Compassionate leadership

Compassionate leadership

By John Hunt

This article has been adapted from a piece which was first published on the Faculty of Medical Leadership and Management website in October 2017

“Compassionate leadership means paying close attention to all staff, really understanding the situations they face and then responding empathetically and taking thoughtful and appropriate action to help”. This quote is from the King's Fund.

Evidence from high-performing health systems show that compassionate and inclusive leadership behaviours create cultures where people can deliver sustainable quality and efficiency improvements quickly.

Developing People: Improving Care

NHS Improvement highlighted compassionate leadership as one of the five conditions it is seeking to create when in December 2016 it published its national framework on action for improvement and leadership development Developing people: improving care. This is what it says:

Compassionate, inclusive and effective leaders at all levels: leaders demonstrate inclusion and compassion in all their interactions. They develop their own and their staff’s skills and capacity to improve health services. They also have the specific management skills they need to meet today’s challenges. Leadership is collective, in the sense that everyone feels responsible for making their bit of the system work better...'

There are “secondary drivers” associated with this:

• Knowledge and practice of compassionate, inclusive high impact leadership behaviours.

• Development and support for all staff.

• A system and approaches for attracting, identifying and deploying the right people into the right jobs.

Caring to Change

Compassionate leadership was explored in more depth in May 2017 when the King's Fund published “Caring to Change: How compassionate leadership can stimulate innovation in health care” by Michael West et al. This paper looks at compassion (which involves attending, understanding, empathising and helping) as a core cultural value of the NHS, and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things.

The table on page 6 of the report gives an especially useful summary of compassionate leadership and the processes that lead to innovation, from the individual level right through to the system-wide level, listing the compassionate leadership activities and the cognitive, emotional and other processes.

The paper goes on to describe four key elements of a culture for innovative, high-quality and continually improving care and what they mean for patients, staff and the wider organisation (see especially figure 2 on page 17):

• Inspiring vision and strategy

• Positive inclusion and participation

• Enthusiastic team and cross-boundary working

• Support and autonomy for staff to innovate.

The report also presents case studies of how compassionate leadership has led to innovation.

Michael West gave a presentation on aspects of this in a talk on collaborative and compassionate leadership at the King's Fund's Leadership Summit in May 2017, and the audio, his slides and a transcript are available. [https://www.kingsfund.org.uk/audio-video/michael-west-collaborative-compassionate-leadership]

Professor Michael West on “Leadership in today's NHS”

The following month, the NHS Leadership Academy and Health Education England produced an excellent 15 minute video. It's introduced by Tim Swanwick (Senior Clinical Advisor and Postgraduate Dean):

“This is a short film, and the messages within it delivered quietly to camera. But within it Michael West summarises a wealth of research and encapsulates a lifetime of experience. Wise words from one of our foremost leadership thinkers.”

In it, Professor West not only provides a clear exposition of what compassionate leadership actually means, but also how important it is to the health and well-being of both patients and staff. He describes in more detail the four behaviours that really make a difference: 

• Attending: paying attention to staff, being present (listening with fascination).

• Understanding: finding a shared understanding of the situation they face.

• Empathising: feeling their distress.

• Helping: taking intelligent thoughtful and informed action to help and to alleviate their distress.  

As well as a founding principle of compassion, he also summarises five evidence-based interventions that create cultures in which high quality care can flourish:

• A well-articulated vision, purpose and narrative.

• A limited number of clear and aligned objectives.

• Enlightened and exemplary people-management.

• Support for quality improvement and continual innovation.

• Effective team working.

In addition he talks about collective approaches to leadership (including shared leadership in teams), something that is more important than ever as the boundaries of health and social care organisations change, merge and reform.

Compassion: A leadership imperative for health systems

This was the title of the editorial in volume 1, issue 2 of BMJ Leader. Here's a quote from it:  

“Leaders can create a culture of compassion—or the reverse—by their style of leadership. There is robust evidence that organisations whose leaders have a supportive style outperform others on a range of quality metrics. Staff who are treated with compassion will be more resilient to burnout and stress themselves and will be more compassionate to patients”.

The editorial cites a number of references which give supporting evidence and more detail.

How useful has this been for you? To what extent do you or others around you use compassionate leadership? Do you have any examples of compassionate leadership in action? If you have any suggestions, views or comments, why not share them on Twitter?