Leadership Listens 6 – The importance of compassion in developing leaders

Paul O’Neill [00:00:01] Hello and welcome to leadership listeners curated podcasts for leaders in health care. My name is Paul O’Neill, head of strategy, research and development at the NHS Leadership Academy, part of the People Directorate of NHS England and Improvement. This mini-series of podcasts as part of Leadership Listens, is a series all about compassionate leadership. It’s a collection of conversations between Professor Michael West and a leader from the health and care sector. This recording is a conversation between Michael and Caroline Chipperfield, director of leadership development and delivery at the NHS Leadership Academy, and focuses on the importance of compassion in developing leaders now for the future at a national level.  

Michael West So a warm welcome to these conversations about leadership in health services, and I feel really pleased to welcome Caroline Chipperfield, director of leadership development and delivery at the Leadership Academy. Caroline and I are old friends and colleagues, and we’ve seen many changes in the leadership landscape in the NHS. It’s lovely to be with you again, Caroline.  

Caroline Chipperfield [00:01:17] Lovely to be with you, Michael. Thank you. Thank you for the invite.  

Michael West [00:01:21] So you, you’re director of leadership, development and delivery for our amazing National Health Service, for this huge sector, a new leader on the delivery and marketing and the engagement of the NHS Leadership Academy flagship programmes. And it’s currently worth just saying a bit about those programmes so that people are aware of what they are. I mean, they’ve been going for a few years now, but they’re really prestigious, powerful development programmes for people in the NHS.  

Caroline Chipperfield [00:01:52] They are, and of course, I’ve got a complete bias on that, Michael, that I think that they are amazing, but the feedback we get from our participants is absolutely amazing. And it is a privilege to actually be able to be the director of the flagship programmes, which started online foundational level. And you know, Edward Jenner right through to our aspiring chief execs through to our aspiring directors. And really, they build on a philosophy around self-managed learning, but a philosophy of inclusive, compassionate leadership styles. We want leaders to create the climates where people will thrive, not survive within their organisation. And we know that it makes a huge difference from the testimonials that we get from our programmes. And interestingly, as I was coming in and preparing for today, was thinking about our online programme. We were closed down during COVID. So the 20th of March 2020, I was asked to find some volunteers to support the bringing back staff, and the academy was literally closed down over a weekend. I was asked to find 35 people to volunteer, 100 turned up on the Monday. And so the commitment of our academy to that, but the programmes are shut down and interestingly, our long line one, which historically would be 2,000 to 3,000 people that would enroll on it by the end of 2020, 20,000 people had enrolled in it. That found us in any case, and people believed that leadership was as important, if more important than ever, going through the crisis of the pandemic. So actually, we’ve turned things back on. We’ve turned them on virtually they’re far more accessible for people now. But the philosophy around developing inclusive, compassionate leaders, which means that our NHS staff and health and care staff actually can really be looked after has been really, really critical.  

Michael West [00:03:45] And the evolution of those programmes has been remarkable. I meet people regularly who talk to me about, for example, doing the Elizabeth Garrett Anderson programme or the Nye Bevan programme, and I often hear people say it changed my life. It’s not just that it changed, in a sense, their approach to leadership to be more inclusive and compassionate, but it changed their life. And I guess what it implies is leadership is maybe as much about a way of being as it is about the doing or a set of skills that we add on. And compassionate and inclusive leadership is now the core of the people plan in the NHS and you and I have, I suppose, involved with the evolution of our understanding about what makes for effective and compassionate and inclusive leadership. Listening to staff, seeking to understand the challenges they face. Empathising with them, caring with them for them and then helping them to do their jobs more effectively. But one of the, I think, reactions of some people to the idea of compassionate leadership is that it all sounds a bit soft cushions and scented candles. You know, how do we then manage difficult people in poor performance?  

