How do we create the conditions within our workplaces – the organisational cultures – where compassion will be nurtured?

Professor Michael WestProfessor Michael West is a Visiting Fellow at the King’s Fund. He recently gave a presentation at the CCG about compassionate leadership and we are delighted that he agreed that we could share his talk with you…

Compassion is a universal value because of two truths – the first is that we have all experienced compassion, no matter our cultural background, upbringing, or the different paths that our lives take. And second, compassion is universal because it is care that flows naturally from a deep part of ourselves, to those who need it, regardless of status, wealth, ethnicity, age or gender. Compassion binds us together, creates a sense of safety and interconnectedness and is a manifestation of love in an encompassing rather than exclusive sense. It nurtures a feeling of belonging to others beyond our immediate circles.

No country in the world has had enough resources to deal with the Covid-19 crisis in the way they would wish to – all health systems have had to find creative responses, to innovate, spread knowledge and collaborate. And to determine how to respond. Most have recognised that compassion is at the heart of any effective response, and at the heart of health and care. Most of us have recognised that we must promote understanding of our interconnectedness with each other – across professional boundaries, across hierarchies, across sectors, across communities and across nations. The learning from the pandemic urged us to seize the moment (every moment) and model and promote compassion within and across our health and care organisations in an enduring way.

Compassion is ‘a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it’. We are motivated to notice and become aware of the distress of the other and pay attention to this distress, while having an empathic insight into the needs of others. These are basic human instincts.

How do we create the conditions within our workplaces – the organizational cultures – where compassion will be nurtured? Organizational culture is shaped by all of us but particularly by its leadership. It is the behaviour of leaders, top to bottom and end to end, individually and collectively, in health care organizations that powerfully determine whether care quality is the priority; all staff have clear objectives; there is enlightened people management; there are high levels of staff engagement; learning and quality improvement are embedded; and good team and inter-team working is endemic. And leadership is potentially demonstrated by all in an organization or community, not only those formally identified as leaders.

Research on climate and culture in health and social care internationally suggests that leadership cultures of command and control are less effective than more engaging and compassionate leadership styles in health and care systems across the world and implies that compassionate and collective leadership approaches are likely to be most effective.

Compassionate leadership involves attending to, understanding, empathising with and helping those we lead. The purpose of compassionate leadership in health and social care is to help create the conditions where all of those in our communities are supported to live the best and most fulfilling lives they can. To be compassionate as leaders in health and social care means being effective as a leader in pursuit of that vision by ensuring direction, alignment, and commitment.

If leadership is not inclusive, it is not compassionate. That means leadership must include all, regardless of professional background, opinion, skin colour, sexuality, religion or gender. Including all is a core value of health and social care and including all is the nature of compassion.

Compassion implies sharing power and influence by encouraging collective leadership, where all feel they have leadership influence. And collective leadership requires leaders to work compassionately together to develop a climate of shared, interdependent leadership prioritising care for those in the communities overall, rather than just our own areas of responsibility.

Compassionate leadership is modelled by leaders attending, understanding, empathising and helping those in other teams, organisations and sectors who contribute to health and care in communities. These themes are explored, explained and evidenced in this book, augmented by practical strategies and links.

Experiencing compassion from others shapes individuals’ appraisals about themselves (e.g., seeing themselves as more capable), their peers (e.g., viewing them as kinder) and the kind of organization of which they are a part. When staff feel valued and cared for (i.e., perceived organizational support), they tend to feel more satisfied in their jobs, and have increased affective commitment to their organizations and there is considerable evidence that this is true in health and care organizations and is associated with high levels of patient/service user satisfaction, care quality and even organizational financial performance.

Research in healthcare has shown that learning and innovation are more likely to take place in a culture of compassionate leadership and psychological safety rather than in a culture dominated by fear and blame. A culture of supportive teams with compassionate team leadership is linked with reduced levels of stress, errors, staff injuries, harassment, bullying and violence against staff, staff absenteeism and (in the acute sector) patient mortality.

Compassionate leadership is therefore at the heart of our efforts to nurture cultures that provide high quality, continually improving and compassionate care for patients and service users.

As Don Berwick, Prerana Issar (new Chief People Officer) and Sam Allen (CEO of Sussex Partnership Trust) commented in a 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.

Compassionate leadership requires courage, resilience and belief – it requires a commitment by each person as a leader (and all staff should be considered leaders in health and care) to be the best that they can be. It begins with self-compassion so that by attending to oneself, understanding the challenges we face in our own work (and life more generally), empathising or caring for ourselves, and then taking wise action to help ourselves, we 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.

Michael West CBE joined The King’s Fund as a Senior Fellow in 2013. He is Professor of Work and Organisational Psychology at Lancaster University, Visiting Professor at University College, Dublin, and Emeritus Professor at Aston University.

He has authored, edited and co-edited 20 books and has published more than 200 articles inon teamwork, leadership and culture, particularly in healthcare. He is a Fellow of the British Psychological Society, the American Psychological Association (APA), the APA Society for Industrial/Organisational Psychology, the Academy of Social Sciences, the International Association of Applied Psychologists and the British Academy of Management.

Michael has extensive experience of working to improve staff experience and care quality. He assisted the development of the national frameworks on improvement and leadership development in England in Northern Ireland, and is currently supporting Health Education and Improvement Wales to develop the national health and care leadership strategy in Wales. He co-chaired the two-year inquiry into the mental health and wellbeing of doctors, Caring for doctors, caring for patients. Most recently, he led the review for The King’s Fund into the mental health and wellbeing of nurses and midwives across the UK, The courage of compassion: supporting nurses and midwives to deliver high quality care (2020).