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Five myths of compassionate leadership

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.