is only sustainable for so long – a saturated sponge cannot take in more water. Leaders must ensure that workloads are manageable if the NHS is to respond to this crisis effectively over the months ahead and not lose staff in the process to a preventable work-related illness, breakdown or a sense of helplessness.

'By working compassionately, courageously and honestly, leaders can support and care for their staff so that they can save thousands of lives across our communities'

Time is very pressured, but staff need to meet with their fellow team members regularly to review, to share learning, to develop innovative responses to the crisis and to simply recover together. Time spent in meeting like this is associated with a 35 per cent improvement in productivity and innovation and similarly large increases in wellbeing. Building short team reviews (even of just a few minutes) in to daily work will establish a rhythm to facilitate greater learning and support to all staff. Regular supportive supervision for all teams and individuals is needed so that their work can be sustained. And it is vital to constantly seek out and share learning from organisations and health care systems around the world about how to deal with the pandemic.

These are the hands, and this is the moment. By working compassionately, courageously and honestly, leaders can support and care for their staff so that they can save thousands of lives across our communities.

  • 1. Rosen M(2020). These are the hands: poems from the heart of the NHS. Alma D, Amiel K (eds). Fair Acre Press

Comments

Cavita chapman

Position
EDI lead, South of England, HEE,
Organisation
HEE
Comment date
31 March 2020

This article is brialliant. Simple, easy to read and connects with me in a way that's true to the message. Thank you for writing this in a time when front line staff need to feel the kindness and compassion from others around them.
Cavita

Simon Kelly

Position
Consultant Ophthalmologist. LNC Chair,
Organisation
Bolton NHS Foundation Trust
Comment date
31 March 2020

An excellent article. Important for NHS leaders to value and listen to staff at all times but vital in times of trouble

Beauty Coles

Position
Project Manager/Consultant,
Organisation
DONBE Systems Ltd
Comment date
01 April 2020

Suzie and Michael.
Thank you for this greatly appreciated and well timed article. Many leaders have no clue about people management. It is very true that by just being compassionate to your staff as a leader, your team is likely to feel inclusive, supported and valued. This in turn benefits the whole team through increased team morale, effectiveness as well as productivity.
Well done you. Hat off to you!
Beauty Coles

CLAUDINE MCCREADIE

Position
Retired,
Comment date
01 April 2020

Thank you for this. It is refreshing to see the best of human values placed at the forefront of a leadership response.

Dr Nupur Arora

Position
GP,
Organisation
Ashcroft Surgery
Comment date
02 April 2020

I couldn’t agree more . What a beautifully written insightful article . I am proud to say I consult with exactly this approach , and from my heart I truly love what I do as a community GP .. and that’s 15yrs of working in an inner city practice - busy, complex health & social care needs . I am the practice safeguarding , trauma , domestic abuse & child health & HR lead and I cannot advocate my holistic approach and trauma informed way enough . Same applies to the leadership in house and on a wider scale . I will certainly be sharing this article with my colleagues , thank you xxx

Jeanete Hutton

Position
Management & Organisational Development,
Organisation
Western Health & Social Care Trust
Comment date
03 April 2020

Suzie and Michael,

Thank you both for a lovely, well written, educational but simple article. The power of human values should never be forgotten and are proving to be critical as we wade through this extremely difficult time. We should never forget we all have the capacity to be compassionate.. Take care and stay safe.

Thank you, Jeanette.

Dr Sharada Abilash

Position
Clinical Director,
Organisation
BCHFT
Comment date
03 April 2020

Times like this bring the best in us. The article clearly highlights what is compassionate care brings to human lives.
Health care settings have probably never seen a crisis like this before .

peter durrant

Organisation
Now long retired but past chair of www.realife.org
Comment date
03 April 2020

Great stuff although, as a long-retired community development/social worker, I'm still longing for the theory and practice of community development theory and practice to be grafted, in a complementary way, on to these important themes. Embracing a commitment to compassionate, inter-disciplinary and fully inclusive services, working 'with,' but not 'for,' people on the receiving ends of top-down services.. Whilst consciously replacing the dismissive description of 'patients' through operating from the grass-roots upwards, challenging the status quo, radical networking and regularly reminding ourselves of where the real power still lies.

