Leading with Compassion
A report from the Shropshire and Staffordshire LETC sharing event
25 September 2015
Shropshire Conference Centre
Shrewsbury
Welcome…
We are all here because we are passionate about
developing compassionate leadership and we need to be
thinking today about where we want to be a year from
now and what we want to be proud of.
We will hear some great examples of what is already
happening. We really need to own compassionate
leadership and it needs to be owned by all of us.
Today we need to think about what we need to do to
make compassionate leadership as good as it can be
across our patch.
Today is a dialogue event. It is about:
Contemplation
Commitment
Inspiration
An invitation…
This is a conscious invitation to relax and
enjoy the day.
We need to meet as a compassionate
community, as equals, recognising our
differences.
Reflection can be difficult – so we need
to take care of ourselves and others
today.
My story: Caroline Donovan…
In 2002 I was expecting another baby. I had two children already but I was
excited and delighted to be having another child. At a scan I was told all was not
well. The message was not shared in a compassionate way, which really didn’t
help me. I have hung on to the memory of this for years.
The information given to me was not totally correct. I’m an articulate, intelligent
individual and I did what we all do and Googled about it. I got far more
information, so much of which was not shared with me at my scan. I discovered
that my baby was not compatible with life, which was extremely difficult for me.
I had to go through labour knowing I was going to give birth to a still born baby
The compassion towards me shown by the consultant was incredible. It had a
huge effect on me and made such a difference.
I had previously felt I was being treated as another number, not as a person. I had
been dehumanised. The consultant’s compassion saved us from making a formal
complaint about our earlier treatment.
We need to think about why compassion is important to all of us. We have
the opportunity to make an impact every day on others’ lives. We need to
step into the shoes of service users / patients as this way we are more likely
to gain compassion.
Caroline…
As a chief executive, I need to think about how I
create an environment in which people feel
that they can deliver compassionate care.
We as leaders need to create a culture in which
staff can say that things are not good enough
and what they need to do in order to do their
job properly – and to know that there will be no
consequences for speaking up in this way.
Leadership is the difference between good and
great care. There is a correlation between the
two. A key ingredient of all good leaders is
compassion.
If you knew how they felt, would you treat them differently?
Be present: the symbol of mindfulness…
Mindfulness is the ability to pay attention without judgement in the present moment.
We need to learn to recognise the emotions that are triggered when we hear someone else’s story.
Be empathetic: we need to put ourselves in other people’s shoes.
We must ensure that we are present because when we are absent, we cannot be compassionate.
Why are we here?
Sarah Lehmann – University Hospitals of North Midlands
Working with compassion and helping people to discover their own compassion is a powerful tool to help them overcome their issues and/or
difficulties. There is a huge talent within the NHS and we need to unleash it to transform patient care. We need to unlock the discretionary effort –
the ‘go the extra mile’. We need staff to be engaged, to feel safe and work to their best. But above all, we need to ensure the wellbeing of our
staff because there is a positive correlation between staff wellbeing and patient wellbeing.
In order to improve staff engagement, performance and wellbeing, we need to move away from coercive leadership towards compassionate
leadership. We need people to be engaged, not resistant.
When we perceive a threat we experience the fight, flight
or freeze response. We are biologically driven to respond to
threats, to defend ourselves and keep ourselves safe – both
our physical and psychological safety.
When focusing on threats, however, we miss other things
happening around us that we should take into account.
Creativity, problem-solving and reasoning etc. are all stifled
when we are feeling under threat as we don’t need them in
order to deal with the threat.
Pushing/driving people with threats activates the drive/achievement
system, which reactivates the threat system. It is self-perpetuating. We
miss the need for people to feel safe – the calming system.
Regularly feeling threatened is draining and exhausting – both
emotionally and physically.
So what are some of the triggers to the threat system when working in the
NHS?
Feeling criticised
Not being consulted
Unrealistic targets
Things that happen that are out of our control
Where does compassion come in?
