Published: 11 March 2019
On arrival in hospital, a number of things happen that can very quickly threaten someone’s identity and feelings of self-worth. Patients are in the hands of people and processes that can feel very powerful. They are often changed out of their own clothes. They are placed in environments where the needs of other patients are very visible and audible to them, as is how very busy the staff seem, and that can make it hard for some people to speak out or ask for help. Patients can worry that non-medical matters, such as needing a wee or a drink or worrying about how your cat is, are not worth the attention of staff. And in this environment, when staff seem so competent and busy, it can be embarrassing to ask for help with, for instance, moving about or using the toilet.
This puts people in a position where it’s hard to say what’s important, to point out that staff have missed something, to ask for help. So important things can be missed and this can mean poor outcomes. A review concluded that you are particularly vulnerable to experiences like this if you are older, have a physical disability, have dementia and/or delirium, are lacking family or visitors, if you have communication difficulties or belong to a minority group.
How people are treated as human beings in the moment of their one-to-one interactions with staff, can shape people’s health care experiences far more than the technical, clinical aspects of care. Our review showed that patients want staff to:
- appreciate who they are as a person and what their individual needs are (“see who I am”);
- establish a warm, human, open line to them that helps them feel safe and significant (“connect with me”); and
- help them to understand and influence what is happening (“involve me”)
Our research confirmed that nurses want the same things for patients that patients want for themselves. If, as a nurse or other member of staff, you can meet these aspirations, it feels great. It’s gratifying, enriching and can feel a privilege to make a difference to someone in distress. But it feels horrible if you haven’t been able to entirely meet the needs of someone who needs your help. If we assume that everyone who chooses to work in health care does so because they want to help people, how do care failures like those at Mid Staffs Trust in the late 2000s develop? We need to start thinking beyond individual health workers and their inherent “goodness” (although that is certainly part of the picture), and focus on how staff can be supported to be compassionate.
When the NIHR called for research that would help NHS organisations provide more compassionate care following the Francis inquiry into Mid Staffs, I was really interested. I wanted to develop ideas about how health care organisations can provide the right conditions for staff to be able to deliver compassionate care. Together with colleagues, I developed an intervention focused on setting up and supporting practices at nursing ward team level that, when adopted as routine by teams, may create those conditions. We called the programme CLECC (Creating Learning Environments for Compassionate Care).
CLECC focuses on creating a work environment for teams in which learning and development for all staff is valued, as is teamwork, dialogue, mutual support, innovation, shared goals, continuous improvement, and where all staff are recognised to make a contribution. We planned that by building relationships and creating an environment of this kind at ward team level, team members would be better able to deliver compassionate care. The NIHR funded us to evaluate the feasibility of putting our ideas into practice and to lay the groundwork for a future evaluations of effectiveness and cost-effectiveness. The study findings were featured in last year’s Themed Review on older people living with frailty in hospitals and we have just published the final study report.
So what did we learn about the organisational conditions that support compassionate care? In such teams/organisations:
- Attention is paid to staff-to-staff relationships: staff also need people to “see who I am”, “connect with me”, “involve me”
- Staff are empowered to speak out, and to innovate
- Expertise is seen as distributed
- Work teams are supported to meet and learn together
- Leaders send signals – through what they say and how they act, about the value of relational practice.
- The workforce has skills, knowledge and time to engage in relational practice.
If you already work somewhere like this, then value it, talk about it and talk about the support needed to keep it going. If your workplace could be closer to this type of environment, maybe it is time to think about the first step that you could take towards creating these conditions for yourself and your colleagues.