Caroline Chipperfield [00:05:04] I think it’s definitely not the soft and fluffy to be compassionate and inclusive. So for me and part of our learning together, actually over the last 10 years and more, around sort of developing this style of leadership is that actually it’s having those difficult conversations, actually doing it with, as you say, listening with fascination but listening to people and helping to really hear them empathise with them. And actually sometimes challenge those behaviours and those performance issues. Actually, it’s more compassionate to do that. And often senior leaders will say to me that, you know, I don’t get the feedback. I don’t know what my impact is. And actually, if we don’t give sometimes the more challenging feedback which is very compassionate, then people don’t know their impact and intent on others. So people will carry on for many years, behaving in a way that’s actually completely unacceptable by today’s standards or any standards. But because they’ve never had that feedback, because people for whatever reason haven’t given it to them, then they can’t change. And sometimes people are shocked. So I’ve often used “talk about don’t make a judgement, ask a question.” So how might that have landed with somebody, you know, so actually seeking to understand them as you talk about a lot? Michael, in terms of that, but seeking first to understand why that might be the case, but actually, it’s not fluffy at all. It’s actually quite challenging, particularly when people are more senior than yourselves and you’re trying to give that feedback. But it comes from a place of compassion.  

Michael West [00:06:44] Very often we don’t give feedback. I mean, I think that we don’t give enough positive feedback. First of all, we don’t appreciate and say thank to people and actually we human beings consistently underestimate the power of being appreciative and the power of saying thank you, that’s something we all do. So as a consequence, we’re less appreciative overtly than we could be. But also then, it makes it easier to give that clear feedback about behaviour that perhaps has been negative, difficult, problematic. And also the point about understanding, I think, is that behaviour is usually more often a consequence of the situation people find themselves in, rather than some mythical personality defect. So taking the time to seek to understand feels really hugely important. And I’ve certainly come across many situations where people have no idea that their behaviour was having a negative impact on those around them. So I guess what I understand you to say is that actually it takes more courage to be compassionate and to have the courage to be direct about the feedback that we give in the context of being generally appreciative.  

Caroline Chipperfield [00:07:59] Absolutely. And it is a leadership piece to take that courage to take that step forward, to be perhaps curious in that way of understanding how that behaviour has come through. And I was interested; part of reading some of the work that you’ve done, Michael. One question for you. You talked about it’s not the people are difficult. Sometimes it’s their behaviours and, sort of, how do we really start to build on that so that we can not de-personalise it, but be able to give really clear examples of the behaviours and therefore take a positive approach to those conversations when you go into them? And the experiences that you’ve shared on that I thought was very insightful because sometimes I know myself as a leader and going into difficult conversations, you want to avoid, sort of, thinking about the person.  

Michael West [00:08:52] So your focus on behaviour rather than people, it mirrors what we understand from psychology. It’s called the fundamental attribution error that we tend to attribute people’s behaviour to them as people rather than to the situation they find themselves in. But it’s usually the situation that determines behaviour. It’s also, I think, from my perspective compassion is inclusive leadership is how we achieve a collective leadership. It’s not just about changing individuals, but how our leadership is consistent across our teams and organisations. And I think that’s a real challenge. So we often end up as it were converting the converted or preaching to the converted.  

Caroline Chipperfield [00:09:32] Yes, Michael. And the importance of teams was loud and clear in our 2020 leadership survey that we did – where at the top of literally the top of everything that leaders want is how do they manage their teams effectively? How do they lead effectively? How do they build their teams? So it’s absolutely critical because the evidence is showing us that people want to be able to do it differently. So I think it’s really important that we help build that confidence to develop those teams to make the difference within the health and care system.  

Michel West [00:10:04] How do we achieve a more collective leadership?  

Caroline Chipperfield [00:10:07] So it’s such a great question because change happens, doesn’t it? That one conversation at a time. But actually, we all need to sign up to the shared purpose that this is going to make a difference, and I think the standards that we walk past of the standards that we set. So I think collectively we can start to think about doing things differently. I think importantly, we at the leadership academy as part of the People Directorate, really thinking about the standards that we set from behavioural perspective. So we talk about the heart, the head in the hands of our leadership way. What do I mean by that? So we set those standards. The heart is all about compassion. So how do you really think compassionately, act compassionately as a leader? The head is, how do you remain curious? So how do you seek to understand? How do you ask questions, not make judgements? And then with our hands, how do we collaborate? How do we do things together? Build that trust, that motivation? That’s really, really key. So I think there’s something about how we build that together. Collectively, we set that behavioural, if you like, standard for want of a better word. But actually, then when it’s not happening, how do we have the courage to call it and call those behaviours? And that starts to really set climates are very, very different to what we’ve got, but the leadership will be key. So that needs to go from board to ward, as we’ve often said, in terms of hospital or from any part of the health and care system. But the senior leaders need to walk the walk as well as talk the talk. So for me, the value base of the NHS Constitution, the behaviours that we set, we know people come to work in the NHS, from a social justice perspective, from a values perspective. They come because they want to do good. And so therefore connecting to the values will start to shift. I believe the climate and build those compassionate, inclusive climates. Because without that and without that collective achievement, we will not see the change that we need to see across the health and care system.  

