Building compassionate leadership

Compassionate leadership is essential to help NHS staff recover from a decade of stress caused by chronic under-staffing and increasing workload, according to Professor West, a leading researcher of the healthcare workforce.

The professor of organisational psychology at Lancaster University was speaking at the National Conference for Radiology Managers, jointly organised by the Society of Radiographers and Philips.

Professor West said more than a third of NHS staff reported being burnt out “often or all of the time”, which had direct consequences for their health, as well as the levels of care provided. “We cannot go on like this, just watching the stress levels among staff continue to rise, year on year - it’s unsustainable. Not least because we are seeing huge numbers of staff quitting the NHS.”

He said that as well as huge health inequities in society, there were similar issues to face within the NHS workforce: “Amongst all of those NHS staff who tragically lost their lives during the pandemic, fully 63% were from minority ethnic group backgrounds. And that’s a desperate indication of the fact that we need to address issues of equity and inclusion within our health service.

“And of course there are the increasing demands on the service that you will all be aware of, and all of this speaks to the need to transform our healthcare systems for the future.”

Professor West said the NHS had to make the workforce its top priority, and that compassionate leadership must be ‘at the heart’ of a new culture, with diversity of all kinds truly valued, and the implementation of serious solutions to staff stress.

“We have to move away from this hierarchical, top down, command and control culture within our health service. We have the largest, most motivated and skilled workforce in the whole of industry, and our challenge must be to release their creativity, their knowledge and skills and abilities to create more collective leadership as we see in the private sector.”

What is compassionate leadership?

Professor West said he used the definition of compassion conceived by Professor Paul Gilbert of the Compassionate Mind Foundation: “A sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it". In practice, he said, there were four behaviours to compassion: to attend; to understand; to empathise; and to help.

But he said despite the extensive research findings showing the power of compassion and its impact on patient outcomes, most clinicians say they do not have time. “Actually the research evidence suggests that compassion does not take any more time. It’s less about doing something additional, it’s about being more attentive, present, understanding, empathising and helping.

“And what’s also significant is that being compassionate to others can have a significant impact on our own mental health, with lower levels of stress and depression.” The challenge now, said Professor West, was how we can bring more compassion into our healthcare teams to the benefit of all.

“The role of leaders is particularly powerful in shaping cultures in organisations because what they focus on and portray in their own behaviour shows us what is important to them. So to create compassionate cultures, leaders must embody compassion in their leadership.”

More than 160,000 people respond to the National Staff Survey each year, and those trusts where staff say their leaders demonstrate the four behaviours of compassionate leadership also show higher levels of staff engagement and satisfaction, higher levels of patient satisfaction, better care quality and financial performance. The opposite is true of trusts where compassionate leadership is not present.

Professor West said effective leadership was characterised by ‘direction, alignment and commitment’ so that every team in an organisation had a clear purpose that was translated from the executive team to every other level in four or five agreed, clear and challenging goals.

“I’ve had the privilege of studying healthcare teams since the 1980s and that’s what predicts team effectiveness. Many of the executive teams in NHS trusts have not done that, so they are not real teams. They are already working as siloed entities.”

Professor West also warned that many organisations in the NHS were failing to properly treat the causes of staff stress, focussing instead on secondary interventions that seek to address the health consequences. “Without primary interventions we are not addressing the underlying causes and so staff stress levels will continue to rise.”

He said leaders needed to meet the fundamental needs of their teams as humans, addressing the “ABC” of core needs: allowing them Autonomy and a voice, a sense of Belonging through feeling valued and respected, and a sense of making a Contribution because their work made a difference.

“We are failing to treat people as human beings. It’s humans that constitute organisations and humans that have basic needs that have to be met in order for us to feel well and motivated.”

At the same time, he said, all healthcare workers needed to learn to better care for themselves: "The most important message I can share with you today is that healthcare workers need to be able to care for themselves so that they can lead and care for others".

Photography by Eva Slusarek