Cidalia Eusebio

Position
Icu nurse,
Comment date
04 April 2020

Beautifully written. It's exactly what frontline asks for.

Charlotte Villiers

Position
Professor of Company Law and Corporate Governance,
Organisation
University of Bristol
Comment date
04 April 2020

I love your blog. I am working on arguments for compassionate corporate leadership and I draw on the NHS values in my work. Here is a link to a recent paper which I hope is of interest.
https://research-information.bris.ac.uk/admin/files/177003539/Charlotte…
I would be delighted to talk/collaborate with you if you have the space to do so. Kind regards
Charlotte Villiers

David Bates

Position
Program Lead in Disaster Response and Humanitarian Action,
Organisation
University of Cumbria
Comment date
05 April 2020

This is a great article but I am continuously frustrated as we are teaching these principles of leadership all the time along with Jack Mezirow's transformational learning through the disorienting dilemmas that you allude to above.
What makes this time different to every other disaster and emergency that we've had to deal with?
The rank and file of support workers, HCAs, AHPs, Nurses and Doctors etc make the NHS work whatever the conditions. I believe that it's a negative feedback system - starve an amoeba of oxygen and it fights to survive; starve an NHS worker of resources they work harder to care for their patients sometimes to the detriment of their own health or life!
We continue to strive through teaching, coaching and mentoring and gain some traction with individuals, teams and even larger organisations through a number of innovative schemes as well as our modules, courses and programs. But these are only tactical victories and will not be turned into strategic capital until the behemoth that is the DH at the strategic level (particularly in England) demonstrates effective leadership and governance. That is made more difficult in a heterogeneous system where no one leader or 'commander' has responsibility for all the assets in the system. The reason why the military performs so well on operations is because it is homogeneous and has an effective command structure that turns tactical successes into the strategic goal.
What is the NHS' strategic goal?
DCB

jonathon hope

Position
Patient Leader,
Organisation
none
Comment date
06 April 2020

Thank you so much for this highlight of an incredibly inspirational approach to leadership style that can challenges us all in its delivery. I strongly endorse your vision and the commitment so needed at this time to a different style of management - as can be seen by some of the staff feedback in the recent HSJ article and others. How can we train for leadership from the heart and the head? The starting point of acquiring empathy and compassion in our working life is to be open to embracing self compassion and self-empathy in our daily life. A big ask for many of us! Also, the skill to implement this style of leadership despite the stressful and often overworked role we may have in the healthcare environment is another challenge. As we know, stress based breaks downs and compassion fatigue are a toll that is present in almost all global healthcare environments. They can block empathy and compassion for ourselves and for others. Lastly, how do we get together approaches/programmes to deliver on this aspiration? Do we start to train compassionate and empathetic staff for leadership or start to train leaders in compassion and empathy? Thanks again for you inspiration.

Sarah Philip

Position
Consultant obsxand gynae,
Organisation
Royal Berkshire Hospital
Comment date
07 April 2020

This was such an affirming and timely article. These are exceptionally challenging times for those in clinical leadership. Thank you!

Caroline Nelson

Position
Midwife,
Organisation
The Princess Alexandra NHS hospital
Comment date
08 April 2020

I have previously listened to Michael talk about Compassionate Leadership and been inspired. This is an interesting article and in these difficult times it has never been more important to show compassion The hope is that moving forward this style of leadership will be the norm I speak as a midwife who has worked in the NHS for 40 years

Bashir Arif

Position
Programme Director/Head of OD,
Organisation
NW London CCGs
Comment date
13 April 2020

Well argued blog that lives up to the core values of the NHS.

A crisis requires a leadership response that is clear, decisive and compassionate.

Thank you Suzie and Michael.

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