Michael West, a compassion masterclass

Michael West is professor of work and organisational psychology at Lancaster University and visiting fellow to the King’s Fund, the NHS think tank.

How did he come to those appointments? He observes that careers often unfold rather than are preplanned. After university he worked in a coalmine for a year. There safety and mutual support were prominent features of the culture. When he returned to university, the experience led him to take a particular interest in teamwork in organisations.

His 35-year involvement with the NHS originated in a study contrasting the working conditions of student nurses and health visitors.

He has just co-chaired (with Dame Denise Coia) an enquiry into the mental health and wellbeing of doctors. He contends that “chronic excessive workload” is the leading predictor of staff stress, but such a workload has become “the unseen pattern on the wallpaper.” Additionally, the complexity of the conditions that patients are presenting with is increasing, whilst resources are constrained – the UK has one of the least well-funded health services amongst the OECD countries.

Michael says that it is tragic that we don’t demonstrate care for a body of people – NHS staff - who have chosen to dedicate their lives to the care of others.

Lately, Michael has turned his attention to compassionate leadership. He views compassion as a core value of the NHS and sees clinician compassion as the most powerful intervention available to the NHS. But if we are to create a culture within which staff can deliver compassionate care, then the leaders of the organisation have to model compassion. This involves attending/listening, understanding, empathising/feeling and helping.

In 2015, Michael jointly wrote a King’s Fund blog with Suzie Bailey entitled ‘The Five Myths of Compassionate Leadership.’ He felt it necessary because compassion can conjure up an image of “soft cushions, scented candles, pilates…” whereas in reality compassionate leadership is tough, involving a strong focus on purpose and quality, being prepared to have tough performance management conversations in a compassionate way, and challenging ruthless power.

Michael believes that people can be trained in compassionate leadership: we are already “hard wired” to be altruistic, to want to help, to be kind and to find giving to others rewarding. Mindfulness and reflective listening are two elements of his approach to engage these characteristics. And compassionate leaders take the view that their role is fundamentally about removing the obstacles to people doing their job well.

Michael points out the crucial difference between empathy and compassion: in empathy the pain centres of the brain are activated, in compassion the reward centres are activated.

In 2016 Michael addressed the leaders of all the national bodies of the NHS in England. Since then Compassionate Leadership, expressed in “Developing People, Improving Care,” has become part of the national strategy for the NHS. It has also become part of the strategy for the NHS in Scotland, Northern Ireland and Wales.

In 2017 Michael co-authored a report by the King’s Fund entitled “Caring to Change: How Compassionate Leadership Can Stimulate Innovation in Healthcare.” (It’s the most downloaded paper from the King’s Fund website.) Purposeful focused compassionate leadership creates an environment of psychological safety in teams. This allows people to talk about errors, overload, and bullying as a starting point for dealing with these issues.

Examples of innovation catalysed by compassionate leadership include substantial reductions in bureaucracy, the use of physiotherapists in primary healthcare to handle the 40% of consultations that involve musculo-skeletal conditions, and the use of community psychiatric nurses.

His involvement with the theme of Compassionate Leadership and its embedment in national strategy is Michael’s proudest career achievement. He is also pleased to have been involved in the preparation of the evidence-based resources that are located on the NHS Improvement website under culture and leadership. Other countries, including Denmark, Canada and New Zealand are also making use of this resource, which is freely available.

The failure from which Michael has learnt most was a lack of humility in his early leadership roles. Did it emanate from a lack of confidence as a leader? Over the years he has developed the courage to admit when he doesn’t know something.

The people who have inspired Michael during his career include staff at every level in the NHS, and also Nelson Mandela, the latter a leader whose compassion overcame an understandable clamour from his followers for revenge.

Michael’s self-care regime includes time with his family, an hour a day in meditation, cycling in the Peak District, reading and taking adequate sleep.

If Michael were to be put in charge of the NHS, a service that employs 1.4 million people and provides services to a million people every 36 hours, his top priority would be to address the chronic excessive workload that the organisation faces. How can it be more effectively managed?

Michael would recommend the book ‘Awakening Compassion at Work’ by Monica Worline and Jane Dutton.

His advice to a young NHS leader today would be to a) recognise the privilege it is to lead a body of people that are so highly motivated and skilled, and b) to be compassionate leader – if all 1.4 million NHS staff experience compassion, along with their patients, those people will take that compassion out into their communities and families. And, in Michael’s view, “compassion is the most important focus we should have now as a species…”

The NHS has the capacity to change the very nature of our society and our experience.