Last week Jeff Ace introduced us to SAM, the Sustainability and Modernisation Programme, that NHS D&G are launching to address the complex and challenging landscape that faces the NHS today; increasing demand, reducing workforce and financial constraint. We started touring the region this week, meeting with teams to discuss these issues and ask them for their thoughts and ideas. It has been energising to hear from you all, there are lots of really good and simple ideas as to how we can change, but it is also apparent that there are many significant obstacles that it will take time to overcome.
Lets be honest, working in healthcare today is really tough. We all know ‘winter is coming’ when in reality it never went away. Our recruitment challenges extend well beyond medics now with difficulty filling nursing, AHP and other professional posts. Beds are blocked, shifts cant be filled, and so on. What do we do?
The following is a quote from a Kings Fund paper titled “Caring to Change’.
“Only innovation can enable modern health care organisations and systems to meet the radically changing needs and expectations of the communities they serve. While adequate financial support is a necessary precondition, it is clear that more money on its own, without transformative change, will not be enough.”
Two words stick out to me, Innovation and Transformation. Both are necessary, both are hard, especially when we are busy, but both can be fun if we work together and support each other to deliver them. Done well they can make our lives less busy and our patients care safer and more person centred. But how can we achieve this? I know many people reading this will be thinking ‘Well, fill all our vacant posts and that will solve the problem’ and they may be right, but we know that is not easy and, whilst we cannot take our eye off the recruitment challenge, we need to do something else.
There is a growing body of evidence showing that a different form of leadership can achieve cultural change and provide the environment that can lead to innovation and transformation. This leadership focuses on compassion. By compassion I don’t just mean Kindness and being nicer to each other (although I will come back to that at the end). So what do I mean?
Compassion can be understood as having four components: attending, understanding, empathising and helping.
If I am going to lead with compassion then first I must be present with you, pay attention, I have to Listen with Fascination. This may sound obvious but is not as easy or common as it may sound. Too often people listen with minimal interest. They clearly are waiting for the talker to stop so they can get their point across. Listening with fascination means giving your all to the person you are attending. Really hearing what they are saying so that you can fully understand their point of view.
If we truly listen to others then we can start to understand their point of view, what is causing this persons distress, angst or worry? It is only by fully understanding that you can apply the third aspect; empathy.
I have heard several people say that it is impossible to truly empathise, how can we feel what others feel when they are a complex mix of experiences and values that differ from our own. This may be true but if we listen and understand their problem then, at some emotional level, we can feel their distress and share their feelings. Then we will be driven to the fourth aspect, the motivation to help.
Wishing to help doesn’t have to mean ‘give me your problem and I will sort it’ but thoughtful and intelligent action to address the individual or teams issues. More ‘what can I do to support you, what do you need or who do you need to talk to to solve this problem?’ Providing reassurance that different ways of working, innovation & transformation, are welcome and will not be criticised and blocked or, if things don’t work, there will be no accusation or blame.
To create a compassionate culture, one in which we can thrive and transform our services, then we all need to demonstrate these simple behaviours. I urge you to ‘Hold the Mirror up’ to yourself and consider your behaviours not others. What can you do to improve your service, not what others can do to improve theirs.
Every interaction, every day, shapes our culture. The ‘leaders’, and by that I don’t just mean ‘management’ but all in senior positions, have a particularly powerful role in this. What they say, pay attention to, monitor and reward communicates what is valued by our organisation. As leaders if we pay attention to our teams, listen, understand, empathise and seek to help then we are a step closer to the high performing, innovative and transformative teams that we need to get us through the difficult times.
To quote Michael West, a founder of Compassionate Leadership….
“Virtually all NHS staff are committed to providing high quality and compassionate care. They represent probably the most motivated and skilled workforce in the whole of industry. However, we impose on them a dominant command and control style that has the effect of silencing their voices, suppressing their ideas for new and better ways of delivering patient care and suffocating their intrinsic motivation and fundamental altruism. Released, their motivation and creativity will ensure commitment to purpose and performance.
Compassionate leadership means creating the conditions – through consistently listening, understanding, empathising and helping – to make it possible to have tough performance management and tough conversations when needed. Staff complain they only see their leaders when something goes wrong and that even if they do listen, nothing changes after the conversation. Compassionate leadership ensures a collective focus and a greater likelihood of collective responsibility for ensuring high-quality care.”
There is a lot more to Compassionate Leadership. Figures 1 and 2 demonstrate some of this which I will explore in a future blog. If you wish to find out more of this yourself you can listen to a presentation from Michael West here or read the Kings Fund paper ‘Caring to Change’ here.
Just before I finish I would like to return to Kindness, which I mentioned earlier. Whilst Compassionate Leadership has many facets and some different ways of thinking, Kindness is at its core. If we are going to survive the next few years then we need to transform and adapt but we must not forget to be kind to each other. In the NHS we often discuss Kindness to patients but rarely do we discuss Kindness as a leadership behaviour. I am not saying that any of this is easy and I am certainly not saying that I have demonstrated Compassionate Leadership over the years, far from it. I am however willing to put my money where my mouth is and practice this way from now on. I would ask you all to do likewise.
Ken Donaldson is the Board Medical Director at NHS Dumfries and Galloway