Introduction
Before you read this explainer, we invite you to ask yourself two questions…
What do I hope to learn from reading this?
What assumptions have I made before I start?
Compassion can be defined as ‘a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it’ (Gilbert 2013). We can experience compassion in different ways: we can feel compassion for other people; we can experience compassion from others; and there is also the compassion we can direct towards ourselves.
Compassionate leadership involves a focus on relationships through careful listening to, understanding, empathising with and supporting other people, enabling those we lead to feel valued, respected and cared for, so they can reach their potential and do their best work. There is clear evidence that compassionate leadership results in more engaged and motivated staff with high levels of wellbeing, which in turn results in high-quality care (West 2021).
How do compassionate leaders behave? They empathise with their colleagues and seek to understand the challenges they face; they are committed to supporting others to cope with and respond successfully to work challenges; and they are focused on enabling those they lead to be effective and thrive in their work. Compassionate leaders don’t have all the answers and don’t simply tell people what to do, instead they engage with the people they work with to find shared solutions to problems.
For leadership to be compassionate, it must also be inclusive. Compassion blurs the boundaries between self and other, promoting belonging, trust, understanding, mutual support and, by definition, inclusion (West 2021). This creates an inclusive, psychologically safe environment in which diversity in all forms is valued and team members can contribute creatively and enthusiastically to team performance.
It is evident that the NHS has struggled over many years to sustain inclusive, people-centred cultures and our research suggests that it is local action in teams, departments and organisations (big and small), where the work to create these types of cultures is most effective, because that is where the people are (Ross et al 2020). Developing compassionate leadership approaches helps leaders hold crucial conversations about inclusion, ensuring they hear and reflect deeply on what staff are telling them and then take necessary action to help address inequities and discrimination in the workplace.
The four behaviours of compassionate leadership
Compassionate leadership involves four behaviours (Atkins and Parker 2012).
Attending This means being present with and focusing on others – ‘listening with fascination’ (Kline 2002). Listening is probably the most important leadership skill and compassionate leaders take time to listen to the challenges, obstacles, frustrations and harms colleagues experience as well as listening to accounts of their successes and joys (West 2021).
This means being present with and focusing on others – ‘listening with fascination’ (Kline 2002). Listening is probably the most important leadership skill and compassionate leaders take time to listen to the challenges, obstacles, frustrations and harms colleagues experience as well as listening to accounts of their successes and joys (West 2021).
Understanding This involves taking time to properly explore and understand the situations people are struggling with. It implies valuing and exploring conflicting perspectives rather than leaders simply imposing their own understanding (Gallo 2017).
This involves taking time to properly explore and understand the situations people are struggling with. It implies valuing and exploring conflicting perspectives rather than leaders simply imposing their own understanding (Gallo 2017).
Empathising This involves mirroring and feeling colleagues’ distress, frustration, joy, etc, without being overwhelmed by the emotion and becoming unable to help (West and Chowla 2017).
This involves mirroring and feeling colleagues’ distress, frustration, joy, etc, without being overwhelmed by the emotion and becoming unable to help (West and Chowla 2017).
Helping This involves taking thoughtful and intelligent action to support individuals and teams. Removing obstacles that get in the way of people doing their work (eg, chronic excessive workloads, conflicts between departments) and providing the resources people and services need (eg, staff, equipment, training) are the most important tasks for leaders (McCauley and Fick-Cooper 2020).
This involves taking thoughtful and intelligent action to support individuals and teams. Removing obstacles that get in the way of people doing their work (eg, chronic excessive workloads, conflicts between departments) and providing the resources people and services need (eg, staff, equipment, training) are the most important tasks for leaders (McCauley and Fick-Cooper 2020).
Why does compassionate leadership matter?
Research shows that compassionate leadership has wide-ranging benefits for both staff and organisations.
For staff
People who work in supportive teams with clear goals and good team leadership, have dramatically lower levels of stress (West et al 2015). Compassionate leadership increases staff engagement and satisfaction, resulting in better outcomes for organisations including improved financial performance (Dawson and West 2018).
