Teamworking, psychological safety and compassionate leadership

In this blog Michael West, senior fellow at the Kings Fund, explores the importance of teamwork and compassionate leadership in creating a sense of belonging for our NHS people and enabling a better experience at work.

It is teams that make up health and social care organisations and they are the most important determinant of daily work-life experience and performance. Teams affect mental health and wellbeing of staff, determine care quality, and, when they function well, are constant sources of innovation. These outcomes depend on the quality of teamworking and particularly whether there is a team climate of psychological safety. The role of compassionate leadership in creating these conditions is fundamental.

Psychological safety is a ‘‘shared belief held by members of a team that the team is safe for interpersonal risk-taking.’’ It describes a team climate characterised by inclusivity, interpersonal trust and mutual respect in which people are comfortable being themselves and expressing their views. Compassionate leadership is key to this.

Compassionate leadership in practice involves attending to, understanding, empathising with and helping those we lead. Attending means being present with, and attending to, those we lead - ‘listening with fascination’. Compassionate leaders arrive at their understanding of others’ challenges through dialogue with those they lead, which may involve reconciling conflicting perspectives rather than imposing their own understanding. Compassionate leadership involves feeling the distress or frustration of others without being overwhelmed. Such empathy stimulates the intent to help. And the most important task of leaders in healthcare is to help those they lead to deliver the high-quality, compassionate care they want to provide. Where these four behaviours are widely present in healthcare organisations care quality, staff wellbeing, teamworking and financial performance are markedly better.

How do compassionate leaders create psychological safety in teams? Such leadership is focused on ensuring a clear, shared vision of ensuring high-quality care and support for those we serve, uniting team members around an inspiring direction for their work. The vision is translated into four or five clear, agreed and challenging goals which are agreed by team members rather than imposed by hierarchical leaders.

Compassionate leadership helps team members process negative emotions – pain and grief – where necessary, not simply emphasising the positive (Schwartz Rounds are a good example). They encourage team members to regularly take time out together to supportively review objectives, strategies and processes (team reflection or ‘team reflexivity’), and consequently they collectively learn and improve at work while ensuring team members’ wellbeing.

Such teams are both more productive and innovative than teams that just continue to spin the hamster wheel. Data from 49 research studies suggests such teams are between 35 per cent and 40 per cent more productive. Such reflection happens in regularly scheduled team away days, meetings, after-action reviews, huddles, debriefs etc.

If leadership in teams is not inclusive, it is not compassionate. Teams composed of people with differing professional and demographic backgrounds, and diverse knowledge, skills, experience and abilities, are more likely to develop and implement quality improvements (or new and improved ways of doing things). This is because they bring usefully differing perspectives on issues to the group. But generally high diversity leads to team innovation only when the team feels psychologically safe. Compassionate leaders therefore focus on ensuring equity and positively and overtly valuing diversity. In psychologically safe environments, all team members feel included and valued not simply those who are in some majority.

Chronic interpersonal conflict is almost always destructive and prevents teams from delivering high-quality, compassionate care. Compassionate leadership involves confronting and preventing chronic interpersonal conflicts. We only discover a solid sense of safety through the effective management of potentially threatening environments. Managing task and process conflicts compassionately, constructively, creatively, honestly and positively in teams ensures high levels of interpersonal and team safety.

The experience of mutual support and concern builds a sense of belonging and safety. To create the conditions that enable health and social care staff to deliver high-quality care, flourish and stay well, all team members must work together to create positive, supportive, compassionate and cohesive teams in the workplace. That also means supporting each other at work emotionally, practically and professionally. Indeed, the factor that makes compassion more powerful and mutually fulfilling than empathy alone, is the intent to help the other. Compassionate leaders, who model such behaviours, have a powerful influence shaping the team’s climate.

Compassionate leaders also promote mutual support across boundaries, encouraging people to build trust, respect and co-operation across teams, departments and organisations by fostering the idea of ‘teams of teams’.

To meet the challenges of delivering health and social care, compassionate leadership must increasingly meet people’s need for belonging and develop and sustain trust. The purpose of compassionate leadership must be to create effective teams, and team and organisational cultures of psychological safety. Such leadership must support health and social care staff to be more collaborative, compassionate and caring, in order to effectively shape our future as health and social care organisations and the future well-being of all those in the communities we serve. Compassionate leadership enables staff to experience joy at work and a sense of fulfilling engagement every day, rather than exhaustion and burnout, thereby ensuring their health and the health of the services they provide.

Adapted from:

West, M. A. (2021). Compassionate leadership: Sustaining wisdom, humanity and presence in health and social care. London Swirling Leaf P