Balancing Compassions with Service Delivery in Health and Social Care

The author will explore the importance of how health and social care leaders balance compassion with effective and efficient service delivery.

Nacioglu (2016) undertook a review on how individual behaviour of not “speaking up” impacted on the quality of patient safety care. A literature review of 53 articles was undertaken to identify what influenced the “speaking up behaviour” from both the patient and provider viewpoints. Some of these influences were due to “an ability to speak up, a lack of knowledge, lack of insight, position, courage or leadership skills, no empowerment to act, impact of cultural background or lack of confidence”. In contrast, the review also looked at the “enablers of speaking up behaviours”, some of these influenced by “leadership support, collaboration, having a culture of safety, good engaged relationships, having patient engagement, positive approach of leaders and staff being empowered for discussing concerns”.

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The author also notes the poor results of her trust’s inpatient survey (2018). A questionnaire was sent to 1,250 patients with a response rate of 36%. The lowest score of 1.8/10 received for “patient views” on the quality of care received during their inpatient stay. Why is this score so low; is it due to a pressure on beds and standardized length of stay, staff unable to deliver compassionate care, combined with vacancy factors or are patients returning within 28 days due to complications.

In addition, an article by Johnson (2018) discusses the findings of a healthcare network survey undertaken by 1,000 NHS staff, which included doctors, nurses, paramedics and managers. The findings demonstrated that 75% of staff stated that “safe staffing” was one of the highest issues currently facing the NHS. It reported that 77% of staff had contemplated leaving the NHS completely. It reported that 76% of staff routinely worked over and above their contracted hours and 75% never stopped for a break. Over 67% were aware of staffing shortfalls within their own departments.

The study undertaken by Crawford et al (2011) echoes the above findings. It touches on “the language of compassion” in comparison to a “language of threat” in a healthcare where staff are managed to deliver organisational goals through a “production-line mentality” approach. The latter overshadowed the study demonstrating low self-esteem, resentment and intensifying staff frustrations due to obstacles preventing “compassionate mentalities”. Compassion described as “sensitivity to the suffering of others with a deep commitment to try to relieve it” by Gilbert (2009).

Therefore, how does the Government’s mandate support leaders and teams to balance compassion whilst delivering an effective and efficient service. One approach is through the NHS Improvement body (August 2018) of a national framework, which encompasses a collaborative partnership at national improvement and leadership board level to “develop people and improve care”. This is a long term leadership strategy to allow all healthcare staff to have a voice and an opportunity to contribute to service delivery at a local, organisational and national level. Smith (2018) echoes that there needs to be an “climate of change” and we need to move away from a “top down” approach and quite simply states that “people should be treated as people” and collaboratively develop the skills of frontline, ward level and senior staff to improve outcomes. Berwick (2018) also encourages learning at every level to support “good individuals and better care”.

Leadership Behaviour & Compassion

Together with Smith and Berwick (2018), West (2016) supported the development of this national framework against the principles of a common vision and purpose, nurturing and integrating teams. With the purpose of enhancing the skills of staff, empowering and engaging them to deliver improved services and better patient experiences.

He states that the framework encourages leaders to be skilled in “compassion” and embrace all those they lead by listening, supporting and creating a culture of “compassion”, moving away from a culture of accusation and anxiety. He states the framework encourages the “right number of diverse and appropriate” leaders by organisations realigning their strategies to the principles of the framework. This is a long term plan at every level of the system allowing the “same values” of compassion, collaborative working and quality improvement to be sustained.

The author relates to the concept of nurturing and integrating teams through the leadership of her director of operations in the establishment of a multi-disciplinary divisional staff experience task force. The objective is to improve the experience and wellbeing of the 1,700 staff working across the division. Aligning to the organisational objectives, in particular, “safe and caring services” and be the place “people choose to work”. The focus of the group is to represent the views of staff in a fair and unbiased way. To ensure that staff have the opportunity to be involved, engaged and be listened to within the division. This is a new initiative, but it is encouraging to see and feel staff enthusiasm, engagement and togetherness across the division.

Zulueta (2015) states that leaders are enablers in the development and protection of “compassionate health organisations”. As discussed above strategies need to move away from the normal “dehumanising model” and move towards a more “adaptive system”, which is integrated through “learning strategies” in collaboration and engagement with staff. This would allow teams to try new innovative models of care within a safe environment and without fear of reprimand. Allowing them the opportunity to reflect and learn from mistakes and continuous improve the delivery of health care pathways.

