News and Notices

Compassionate Care by Dr Alan Blair

The concept of compassionate care is getting a lot of attention at the moment, although the idea of acting with compassion is something that has always been intrinsic to health care work.  Indeed, it is precisely the vision of acting with compassion that underpins the values that created the NHS.

The Francis report in 2013 emphasised the importance of caring, compassionate and committed staff working within a common culture.   So what does it mean and why should we give it any attention?

One way of thinking about compassion divides it into 4 key components:

attending; understanding; empathising; and helping

We experience compassionate care when we feel that we are being listened to, that we are understood, that the listener empathises with our situation and that they are helping us; we need to have all four to experience compassion. 

There are perhaps 2 areas to consider under “compassionate care”: compassion to others and compassion to ourselves.

Compassion to others

When we approach our patients (and to those most connected to them, such as families and carers) with compassion, this can lead to better outcomes.  Research has shown that when patients feel they are being treated with compassion, this can improve diagnostic accuracy, can promote quicker healing, can reduce patient anxiety; can reduce the attendance rates of frequent attenders and can increase patient satisfaction.

There are many things that can get in the way of us being fully compassionate in our work.  This includes stress; whether it is caused by work overload, work conflicts or other work pressures.  Sometimes, we can feel less than compassionate in our work.  We may not “click” with the patient, we may feel run down or overburdened; however, there is a difference between feeling and acting compassionately.  Sometimes it is possible to act compassionately, even when our feelings don’t fully match.

Of course, creating a culture of compassion means doing the right thing rather than, necessarily, doing the done thing.  Provided we check out with our managers what is acceptable, it can be OK to vary from standard care in order to deliver truly compassionate care; care that allows the patient to feel fully understood and helped.

And compassion in work isn’t just about compassion to our patients, it is also about compassion to our colleagues.  One concept that is receiving a lot of attention at the moment is “compassionate leadership” (rather than “command and control” leadership)It is helpful for leaders to “walk the talk” and understand that every communication every day creates the organisational culture.  It is the behaviours of leaders that tell us what is truly valued in the organisation (i.e. not necessarily what is written on a website or in an information sheet but what is said and done, what is paid attention to and what is rewarded). And an effective leader can act as a positive role model for staff; how they behave will influence their staff’s decisions of how to behave towards themselves, towards their colleagues and towards patients.

But showing compassion in the workplace isn’t just something that “leaders” should be doing.  It is the responsibility of all of us to give loving attention and appreciation to our colleagues.  It needs to be embodied and nurtured and to be prioritised across an organisation with consistency and with authenticity and involves the same 4 components of listening, understanding, empathy and helping.     It involves a high degree of self-awareness and bringing an emotional intelligence to our work.

Sometimes due to the stresses and strains of work and life, the compassion that we show towards our colleagues can be diminished and this can have a wide ripple effect within and beyond our immediate team.  Having the confidence and taking the time to notice and appreciate positive things in each other and ourselves can make a big difference; for example, when a colleague affirms something about us it can boost our mood, well-being and confidence in our work.

Staff are more likely to be effective in their work and less likely to feel work-related stress or dissatisfied when they feel that they are truly being “heard” and when they experience that their colleagues and leaders are assisting them to do their best for their services from this position of understanding,.   Indeed, the way healthcare staff feel about their work can have a significant impact on the quality of patient care as well as on an organisation’s efficiency and financial performance.

Compassion towards ourselves

Just as importantly is the value of acting with compassion towards ourselves; again using the same 4 key components.   Perhaps for those working in health care, this is the area that is most frequently lacking; we may find it hard to create the time or give ourselves “permission” to provide the same compassionate attention that we might seek to demonstrate towards our patients or colleagues. 

Acting with self-compassion means listening to our own inner voice and recognising and understanding what we need in order to feel well, physically and mentally.  It means acting with empathy towards ourselves rather than negatively judging our thoughts and feelings.  And it means “helping” ourselves, i.e. taking action to improve our well-being in whatever ways work for us.  When we learn to approach our experience with warmth and compassion, we can turn down our natural stress response.

Dr Kirstin Neff, one of the best-known researchers in the area of self-compassion, views it as consisting of three key components: self-kindness (being kind, gentle and understanding with ourselves, including when we are suffering); common humanity (recognising that we not alone in our struggles; that they are part of our shared experience as humans); and mindfulness (observing life as it is, without being judgemental or suppressing our thoughts and feelings).  

Neff suggested strategies to deal with challenge in a self-compassionate way including: considering how we would treat someone else and acting in that way towards ourselves; being thoughtful and kind in the language that we use towards ourselves; comforting ourselves with physical gestures; exploring self-compassion through writing and keeping a journal; practicing guided meditation; taking regular self-compassion breaks within our normal day; and reflecting on what we really want and our core values.

If you are interested in thinking about more about self-compassion, you may want to evaluate how self-compassionate you currently are by completing an on-line test: http://self-compassion.org/test-how-self-compassionate-you-are/

DCHS and Compassionate Care

So, how do we in DCHS stack up with regard to compassionate care?  Do we always  act with compassion towards our patients, our colleagues and ourselves?

Well, the CQC have something to say on the subject.  When it comes to acting with compassion towards our patients, we seem to be doing a pretty good job.  In their summary, the CQC said: “Patients were treated with kindness, compassion, dignity and respect throughout all of the services we inspected…. During our observations of staff and patients interaction we found staff were focused on the individual needs of patients making them feel valued and respected….Staff were observed going above and beyond what they were expected to do so they provided the best possible care for their patients.”  Generally, the quality of compassionate care is something that we can be rightly proud of in DCHS

With regard to compassionate leadership, we are certainly heading in the right direction, although, undoubtedly, there is more yet to be done.  In addition to the excellent compassionate leadership that so many DCHS staff currently demonstrate, DCHS are working hard to promote this further within the organisation, including through the various leadership development programmes.

And promoting compassionate self-care also seems to be very much on the agenda of DCHS.  As well as such long-standing resources such as the Resolve service, more recent developments include Schwartz rounds which are open to all in the organisation as a safe and supported space to reflect on the impact of our work. Clinical supervision is another area which is in the process of development within DCHS.   Such supervision sessions should ideally be a place to reflect both on specific clinical issues and also on our work experience; in order that we can be as effective as we can be while remaining well and resilient.

DCHS are also signing up to series of Time to Change actions which are targetted on promoting a positive attitude towards mental health problems within the workplace.  And DCHS remain very committed to taking action on the health needs assessment survey that staff took part in earlier this year.  Expect to see some interesting developments with regard to this over the coming months…

Your views

Above are some of my thoughts about compassionate care within DCHS.  But what do you think?  How good are we at caring compassionately for our patients, for our colleagues and for ourselves?  What could we be doing differently to move further towards DCHS’s compassionate care aspirations? 

If you have any views about any of the above and/or would like some ideas for how to go about improving compassionate care towards ourselves, please let me know by e-mailing me at alan.blair@nhs.net or messaging me on Twitter at @DrAlanBlair.

Alan Blair, Clinical Director, DCHS Psychological Services (Alan routinely works Tuesdays and Thursdays)

Many thanks to Barbara Fountain, Bola Owolabi, Caroline Savidge, Rachel Holt, Emma Kelly, Carolyn White and Sara Dennis for their wise and helpful comments on earlier versions of this.