Michael West [00:12:16] And so the evidence we have from research on organisational culture over the last hundred years tells us that leadership is probably the most important intervention or the lever that we have to help change culture. Although every interaction by every one of us every day is an opportunity to shape culture through how warm or kind or irritable or cynical or compassionate we are. But for me, another issue is that I think that our institutions also need to model compassion. So when we look at, for example, national organisations like NHS England and NHS Improvement, Health Education in England and our NHS trusts, it seems to me that needs to be also the kind of awakening of intent that is institutions we should be attending, seeking to understand, empathising and then seeking to help the other organisations and institutions we interact with, rather than being seen as top down control in monitoring, criticising and so on. So I suppose it’s exploring the notion of what institutional compassion would look like within our healthcare system.  

Caroline Chipperfield [00:13:30] Absolutely. And it has to be for everybody, doesn’t it? People have to say that it’s their role, well, every level within any organisation. And for me, the data isn’t showing that we’re compassionate. Many occasions we talk about the staff survey, it’s all in the public domain. We know that people do not feel as though they belong within many of the organisations. So how can we use that data to change for the better? So when we know it’s happening, when we’ve got to focus on it? So how do it every level? Do we talk about behaviours? So for me, it would be instigating all through my organisation if it was me. In terms of appraisals, we often look at the technical side and we assess people on the technical side of their work, but we don’t always assess them on the behavioural side of their work. So why can’t we change that conversation that starts with not what you did, but how you did it? And when you start to have that conversation, then you get a very different conversation as part of your institution. Some of the organisations that I’ve seen that do this amazingly well do it on value based. I would use Frimley as an organisation that I work closely with. Everything is about the values and about how they get feedback from their staff, from their patients and the service users. They start every board meeting with a staff story or a patient story. Let’s bring it to life, let’s talk about the people. If people are truly our most important asset, then let’s talk about them first. Not the money, not the quality. Because if the people are doing the right things and doing the right things well, everything else follows, in my view. So you have to change what gets focussed on gets done. So if you focus on the numbers, that’s what people talk about. But if you focus on the people, you make a huge difference as an organisation and you do that at every level. And there’s some tools that we’ve got there, like an appraisal that we can use very, very differently if we just switch it. So for me, it would be saying talk about the behaviours and how you did things, not just the what that you’ve done, because technically we’ve got some of the most highly skilled people, in my view, in the world working across the NHS in England and Wales and Scotland, Northern Ireland, our four nations we’ve got amazing people. So let’s focus on some of the positives that they do, build on a strength based approach to it and take the conversation in a very, very different way. That’s what I think collectively and institutionally you start to change it. So it’s not just one or two people talking about it being the right thing to do. It becomes the right thing to do because that is the way that is around here. You set the culture, you set the climate because you’re talking about your people and then you get less stress, you get less workplace stress, you get less absenteeism and presenteeism. And we see a lot of that, too. So how you start to shift the dial on your data, but you do it through and with your people, of course, we’re public sector, of course, we’ve got to have value for money. Of course, we can have high quality care. But my view is where does the conversation start? And if the conversation starts with our people and the behaviours, then I think that’s what shifts it culturally within the institutions. 

Michael West [00:16:49] and that focus. Seems to me is fundamental because organisations, work organisations, hospitals, mental health units. Or simply another form of human community. And I think when we see them in that light, it changes the way we think about how to nurture enabling cultures. And it does seem to me important to acknowledge where we are in our health services. You know, we’ve, as you say, probably got the largest, most motivated and most skilled workforce in the whole of industry. Yet the sad reality back in 2019 was over 40 percent of them had been unwell as a result of work stress in the previous year, according to the national staff survey, and one in four nurses were leaving the NHS within three years of joining. And they were very high levels of intention to quit. GPs have been quitting. We’ve been unable to increase the number of general practitioners, and absenteeism, of course, has been running quite hot.  

