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Our work at the Point of Care Foundation promotes cultures within health and care organisations that are caring and supportive – for patients and the people delivering care. I stress these two groups because they are both important, and they are linked. It is often said that if healthcare professionals are happy then they deliver better care. In one sense this much is obvious: it is common sense that if staff are well looked after they are more likely to deliver high quality care. The same would be true for the delivery of any service anywhere. Indeed, there is a solid body of evidence to support this.
But the link is also based on evidence, drawn from the perceptions and self-reporting of staff and patients through the NHS national staff and national inpatient surveys. In our work in trusts, surgeries and other care settings, we often see that staff wellbeing has very tangible knock-on effects for patients. The link is real, direct, and in many cases, it is something that can be addressed.
A good example of one such link was brought to light in a forum theatre workshop we hosted at an event last year, with arts group Performing Medicine.
A scene of a patient-doctor interaction was played out, based on interviews from real cases. It showed a doctor who seemed irritable and unable to listen properly to his patient. The patient was exasperated at having to retell her history and felt unable to get what she needed from the meeting. It seemed like a caricature of everything you wouldn’t want to experience as a patient, but under the surface there was much to learn from it. When the audience scrutinised the characters’ actions and motivations, it emerged that the patient’s notes hadn’t arrived in advance, and the doctor had not had time to use the toilet before the appointment. Small process changes might have made a big difference to how each party experienced the scene.
It was agreed by the audience that the doctor in the scene needed to show more empathy with his patient and to take more time to listen. Perhaps there was an issue with his manner that he could seek to improve. But he may have just been having a bad day – and he was operating in a culture that militated against empathy. Across the NHS, overwork and stress are making it increasingly likely for all sorts of health professionals to experience bad days. We believe compassionate culture can make it less likely.
Much has been said and written about compassionate culture by Michael West and others.
It can be summarised as a culture where organisations care about their staff as people, establish good mechanisms for two way communication with staff, and help people feel more able to cope with the overwork and stress that is currently endemic within the NHS. But how do we achieve it?
The major contribution we at the Point of Care Foundation make to fostering compassion within organisations is to promote and support Schwartz Rounds, a unique forum for clinical and non-clinical healthcare staff to come together to reflect on the emotional and psychological impact of their work. Rounds have been found to benefit participants, with the process of sharing and reflecting on experiences increasing empathy for patients and each other, reducing feelings of isolation and improving communication with colleagues. Evaluation evidence shows people who attend Rounds to be less stressed and in better psychological health than their non-attending colleagues. It also identifies ripple effects for the organisations hosting Rounds, including increased empathy among staff and better understanding of each other’s roles and experiences, reduced isolation, improved teamwork and improved communication.
Schwartz Rounds are an indicator that the senior leadership in organisations do not take staff for granted and acknowledge their support needs. Last September we published a report
looking at staff engagement in three NHS Trusts that had been identified as doing staff engagement well. We wanted to identify other behaviours they were employing that others could emulate.
Our findings showed that successful Trust boards prioritise understanding properly how staff are feeling at the point of care, through effective measurement of wellbeing. Being seen to ‘walk the walk’ on staff engagement – making it more than rhetorical by putting investment and resources in place for all staff to participate meaningfully – and having leaders who are visible and trusted to deliver on organisational values, are key requirements. Particularly important is the need to provide extra support for middle managers and line managers – those people charged with running services, who are squeezed between board level directives and the reality of trying to operate in a stretched system.
But, day-to-day, it is the teams people work within that make the biggest difference. We found that for people delivering care, engagement is defined by relationships with the people around them, rather than the larger entity of the organisation or the wider health service. At their best, teams provide deep wells of empathy between colleagues who live through the ups and downs of working life together and are responsive to each other’s emotional, as well as professional, needs.
How departments work to establish new people within teams, and how new people assimilate into a team dynamic, may be essential to securing a culture in which people can thrive. Helping people to make transitions into new roles could provide the support infrastructure to enable professionals to face down the challenges that a health career throws at them. This is an area we are interested in exploring further.
None of this absolves those who make policy of their responsibilities. Clearly there is a need to relieve pressure on the whole system with adequate resources and an effective response to the workforce crisis that is engulfing the NHS. In ‘Priorities for the Plan’ last year we set out our recommendations for how government and NHS leaders need to think differently about the health workforce. Since then we have seen the publication of the long-term plan for the NHS, but as yet no meaningful action to address workforce issues.
But there are things that can be done, now, to support compassionate cultures within healthcare organisations. Getting staff engagement right, listening to what people on the front line need, and making modest investments in the means to reflect and listen to one another, are all steps that will make a difference to people working in healthcare – and in turn the people they look after.
Jocelyn Cornwell is chief executive of the Point of Care Foundation