Authenticated user menu

16 April 2013
Total views

Kindness and the Francis Report: A Socratic Dialogue

Q: Must I really read the Francis Report?

A: Of course you must. The Francis Reports, in particular the most recent one, set out in detail the failings that occurred at the Mid Staffordshire NHS Foundation Trust over several years, in the course of which possibly hundreds of people died avoidable and premature deaths, some in conditions of misery and squalor that the whole NHS should be ashamed of. Every self-respecting leader should want to read these reports in order to make sure that this never happens again. I am surprised you would even ask the question!

Q: I know all that. It’s just….well I just wonder whether it will really make a difference?

A: What on earth do you mean? The reports give voice to the experiences of hundreds of neglected patients and their families in what was clearly a broken culture. In the most recent report, not only the behaviours of clinicians, but the roles of Trust management, the whole system, and NHS culture are examined. We owe it to all of those patients and all patients in the whole NHS to acknowledge those terrible experiences, and to galvanise ourselves to do better. Anything less would be adding a shameful disregard on top of the experiences themselves. It would be adding insult to injury.

Q: Yes, I know that, too….it’s just….well I am not sure that the report is going to help me make my own organisation any better?

A: That’s just complacency and arrogance and weak leadership! The inquiry cost millions of pounds and the report has made 290 recommendations! So for a start, you can get on and implement the recommendations. That will make things better.

Q: But which ones? How will I decide what to do?

A: I can’t believe a decent leader would ask that! Get your clinical governance team and your managers to do a gap analysis of how your organisation measures up against each of the 290 recommendations. Take that to the Board, and ensure there is a high level action plan. Make sure that this action plan is owned by the Board, the Trust management structures, and the front line clinical and support staff, and if need be, performance manage its implementation. You need to demonstrate that lack of compassion and poor quality care will not be tolerated.

Q: How will I do that?

A: Well you need to change the culture. For a start, you can root out, discipline and if need be, dismiss all those who are not compassionate, all those involved in providing poor care or in managing systems that do, and all those who don’t put the patient first at all times.

Q: Gosh….don’t you think that might be quite a lot of people? Don’t you think we have all failed in that way at one time or another?

A: Well, perhaps, but that is not the point. The point is that now, it can no longer be tolerated. Everyone needs to shape up!

Q: But if we can’t tolerate the occasional lapses that human beings will always make, and build systems that support them while still protecting the patients from harm, how can we expect staff to bring their humanity into the care we want them to give to patients?

A: I am not sure where you are going with this. Let’s stop debating it. Just get it done.

Q: But in all seriousness, get what done? We are asking our staff, as human beings, with human fallibilities and emotional frailties, to engage in some of the most profound and intimate acts possible; to care physically and emotionally for strangers in pain and distress, facing death, disability, disfigurement or the diminishing of their faculties and independence. We are asking our staff to do that day in and day out. Don’t you think that is a lot to ask?

A: That is not the point. These people are professionals and this is the job they have chosen. Society expects them to deliver excellent and compassionate care and our job as leaders is to make sure they do it and take action if they don’t.

Q: Yes, but it’s the how that is so crucial here.  You might enjoy reading a book on this called Intelligent Kindness, by Ballatt and Campling. It’s really….

A: Oh here we go! We have the Francis Report to read and respond to, and you want us to read a book….on kindness, of all things! Forget that. We have to drive compassion into everything we do and implement the 290 recommendations!

Q: The thing is, it’s not a long book. It’s really well argued. It’s very easy to read. It was written after the first Francis Report and so it explicitly considers what happened at Mid Staffs. And I guarantee you will be able to read it faster than you can read the whole of the Francis Report.

A: Yes, but what has…Intelligent Kindness, did you say….got to do with organisational failures like we saw at Mid Staffs and that we must not allow to happen ever again?

Q: Well…the book reminds us that kindness is a remarkable human virtue that lies at the heart of caring for others. But it goes on to remind us, too, that kindness has a personal cost for the individual being kind. To sustain kindness, it is often necessary to act, and there is always a moment when one experiences, to some extent, the plight of the other, and the distress they are experiencing. Being kind and compassionate can hurt. Especially if you do it all day, every day.

A: Not if you keep rigid boundaries and protect yourself.

Q: Doing that might be hard for some people, and even if you can do it, it might actually stop you being kind. Those boundaries might be ways to prevent the patient’s distress affecting us, but if they are too rigid, they may do nothing to help alleviate the patient’s distress.

A: This is nonsense. When a demented old lady is incontinent in the bed, they need cleaning up, not kindness! Imagine just making kind noises and doing nothing!

Q: No, I couldn’t imagine that. It would not be kind. They would need cleaning up, and the sheets changing….but they would need more than that. If it was you or one of your relatives, would you rather the person doing it was kind, or was….what did you say? Keeping rigid boundaries to protect themselves? That sounds a bit cold and inhuman to me. Haven’t we seen lots of examples of how that kind of behaviour is interpreted by patients as being mechanical, uncaring, part of a technical view of healthcare that has lost the balance between kindness and care on the one hand, and technological interventions on the other? Aren’t most of the complaints and even some of the safety incidents we see created by a lack of kindness between healthcare workers and their patients, or even within and between teams of healthcare workers? Kindness is vulnerable; to other pressures on individuals, and on organisations, that cause unkind cultures to emerge.

A: What are you saying?

Q: I am saying that we need to do much more to acknowledge the emotional cost of providing healthcare and the fragility of kindness in cultures and environments that are under huge pressure to forget it. Pressure from how society currently thinks we should go about meeting the challenges of resource, ageing, disease and death, and our anxieties about all those things; pressure from how politicians and the media articulate these anxieties; pressure on operational and financial performance; pressure from ourselves when we get too tired or impatient to stay kind.

A: And you are saying that has implications for leaders?

Q:  I am saying that all of us, especially leaders, have to work actively and consciously to maintain kindness in our organisations, in all our dealings with each other and with our patients. I am saying that there is a visionary book called Intelligent Kindness that argues this better than I have, that you will be able to read faster than you can read the Francis Report, and that will inspire you in ways the report never will. Read this book, and you may be uplifted and motivated to connect with something that technocratic medicine, leadership or management may have made you forget. And with that kind of inspiration, the kind the Francis Report may drive you to look for but can never itself provide, you may actually be able to begin the long and hard work, with those you lead, to create a better culture for patients and for staff, and to deliver better quality as a result.

A: Hmm….sounds as if I should read this book. So…in that case, do I really need to read the Francis Report?

Q: I think that is where we began…..

 or  Register to add a comment

About the author

Anthony Berendt's picture

Anthony Berendt

Tony has worked at Medical Director level in acute Trusts since 2004 and he is particularly interested in organisational dynamics; their influence on individual, team, and organisational behaviours and performance; and the role of leadership in creating healthy organisational cultures.


Array ( [0] => sitewide [1] => advert_external_leaderboard [2] => not_front_desktop [3] => advert_external_wideskyscraper [4] => comments [5] => comments_login_prompt [6] => jobs_content_pages [7] => node-social-accelerators [8] => node_blog [9] => related_content [10] => advert_internal_desktop )