Trust is both seed and fruit of a culture in which people are working at their best. In organisations with high levels of trust, costs are lower, clients are better served and innovation is more likely to flourish. Ed Smith and Richard Reeves, Papering Over the Cracks
I’m deeply interested in how we enact a wholehearted rebellion by ‘showing up’ as our true selves in a world that is obsessed with efficiency and rife with burn-out. Parker Palmer has referred to this burn-out as: violating my own nature in the name of nobility.
A violation that sees many of the people who work in healthcare stressed, burnt-out and exhausted. The Medical Journal of Australia has this month published the research of Dr Marie Bismark and her colleagues at Melbourne University revealing that female doctors take their own lives at nearly three times the rate of the general population. Female nurses had a suicide risk almost four times greater than women in other jobs. MJA Link here
The Expert Advisory Group on discrimination, bullying and harassment advising the Royal Australasian College of Surgeons found that nearly 50% of College Fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment. This level of bullying and harassment at work is experienced across the entire healthcare workforce. It is not the exclusive experience of surgeons or nurses. We have created a culture that is harmful to everyone.
Culture can be simply understood as ‘the way we do things around here’. It was the key problem identified by both Robert Francis and Don Berwick in their reports resulting from the appalling failures at Mid Staffordshire NHS Trust.
Guess what the most important influence on culture is? You guessed it: leaders. From top to bottom and end to end. What they focus on, attend to, monitor, model, reinforce and do shapes the culture. Every interaction by every leader shapes the culture of the organisation.
The paper Reforming the NHS from Within showed that a shared culture, a patient-centred vision, and investment in leadership and quality improvement are more important than structural reforms in driving up quality of care. We cannot achieve the shared culture and leadership we need in healthcare through regulation and policy development. We are simply building a heavier reliance on what Ed Smith and Richard Reeves referred to as ‘regulated trust’ rather than ‘real trust’. This will only erode our behaviour. In the long run corporate rules are no substitute for cultural conscience.
How do we achieve the cultural shift we need in healthcare? We do it by investing in developing and growing a new breed of leadership. Across the world this is referred to as Compassionate Leadership.
A compassionate leader is someone who uses a high level of self-awareness and emotional intelligence to truly listen to what people tell them, then responds with empathy and action that makes a positive difference. Compassionate leaders are mindful and attentive to the ‘here and now’ – which enables them to tap into feelings and concerns that are left unspoken. And they are able to nurture positive emotions of compassion and empathy in others, too. Sarah Massie, Senior Consultant, Leadership Development, The Kings Fund.
Michael West, Senior Fellow at The Kings Fund has written extensively about Compassionate Leadership. In a recent article he describes the imperative for Compassionate Leadership so succinctly.
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. Michael West
This leadership does not just refer to individual leaders in organisations but the leadership in the whole of the health system. It includes the bodies and ministers that oversee the healthcare workforce and service provision and it includes funders, governments, regulators, commissioners and accreditation agencies.
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. Michael West
We can’t bully or demand our way out of an intimidating and destructive culture. No amount of ‘firing squads’ or ‘flying squads’ or table thumping and policy writing will deliver the new compassionate culture that needs to be ushered into the world at the moment.
It will take investment, nurturing, listening, planning and tenacity to get us to where we need to be. I think we can get there. My work at the moment is focused on creating a Compassionate Leadership Lab to enable those who want to learn how to develop into Compassionate Leaders the space and tools to do so.
Join my mailing list if you would like to be notified of the first One Day Intensive Compassionate Leadership Lab in February 2017.