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. vicky.robertson@publicsectorpr.co.uk