Compassion – setting apart the good from the great leader
Being a good leader is not an end point; it is a vehicle on a journey to a vision. In the NHS, we have a great vision for quality, safe and effective patient care. Reproducibly achieving this pinnacle of outcomes for our patients must go hand-in-hand with effective and sustainable staff engagement.
When the NHS was created in 1948, it was with an ideal to provide healthcare to all regardless of wealth and free at the point of delivery. We’re now, over 70 years later, and, in a nation that is in a myriad of ways vastly different from the one in which the NHS was born. It might now, seem a little naïve, to want to embrace, so fully, this compassionate foundation. Yet, to provide a sustainable future to the NHS, to be able to maintain its vision with longevity the hearts of its staff must be continually motivated by care, empathy and responsibility to achieve the best that we can for our patients. What is humbling is to understand, that there are many staff in the NHS that are so motivated, even when faced with the toughest of situations.
However, whilst continually reaching its vision for excellence in patient care, the NHS continues to face hurdles. One such hurdle, is that we should be aiming to achieve good patient care whilst, at the same time, looking after the very people on the front line who have come together to deliver that healthcare. However, for a long time the NHS has been an organisation that has somehow achieved notable patient care at the expense of those who deliver that care and has ultimately therefore resulted in patient outcomes that are less than we are capable of.
With 497,000 responses and an average response rate of 46%, the 2018 NHS staff survey(1) is the largest workforce survey in the world. It gives a window into areas of experience and engagement for staff across the NHS. 39% of staff reported feeling unwell due to work-related stress in the previous 12 months, whilst 56.5% of staff had attended in the last three months, despite feeling unwell, because of pressure they felt from their manager, colleagues or themselves. Both of these figures had increased from the year before. 13.2% of staff reported experiencing bullying or harassment from a manager in the last 12 months, this was an increase on the previous two years (12.5% & 11.8% respectively), and BAME staff were more likely to report discrimination (15.3% vs 6.4% for white colleagues).
Strong leadership has often been equated with directive top down models both within the NHS and within organisations in general. Conversely, though, research and real life-examples(2) within healthcare and other spheres have demonstrated that leaders who are compassionate are successful not only in engaging staff and enabling them to feel valued. Also, such leadership engenders effective strategies and innovation that leads to improved outcomes for patients.
Compassion is not a soft, optional skill to be employed by the weak or unsure leader. Compassion is a bold and important NHS value that leads to vision and change and helps propel staff and trusts to a higher level of positive participation and ultimately better patient care.
When defined as “being moved by and feeling sorrow for another person’s suffering and taking action to alleviate the pain felt by that person”(3), compassion is more than just a feeling it is a recognition of need and pain and an active response to do something about it. It is the very active nature of a compassionate response that can make it a rare response in organisational life. In our day-to-day work we are busy and under pressure to be productive and efficient, we may hardly have time to notice let alone act on another’s need. Our NHS culture has not always leant itself to being compassionate to ourselves and our colleagues. Does this matter though? Is the workplace an area in which compassion is needed or appropriate?
We can turn that question on its head and ask if workplaces, especially within the NHS, can afford to not have compassion? Research into the effect of compassion at work is still growing but research has shown that
“those who experience compassionate leadership at work are more likely to report affective commitment to their organisation and talk about it in positive terms”(4) and
“ ..reduces employee turnover and increases organisational citizenship” and
“lowers heart rate and blood pressure. It also decreases employees’ psychological distress…it can contribute positively to the lowering of the incidence of sick leave”
The “Developing People – Improving Care”(5) strategy from NHS improvement has a number of ‘conditions’ for developing team leaders at every level of the NHS to develop improvement and leadership capabilities among their staff and themselves. Condition two states that “we need compassionate, inclusive and effective leaders at all levels”. They go on to elaborate on the fact that a powerful way in which to influence organisational culture is leadership and that compassionate leadership creates an environment where there is “no bullying and where learning and quality improvement are the norm”.
Prof Michael West, of the Kings Fund, makes the crucial point that the influence of leaders is pivotal because “what leaders pay attention to, what they monitor, what they reward, what they talk about communicates to staff; what it is that’s valued in the organisation i.e. the culture”(6)
If those of us who lead in any capacity are committed to a sustainable model then we all need to gain a handle on what compassion is and how we can develop that in ourselves.
Mrs Rantimi Ayodele is a consultant trauma and orthopaedics surgeon at the Maidstone and Tunbridge Wells NHS Trust .