Caroline Chipperfield [00:17:55] I completely agree. I mean, the moral distress that colleagues have had over the last couple of years and the increase in work related stress due to the pandemic. I don’t think the survey is going to show it any better when it’s publicised later in the year. Part of my focus of the last couple of years is to be really mindful about asking leaders and each other, team members, to spot the signs of stress, you know, within each other within self. We’ve done some work on health and wellbeing and how you might be able to just by focussing on it, acknowledging the stress, being able to walk away sometimes from the situation. I mean, you will have heard as well as I, the stories on PPE, particularly the early days of the pandemic, but also the fact that people couldn’t see their loved ones and or couldn’t be with their loved ones for births. For deaths and the stress that that put on our health and care system cannot be underestimated. So the piece for me around being able to psychologically put people in a better place. So thinking about recovery, whether it works for you, for going for an outdoor walk, so that’s my bag. You know, I need to go out and walk the hills and sort of relax and get away from things, whether it’s yoga, whatever it might be for individuals. But, how do we make sure as a team, we talk about health and wellbeing? So I think it’s really important at team meetings that you check in. So what do I mean by a check in? I mean, literally checking into that meeting, how are you today? How are you feeling? What are you bringing? What do you need from each other within the team in which you’re working will really help to support that workplace stress and know that it’s OK not to be OK. I think that that’s been really, really important messages over the last couple of years that people have heard and we have seen a massive increase, haven’t we, in mental health issues over the last couple of years, but actually people talking about it in a way that they’ve never talked about it before. It’s been really, really important because it is okay not to be OK in a global pandemic, looking after loved ones and not forgetting that the workforce and the NHS workforce and social care workforce are also patients and service users themselves over the last couple of years. So some of the absenteeism is because people have been ill themselves. So there is something about acknowledging that, but in a way that is really value based, that is compassionate, that is inclusive. We’ve learnt so much, haven’t we, in terms of inclusion in the last couple of years, the disproportionate impact of COVID on colleagues from black Asian minority ethnic backgrounds, that whole stress anxiety within the workplace, how people have felt been treated. We have to be able to acknowledge that that’s OK, but also that there is help and support available. And that’s been a lot of our work putting people into health and wellbeing spaces, psychologically safe spaces to have a conversations at every level. So senior leaders working to that as well.  

Michael West [00:21:11] So that I think has been hugely important in raising awareness of the wellbeing of staff. And it’s important also not only in and of itself, but because we know that there is a direct link between staff wellbeing, staff engagement and patient outcomes, care quality, actually financial performance, avoidable patient mortality and so on. And I think that it’s been hugely important this last two years how we’ve each managed to take care of ourselves. I’ve been, I suppose, even more focussed on ensuring my wellbeing so I can do my work effectively. I practice meditation every day. I have done all my adult life. It’s a really important part of my life. I go for cycles in the countryside, spend time in the country my wife and I have had far more time together this last two years and that sense of spending lovely time with people you love and who love you is so nourishing as well. And also, I suppose from the work I’ve been involved with, I’ve become much more aware of the danger of focussing our reaction to the difficulties staff face primarily on health and wellbeing programmes that are about things like yoga and meditation and mindfulness and exercise and spending time in nature, but not really addressing the workplace factors that are creating the difficulties in the first place. And as you know, I had the privilege four years ago now of co-chairing an enquiry with the late Dame Denise Coyne wonderful, wonderful person, an independent enquiry on behalf of the GMC into the mental health and wellbeing of doctors and medical students. And then, two years ago, an enquiry commissioned by the Royal College of Nursing Foundation into the mental health and wellbeing of doctors and midwives. That was with colleagues in the King’s Fund. And what was clear from all of the research we reviewed and the conversations and focus groups was that people were suffering because we were not getting the work conditions right, so people didn’t feel they had voice and influence. I mean, we called it the ABC of core work needs autonomy and control, belonging and contribution or competence. And what we had was people didn’t feel they had voice and influence. They felt they were working often in climates of fear and blame. Rather than learning. They couldn’t even control some biological needs getting access to water when they were working, or nutritious food, on night shifts or having time to go to the toilet or being able to influence work schedules and rotas so they could balance home and work lives. So voice and influence or autonomy and control, if you like, was a huge issue and does feel that our leadership in the future has to be a leadership which is focussed on creating more collective leadership where people feel they have leadership, responsibility and control.  

