How do we create the conditions within our workplaces – the organisational cultures – where compassion and speaking up will be nurtured? Organisational culture is shaped by all of us but particularly by its leadership. It is the behaviour of leaders, top to bottom and end to end, individually and collectively, in healthcare organisations that powerfully determine whether care quality is the priority; all staff have clear objectives; there is enlightened people management; there are high levels of staff engagement; learning and quality improvement are embedded; and good team and inter-team working is endemic. And leadership is potentially demonstrated by all in an organisation or community, not only those formally identified as leaders.

Research on climate and culture in health and social care internationally suggests that leadership cultures of command and control are less effective than more engaging and compassionate leadership styles and implies that compassionate and collective leadership approaches are likely to be most effective.

Compassionate leadership involves attending to, understanding, empathising with and helping those we lead. The purpose of compassionate leadership in health and social care is to help create the conditions where all of those in our communities are supported to live the best and most fulfilling lives they can. To be compassionate as leaders in health and social care, means being effective as a leader in pursuit of that vision by ensuring direction, alignment, and commitment.

If leadership is not inclusive, it is not compassionate. That means leadership must include all, regardless of professional background, opinion, skin colour, sexuality, religion or gender. Including all is a core value of health and social care and including all is the nature of compassion.

Compassion implies sharing power and influence by encouraging collective leadership, where all feel they have leadership influence. And collective leadership requires leaders to work compassionately together to develop a climate of shared, interdependent leadership prioritising care for those in the communities overall, rather than just our own areas of responsibility. Those are the conditions within which people will speak up.

Compassionate leadership embodies both a sensitivity to the challenges that colleagues in health and social care face and a commitment to help them respond effectively to those challenges and to thrive in the process of their work, through modelling the four elements of compassion.

Caring for the health and well-being of others is an intrinsically compassionate behaviour that is an expression of the core human value of compassion. Virtually all those who work in health and social care services have dedicated their lives to caring for others. Compassion is therefore a central value and motive in their lives and the extent to which their organisations mirror in practice that value of compassion will influence the value ‘fit’ between them and their organisations. The stronger that fit – the alignment of individual and organisational values – the higher the levels of their commitment, engagement and satisfaction. Where organisations place more emphasis on financial performance, impression management or productivity, the value fit will be poorer with an associated loss of staff motivation and satisfaction, and less likelihood of people speaking up.

Compassionate leadership that encourages speaking up involves the four elements of compassion but understood and applied in the context of leading others:

Attending: The first element of compassionate leadership is being present with, and attending to, those we lead. Leaders who attend will model being present with those they lead and ‘listening with fascination’. Listening is probably the most important skill of leadership and involves taking the time to listen to the challenges, obstacles, frustrations and hurts of staff experience, as well as the successes and pleasures.

UnderstandingThe second component involves leaders appraising the situation those they lead are struggling with, to arrive at a measured understanding. Ideally, leaders arrive at their understanding through dialogue with those they lead, which may involve reconciling conflicting perspectives rather than imposing their own understanding. Sadly, in the context of highly pressured work situations, health and social care staff often feel they are not listened to, cannot speak up and that their leaders do not understand the situations they face.

EmpathisingThe third component of compassionate leadership is empathising. Compassionate leadership requires being able to feel the distress or frustration of those we lead without being overwhelmed by the emotion and unable to help. Putting oneself in the other’s shoes means taking their perspective which increases understanding of the sources and context of the difficulties they face.  

HelpingThe fourth and final component is taking thoughtful and intelligent action to help the other. Probably the most important task of leaders in healthcare is to help those they lead to deliver the high-quality, compassionate care they want to provide. Leadership, according to all definitions, includes helping and supporting others. Helping means removing the obstacles that get in the way of people doing their work and providing the resources (staff, equipment and training for example) and that requires encouraging people to speak up to identify the problems that get in the way.

These four elements of compassionate leadership are particularly relevant in healthcare, where the workforce is composed of highly skilled and motivated professionals, intent on doing their jobs to the highest possible standard. They require support rather than direction and enabling rather than controlling interventions from leaders. When leaders demonstrate compassion, they provide this support in a way that is consistent with the core value orientation of those they lead. But they also legitimate it as a valued and worthwhile way of behaving, thus encouraging those they lead to respond compassionately in the face of suffering and to speak up when they see a need for change.

Adapted from West, M. A. (2021). Compassionate leadership: Sustaining wisdom, humanity and presence in health and social care. London: Swirling Leaf Press.