Strategies for Health Care Leaders to Build Compassion at Work

Countries around the world face a health care workforce crisis: The World Health Organization estimates that by 2030, an additional 40 million health care professionals will be needed. Meanwhile, in most countries, health care staff are experiencing high levels of stress and burnout, resulting in ill health and many leaving their professions. The pandemic exacerbated these problems and caused worsening mental health and long-term physical health consequences for many. Aging populations in many countries of the world produce additional pressures on health care systems and staff.

Our challenge globally in this context is how to create the conditions where we can provide high-quality, compassionate care for patients and high-quality, compassionate support for health care staff.

This requires that we develop and sustain a culture of compassion throughout health care organizations. But this doesn’t only fall to individual health care professionals; it is the job of health care leaders and workplaces to spread and model compassion.

The power of compassion

Compassion is a powerful practice in health care, as evidenced by hundreds of studies internationally. When health care providers practice compassion, benefits include faster recovery for patients after surgery, longer lives for patients diagnosed with lung cancer, better outcomes in long-term disorders such as HIV and diabetes, and better results in the treatment of mental health problems. There are also significant associated cost savings. Moreover, being compassionate improves the well-being of health care staff, resulting in lower levels of anxiety, stress, and depression. When we are compassionate to others, both they and we benefit.

Beyond individual interactions with patients, though, there are also benefits when the cultures of health care organizations are compassionate.

Culture is a consequence of the behaviors of everyone in an organization—every interaction every day is an opportunity to shape the culture. But the role of leaders is particularly powerful. The last 100 years of research on organizational culture finds that leadership is the most important factor in shaping organizational culture. What leaders pay attention to and model in their behaviors shows what they value and by extension what employees should value.

International data, gathered over the last 20 years, find that compassionate leadership has wide-ranging benefits not only for patients but also for staff and organizations:

• Compassionate leadership makes staff more engaged and satisfied, resulting in better outcomes for organizations, including improved quality of patient care and financial performance.
• Compassionate leadership tends to go hand in hand with more effective management of organizational change, mitigating the negative effects on staff well-being and morale.
• People who work in supportive teams with compassionate team leadership and clear goals have dramatically less stress.
• In hospitals where staff report the absence of compassionate leadership, staff also report greater work overload, less influence over decision making, and less quality improvement.
• Staff who are treated with compassion are better able to direct their support and caregiving to others. This results in higher-quality care and more satisfied patients.
• Workplaces where staff generally report the absence of compassionate leadership tend to see less satisfied patients, poorer-quality care, and more avoidable patient deaths.

For example, Berkshire Health, a British health care organization focused on mental health, community health, and those with learning disabilities, has been retraining all its staff in compassionate leadership for the last five years. They now have the highest staff engagement and the lowest staff stress of any organization in the English National Health Service. The care they provide, and their financial performance, are both rated as outstanding by the national audit body.

Compassionate leadership in practice

How then do we create the conditions in health care organizations where staff will be (even more) compassionate to patients, each other, and themselves? In other words, how do we develop compassionate cultures?

Leaders in health care must recognize that compassion is the core work value (if not life value) of virtually all of those who work in health care. They are called to their professions by a desire to help alleviate the suffering of others. To the extent that leaders mirror this core value, those working in health care will be more engaged and less likely to quit, even in stressful working environments. So, leaders must embody the four behaviors of compassion in their leadership:

