Creating compassionate NHS organisations

In advance of her November workshop, we asked Maria to tell us about compassion in the workplace.

What is a 'compassionate organisation'?
An organisation espousing the value of compassion. Buddhist teaching on compassion presents a way of being which cherishes living beings and demonstrates concern for alleviating the suffering of others. A compassionate organisation is one which holds this at the core of its functioning and its purpose, both in how it interacts with its external environment and at the micro level. This can sound like a lofty aim – there are some practical solutions stemming from research in this area that can help foster a compassionate organisational culture. However, research in this area, or an evidence-base, arguably needs development. We can usually feel a sense of compassion in our workplaces, as well as the lack of it; defining the aspects of a compassionate organisation, as well as capturing their impact, can be difficult. This likely relates to the notion of compassion stemming from the spiritual realm, debatably making it an ill-fit with more positivist research approaches in the area of organisational development and workplace wellbeing. 

If an organisation is not compassionate, what are the consequences?
Papers in this area tend to look at related concepts such as stress and burnout, mindfulness, and the quality and nature of relationships within the workplace. We have a growing evidence-base that compassionate actions within an organisation may reduce employee burnout, increase staff retention, foster innovative collaborations and a sense of belonging. The Mid-Staffordshire case is often cited as an example of the absence of compassion both on the individual employee level and organisationally which, as we know, led to serious failing in standards of care with harrowing consequences.

Are there specific challenges for creating compassion within NHS organisations?
Indeed, the Francis Inquiry called for a greater focus on delivering compassionate care, and identified recruitment, training and leadership as some of the domains of NHS organisational functioning where compassion should be embedded. Compassion is fundamental to patient care and is a value at the core of how the NHS aims to interact with its users and the public. Yet, compassion is difficult to define and thus to operationalise, especially in response to a top-down mandate. Since 2010, the NHS has undergone an uneasy period of unprecedented change, against an austerity backdrop. Some commentators have argued that organisational compassion in a market-led NHS is a fallacy. The challenges of recruitment, retention, absenteeism, presenteeism, reports of bullying and staff burnout at all levels are ever-present. There is talk of resilience building in staff, but my feeling is that this can pathologise and shift the blame onto the individual, without taking responsibility at the organisational level for creating an appropriately resourced infrastructure. Thus, systemic problems require our attention. I think there is great opportunity for compassion to be nurtured not only in how the NHS interacts with its external environment but in how it treats its staff and how its staff treat one another.

What is the number one thing that organisations can do to be more compassionate?
I am not sure there is a number one thing! There isn't a quick fix. Compassion takes time to embed and sustain. At the risk of giving an anecdotal answer, during 15 years of my organisational development work with NHS organisations, I have witnessed that a safe protected space to reflect goes a long way in helping to foster a mutually supportive empathetic environment. This may sound simple, but we are so busy, so focussed on productivity, often over people. There is the 'slow food' movement – I would argue that conscious 'slow work' can go a long way towards creating organisational compassion.

Is there anything that individuals can do to improve compassion in the workplace?
Yes, plenty. The practice of compassion encompasses a commitment to alleviate the suffering of others. Literature suggests that role-modelling is a powerful tool in teaching, so demonstrating compassion towards colleagues likely encourages others to do the same. Being willing to discuss good practice, as well as errors, openly in a non-judgmental manner can foster a sense of trust and a willingness to work together to solve problems. Paul Gilbert speaks of developing a compassionate self-identity through identifying and picturing the qualities one wishes their compassionate self to have. To end with a quote from the Dalai Lama 'if you want others to be happy, practice compassion. If you want to be happy, practice compassion.'

- Dr Maria Kordowicz is a Chartered Psychologist, Quality Improvement Research Fellow and Programme Lead for the MSc in Public Health at the School of Population Health and Environmental Sciences, King's College London.

Maria will be facilitating the workshop 'Creating compassionate NHS organisations', reflecting on the meanings and benefits of compassionate NHS organisations, to help develop strategies for embedding compassionate practices within the NHS on 6 November 2019 in Liverpool. Find out more and register.

Illustration: www.elizasouthwood.com