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Compassionate leadership and caring to change

Deborah Homa, senior consultant at The King’s Fund, discusses the importance of compassionate leadership.

Judith, CEO of an acute trust in financial special measures, stared at her phone. She had been in post six months. She was focused on a particular email. It told her to attend a hastily arranged meeting with the regulator that afternoon to review progress on their financial recovery plan. Judith faced a dilemma: she had a long-standing commitment that afternoon to listen to more than 100 frontline staff in a leadership development session. She was thinking about who she should let down… 

Judith’s dilemma will be familiar to leaders across the health service. The NHS faces unprecedented challenges. Rising demand and pressure to do more for less requires transformational change. Large-scale structural reform and external performance management, inspection and competition have only taken the system so far. What is needed are innovative solutions, thoughtfully-led with greater emphasis on commitment rather than compliance, avoiding short-term answers to long-term questions.    

There are some shining examples of successful improvement programmes in local systems. At the same time, examples of radical and sustained innovation are rare across the NHS. Innovation, both developing creative ideas and adopting them from elsewhere, will be vital in ensuring the health system can meet 21st-century challenges. Creating the conditions for innovation to flourish within NHS organisations requires consciously different ways of working and thinking at every level.  

Leadership is central. There is a link between supportive leadership and quality of care in the NHS.  Heroic, hierarchical and top-down leadership approaches frequently disappoint. Leaders who model, through both words and deeds, their commitment to quality improvement profoundly affect patient safety and experience; efficiency; the health, wellbeing and engagement of staff; and the spread of innovation within the healthcare system. The question is not if the opportunities for improvement exist, but if we choose to take them.  

Nurturing innovation 

There is clear evidence that compassionate leadership can nurture innovation. Compassionate leaders – those who pay attention, understand, empathise and help – establish caring and compassionate connections in their organisations. They work with staff to make sense of their challenges and help them to discover their own solutions.  They motivate people by listening to their views and appreciating their perspectives. They dedicate time and resource to supporting innovation and removing obstacles.  They nurture four elements of culture in their organisations: inspiring vision and strategy; positive inclusion and participation; enthusiastic team and cross-boundary working; and support and autonomy. 

Board members and other leaders can make tangible progress towards stimulating innovation in healthcare by focusing on these four key elements of a culture of innovation right now. 

Spreading this style of leadership across the NHS requires determined leadership development that focuses on developing skills of collective and compassionate leadership fused with broader and deeper understanding of quality improvement approaches. The national improvement and leadership development framework offers a way forward. It provides a platform for skill building, leadership development and talent management for all those in NHS-funded roles. It also contains an important pledge from regulatory and oversight bodies to role model and practice compassionate leadership, to give organisations the control, space and support they need. If followed through, this commitment to work to enable professionals, organisations, teams and local systems to improve patient care and outcomes opens doors to new opportunities. 

There are compassionate and inclusive leaders throughout the NHS. The King’s Fund’s ‘Caring to change’ report includes inspiring case studies of service transformation delivered through a sustained and systematic focus on cultures of high-quality care and compassion, with a relentless focus on helping people develop and experiment within safe boundaries. It also makes it clear that organisational performance does not transform unless the individuals within it are encouraged to transform their belief in what is possible.  

Having pondered her dilemma, Judith pressed ‘call’ and dialled the regulator: “Hello, Judith here… I’m afraid I have a pre-existing commitment to staff this afternoon. It’s clear to me those very staff have the solutions to our financial recovery. So, we’d like to invite you to come to meet with all of us this afternoon, to work with me and my teams on our challenges. Let’s work on this together…”

The ‘Caring for change’ report can be accessed at:

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