In NHS trusts where staff report the absence of such leadership, staff also report higher levels of work overload and less influence over decision-making (West et al 2022) and organisations have poorer outcomes (West and Dawson 2012; West et al 2011).
For patients
Staff who are treated with compassion are better able to direct their support and care giving to others (Goetz et al 2010). This results in higher-quality care and higher levels of patient satisfaction (West and Dawson 2012; West et al 2011). Where staff generally report the absence of such leadership there are lower levels of patient satisfaction (West et al 2022), there is poorer-quality care and (in the acute sector) higher patient mortality (West and Dawson 2012; West et al 2011)
Understanding the core needs of health and care staff at work
Meeting people’s core needs at work is important in supporting their wellbeing and motivation. Compassionate leaders constantly strive to understand and meet the core needs of the people they work with (West 2021).
The Health and Care Select Committee recently conducted an inquiry on workforce burnout and resilience in the NHS and social care (House of Commons Health and Social Care Committee 2021). It concluded that burnout is a widespread reality in today’s NHS and has negative consequences for the mental health of individual staff, which has an impact on their colleagues and the patients and service users they care for.
Recent studies on doctors (West and Coia 2019) and nurses and midwives (West et al 2020), including those in training, have shown that the wellbeing, flourishing and work engagement of health and care staff, is affected by eight key factors that can be organised into three core needs (see figure below). Meeting the core needs of health and care staff can help transform their work lives and in turn, the safety and quality of the care that they deliver.
Compassionate leadership and managing performance
Compassionate leadership is not a ‘soft option’ and can help leaders effectively manage the performance of individuals, teams, organisations and systems (West 2021). Within health and care systems, too often performance problems are not directly addressed and so-called ‘wicked problems’ are avoided or hidden (Dixon-Woods et al 2014). The skills of compassionate leadership help in the management of performance problems through encouraging the collective responsibility of teams for solving them, helping to promote a culture of learning, where risk-taking (within safe boundaries) is encouraged and where it is accepted that not all innovation will be successful (West and Markiewicz 2016).
Compassionate leadership helps to create psychologically safe working environments by encouraging team members to share learning and improve the quality of their work through regular reviews (West 2021). Moreover, considerable research evidence shows that such teams are both more productive and innovative (West and Markiewicz 2016). One meta-analysis of 49 research studies suggests such teams are between 35 and 40 per cent more productive (Tannenbaum and Cerasoli 2013). In safe team environments, there are higher levels of learning and innovation. In contrast, blaming cultures are fearful, inhibit compassion and prevent learning (Edmondson and Lei 2014).
What gets in the way of being compassionate?
Several factors can influence the capacity of people and teams in health and care to be compassionate, including poor working conditions, poor leadership, role confusion, role conflicts and excessive workload (Gilbert 2017; Cole-King and Gilbert 2011).
One study has suggested that 56 per cent of health care providers don’t think they have the time for compassion because they need to focus on other tasks including administration, reducing costs and regulation (Reiss et al 2012).
Time pressure is clearly a powerful factor in health and care environments but Trzeciak and colleagues (2019) stress that the quest for efficiency and a focus on the important human side of health care are not mutually exclusive: ‘You can go through your daily activities with brusque efficiency and let people know how busy you are, or you can go through your day valuing human connection and showing compassion and it actually doesn’t take any longer.’
Many national health and care organisations in the UK now recognise the importance of their own compassionate leadership in helping to tackle issues that undermine compassionate leadership including the burdens of excessive data reporting, bureaucracy, and misaligned policies. See for example (National Quality Board undated).
Conclusion
Compassionate leadership must be at the heart of local, regional and national efforts to nurture cultures that provide high-quality, continually improving and compassionate care for people and communities.
Given the increasing complexity of delivering health and care, chronic work overload and additional pressures created by the Covid pandemic in health and care, it is vital for leaders to place a high priority on supporting the health and wellbeing of people at work.
