Leaders and managers have a significant impact in shaping organisational culture. Leadership style has been shown to influence a range of important outcomes in health and social care settings. These include; patient care and satisfaction, staff wellbeing, staff turnover and absenteeism.
The following articles provide information and resources for leaders and managers in health and social care settings.
The Keeping Well service are also available for consultation to support teams, contact us to find out more.
Compassionate workplaces require leaders who are able to demonstrate compassionate behaviours such as listening and responding to staff needs. Compassionate leadership training can help support leaders to hold conversations with staff and build a culture where compassion and care are valued. The right support from managers can help staff feel a greater sense of belonging and allows their personal welfare to be valued and recognised.
Research reveals that leadership is the most significant influence on culture. Every interaction by every leader, every day, shapes the culture of the organisation.
We must develop and continually reinforce the right leadership values and behaviours – such as developing and empowering people, encouraging shared learning and continuous improvement, building trust and co-operation, supporting inclusive climates, and managing performance – needed to nurture these cultures.
Professor Michael West, 'If it's about NHS culture, it's about leadership'
A compassionate leader encourages employees to talk about their problems and to provide support for one another. Compassionate leadership is about both being a compassionate person and trying to create a culture whereby seeking or providing help to alleviate a sufferer’s pain is not just acceptable but is seen as the norm.
Roffey Park, 'What is Compassionate Leadership?'
Below are a set of resources on how to introduce more compassion in one’s leadership that are applicable at any level of seniority.
Behaviours of compassionate leaders
The four key behaviours that the King’s Fund model of compassionate leadership seek to strengthen are:
Attending – pay attention to staff by ‘listening with fascination’ and without judgement.
Understanding – arrive at an understanding of the challenges staff face through a dialogue with them.
Empathising – empathising with staff and the stresses and pressures they may be facing.
Taking action – taking decisive action to enable staff to do the job that they want to do.
Below are further resources on developing these behaviours:
In this video below Michael West shares his thoughts on compassionate and inclusive leadership for a recent event The challenge of culture change: sharing system-wide learning to deliver the NHS long-term plan.
The Kings Fund - ‘If it’s about NHS culture, it’s about leadership’: Professor Michael West describes the impact of individual leaders on the culture of an organisation, and the early development of the NHS Culture and Leadership Programme.
NHS course - compassionate leadership in crisis: This free NHS bitesize course provides a guide for how to demonstrate compassionate leadership in a crisis.
Roffey Park – ‘What is compassionate leadership?’ : This paper outlines 5 compassionate behaviours and provides a short quiz to consider how compassionate you are as a leader. It also outlines the research base for compassionate leadership in the workplace.
NHS England have compiled a range of resources on compassionate leadership. These may be useful if looking at how to introduce more compassionate leadership into your organisation as a whole.
All the NHS courses in the above resources are free and require an NHS login to enroll.
NHS England outlined in the NHS People Plan 2020/21 that all managers hold wellbeing conversations with their staff, and that every member of the NHS should develop a personalised plan.
Wellbeing conversations are a key part of the NHS framework because they are designed to help nurture the recovery of staff and help managers to guide staff to additional support and to reduce the long-term impact of their distress, according to Our NHS People.
“Health and wellbeing conversations are intended to be regular, supportive one-to-one coaching-style conversations that focus on NHS people’s wellbeing. The conversations aim to consider the whole wellbeing of an individual, to identify any areas of their life where further support may be required.”
Our NHS People, ‘What is a Wellbeing Conversation?’
- ‘What is a wellbeing conversation?’: A short NHS guide on holding wellbeing conversations.
- ‘Holding wellbeing conversations’: a 3 minute animated guide from NHS Employers to support and guide line managers through wellbeing conversations.
- ‘How wellbeing conversations helped me’: a 3 minute staff experience video on how wellbeing conversations helped them personally and why they are important.
- NHS course – conversations about painful subjects: A guide for leaders and managers on how to approach discussing painful subjects.
- NHS course - how to work with emotions and care for your team: A free 30-minute introduction to helping and supporting your colleagues to work through their reactions.
- ‘Wellbeing conversations – case studies’: Three case studies of NHS organisations who have rolled out wellbeing conversations across their patch, and what the challenges and benefits were.
What is trauma?
Trauma can be defined as a response to a distressing or disturbing event or set of events. Trauma can result from a variety of sources, including adverse childhood experiences, relational difficulties, race-related experiences, violence, terrorism or accidents/disasters. Research suggests there are a variety of common experiences after exposure to trauma.
Psychological responses can include, but are not limited to, intrusive thoughts or flashbacks, feelings of guilt, anger, stress, sadness or numbness. Physical responses may include difficulties with sleep, hyper-arousal (an increased state of alertness), increased heart rate or fatigue.
Trauma within social and health care settings
Some examples of traumatic events which may occur within health and social care settings include:
- witnessing or experiencing an assault or verbal abuse
- terrorist attacks
- or events which cause high patient mortality (for example due to the Covid-19 pandemic).
