How do we put ‘compassion’ into the care system?
Firstly, we do not know whether we have somehow ‘lost’ our compassion for others, or whether it has ever really existed. However, we do know that over the past few years ‘compassionate care’ is not something we can assume exists. Whether the provider of care is from the public or private sector, we cannot take for granted that care will be provided with compassion, nor that patients will be treated with dignity and respect.
So how do we ensure ‘compassion’ becomes the ‘norm’ in the provision of care, regardless of the setting?
We need a change in approach from leaders across the sector, a change from a transactional style of leadership to one that is transformational. Transactional leadership is based on bureaucratic authority with an emphasis on task orientated goals. An organisation characterised by a transactional leadership fosters a management structure which leads to the development of a ‘defensive culture’ where members are expected to conform and follow rules without challenge.
However, transformational leadership is a process that motivates followers by appealing to higher ideals and moral values. Transformational leaders must be able to define and articulate a vision for their organisations, and the followers must accept the credibility of the leader. Organisations characterised by transformational leadership are more likely to have a ‘constructive culture’ where members experience constructive cultural norms, for example, organisations set challenging but realistic goals and manage in a participative manner where relationships are constructive and open so as to achieve agreed goals. This is not to suggest transactional management is not also required in some measure, however, the transactional approach seems to have carried greater emphasis across health and social care. This has been my experience working in the public sector.
Coming from a social care background my experience suggests a lot of the current problems across the health and social care system stems from poor leadership and management over the last 20 years. The introduction of performance indicators were meant to drive standards up, however, successive managers seem to think the purpose of an indicator is to meet the indicator! If the leadership and management of an organisation focuses on targets instead of care, that ethos frames every process within the organisation, leading to everyone no longer seeing the patient as a person, but a target to be met. Those who try and keep a patient focus soon find they cannot fight a system geared to targets alone.
An ethos of an organisation comes from the top, an ethic of care informing leadership and management practice would make a huge difference. You just have to think about the ethos of where you work to think about how it affects you in your day to day work. It’s no different on a hospital ward or in a private care home.
The care sector requires inspirational leadership. Arguably the NHS is over managed and under led at present. There is a difference between leadership and management, although, both are required, but leaders are central to how their managers perform. When I think of a ‘good’ leader I think of people like Gandhi or Lincoln, people who are humane, humble, who inspire you to engage, to strive to achieve change for the greater good. They have a grand vision, and not a vision solely focused on targets and value for money, but higher values, such as compassion, dignity and respect is their motivation. The type of values that are the foundation stones of a humane care system.
Another key factor involves ensuring the right people are in the workforce – we have to ask are we recruiting the right people into the care sector, whether as carers, leaders or managers? Clearly there are many good carers/leaders/managers out there, but we need a lot more, however, this has to be based on suitability not availability. On the ‘frontline’ care providers, whether public or private, have had real difficulty in attracting people into the workforce. This is not surprising when you consider how government and wider society not only undervalue such jobs, but also those being cared for, with the vulnerable being marginalised in society for being, well, vulnerable and in need of care!
Caring for people is a demanding, and rewarding job, but, carries little status and is seen as something ‘anyone’ can do. Believe me it is not. From my professional experience I’d say the best front line carers are those who have a deeply ingrained respect for others, and who genuinely like people. This is not something that can be taught, but they are the characteristics required to develop a professional, and caring, workforce. Recruitment of the right people is central to turning the system around.
Our current system of care provision leave many people mistreated and without support. Arguably where leadership is insufficient or weak, a strong philosophical, moral, and ethical framework maybe required to guide the workforce in meeting any responsibility to ensure vulnerable people are not mistreated. Where both are weak those most vulnerable will continue to suffer.