Caroline Chipperfield [00:24:13] Absolutely. And you touched on something that’s really close to my heart as well, Michael, who in terms of having a voice. We talk about freedom to speak up across our workplace and actually in the past year, having freedom to speak up Guardian’s that are non-Execs within all of our organisations. So how do you really give voice to how do you again create that climate collectively that people can speak up without fear of retribution and blame? And again, you’ve got to create the climate for that because the moment that it happens and somebody does speak up and then the behaviour is the traditional behaviour of, well, actually, they’re just sort of cover it up, then that’s not how it works. You’ve got to be able to say, we’ve got this wrong, you’ve got to be able to publicly say, we haven’t quite got this right. Let’s collectively, as you say, get the autonomy to do it together. You know, that sense of belonging and teamwork and teaming really sets for me the culture and the leadership, that sense of belonging. And if people don’t feel as though they belong, that they will leave, you talked about the nurses leaving within three years of their career. We’ve got to be able to not have that and retain people, and that’s so important collectively to do that.  

Michael West [00:25:27] So that, I think is about making sure we’re meeting people’s core needs. The importance of teams in health care is it’s kind of almost taken for granted good. Yet we know there’s a lot of work to do to really develop effective team working and to develop more effective leadership are their creative ways of thinking about all of that?  

Caroline Chipperfield [00:25:47] So I think there’s been some great examples of how you might think about it differently. Often people see perhaps the programmes that we put on from a leadership academy perspective are seen as individuals. One of our system leaders took her 500, if you will, 500 leaders, so people who are new to leadership roles are getting a foundation in leadership in which they can do online and anybody can do. And then newly appointed line managers took them through the first line management all Mary Seacole programme. Then the middle managers were taken through the Rosalind Franklin programme in teams, and then the aspiring and senior leaders went on their own leadership programme as well, and at each level did it in teams. So all 500, if you like, within a system taken through, but not as individuals, but as teams, I think that is hugely innovative. But I also think it made a huge difference to the way that that system now runs. And I believe that if we took that approach, of course, with integrated care systems, working with our senior leaders to be able to develop each of their 500 leaders, maybe more than that, but how might we do that at every level within the health and care system fundamentally shifts it as teaming and team ways of working, not just about individual learning  

Michael West [00:27:12] to create a team in ecosystem for growth? I think your point about team working is really important. How do we build more effective teamwork in the data we have suggests that only about 40 percent of staff working teams with clear goals that meet regularly. And yet all of the evidence we have is the more people who do work in such teams, the better the care quality, patient satisfaction, lower levels of stress, better financial performance, dramatically lower levels of avoidable patient deaths. But we have to develop that team base working. We have to really focus on developing compassionate leadership that nurtures effective team working. I think we also have to have the courage to start addressing the hierarchical nature of the NHS. The most effective organisations in the world, regardless of size or sector, usually have no more than three or four reporting levels. You know, when you look at the typical NHS Trust, reporting levels are in double figures. And I was reading a paper recently suggesting that every reporting level you add, that’s about 10 percent to bureaucracy. So I think there’s something for the future. How do we transform our teams and organisations for the future, how we create more collective, compassionate leadership of developing supportive team working? And I was really struck by the 2020 staff survey showing that the main factor in helping staff cope during that first year of the pandemic was their colleagues and their teams. So there’s something about developing really effective team working, but also having the courage to say, we’ve got to reduce all of this hierarchy in the system. It’s just oppressive. It’s not helpful. It disempowers people. I think that’s a really tough challenge, but I think it’s one we have to face.  