Vicarious trauma (also referred to as secondary trauma) is where a person does not experience trauma first hand but is exposed to traumatic material indirectly through hearing, seeing or reading about another person’s experiences. Staff who are engaged in supporting people who have experienced trauma may experience secondary traumatic stress as a result.
Responding to trauma in the workplace
The National Fund for Workforce Solutions suggest that identifying trauma and its impact within a workplace is not always simple. They propose that many employees may not want their employer to know they are struggling. When staff members are experiencing negative impacts of trauma it may not be obvious and may present as absenteeism, presenteeism or high staff turnover within services.
Managers should be aware of the service and/or local policies and procedures to follow in response to traumatic or risk related incidents. The Centre for Health Care Strategies advocate for the development of organisations which are both physically and psychologically safe for staff. Line Managers can support staff by facilitating access to psychological first aid and wellbeing conversations.
Managers should also make staff aware of services which are available to them such as Keeping Well NWL, Employee Assistance Programmes and Occupational Health.
Trauma-informed approaches in health and social care
There has been a movement towards trauma-informed approaches within many health and social care settings. For example, the NHS long-term plan commits to developing trauma-informed approaches for organisations supporting adults with mental health difficulties and young people in contact with the criminal justice system. The US governments trauma and justice strategic initiative (SAMHSA) suggest that the goal of trauma-informed approaches (also known as trauma informed practice or care) is to ensure that all staff are aware of the wide impact of trauma. Trauma-informed approaches aim to promote care which fosters recovery from trauma and prevents the re-traumatisation of clients and staff.
SAMHSA suggest that staff should experience their workplace as “safe, inviting, and not a risk to their physical or psychological safety”. They have developed a framework of trauma-informed practice which involves four key assumptions that organisations should embed into practice:
Realising the widespread impact of trauma and pathways for recovery.
Recognising the signs and symptoms of trauma in staff and clients.
Responding by integrating knowledge about trauma into policy, procedures and practices.
Resisting re-traumatisation of clients and staff by facilitating supportive and proactive services.
Trauma-informed responses to the COVID-19 pandemic
Preliminary research has begun to examine the impact of trauma-informed responses to support staff well-being during the COVID-19 pandemic:
- A rapid response groups of clinicians and researchers created guidance in responding to stress experienced by hospital staff as a result of the COVID-19 pandemic.
- The response to the COVID-19 pandemic has meant that more staff are working remotely. The British Psychological Society have composed advice for leaders of teams who engaged in trauma-related work from home.
- The following NHS case study explores learning and advice from Northampton General Hospital following the development of staff support services as a result of the pandemic.
Understanding the Impact of Trauma - explores trauma informed care in the behavioural and health sciences
Royal College of Psychiatrists - covers a wide range of traumatic events and the subject of post-traumatic stress disorder (PTSD), which may affect some staff after a traumatic incident:
Crisis management guide for employers supporting staff affected by suicide
The American Counselling Association have developed a factsheet on vicarious trauma in counsellors.
Have you thought about creating wellbeing roles within your team?
There are many to consider, including wellbeing guardians, wellbeing champions and Mental Health First Aiders. All roles are different, although the terms are sometimes used interchangeably, and the definitions we are using are below:
A Wellbeing Guardian is a senior member of staff who takes forward the wellbeing agenda within their organisation.
They typically take an assurance role at Board level, in which they look at the organisation’s activities through a health and wellbeing lens.
NHS England recommend that the role is best suited to a Non-Executive Director. They should be able to check and challenge the executive team, but do not need to have specialist wellbeing knowledge.
- Organising informal catch ups within the team
- Encouraging participation in current wellbeing activities within the team
- Encouraging the team to input their ideas for promoting wellbeing
- Raising issues with senior staff on behalf of the wider team
- Liaising with senior staff to introduce training for teams that require additional support
- Creating a team display board to celebrate successes and to share ideas
- Communicating with colleagues within team to find out their different interests and pastimes
- Organising social activities outside of work, i.e. team away days
- Encouraging a culture of kindness, appreciation and compassion
Mental Health First Aiders
Mental Health First Aiders are members of staff who receive training to identify anyone who is developing a mental health problem, experiencing a worsening of a mental health problem, or in a mental health crisis.
Their training teaches an in-depth understanding of mental health, enhanced interpersonal skills such as non-judgemental listening and the knowledge to help guide others to further support.
Would you like further information on wellbeing roles in a work environment? Click here for more.
Resources throughout the Keeping Well Academy will be helpful to a wellbeing guardian who would like to study more about how wellbeing is shaped by the workplace, and what organisations can do to improve wellbeing.
“As a Wellbeing Guardian, you have the opportunity to make a real difference in your organisation, placing staff health and wellbeing at the heart what we do. You will be in an ideal position to support, influence and seek assurance from your senior leaders, creating a culture of wellbeing where the organisation cares for its people, who care for others.”
NHS England provide information to welcome new Wellbeing Guardians and offer resources to support the role. They cover the following areas mixing video and written content:
- Why this role is important
- What this role involves
- How to get started
- Community development and resources
- Regional Networks
Have a read of the NHS Wellbeing Guardian guide for further information about the role and expectations.