Compassion directly activates the calming system and helps to reduce
the threat response. It is not just soothing but acts on it to reduce the
threat.
Leading with compassion should…
Connect with others in supporting relationships
Reduce stress/negativity
Be authentic
Be positive and empowering
There is a balance of emotional regulation to get the best from our staff.
We need to know how to switch compassion on and be mindful of what
switches it off.
Compassion
begets
compassion. When feeling threatened as a leader, we need to absorb this
feeling, not cascade it.
There is a natural tendency for the threat system to be activated
and for it to be cascaded.
We need to forge a path in the brain to switch on our compassion
system. And we need to practice this.
The more we do this, the more natural it will become. The more we
go down the same path, the more familiar it becomes and the less
effort is needed to go down that path again.
So the more we practice compassion, the more familiar and natural
it will become. We will need to consciously think about it less
because it will become a more instinctive way of leading and
behaving.
Self-compassion and grounding ourselves…
We want to move more towards a flow of compassion. There are three ways to do this:
Self to self Me to you You to me
Andy Bradley…
Make a fierce commitment to caring for yourself. Fall in love with your life
outside of work. Don’t lose the ability to say no. Compassion starts with
ourselves.
Whatever we focus on grows. The mind is like a garden and we can ‘grow’
four different parts of our brains:
Resilience – the ability to bounce back
Savouring – looking to the good
Attention – focus on particular ways
Generosity – the things we feel grateful for make us more generous.
We work in hierarchical systems in healthcare but we need to focus on
compassion and equality.
Have fun with it and be willing to do things differently. Pay attention to
things you don’t normally pay attention to.
We need to invite people to dismantle the hierarchy where appropriate.
There is an invitation to you today to move 20% more slowly with 20% more
purpose. Walk your way into calm – people make fewer mistakes this way.
It may feel alien to you in your working environment, but it really does work
and is part of the brain rewiring process.
Take in the
good.
And
Great expectations: the partnership approach
Tina Harkin and Fiona Shield…
Our journey started with the integration of three different organisations
and cultures. We listened to staff and what they wanted. We looked at
what was happening locally and in the wider context (nationally). We
recognised that compassionate care requires compassionate leadership.
We created a model around compassion and staff needs:
* An enabling/no blame culture
* Courageous conversations (rather
than avoiding them) when
behaviour is disruptive to team
working
* Innovation is encouraged
* Consistent, positive approach to
leadership development
* Authenticity of leaders
* Authenticity
* Time for reflective learning
* Action
* Reflective learning – learning
positively from mistakes
* Listening, hearing and acting
* Openness and honesty
* Encouraging innovation
This is what our model was built on. We delivered things in-house. We
built relationships with teams, put ourselves in their shoes and took a
holistic view to ensure that staff felt engaged, empathetic and
understood the challenges.
We were taking staff from a dark place to a brighter place. We had to
show that leading with compassion was a credible way of delivering
care. We have listened, been flexible and changed things along the way
in response to feedback.
Paula Dabbs…
Prior to Victoria’s appointment as Workforce Director and the
appointment of Peter Herring as our Chief Executive in 2012, there had
been little investment in organisational development and our workforce
directorate had a very traditional transactional HR focus.
Peter our chief executive led our journey in developing our values and
has been personally very involved in talking to staff about what our
values should be and what it means to work for SaTH.
We had over 600 suggestions from workshops, which were then grouped
into themes and staff were invited to discuss. From this, we arrived at four
agreed statements/values for the organisation.
Our values then became visual with the use of pledge cards, lanyards
and a badge recognition scheme. This has further developed over time.
Our senior team increased their visibility, speaking to staff and giving
personal accounts of what the values mean to them. But we knew that
our staff and patients don’t experience our values, they experience our
behaviours. Collectively and through a workshop approach (again CEO-
led), we asked staff what behaviours they would identify against our
values to give us our behavioural standards. We have a visual
demonstrating the behaviours and our leadership dos and don’ts, which
complement each other.
