Roger and Simon have previously highlighted the importance of leadership and the reinforcing systems necessary to sustain compassion in organisations. I want to share some thinking about how the organisation’s senior leaders can create the strategic context to promote and sustain these individual and systematic aspects of compassion and humanity within their organisation.

My personal perspective has developed over 20 years of close involvement with health care. I remember vividly my emotional responses when, as a trainee NHS manager, I spent two weeks as a nursing assistant on two different wards, providing basic care for very vulnerable and frail patients. Their gratitude at the little I could do and more significantly the expert care and concern shown by some of the nurses was a massive lesson to me. And then I recall the care of an experienced midwife who ‘went the extra mile’ when our first child took a long time to appear and then arrived in a chaotic burst of frightening medical activity. And the professionalism and sheer vivacity of a specialist urology nurse (who worked across the corridor from my office) putting worried patients at ease and preserving their dignity as they endured a range of urodynamics procedures. And then I met Robin Youngson.

My first real encounter with Robin was to sit in a press conference in Waitakere Hospital, New Zealand on the first day I arrived to work there. Robin and the hospital General Manager, Rachel, faced a room of TV cameras and journalists to report on a serious operating room fire where a mother received massive burns during an emergency caesarean. The report and conference demonstrated a rare combination of open disclosure, real care for the patient and her family, as well as for the staff. It was coupled with a determination to apply a holistic open learning systems approach to understanding what had happened. I could barely restrain myself from declaring to the assembled hacks how different this was from the norm!

This really got me thinking about what was systematically different here. As I worked with Rachel, Robin and the wider team I learnt that what I saw that first morning was the result of a deliberately thought through strategy based on a shared set of values – the ‘Waitakere Way.’ They include a commitment for instance to ‘no harm’ for patients and staff – avoiding emotional, psychological and spiritual harm as well as physical harm.

Robin’s own experiences following his daughter’s serious car accident have been described in his recent paper.2 Within this he proposes an action plan for compassion:

  • Declare ‘compassion’ as a core value.
  • Reward rather than punish compassionate caring.
  • Hone communication and relationship skills.
  • Provide space for staff to discuss difficult issues.
  • Challenge models of professionalism.
  • Hard-wire new behaviours.
  • Declare compassion as a management and leadership competence.
  • Engage health consumers in the change.

If senior healthcare leaders are serious about embedding and sustaining compassion, then this seems a good place to start.

My reflections tell me this won’t happen without serious and sustained intention, combined with wise action. Sad as it is, it is not the default position of many of our healthcare organisations. Witness the 3 hospitals in 24 hours story from Roger.

I am convinced strategic leadership is required to nurture and embed compassion and humanity in care-giving organisations. This is not only what patients want and staff long for, but the evidence is growing that it’s good for the organisation too. As K L Gramling wrote in 1997, ‘we cannot leave caring to chance – it must be consciously orchestrated’.

Alastair Mitchell-Baker