talking more about productivity and financial performance than high quality, compassionate care, their engagement declines. Yet our research shows that the single most important lead indicator of the performance of NHS organisations is staff engagement, particularly involvement in decision-making. Compassionate leadership is the key lead indicator of staff engagement, which in turn is the key predictor of NHS performance, care quality, patient satisfaction, staff retention, avoidable patient mortality, fewer errors, fewer infections, etc. CHANGE ON THE GROUND Organisations increasingly recognise the need for changes in their cultures. I have been privileged to help promote initiatives on compassionate leadership at organisational and national levels across the UK and more widely. A good example is Berkshire Health, who have been retraining all their staff in compassionate leadership for the last six years. They now have the lowest levels of stress and the highest levels of engagement of any NHS trust in the country, and they are rated outstanding in terms of care quality by the Care Quality Commission. In Wales, I am working with all the NHS organisations as part of a 10-year strategy, supported by the Welsh Government to create compassionate leadership and cultures across all of health and social care by 2030. They have invested and continue to invest courageously in transforming all parts of health and social care to ensure compassionate high-quality care cultures – not only care for patients but also for staff. All the NHS trusts and boards in Wales have now signed a compassionate leadership pledge, developed by Health Education and Improvement Wales to facilitate organisational commitments over the long term to developing compassionate leadership and cultures. We have created compassionate leadership training courses, which are being rolled out across the entire system of healthcare and social care. These inspiring changes give hope in dark times. MORE IS NEEDED We need broad and sustained changes at every level of our health and care systems in the coming years. Firstly, we must make workforce the priority, with compassionate leadership at its core. If leadership is not inclusive, it is not compassionate. We must address issues of equity and inclusion. We must better meet the core needs of staff, because problems of stress are not solved by simply giving people access to mindfulness apps and advice on diet and yoga. It is much more fundamental. It is to do with the working conditions people face – not having voice and influence, having chronic excessive workloads, poor team working, poor supervision, and so on. We must move away from the hierarchical command and control cultures which characterise healthcare. The announcement earlier this year of the abolition of NHS England seems radical, but unless that change is accompanied by devolution of responsibility to local organisations, it will just be another disruptive structural change. At a deeper level, we need to make sure organisations are not box ticking in relation to developing compassionate and inclusive cultures. We have to embed it in the DNA of organisations. We must collaborate internationally to learn, to develop and to share ideas about how to develop and sustain compassionate and inclusive cultures in our health and care systems. I am involved in a coalition of nations for compassionate healthcare, where we are seeking to share good practice and support each other in our various countries to influence policy and practice at national level. The changes must be in partnership with communities and patients, because none of this is going to happen unless they are involved in the co-design and co-ownership of health and care services. IT TAKES A VILLAGE The only way to care for the well-being and happiness of the people of our communities is if all the agencies, such as local government, education, criminal justice systems, health and social care, work together more effectively and in an integrated way. To do that, they need common cultural values. Compassion must be the glue that binds these organisations together, because that is what they are there to do – to help people lead the happiest lives they possibly can. I would include universities as central to this. We play a key role in advancing understanding about the factors that promote the happiness and well-being of people, and indeed of the of the wider environment and of the planet. We must model the compassionate and inclusive cultures which aid human flourishing and work together with agencies, policy makers and politicians to pursue a vision of sharing a commitment to creating a far more compassionate and inclusive society, and with an NHS that is far better able to serve both staff and patients. FIFTY FOUR DEGREES | 9 Michael West CBE is a Professor in the Department of Organisation, Work and Technology. His research explores organisational innovation and effectiveness, and the cultures of quality and safety in healthcare. He has worked with organisations including NHS England, the UK General Medical Council, the Royal College of Surgeons of Ireland, and Health Education and Improvement Wales (HEIW) to implement compassionate healthcare and leadership. He is Senior Visiting Fellow at The King’s Fund, London. m.a.west@lancaster.ac.uk
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