In contrast Benson and Hogan (2008) discuss the “dark side characteristics” which impact leadership and organisational effectiveness. Their work reviews many years of research into defining the traits of “good and bad leadership”. They make reference to the work by McCall and Lombardo (1983) who state that both the individual characteristics and achievements cause managers to “derail or fail”. They note those publications which described “toxic leadership” with common terms such as “abusive, bullying, undermining subordinates’ effectiveness” or those leaders who are opposed to the organisational values and behave in an “unethical or illegal” manner. The author herself has been a victim of “bullying” by executive members within her trust in a senior performance management meeting. The author was spoken “down to” and challenged over divisional performance and financial spend. The author has also been made aware of the lead nurse who has spoken to a junior doctor in a condescending manner and the consultant who has shouted at the secretary for overbooking his clinic.

Benson and Hogan (2008) refer to the “downward spiral of dark side leadership behaviour”, stating that on going “toxic dark side” behaviour, may gain short term achievements, but is also the start of a “downward spiral” to failure. The executive member mentioned above by the author has shown a “dark side” of her personality by being dismissive, forceful, temperamental and mistrusting of teams. As a result there has been a vote of “no confidence” in the executive board members, resignations have followed and current leadership strategies are being reviewed.

Gillon (2013) makes reference to “humanity in healthcare”, taking the findings of The Francis Report and taking the ethical approach to deliver a healthcare with “compassion or humanity”. At the time of this article the government, national nursing and medical organisations are driving compassion as a fundamental value to deliver healthcare. Reference is also made to the update of the NHS Constitution following The Francis Report asking all members of the NHS to strive for delivering the “highest standards of care”, ensuring individuals are treated with “compassion, dignity and respect” and being aware how individuals impact the wider organisation and other team members.

Leadership & Self Awareness, Self Assessment

Gillon (2013) goes on to question “self-assessment” and individuals taking ownership for their own actions and conduct. He suggests that individuals need to question their personal skills, values, character, qualities and need to ask themselves “do I respect my patients, am I friendly, do I interrupt too much, am I perceived as arrogant”.

Individuals can be supported with self-assessment tools through a 360 degree assessment, their yearly appraisal, clinicians who undergo their professional validation and revalidation appraisal, which could include patient questionnaires on the quality of care received.

Covey (1989) suggests that effectiveness can be achieved whilst balancing compassion for those who achieved the desired outcomes. He suggests individuals need to have self-awareness by understanding their our attributes, skills and desires and then by working in collaboration with individuals, teams and organisations to achieve goals and objectives making continuous improvements at a personal and professional level.

Also, the author found the model by Schein (1987) ORJI cycle a useful tool for self-awareness to continuous improve “repertoire” skills with a clear mind without prejudging or having biased thoughts when being presented with information or involved in discussions.

Conclusion

As echoed above, there needs to be a national direction of change by investing and nurturing the NHS workforce. To allow every member of the NHS to be an enabler to drive compassionate healthcare and have realigned visions and values that truly reflect the national drive to “develop people and improve care”.

References

Benson, M. and Hogan, R. (AUGUST 2008). How Dark Side Leadership Personality Destroys Trust and Degrades Organisational Effectiveness. Organisations & People. Vol 15. No 3.

Berwick, D. (Last Updated August 2018) NHS Improvement. Developing People – Improving Care. Available at: https://improvement.nhs.uk/resources/developing-people-improving-care/#h2-a-vision-for-improvement-and-leadership: NHS Improvement.

Care Quality Commission (13 June 2018). The Dudley Group NHS Foundation Trust. Available: https://www.cqc.org.uk/provider/RNA/surveys: Care Quality Commission.

Covey, S. (Accessed: November 2018). The 7 Habits of Highly Effective People. Available at: https://en.wikipedia.org/wiki/The_7_Habits_of_Highly_Effective_People#Independence: From Wikipedia, the free encyclopedia.

Crawford, P., Gilbert, P., Gilbert. J., and Gale, C. (2011). The Language Of Compassion. Taiwan International ESP Journal. Volume 3: 1, 1-16.

Gillon, R. (2013). Clinical Ethics – Restoring humanity in health and social care. Available: http://cet.sagepub.com/content/8/4/105: Sage. Pages 105-110.

Johnson, S. (March 2018). Patient safety hit by lack of staff, warn 80% of NHS workers. Available at: https://www.theguardian.com/society/2018/mar/18/hospitals-staff-shortage-nursing-nhs-rcn-patient-care-sarah-johnson-survey. The Observer.

Nacioglu, A. (2016). As a critical behavior to improve quality and patient safety in health care: speaking up! Safety in Health.

NHS Improvement (Last Updated August 2018). Developing People – Improving Care. Available at: https://improvement.nhs.uk/resources/developing-people-improving-care/#h2-a-vision-for-improvement-and-leadership: NHS Improvement.