Caroline Chipperfield [00:28:56] We absolutely do. And I think in terms of developing teams, obviously, and the leadership role, inclusively developing and compassionately developing the teams where you create those cultures that people can speak up within the team that can speak up within the organisation really transforms it. Some of the examples that I’ve seen during COVID, actually when people who’d never met each other, ever came together for a collective endeavour. They were given the autonomy to move through that work. They cut out so much of the bureaucracy in terms of levels of permission, shall we say, that actually achieved some of the amazing stuff. So the volunteers bringing back staff into the NHS, the teams that were put in and they were doing it in majority virtually. So have never met each other and maybe still have never met each other, but we learnt to build teams in a virtual way. We learnt to have a clear goal and purpose given the autonomy and people just went. I mean, I just saw some amazing work by every level within our organisation, and these were people that that’s not what they came in to do. They came in to do leadership development, but what they did was they led teams because they knew how to lead teams. Yes. So and they did it in a way that built that trust that relationship, which meant that people can make decisions and were left able to make the right decisions. I am really hopeful on the ICS, ICB world. It’s been a horrendous couple of years. Let’s not underestimate what we’ve been through, but let’s take some of the good of that of how if you get autonomy to be able to lead across your system, to be able to take out some of that. If you like decision making so you do it collectively for the benefit of your population health, so you’ve got a common goal and you’re not competing against organisations aren’t competing against each other, they’re collectively working together. So then you build teams at every single level, in my view.  

Michael West [00:30:53] So, Caroline, I agree. I think integrated care systems are a really important step towards much more community ownership and community involvement in our health and care services and working across boundaries. I think many people still don’t know really what integrated care systems are. They sound like abstract concepts of organisations. Can you say this about what it means?  

Caroline Chipperfield [00:31:17] Yes, of course. And I’ve been privileged to be part of if you like some of the recruitment to some of the integrated care boards. So our ambition with the NHS Bill and Health and Care Bill is to be able to ask the system when I talk about the system. So it will be the collective of the organisations within a defined geographical area that will be given the, if you like, the statutory responsibility to look after the population health within that area. So we will develop two things really. An integrated care board, which will be predominantly around NHS organisations that will be within that, that will look at commissioning standard. Quality of care and workforce and leadership of that system. And then they will work collectively with all of the other partners in the integrated care system. So health and care voluntary sector for  

Michael West [00:32:14] local authorities,  

Caroline Chipperfield  [00:32:14] local authority. So anybody that has an interest in health and health care will be part of that. So they collectively look at perhaps three or four things that only they could look out for me. System perspective to be able to really drive change across that place or that system so that they have the autonomy and you have a sense of belonging in terms if you belong to those more locally defined systems. And then they find their own contributions. Also, they define their workload. They define things that they will bring in. So within that, we can make the change happen.  

Michael West [00:32:54] So it’s a kind of vision for the future of having all of the agencies, voluntary sector, community agencies, health care, social care, working together to nurture the health and well-being and happiness and fulfilment of the populations in their area.  

Caroline Chipperfield [00:33:11] Absolutely. You put that so beautifully, Michael.  

Michael West [00:33:15] It seems to me a really powerful and promising vision. I think the area that worries me, most of all in terms of our staff, their well-being. And it may be that integrated care systems are part of the solution is the problem of chronic work overload or chronic excessive workload. And I think it’s a bit like the pattern on the wallpaper we no longer see. And some of the conversations we’ve had in these podcasts have really brought to the fore just how much pressure people are under and how utterly damaging it is. And we know that chronic work overload is the number one factor in staff stress the number one reason why people quit, whether it’s primary care or secondary care. You know, we know from the research it has a huge impact on staff health, on cardiovascular disease, on addictions, alcoholism, cancer, diabetes, depression and I do feel that somehow leaders don’t talk about work overload. It’s almost as though there’s a fear about talking about chronic excessive workload because we don’t have the solutions. I think that’s a mistake. You know, that’s not the role of it is necessarily to have solutions, but it is to bring our attention to bear on the most difficult problems we face. So over the last four years, I’ve, first of all, have the privilege of being involved in co-chairing an independent enquiry with the late Dame Denise Correa. Wonderful woman. We undertook this enquiry on behalf of the General Medical Council into the health and wellbeing of doctors and medical students. And then two years later, leading the enquiry commissioned by the Royal College of Nursing Foundation, along with my colleagues in the King’s Fund, into the mental health and wellbeing of nurses and midwives across the UK. And then the pandemic came along with all of the associated increases in work demands in the fears that staff had for their lives and the lives of their patients, the lives of their loved ones. And we’ve seen a big increase in staff stress over the last two years. And I find it personally harrowing to talk to staff very often because the stories I hear are so painful to hear what staff are going through. It does feel to me that leadership individually and collectively must be focussed on that issue. And chronic excessive workload has such an impact on staff wellbeing on their lives, but also on patient safety, patient satisfaction, care quality. And I feel that people are really reluctant to talk about it in the NHS because they don’t have solutions, but I think we must talk about it.  