Our staff are central to the delivery of our trust’s vision so our aspiration is that
we have our values as the golden thread throughout everything we do.
Values-based recruitment…
Within workforce this is through our employee lifecycle and we have a
values, behaviours and attitude interview as part of every recruitment
process and a values-based induction programme.
We support an employee led values-based appraisal process and
deliver values-based conversation training to support our everyday
conversations.
In the first 12 months, 79.9 % of staff stated that they knew what our
values were and 57% of these felt that are values were lived within the
organisation.
There will always be plenty of work to do but our commitment is there
to deliver.
Paul Draycott…
We had a new chief executive and a largely new executive team
who wanted to try and do things differently. They wanted to unleash
the talent within the organisation, to create a climate for change and
move forward towards a culture of compassionate leadership.
Mental health services can be an ‘island’ – we wanted to bring them
into the mainstream…to integrate them with ‘physical’ health services
and to treat people as one. We had no previous focus on
compassionate leadership and needed clearer structures and greater
clinical engagement.
In order to create a culture for compassion, we needed to connect
with people, work with them, be inclusive and turn listening into
action.
Staff are fully involved in lots of our work. They are helping to spread
the message, breakdown concerns and reassure people. It would be
much more difficult without them and they have fully embraced it
and got on board.
Honest, open communication has been critical. A positive
environment is essential for compassionate leadership to surface and
survive. It is not an initiative – it is here to stay.
Our Dear Caroline site for people to post issues, concerns and
questions increasingly saw users not posting anonymously and moving
from criticism/what’s wrong posts to good suggestions for the future.
Leading with compassion is
conscious work.
Unconscious work leads to
primal instinct behaviour.
Collective leadership
Ruth Tyrell…
The starting point for us – our strategy – was that we are all in this
together.
We engaged with staff to ask them if collective leadership was right for
us and if everyone would buy into it. We also asked if we already
have a culture of high quality care. The answer was yes. The
organisation was up for compassionate, collective leadership –
particularly senior leaders.
We then asked what this should look like – what it should include. It is
all about behaviours, being clear what is expected and modelling
those behaviours. We needed a leadership charter to include our
values and associated behaviours and all our activity had to be
mapped across these behaviours.
We were proposing a new approach of a coaching culture…not
imposing it but asking if it’s something the organisation would like to do
before moving forward with it.
Our approach is one of collective leadership with compassion. It’s
about changing the way we interact and changing the behaviour of
our staff rather than care itself - because already achieving good
quality care.
Compassionate leadership: an uncompromising commitment
Alex Brett…
Our agenda is challenging because of our geography - 3,500 staff with
services from as far away as the Isle of Wight to Cambridgeshire to
Shropshire!
We have been on a bit of a road trip to build a culture of
compassionate leadership. We have made an uncompromising
commitment to compassionate leadership: we are not there yet but we
have made good progress.
Behaviours are the embodiment of organisational values. They need to
be embedded into practice and, as such, we have a framework and
charter around behaviours.
Compassionate leadership behaviour is promoted, modelled and
rewarded in many ways including awards, board development, team
interventions, 360 degree reviews and a conversational approach to
appraisals.
Our behaviours framework is embedded throughout the organisation
and across everything we do. Compassionate and caring behaviour is
not being soft and fluffy - it is about the way we do things, appreciating
the needs of others and doing the right think in the right way.
We are making connections between various strands of work from
organisational development, service improvement and individual and
team development. It’s not about process – it’s about people.
Leading with compassion
Sonia Orr…
Our trust was formed in 2011 from two PCTs. This coming together left
a sense that there were different cultures in existence. 2013 brought a
change of direction as we had a new chief executive who
acknowledged that we needed to move away from our culture of
fear/targets towards a culture of autonomy and compassion.
We spoke to staff: they told us the values and behaviours they wanted
to see. We boiled these down to our organisational values. We then
wanted to see what our values looked like if we lived them so we went
out to staff again.
