These are the hands
That touch us first
Feel your head
Find your pulse
Make your bed
— Michael Rosen, These are the hands: poems from the heart of the NHS1
These are the hands of health and care staff who dedicate their lives to caring for others. And who are now committed to caring for their communities during a grave global crisis, risking their own health and wellbeing. Last night, millions of people across the United Kingdom took part in a national applause of thanks for health workers and carers helping in the fight against Covid-19 (coronavirus). The collective gratitude and respect for the work of health and care workers was emotional and uplifting at a time of global crisis.
No country has the resources to deal with this crisis in the way they would wish. Last week, the Chancellor of the Exchequer, Rishi Sunak, said, ‘we will be judged by our capacity for compassion and individual acts of kindness’. All health systems have to find creative responses – to innovate, spread knowledge and collaborate. How should those who lead health and care services respond? Certainly with compassion at the heart of their leadership.
‘Connection and compassion are certain, unchanging and provide a safe refuge in the face of this onslaught on health and care systems and our wider communities’
This moment of crisis is also an opportunity to collectively improve the leadership culture across the NHS. It is vital that, as the NHS responds to Covid-19 challenges, leaders and managers model and promote compassion in an enduring way including self-compassion. Connection and compassion are certain, unchanging and provide a safe refuge in the face of this onslaught on health and care systems and our wider communities. Compassionate leadership is the most potent way people can deal with what feels frightening and overwhelming and leaders need to focus compassion on all those who provide health and care services whatever their role or grade.
The Covid-19 pandemic is placing huge pressure on the ability of the NHS to deliver safe, high-quality care. This means leaders have to sharpen their focus on meeting the core needs of staff, ensuring their wellbeing and sustained motivation to help them deal with this rapidly changing situation. In a crisis, managing emergency response and recovery is based around the concepts of command, control and co-ordination, alongside the need for clear structures and guidance. However, this can come with an understandable reversion to a style of leadership that goes beyond what is necessary, instead overly directing people. This risks alienating the very staff that need to be engaged and motivated.
The Covid-19 situation is full of uncertainties. Leaders are struggling to find the right solutions as the context changes almost hour by hour. Now more than ever, leaders need to draw upon all available resources, most particularly their people, utilising the collective intelligence of experience and knowledge while adapting and revising solutions as the situation unfolds.
NHS staff are highly skilled and motivated. They have great wisdom, experience and profound values of compassion. They can all be leaders if the right conditions exist for them to be able to do what they know to be the right thing. Unleashing their collective wisdom requires compassionate leadership. That means paying attention to all staff, truly listening to them and being present with them. It means truly understanding the challenges they face, rather than seeking to impose understanding. Empathising with them, feeling their fears, stresses, uncertainties, anxieties and exhaustion, provides the motivation to always ask the question ‘how can I help you?’, the most important task of leadership. Compassion should also be guided by appreciating and meeting the core ‘ABC’ of human needs at work.
A: autonomy and control
People instinctively want to have control and not feel coerced or directed, particularly when under huge pressures in a crisis. Staff must have voice and influence over decisions that affect their delivery of care and their own workplace environments. They need to be trusted to make the best decision they can. Taking away autonomy in a high- demand situation creates stress. Ensuring autonomy and control means listening to staff every day and taking account of their knowledge, skills and experience to make crucial decisions.
Control also means being able to take regular breaks from the inevitably high workload to ensure staff do not make mistakes, get sick or patient care suffers. Staff need access to food and drink to meet their basic biological needs and they need time to care for their health and wellbeing.
The key role of leaders is to provide the resources and clear away obstacles to fulfilling these needs on the path to successful management of the pandemic. Leaders also need to be honest when resources are in limited supply and involve staff openly and honestly in both assessing the impact and risks involved and in making difficult decisions.
Belonging is fundamental to human wellbeing and the need to belong is greater during a crisis. Everyone can feel frightened and overwhelmed in the situation we now face. We cope by feeling supported, loved, cared for and building a sense of belonging as part of a larger, caring whole. And our immediate work group, team, department is critical. Not only must leaders ensure a positive, caring and supportive climate but also encourage and enable sustained multidisciplinary team-working where everyone is clear about each other’s roles.
This means everyone being a member of a ‘home team’ (preferably multidisciplinary) that provides support, enables a shared focus on the task and provides the medium for collective learning and innovation. Such team-working leads to better care, better staff wellbeing and more innovation. And working flexibly, supportively and collectively across boundaries is the way forward in this crisis and for the future. This can only be successful in the context of a compassionate and collective organisational culture.
All staff desperately want to deliver high-quality care during this pandemic. Leaders will need to enable and support staff to work effectively during what will be a very testing and prolonged period. Work overload is only sustainable for so long – a saturated sponge cannot take in more water. Leaders must ensure that workloads are manageable if the NHS is to respond to this crisis effectively over the months ahead and not lose staff in the process to a preventable work-related illness, breakdown or a sense of helplessness.
‘By working compassionately, courageously and honestly, leaders can support and care for their staff so that they can save thousands of lives across our communities’
Time is very pressured, but staff need to meet with their fellow team members regularly to review, to share learning, to develop innovative responses to the crisis and to simply recover together. Time spent in meeting like this is associated with a 35 per cent improvement in productivity and innovation and similarly large increases in wellbeing. Building short team reviews (even of just a few minutes) in to daily work will establish a rhythm to facilitate greater learning and support to all staff. Regular supportive supervision for all teams and individuals is needed so that their work can be sustained. And it is vital to constantly seek out and share learning from organisations and health care systems around the world about how to deal with the pandemic.
These are the hands, and this is the moment. By working compassionately, courageously and honestly, leaders can support and care for their staff so that they can save thousands of lives across our communities.
Professor Michael West CBE is our guest speaker at the Community Event Compassion and Compassionate Leadership: Open Community Event
You can also watch Michael talking about this here
1.Rosen M(2020). These are the hands: poems from the heart of the NHS. Alma D, Amiel K (eds). Fair Acre Press