The rewards of leading with kindness and compassion
Kindness is the language which the deaf can hear and the blind can see.
- Mark Twain
Imagine that you are working in a cash-strapped system with an ever-increasing workload and limited ability to recruit, even if you could afford to. Inevitably, you can also ill-afford to pay overtime. One solution is to get more from the current workforce. If you happened to be working in healthcare you would be on to a bit of a winner, because people choose to join to do good and have, for decades, shown that they will go the extra mile for the sake of those that need their help. However, (a message to the cynics and manipulators) even the most dedicated staff members have their limits and one wonders how close we are to those limits in today’s NHS. It is important (and frightening) to reflect on the possible consequences of driving out the goodwill of a dedicated healthcare workforce.
There is a simple concept which might help this difficult conundrum – discretionary effort, which is neatly defined as “the level of effort people could give if they wanted to, but above and beyond the minimum required.” [i] It is disappointing to note that many organisations “manage by exception, providing consequences for workers’ performance only when it falls below the standard or minimum required. …. It suppresses discretionary effort because there’s nothing in it for people to do more than the minimum required.”i Sound familiar? Let’s consider the flip-side: I have asked many groups what would encourage more effort from them – most of the answers are free (being treated like a human being) or inexpensive (food and water). Many have benefits for the organisation or system (more education/training, better IT) and pay is low on the list as Herzberg and Maslow have suggested.
When I was a trainee, we did what would now be considered dangerous hours, but we were happier. That might have been because we knew no better and had no choice, but I always felt cared for. We were fed in canteens which were seldom closed, even during the night. Tea and toast in sister’s office was commonplace, as well as a privilege for those she deemed were performing well! Free sandwiches were the norm in theatre and would appear in the mess (yes, we always had one of those) at various times in the evening for those who had missed supper. Beds were organised for us, parking was free and we were trusted with a bar! We had separate doctors’ (and nurses’) dining rooms which were later sacrificed on the altar of political correctness and economic reasons. This simply led to many doctors missing lunch and valuable cross-specialty discussions becoming less accessible. Consultant behaviour could occasionally be draconian, but they would have (and often did) put a stop to any threat to our creature comforts – where are these comforts now? Over the past forty years, I have witnessed the gradual erosion of anything which could be called a privilege – a result for greater egalitarianism, but an ‘own goal’ in terms of plummeting morale! In fact, for ‘privilege’ read decent employment practices and most of Maslow’s hierarchy of needs.
A recent Guardian article [ii] depressingly highlighted continuing issues of what are referred to as ‘petty tortures’. A junior doctor collated more than 400 examples of the issues which gnaw at their enthusiasm and dedication, which seem unacceptable. Have we learned nothing from the junior doctors’ strike? Indignation is appropriate and remedial action even more so. We must be wary of simplistic solutions to complex problems, but there are some simple solutions which would go a long way to making all our colleagues feel valued with beneficial effects for them and their organisations (see above). For junior doctors we now have junior doctor fora supported by FMLM guidance [iii] – and if you haven’t already done so, do consult with them. If you also give them a modest budget and the challenge to improve the status quo, they will almost certainly do it better than you, but everyone will reap the benefits.
People should be kinder to each other and the default position for managing colleagues should be trust, those who betray that trust can have what they deserve. More doctors and nurses cost money, but civility and compassion are free and accessible to all. To state the obvious, that works in three directions – up, down and across (yes, I do mean up – your boss is human too). This is evidence-based management and leadership for which there are deep and powerful arguments showing benefits for individuals, organisations and patients alike. If you want to learn more, come to the FMLM Scotland conference [iv] in Edinburgh on 26 April and hear Professor Michael West’s compelling arguments and research. I guarantee that you will be inspired.
The endgame is simple: being kind, being decent, being civil to everyone has immeasurable benefits and it is free.
When I was young, I admired clever people. Now that I am old, I admire kind people.
- Abraham Joshua Heschel
[i] https://www.aubreydaniels.com/discretionary-effort
[ii] https://www.theguardian.com/society/2019/mar/28/nhs-trainee-doctors-denied-leave-dossier-hospitals?fbclid=IwAR3cSB-f6lE1eM_C5W4fMSyBHNLaezf1dE_j7OuYSjzDD42nHqNYldwGj7Q
[iii] https://www.fmlm.ac.uk/members/resources/leading-as-a-junior-doctor
[iv] https://www.fmlm.ac.uk/events/compassionate-leadership-from-striving-to-thriving-in-the-nhs