We then had to decide how we could create a culture of compassion
from the values work. From all that we learned, we are currently
focusing on two main workstreams:
1. Mentoring with care, concern and compassion
2. Our way of working values into action – tackling challenges
and making a difference.
The programmes have been a challenge…the biggest of which is the
capacity to release people - and some people are still reluctant to be
coached/mentored. There is a lot to do still but progress is happening:
Staff feel more empowered, things feel different
Fewer requests for team mediation/intervention
Fewer staff grievances and a better staff survey.
Compassion through health and wellbeing
Zoe Grant…
The case for change in our organisation included low morale, recruitment
challenges, high incident rates, a stressful working environment and lot of
sickness/absence.
I developed a staff stress tool - a simple traffic light system, which provided
a daily opportunity to see how stress levels were among staff. Staff could
depict their stress levels as red, amber or green and the ward manager
would review these on a weekly basis.
Where staff identified stress, we sat down with them to offer an opportunity
to discuss the root cause of their stress and determine next steps. They
generally looked like this:
Do nothing – staff felt better to have an outlet/to offload
Buddy-up with more experienced staff
Link to staff counselling service
Increased clinical supervision
The benefits of this system include: an early warning system, proactive
intervention, morale-boosting, positive support, improved relationships and
a temperature gauge of teams/the organisation.
We have piloted three versions (paper, tokens, electronic) and are in the
process of rolling this out trust-wide.
An important message to teams using the tool and managers has always
been that The process is only as good as the team leader who is managing
it. Managers need to own this process at team level and retain a clear
understanding that this is a tool to support early intervention to staff and not
a performance tool.
An extraordinary thing
Compassion through culture
Rob Cragg and Nicole Ferguson…
Incidences like the one on the right – where a member of staff
acted compassionately because she felt empowered to do so
– are everywhere in WWL. They are not an initiative but are
embedded in our organisational culture. It is the mindset of our
staff that drives these acts of compassion.
We don’t leave compassionate care to chance…we have
engineered a culture that enables compassionate care. Our
OD strategy is the strategy for the trust and we have quality at
the centre of everything. Our values drive everything we do.
Our approach is scientific and data-led. We forensically
examine everything (feelings, behaviour etc.)
We are trying to create a social movement, starting with just a
few teams initially. Others are starting to see the impact and
poor teams have been putting their hands up and saying they
could benefit.
We want people to lead their own improvement. It is a slow
process, but we are working our way through.
We are already seeing a massive improvement in just four
years…4% per year improvement with a significant reduction in
sickness, which has had a massive benefit.
Empowerment and engagement
enable staff to provide better care: not
panicked or stressed but having the
head space to provide the best care
possible.
Making compassion contagious
Compassion through recognition
Laura Rogers and Rob Cragg…
We have heard some great examples of leading with compassion
today and there are many common themes.
We need more stories/examples from every organisation across
Shropshire and Staffordshire and to share them so that we can learn
from each other in order to create our own definition of what
compassion means to us.
Compassion needs to come from every direction. It is not just for
patients but for ourselves, our colleagues and our community.
We need to create a culture where compassion is appreciated and
practised at the right level in the NHS. We need to show that it is not
light and fluffy but is a powerful way of working that has a positive
impact on the wellbeing of both our staff and patients.
A social movement of recognition…
Collectively we propose the creation of a dedicated recognition of
compassion scheme across the local health economy.
We will create a central point where staff, patients and carers can
complete a simple nomination form to put forward someone who
they feel has demonstrated leading with compassion. Every
individual nominated will receive a personalised badge and card
bespoke to their organisation.
This will provide a unique definition of compassion derived only from
the staff and patients in our system. It will enhance staff
engagement, patient involvement and confidence. It will also
provide ‘best practice’ in compassion sourced for every
organisation for use locally in induction, communication and
education.
