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For Primary Care| View from the ground

Where Has the Compassion Gone?

View From the Ground, by Dr Sarah Merrifield

As a portfolio GP, one of my roles involves delivering a leadership course to doctors in postgraduate training. The course includes a section on compassionate leadership. We discuss the principles of displaying compassion in the workplace, which relies on four behaviours:1

  • attending
  • understanding
  • empathising
  • helping.

There is a clear evidence base to support the practice of compassionate leadership.1 Research has shown advantages for staff, organisations, and patients. 1 The benefits aren’t solely around reducing stress and improving staff wellbeing; compassionate organisations also demonstrate improved financial performance and increased staff engagement.1 Conversely, healthcare organisations lacking compassionate leadership have higher levels of patient mortality and lower-quality care.1

Being a compassionate leader doesn’t just mean being a nice, fluffy, and warm person. It takes courage and strength to stand up for issues, and to take action when needed. Sounds great, doesn’t it? So why isn’t it happening across the NHS?

Compassionate leadership starts with self-compassion, which is arguably hard to achieve. We’ve all heard the proverb ‘fit your own oxygen mask first’, but this may be easier said than done. However, if people are to buy into the concept of compassionate leadership, it needs to be conducted authentically. How many of us have been told to look after ourselves by a colleague only to receive an email from them at midnight? Their email signature may read ‘I send emails at all times, but do not expect others to respond’—but if it’s not possible for those in charge to have firm boundaries, how can we achieve it for ourselves?

In the compassionate leadership section of the course, we ask participants to share experiences of when they’ve felt looked after in an organisation. The responses often consist of not grand gestures, but simple ones—for example, managers learnt their names, found out what they were interested in, and took steps to help them with their career plans. These are small acts with a big impact. As a medical student, I remember feeling looked after in my general practice placement far more than I ever did in my hospital placement—it’s one of the reasons I ended up where I am. It is evident from speaking to my students that general practice, as a small business, still has this advantage.

You only need to spend a day working in the NHS to recognise that we are all working with ‘full stress buckets’.2 Stressors, both within and outside of work, leave little room for anything other than basic and reactive functioning. As our overflowing buckets clash, the cycle perpetuates.

If we are to make the move towards compassionate leadership, we must start with ourselves. This doesn’t mean going on a resilience course, or completing a wellbeing e-learning module. It means having the courage to say no, avoid opening emails at the weekend, and forgive ourselves for not being perfect when trying to spin a hundred plates.