Leaders need the courage to move away from traditional hierarchical leadership approaches, towards a compassionate leadership approach. It requires a sustained shift in mindset and behaviours of people working in health and care to deliver and sustain this culture change. For the sake of patients, service users, staff and communities, such sustained courage and commitment is essential.
If you would like to learn more about how you can develop your own compassionate leadership practice, The King’s Fund has a free short online course, An introduction to leading with kindness and compassion in health and social care, for anyone working in or interested in health and social care in its broadest sense, regardless of sector, experience or role.
After reading this, you might ask yourself…
- What have I learned?
- Who will I discuss this with?
- How can I help to change things for the better where I work?
You may like to try some of the practical tips offered below.
Some practical tips
Through your daily work (whatever your role and regardless of your seniority), you can practise compassion through how you attend, understand, empathise and help.
Attending
- Notice suffering at work (your own and others’)
- Ask people about suffering, difficulties, challenges
Understanding
- Be curious
- Withhold blame, focus on ‘What’s the learning here?’
Empathising
- Be aware of continually changing conditions in yourself and others
- Develop empathic listening and tune in to feelings of concern
Helping
- Direct your efforts towards what is most helpful in alleviating others’ suffering
- Create flexible time to enable others to cope with suffering
Comments
I'm struck by the similarity between the figure of 3 core needs - Autonomy, Belonging and Contribution and the Ryan and Deci's Self-Determination Theory SDT (Autonomy, Competence and Relatedness - the latter being described very alike your Belonging). Should Ryan and Deci not have a citation here?
I’ve learned that compassionate leadership is leadership of strength and courage. To be compassionate and kind always in leadership need a lot of strength so as not only to be task oriented but above all to be people oriented whilst at the same time achieve the best outcome.
This is a masterpiece. As a student on placement, I often wonder how healthcare staff can meet up with the "compassionate" side of the profession. The spirit is there but the reality of short staff and too much workload make the application often tricky. In trying to prioritise your care, some compassionate aspect of the care is lost.
The current rate of change in Aged Care creates conflicts for some in keeping up with change but still doing the every day tasks. Compassioate Leadership is about helping staff manage their own concerns and to learn self management practices to stay relaxed and outwardly focussed on the client.
The contrast between the way we treat patients and colleagues can be stark. Whilst leadership starts from the top and sets the tone of an organisation, ultimately we're all in charge of something and a discoid approach should not be discounted.
Good article - a quick read, references hyperlinked with further reading recommendations, and suggested practical actions listed at the end.
The crux of the matter is that compassion is the first to go in the face of constant stressors in the workplace. Maximising comparative advantage by placing people in the right roles and addressing demand management effectively are two such ways, but neither are going to be consistently realised in a cash-limited system.
I sat down to an older man, he could not stop shaking. No-one was talking to him, despite older people around him. I started a conversation, he shaking all the time, but could speak with difficulty. Yet we manged and even had a laugh. He was most thankful for me talking to him. One small gesture had probably made him feel normal and care showed to him.
My mum with short term memory, compassion made her life, she loved the activities we did. She still was very friendly despite her condition and was loved by all she met. Even inviting people, even strangers, to visit her for a cup of tea. She should not have been put on a coded, palliative pathway of neglect and then murdered because she was desperate to go home, all kept from family. No truth given to Coroners', family or Ministry of Health by this Consultant or answers to family by the Chief Executive of the Trust.
Very interesting reading so far. The compassion towards staff is lacking in most nursing profession that is why people gets demotivated and nursing is no more a noble profession.
Interesting read, one’s psychological well-being impacts their working environment, service users and colleagues alike. While working with people, the primary focus is compassion and care, yet it is often shown to service users. However, it can be absent when it comes to staff and colleagues; this needs to be improved to foster mental and psychological well-being within the working environment.
Worthwhile read. Really resonated with me. I sense a calling.
Definitely need publicity with the Health service.
Add your comment