1. Attending: This means having the courage to be present with those we lead. Being present means being here and now and letting go of other distractions. Being present with those we lead enables the other element of attending: listening or listening with fascination. Compassionate leaders take time to listen to the challenges, obstacles, frustrations, and harms colleagues experience, as well as their successes and joys. This means listening (for example) to maternity staff telling you there are not enough qualified midwives in the maternity unit to deliver safe care for mothers and families. Attending provides a powerful base for the other three behaviors of compassionate leadership and is a prerequisite for understanding.
2. Understanding is having the courage as a leader to be curious and explore and understand the situations those we lead are struggling with. It implies valuing and exploring conflicting perspectives rather than simply imposing our own understanding, especially if from some remote, hierarchical position. For example, when health care staff are struggling to meet the targets imposed on them in relation to waiting times in the emergency room, leaders may need to understand how chronic work overload affects cognitive functioning, the ability to improve quality, and the capacity for helping others. Attending and understanding create the conditions for empathizing.
3. Empathizing involves mirroring and feeling colleagues’ distress, frustration, joy, and other emotions, without being overwhelmed by them and becoming unable to help. Virtually all of us as humans are hardwired to empathize—to put ourselves in the other’s position and feel with them. Leaders must have the courage to empathize, for example, with the nurse on her third 13-hour night shift in a row, who is exhausted and depleted. She has not had time to take her rest break, feels guilty because she could not spend sufficient time with an elderly patient in distress, and now feels afraid to drive home in her exhausted state. Empathizing as leaders gives us the motivation for the fourth, critical element of compassionate leadership: having the intention to help.
4. Helping or the intention to help is fundamental to compassionate leadership. Indeed, compassionate leadership can be understood as more a motivation than an emotional orientation—the motivation to help those we lead. Helping those we lead to do their jobs more effectively is the key task of leadership. This involves taking thoughtful and intelligent action to support individuals and teams by helping them ensure they have clear direction for their work; helping them to remove the obstacles that get in the way of doing their work effectively (like chronic excessive workloads, conflicts between departments, or unnecessary bureaucracy) and providing the resources, people, and services they need (like staff, equipment, and training).

The same four behaviors that constitute compassion underpin effective leadership because they are the basic human behaviors that enable us to connect with each other and build a sense of trust and belonging—an antidote to stress and loneliness for health care workers and leaders. And these are behaviors that can be practiced in all our interactions—not only in leadership contexts.

Start with self-compassion

One thing that can help leaders adopt these behaviors is having the courage to practice self-compassion. Where leaders practice self-compassion, those they lead go on to provide better-quality and more compassionate care to patients. Self-compassion is being present with ourselves—knowing when I am feeling overwhelmed, anxious, angry, hurt, ashamed, or inadequate. Self-compassion requires we accept rather than reject such feelings in order to cultivate curiosity about them and understand them. Rejecting or denying our feelings distances us from ourselves and therefore hinders our ability to connect authentically with others. Self-compassion is asking:

What am I feeling?
What do I need?
How can I get those needs met?

This is not narcissistic self-indulgence, but caring for ourselves in the same way we would care for a dear friend who was suffering. After all, each of us is as deserving of love as every other human being on the planet. When we connect deeply, courageously, authentically, and compassionately with ourselves, it enables us as leaders to connect more deeply, courageously, authentically, and compassionately with all of those we lead, indeed with all of those we interact with in our lives.

A movement toward compassion

In Wales, national leaders are convinced by the evidence and have committed to developing compassionate leadership across all of health and social care within 10 years, with the resources and supports to enable this. This includes compassionate leadership training, and compassionate systems, structures, policies, strategies, teamwork, and cultures. They, along with others such as the Irish Health Service Executive, are also working with the Global Compassion Coalition to support the development of compassionate leadership in health care worldwide. In fact, initiatives in many health care organizations around the world are combining to create a social movement for compassionate leadership in health care. Compassionate leadership is also a key element of the World Health Organization’s strategy for primary care.

Compassionate leadership is not some soft-cushions, scented-candles approach to leadership, however. Compassion involves leaning toward pain and difficulty. Compassionate leadership therefore involves leaning in to dealing with difficult behaviors (aggression, discrimination, harassment, poor performance) and doing so with compassion—attending, seeking to understand, empathizing, and helping, perhaps using coaching models and agreeing on clear objectives for behavior change with those involved. It involves having difficult conversations and giving clear and constructive negative feedback. It involves dealing openly and courageously with conflicts, particularly the damaging chronic conflicts that so jeopardize health care team effectiveness and thereby patient safety. Compassionate leadership requires courage and wisdom in equal measure to transform the cultures of health care organizations so that they can deliver better health care and outcomes for those they serve.

Compassionate leadership must be at the heart of local, regional, and national health care efforts to nurture cultures that provide high-quality, continually improving, and compassionate care for patients and staff. Leaders must have the courage to shift from traditional hierarchical leadership approaches to compassionate leadership. This requires a sustained shift in mindset and behaviors by leaders in health and care (and other public sectors) to deliver and sustain this culture change. For the sake of patients, service users, staff, and communities, such sustained courage and commitment to developing compassionate leadership is essential.