Caroline Chipperfield [00:35:54] We need to make it part of our everyday conversation, don’t we? We know that some of the staff ratios and particularly through the pandemic, has not been right. The nursing ratios and the workload has become hugely excessive actually, even more so. So I was talking to a nurse actually only a few weeks ago around sort of that four days, 12 hour shifts. They used to be able to perhaps get some additional incomes through banking and doing an extra shift here and there. But they’re exhausted. They’re so tired that they’re not able to physically do any additional shifts because of the workload and not the hours, but the amount of work. So there’s something about hours worked as well as the workload within those hours. And how do we get to a place where people can start to discuss the workload, start to set what are reasonable workloads within that and start to address that as a team? And collectively, why can’t teams start to think about or what should be our workload? What should be a working pattern? How do we take responsibility and accountability for the rotas that we set and do it in a way that’s going to be manageable for a particular part of the health and care system. So from GPs intensive care units, you know, we’ve got to be able to start to have a different conversation and use again some of the ways of working that we’ve learnt that can be more efficient. So I heard that people didn’t like having the face to face over Skype with their GPs, so I was poorly. It wasn’t COVID, but I was quite ill a couple of weeks ago. Eight o’clock, I did an e-consult, so I went online, did what I needed to do. By 9:15, I had a telephone call. By 11:00 o’clock, I was seen. So there’s something about actually the diagnosis was done, whether or not I needed to be seen online. So how can we use some of those ways of working? Our people promised talks about being able to work flexibly and be able to have manageable workloads and have good goals at work. So if you go back to setting your objective, setting your workloads, doing that as a team and then having the courage if we come back to courage to push back, if the workloads aren’t right because of ways of working, have to change first to be able to deliver the health and health care that our population deserves to the standard that it deserves.  

Michael West [00:38:17] Absolutely. And I think that those conversations should happen in teams, as you suggest. I think every executive team meeting and every board meeting, there should be conversations about workload, given its significance in the landscape of health care, that every appraisal should be a conversation about workload. And that means leaders having the courage to have those conversations at every level and continue to have them because we’ve just neglected this issue year on year on year on year with huge consequences in terms of patient care, staff, wellbeing, staff turnover and financial performance as well. And so I do think it’s really important we address it. And as you say, the use of new technologies, the use of better team working. East London Foundation Trust, as you know, really outstanding mental health learning Disability Community Services Trust in East London regularly asks its staff what they would reduce or get rid of in their work and staff consult with patients about what they propose to do. And the staff are free to make the decisions themselves, rather than having to be approved by an executive, team members or whatever. And they’ve reduced hugely bureaucracy seeking managerial permissions, certain decisions, unnecessary travel to trust headquarters and eliminated an astonishing 85 percent of clinical audit activities. Because they’ve got this pervasive quality improvement, culture and examples like that give hope for how we can bring about change. But I think the starting place in terms of compassionate leadership is we have to have the courage to start and then keep talking about chronic work overload for staff.  

Caroline Chipperfield [00:40:02] Absolutely. And yeah, East London’s done some amazing work and is giving that autonomy to the staff is, as you say, and it’s not difficult, you know, it’s not difficult. It’s really easy to say thank you to somebody. But if you’ve got that quality improvement mindset along with excellent leadership, then you can create magic, anywhere.  