Collectively we also propose to create a community of practice
across Shropshire and Staffordshire. The purpose of this network of
leaders is to;
1. Share best practice with a view to self and organisational
reflection
2. Progress the high level outcomes of the “Leading with
Compassion” event
3. To jointly expand the field of knowledge around compassion
4. To share barriers and issues for collective resolution
5. Networking and peer support in a multi-professional
environment.
Be mindful that people focus on what we ask them. So if we ask them about
low, medium and high stress, they think about stress. So maybe we should
ask about happiness levels…move people towards the behaviour we want
them to exhibit.
What great practice discussed today has inspired you to do
something different and what could that look like?
Making leading with compassion the heart of our organisational
strategy and focusing on the behaviours we want to see
Don’t develop strategy in a darkened room: engage staff and
patients
There are bruised people in the system at the moment. We need to
look after them, each other and ourselves
We need to seek out others of a similar mindset so that together we
can work out what we can do to make a difference
There is lots of commonality in the work we are doing. We need to
share this and ensure that we don’t reinvent the wheel
We need the infrastructure to support a culture of compassion
We need buy-in and ownership at every level – top down and
bottom up
From reflection on today, what do you think are the future building blocks for
spreading a compassionate culture?
Lots of energy and engagement and the right attitude
Compassion should run through every leadership programme
Appreciate everyone
Executive teams and boards actively engaged in conversation and taking
ownership of compassionate leadership
Create a hub for sharing good news
Compassion an integral part of student programmes
Recognising and rewarding compassionate care
Being mindful of the working environment and how it can potentially
damage/restrict the growth of compassionate leadership
Respectful of the diverse and great practice we have heard today, what in our
collective understanding is still missing or needs further refinement?
We need a whole systems approach – not just NHS staff but connecting with
everybody
More about morality and ethics
Better understanding of how to do compassionate leadership – we are perhaps
much better at compassionate care than compassionate leadership
Community and citizenship
A culture of compassion
Training and education for frontline staff
Time for listening and to go the ‘extra mile’
How can we sustain today’s focus so that we continue to collectively learn
and grow?
Working across organisations – a community of practice to link everything
together
Buddying across organisations
Peer-reviews across organisations to share good practice
Narratives that come from compassionate care – use them to help people
appreciate its power and impact
More positive patient stories and a hub for sharing good news
Taking ownership/responsibility as individuals
Engage and share work
Review and evaluate our work in three months’ time
A single act of compassion can change someone’s day.
A series of compassionate acts can change someone’s life.
Take care of you. Take care of me. Take care of us.
Sto
Four key messages to take away from today…
1. Engaging staff across the frontline is important but we also need to engage boards in compassionate
leadership.
2. There is compelling evidence that we are truly only as good as the staff we employ. We need to ensure staff
wellbeing to ensure patient wellbeing.
3. Compassionate leadership is not soft and fluffy – it has power, merit and value. We need to engage clinicians
and managerial staff across the organisation, not just in HR/OD.
4. Enjoy being at work, enjoy our lives and have fun together. Take care of ourselves and each other.
There is much more to do. We will take the outputs today and use them to help plan the next stage of our journey.
Thank you everyone for your time and commitment.
To care for myself I will…
Practice walking
more slowly and
being mindful.
Be less selfish and
think of others.
It’s not all about
me.
Stop doing my
email at 10pm –
tomorrow is
another day!
Connect with the
moment.
Take the time to
think good, kind
thoughts.
Keep positive
about the
impact I am
making.
Increase my
levels of exercise.
Stop blaming
myself for all my
team’s
difficulties.
To care for others I will…
Take the time to
listen.
Appreciate and
thank people in
person, not
email.
Think more as if I
was in another
person’s shoes.
Forgive easily,
live in the
moment and be
appreciative.
Listen more and
do something
about it.
Act with
compassion – at
work and at
home.
Smile with my
eyes when I
communicate.
Concentrate on
the positives, not
the negatives.
Hello my name is Vicky Robertson and I am the author of this report. [email protected]