This assignment will evaluate the current literature to identify the impact of compassion and compassion fatigue on efficiency. Consideration will be given to the direction and impact of the dark side of leadership, as Schantz (2007) highlighted that for nurses (leaders) to powerfully impact the world; compassion is their most effective tool if they use it appropriately.
Reflections from the clinical workplace will be used to illustrate and inform the discussion. Compassion evokes deep feelings of sympathy, empathy, and the need to help someone in distress (Cambridge, no date). Compassion is one of the core values of the NHS Constitution (DoH, 2009); and is often referred to in the same context as good care to give a level of assurance, which it is argued dilutes its true significance and validity.
Recent change has seen compassion elevated to a subject of extensive consideration and debate in policy reform and strategy development (Sinclair et al., 2016). Dewar and Christley (2013) argue that the Compassion in Practice Strategy (DoH, 2012) isolates the fundamental aspect of care which is compassion, risking individual interpretations of implementation. Similarly, Crawford and Brown (2011) posit that the utilisation of a strategic compassionate approach, incorporating all six C’s to support the development of progress is more likely to achieve its goals of implementation. Dewar and Nolan (2013) welcome this view, as while there remains ambiguity around how to measure compassion, it will continue to be a political ruse to reassure the public that poor standards of care are being addressed. In conflict with this approach, Watson (2006 and 2009) demonstrates that the tools and outcomes of a metrics based approach do not go far enough to evidence the intricate layering required to fully represent what is needed to realise real compassion. It is asserted that this compromises its use as a foundation for transformation and should be used with informed caution. Crawford and Brown (2011) introduce the concept of ‘fastcare’, warning that there is too much focus on what people have been unable to deliver and not enough on what has facilitated the outcome. When this is considered in the context of the NHS becoming more business focussed (Lister, 2008), it is possible that a culture of threat will develop (Crawford et al., 2011), which Rothschild (2006) sanctions, can lead to compassion fatigue. Crawford et al. (2011) warn that this fatigue can cultivate a production line mentality, which is task and not patient focussed. Sadly, this is in direct conflict with Darzi’s (2008) plea for greater patient safety and dignity. Frustratingly, healthcare and social care workers experiencing feelings of stress, guilt, and exposure to bureaucracy, job instability and micromanagement are at high risk of becoming defensive, which in turn can prevent them from being compassionate (Gilbert, 2009). Adding to the picture, Cooper (2012) identifies that every day NHS leaders are faced with the fear of failure, amplified by the threat of external scrutiny which their organisations are unable to affect or control; the impact of these dictates a defensive mindset.A reflection recalled a patient in her last hour of life (‘Mary’); Mary was brought to the ward unannounced by a senior manager and a Matron as she was about to breach a 12 hour A&E target. They placed Mary in the day room as there were no beds available on any ward. Assertively challenging their action and reasoning, I was advised not to worry, as Mary didn’t have any family, positively noting that their action prevented a system breach. Continuing to challenge, I was shouted down and advised that I wasn’t senior enough to understand that this was a ‘good call’.
The learning from this situation identified that the lack of compassion demonstrated by the senior leaders was due to fear of a target breach and external scrutiny, which overrode their compassion threshold, making a normally unthinkable idea an acceptable solution.
It shouldn’t be assumed that ineffective leaders mean there is no leadership, advises Ashforth (1994) supported by Einarsen et al. (2007), whose model of destructive and constructive leadership behaviours, identifies the traits of the darker side of leadership behaviours. Benson and Hogan (2008) go on to caution that the darker side characteristics are present in all leaders. This is further exacerbated when leaders with narcissistic personalities do not receive targeted development as they will leave chaos in their wake argue Higgs (2009) and Maccoby (2000). These assertions have a considerable impact, when thinking of senior leadership; however it must be realised that there are leaders at all levels remark Goffee and Jones (2000), therefore it is considered reasonable to argue that the impact will be felt at all levels, moving up and down through service delivery processes in every team. It’s a fine line, posits Maccoby (2000), as narcissists are often skilled strategists who are able to clearly articulate a vision and inspire others, but if a person is perceived as blocking their progression they are likely to be perceived as an adversary.
Schein (1987) advises that human culture and socialisation determines whether a person will feel positive or react negatively, to the interpretation data gathered by an individual feeling and sensing and interpretation of risk. Therefore the skill of reading the room, or more appropriately, emotional intelligence is often attributed to women remarks Fletcher (1999), adding that this makes it inherently undervalued.
‘Nice’, ‘helpful’ and 'thoughtful' are not found on many lists of leadership characteristics.’ (Fletcher, 1999, p115)
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The importance of emotional intelligence cannot be underestimated contends Goleman (1994), identifying those leaders as being distinguished, and step ahead of the others. Linking relational practice to emotional intelligence, Holmes and Marra (2004) present relational practice as the practical element of emotional intelligence; valuing the corridor conversations, welfare check-ins with a colleague delivered with congruence and trust. Surprisingly and in spite of this, Holmes and Marra (2004) found that in some organisations a culture of aggressive competition can craft strong teams and leaders, noting that for some people there will be a psychological disadvantage. It is strongly challenged and argued that the teams described by Holmes and Marra (2004) are pseudo, not real teams as defined by West and Lyubovnikova (2013), the variance in which are considerably better outcomes and experience for patients and staff for those cared for and working in real teams.
Fletcher (1999) refers those people that are disadvantaged as the ‘disappeared’; notably women, working within an organisation where they are not heard and as such are blocked from progression as they are perceived as under-achievers or not noticed at all.
A personal reflection highlighted the overt use of gender stereotypes in personality profiling within an organisation. Having completed a Myer-Briggs (1962) assessment profile, posters distributed contained images portraying women with children and books against the personality types linked to nurturing and teaching roles. Pictures of males in authoritative roles were aligned with the words ‘Inspector’ and ‘Fulfiller’. Individual concerns raised were noted and staff told they did not need to display them if they didn’t want to.
On reflection, I have realised that it was the informal corridor conversations which enabled a small group to share compassion with one another. This built their confidence and trust, enabling them to make a formal complaint about the posters. Many colleagues were oblivious to the stereotyping, hearing the concerns of others lent their support and encouragement to factor change and raise awareness.
The conclusion of the reflection was that although these corridor conversations reached a positive outcome, they can also be used negatively to marginalise and exclude a person or group, which is akin to the darker side of leadership (Benson and Hogan, 2008). This assignment has critically analysed the core arguments concluding that it is essential to balance compassion with effective and efficient service delivery.
The challenge remains how to effectively measure the presence of compassion without introducing meaningless metrics, which are evidenced as a causal factor of compassion fatigue. A reflection demonstrated the impact on compassion when the threshold of compassion was breached, leading to a quick-fix solution to Wicked Problems (Rittel and Webber, 1973) compromising individual and organisational values.
It is argued that congruent delivery of compassion improves patient outcomes and job satisfaction (Roze des Ordons et al., 2019), which inherently paves the ground for efficient real team working. It is maintained that compassion is an essential vehicle from which efficiency can be delivered; it is not a metric to demonstrate efficiency.
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