Michael West [00:40:26] And the point you made about what we’ve seen during the pandemic is people were given autonomy and the walls, as it were, of organisations came tumbling down and people work together with energy, enthusiasm, supportiveness. And we saw the most extraordinary innovation. I mean, I think some of the themes that you’ve articulated for us about being supportive, about having a vision, about having clear values, about translating that into clear goals, about giving clear performance feedback, you know, creating a sense of direction, aligning people’s efforts around what we need to be doing and building trust and motivation are at the core of effective leadership. I guess I want to ask you two questions to, in a sense, bring all of this together. One is, can you offer one or two examples of places that you see are beginning to get this right? And then what would be your practical tips for leaders in the NHS from all of your experience? What would you ask them to take away? First and foremost.  

Caroline Chipperfield [00:41:32] So I think two things where I’ve said it well, I mentioned Frimley early on I work closely with Andrew Morris and now Neil, where they set the values and they give their teams the freedom to operate within set boundaries and people feel that their work is valued. And I think that that gives hope that we know it can be done and we know where there’s reduced variation. People are working collectively together to solve the problems, and I think Frimley is a really good example of that. If I took a national example of that and I would put Emily Lawson as one of my people I have admired over the last two years and how she led the vaccination programme. So from a place of having direction, absolutely clear direction, the vision to vaccinate the population, to reduce the spread of COVID and to reduce the hospital admissions. Everybody knew what they were doing. Everybody knew what they needed to do. Within that. We didn’t know how it was going to work out. We really didn’t because we’d never done this before, but setting the direction, the alignment with clear goals and where people needed to be, what the work force needed to do. And then the amazing commitment of the staff, the volunteers of everybody to do that. The public to get vaccinated meant that as a UK, we have successfully vaccinated a huge amount of people. But that to me, was those organisations like Frimley. And you get it when we need to come together as a country, actually as a world in this case, but particularly I would raise that  

Michael West [00:43:14] such a lot of learnings from that vaccination. And your practical recommendation?  

Caroline Chipperfield [00:43:19] Some of it is understand self as a leader first. So the only people we can change is ourselves. So unless we understand ourselves as a leader and our impact on others, then I think that’s our starting point. And then we find out perhaps where our strengths are and where our development areas are and we go develop. I believe every day is a school day. I’ve never stopped learning since, you know, I left school or before that. There’s something about our lifelong learning. Just because we become perhaps more successful in our careers doesn’t mean to say we don’t need to learn more of how to lead compassionately, inclusively. Practical hints and tips: Ask for feedback. Don’t wait for it, because if you wait for it, it may never come, and therefore you don’t know your impact on others. Do a 360 if that’s what it takes. In terms of looking at yourself, you can have a 360. You can know your development areas. Take the courage to ask those questions, and if you do ask it, then do something about it. So don’t just listen to the feedback. You have to act on the feedback. And that might mean asking for help in the way that you are leading to do it differently to be inclusive. And then I would take us right back to the behaviours that we need as a practical hint and tip, and to really develop as an inclusive and compassionate leader. You need to lead with compassion through your heart and mean it. You need to lead through curiosity through your head and be able to really ask those questions of self and others and challenge ourselves. And you need to do it collaboratively. That means sometimes rolling up our sleeves, using our hands and actually just getting on with it, whatever our level is. So I think that there’s some know self, start with self because that’s what you can change. You can do it through some practical tools that you can use to find out how you lead. You can ask for that feedback. Don’t wait for it. I think you lead to the behaviours of our leadership way. Therefore, it comes right back to what you and I have talked about for 14 years, Michael, it’s about how do you create the cultures where people can thrive and therefore you act inclusively and compassionately? And you think about everybody. So you take that levelling up agenda it’s not about equality, it’s about equity. So how do you start to make a difference to your population through the way that you behave and lead? But we can only change ourselves, so change has to start with me.  

Michael West  [00:45:50] Thank you, Caroline. It’s been a hugely rich, powerful, inspiring, helpful, hugely enjoyable conversation, and it’s been a privilege for me. Thank you very much.  

Caroline Chipperfield [00:46:01] Thank you, Michael. Privileges in mind. Thank you.  

Paul O’Neill [00:46:09] I hope you enjoyed this conversation. Please look out for others in this mini-series and subscribe to the Leadership Listeners’ Collection for more content like this.