How do we create compassionate cultures?
Two weeks into my first job as a medical doctor I contracted viral meningitis. I was suddenly a patient in hospital for a few days, then returned to work too soon, whilst my body battled fatigue and headaches.
But I had just studied for 5 years to get here! This was the start of my career! I had to battle on!
And so I did, on a brutal schedule, trudging between patients, trying to get around the relentless workload, trying to be a good doctor. Caring. Until suddenly I couldn't any more.
I remember sitting in the cardiac unit, trying to fill out a patient's notes, and realising I had to stop.
Not just for a day or two, but I was about to walk away from the job I'd dreamed of. Tears streamed down my face. I put my head on the desk and sobbed.
Nobody said a word.
That was the worst part. People looked, with pity or disdain, but they didn't come over to see if I was okay. I didn't know if they thought I was a loser or were afraid of their own emotions. Or just didn't know what to do.
Nobody said a word or did anything at all. I found my boss and told him I couldn't go on. He said "take the rest of the day off." And I said "No, I can't do this. I'm resigning."
I wasn't in a fit state to make that decision but he didn't try to stop me. He just looked uncomfortable because I was distressed.
All I knew was that my whole world was falling apart.
I did eventually return to medicine, and worked for over 20 years, as a GP, and in leadership roles, and I loved my patients. But my view of the culture in medicine never really changed. Most Medics are not very compassionate to each other. They are mostly competitive and judgmental, looking at someone else who struggles as weak. There are fantastic individuals, of course, but the culture is brutal.
My work is now helping leaders to learn to be more compassionate to themselves, which in turn helps them to be compassionate leaders. They learn they don't need to be so judgmental (of themselves and others), and can handle failure, and can look after themselves when burnout beckons.
But I'm also fascinated with how we change organisational culture. And so I'm returning to my early experience to unpick what goes wrong.
Noticing: To be compassionate, we need to be prepared to notice suffering in others, not just turn away. On that cardiac unit, if the clinician in charge had checked on me, taken a moment to say "you don't look okay, what's going on?" that would have role-modelled "noticing" for others to emulate. It would have also helped me. Because they didn't, everyone else kept their head down. Being ignored in that moment was horrible.
Interpreting: To be compassionate we need to get over our judgmental attitude to suffering. When I work with groups, they are mightily relieved to hear that EVERYBODY struggles. So it's time we stopped pretending, and turn towards struggle with generosity. Struggle is often temporary, legitimate, and responds well to validation and support. So a first step is to acknowledge struggles with an open mind.
Feeling: How do we help people to feel more concern for each other? In my experience, when we teach people self-compassion, they soften towards their own flaws and struggles, and that immediately makes them more open to the suffering of others. If we're all walled-in, pretending to be okay, we don't have the capacity to feel supportive to others. Many people are terrified of their emotions, and are out of touch (or in denial) of their own feelings, so the whole subject of feelings seems scary. I think we need to be more aware of trauma, and have much more openness about the emotional impact of challenging work. Opportunities to connect and have honest conversations are so helpful. Schwartz rounds in hospitals have been very effective in this regard - and we should expand that approach into medical schools, primary care, paramedics, nursing. Our current approach leaves people privately traumatised, and compensating for- rather than processing - their difficult emotions.
Acting: The culture we role-model has a huge impact on organisations. I think it's worth saying that Politicians and NHSE generally don't role model compassion well, and there are many examples of egotistical and toxic leadership in the NHS and beyond. And when juniors see their seniors acting in ways that are rude, dismissive, and lacking compassion, they believe that's the only way to be. I'm not talking about giving everyone sweets to say thank you for working overtime. I think we need to consider basic human needs as a starting point: somewhere to eat, sleep, and be safe. Recognition and validation. Greetings, eye contact, rotas, and communication. And the needs of senior staff are just as important as juniors - many senior leaders feel isolated, abused, trapped between politicians/management, and the teams they are trying to lead. Our actions speak louder than words, but words matter too. To create compassionate organisations, we need to think about ways that would make it normal to act with compassion at work. In many workplaces we're some way off that, currently.
It might be trendy (and important) to talk about being a Compassionate Organisation, but I think it's worth digging into this subject to do it justice. It's unhelpful to put up a notice pledging to be a compassionate organisation if these fundamentals are not in place. We can change cultues, but we need to challenge our existing behaviours and be prepared to get out of our comfort zone.
I also want to express some optimism. Individuals can have tremendous impact. If you focus on compassionate, courageous, and boundaried leadership, your behaviours will have a ripple effect. The leaders that I work with are changing lives. And they are changing cultures, one conversation at time. How you show up really does matter. Every smile, eye-contact, connection, action, has an impact. You can do this!
If you'd like to find out more about support for leaders, and building compassionate cultures, contact Nicola via https://nicolaharkercoaching.com
(I would like to credit Monica Worline with the inspiration for the headings I've used here - her book Awakening Compassion At Work is a must-read and she continues to inspire and guide my work.)