New evidence links patient experience to staff wellbeing, and to a working environment that encourages good behaviour
At NHS England we have been working for the past few years on understanding how compassion as a concept, value, belief or skill can help improve the care experience of the millions of patients who visit hospitals, clinics or GP surgeries every year or receive care at home.
In 2012 Jane Cummings, the chief nursing officer for England, published a three-year vision for nursing, Compassion in Practice, starting the debate on what compassion is, whether it can be measured or taught, or if it is innate in individuals. It also looked at the impact compassion has on patient outcomes and experience.
The work that we have completed suggests that focusing on providing compassionate care can make a significant difference. And often all that is needed is simple and thoughtful behaviour. Cynics may ask: “If it is that simple, why can it not happen all the time?” That for me is the crux of the matter.
Research commissioned by NHS England, Building and Strengthening Leadership – Leading with Compassion (pdf), surveyed a number of NHS clinical and non-clinical leaders on their understanding of compassion in practice. Through a number of follow-up interviews they explored how they showed compassion in their everyday practice and identified some of the barriers nurses face in acting with compassion at all times.
Researchers highlighted the challenge in bringing compassion to life in people, teams and organisations. They concluded that “to create environments where compassion can thrive practices are needed which reconnect people to the values and behaviours that underpin their work and values”.
The research concluded that there is no silver bullet. It requires a multi-faceted approach that can be targeted at the level of the individual; the manager/leader; the team and the organisation – and usually all four if it is truly to thrive.
While there is no recipe, compassionate behaviour is often affected by the environment and culture of an organisation/department. Engaging staff at all levels is key – evidence is emerging that links patient and staff experience, and that positive experiences are unlikely to happen to one without the other.
Our research also identified that compassion applies to everyone. At an individual level people need to develop routine habits to stay balanced, keep rooted to their core purpose, and plan ahead for situations where work is personally depleting, and notice the signs when they have to activate those plans. The role of the manager/leader is pivotal. He or she must be able to notice and respond to need, while connecting individuals and teams to their core purpose. The norms, practices and capabilities of teams contribute to the formation of effective working relationships and determine whether there is a micro-climate that allows compassion to thrive.
It is important to note that the culture and environment at the organisational level has the potential to trump other determinants: good people in corrosive or toxic environments have been known to collude in undesirable behaviour.
To enable staff to act with compassion, organisations should:
• listen first-hand to experiences of staff and patients
• define and clearly articulate values in behavioural terms and ensure these are incorporated into organisational life
• connect the organisational strategy with individual goals and objectives, which includes holding people to account on both performance and values
• Signal what is valued and retain your best people
If you get the basics right and help people reconnect with their work, it can transform patient care. How we behave towards each other is key to setting the groundwork for true compassion in practice. This should be done at all levels, no matter what the interaction or how brief the encounter.
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