Professor Michael West has spent the greater part of his career undertaking research into the factors that determine the effectiveness and innovativeness of individuals, teams and organisations at work. In this blog, Michael talks about the value of compassion in the NHS.
The NHS was founded on the core value of compassion and a commitment to providing care for those who need it, regardless of status, wealth, ethnicity, age, gender. All NHS staff make the decision to dedicate a major part of their precious lives to caring for others in their communities. Their motivation and effort will be at maximum therefore when they work in organisations where the core value is compassion.
Compassion has four components. It means paying attention to the other person – listening with fascination, coming to an understanding of what is causing the other person difficulty or pain or distress, having an empathic response, and finally taking thoughtful or intelligent action to help them.
We therefore need leaders – as the carriers of culture – to embody compassion. We need leaders who model compassion through their leadership. This means leaders paying attention to those they lead (listening to them with fascination), arriving at a shared understanding of the work situations of those they lead, being empathic towards them, and constantly striving to take intelligent and thoughtful action to help them in their work. This is such a simple model but so powerful in practice and in its implications.
Leadership means not just individual leaders in organisations but the leadership in the whole of the NHS. It includes the bodies and ministers that oversee the NHS – NHS Improvement, CQC, Department of Health, NHS England. If the way these agencies interact with the system is (or is perceived as) directive, controlling, punitive, threatening or uncaring, then compassion dries up and an environment is created in which bullying becomes dominant.
According to the NHS national staff survey, approximately one in five NHS staff report bullying and harassment by managers or colleagues each year. The effects of being bullied (or perceiving that one is being bullied) are seriously damaging to health and wellbeing. Yet, in some trusts reports of being bullied are higher than two in every five staff. What is to be done?
By studying and nurturing organisational culture we find the solutions to bullying and harassment, discrimination and work stress, and poor quality care or lack of compassion. Focusing on bullying alone is dealing with one symptom of a deeper cultural malaise and is unlikely to succeed. Attempts to eradicate bullying by introducing specific interventions have limited success.
We need to take a broader perspective and nurture cultures in which bullying, discrimination, stress and fear are minimised. Every interaction by every individual in every organisation shapes the culture of the organisation – we are all responsible for nurturing culture. Leaders influence culture, culture shapes behaviour, behaviour affects staff wellbeing and patient outcomes. And staff wellbeing and patient outcomes are inseparable. Where staff are bullied, patients suffer also.
To create cultures of compassion, we need more mature approaches to leadership, leaving behind command and control, excessive hierarchies and professional silos which create conditions for bullying and reduce compassion. We need a collective approach to leadership – leadership of all, by all, for all. We face a choice in deciding whether to promote cultures of compassion or cultures of bullying in our workplaces. And each of us, through our every interaction at work every day, makes a choice as to which we are creating.