Leadership Listens 3 – Creating a compassionate culture in organisations

This recording is a conversation between Michael and DrDeborah Lee, Consultant Clinical Psychologist, Lead for Compassionate Leadership at BerkshireHealthcareNHS Trust, Honorary Associate Professor, University College London and focusses on Compassion in Health and Care and creating a compassionate culture in organisations.

Paul O’Neill: Hello and welcome to Leadership Listens. Curated podcasts for leaders in health and 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 of the health and care sector. This recording is a conversation between Michael and Dr. Deborah Lee, consultant, clinical psychologist, lead for compassionate leadership at Berkshire Healthcare NHS Trust. Honorary Associate Professor at the University College of London. And it focuses on compassion in health care, compassionate leadership and the myths surrounding it. 

Professor Michael West: Hello, everyone, my name is Michael West, I’m senior visiting fellow at the King’s Fund and professor of organisational psychology at Lancaster University. And this series of conversations about compassion and compassionate leadership in health and social care has been just a privilege for me to be involved in. And today, I’m delighted to be joined by Dr. Deborah Lee, who is consultant, clinical psychologist. Deborah, it’s just a privilege and a pleasure and an honour to have this conversation with you. Welcome. 

Dr. Deborah Lee: Thank you, and thank you very much for inviting me. I’m really excited and I feel privileged to have been invited along to contribute to it, so thank you. 

Professor Michael West: Well, I want to say a little bit about you. As I said, your consultant, clinical psychologist, you have an honorary associate professorship with the sub Department of Clinical Health Psychology at University College London. And you’ve been working in the area of trauma and post-traumatic stress disorder for nearly 30 years now. And and I know also, I know a lot about your work at Berkshire Traumatic Stress Service in South Central England Veterans Services. You’ve been a real pioneer in developing compassion and compassionate leadership in Berkshire, and that something that be a real delight to talk about. And I know you’ve been a member over the last two years of the University College London Expert COVID Trauma Response Working Group, which has been working hard to develop guidelines and do research to promote trauma informed care, natural recovery and psychological first aid to reduce the psychological impact of COVID 19 on hospital staff and patients. And you also, and for some years now, you were a founding board member of the Compassionate Mind Foundation, and for some years that’s been a really influential body in developing our understanding of compassion. The work that you do with Professor Paul Gilbert. So, you’re the ideal person to ask this question. Passion’s one of those words, it sort of shimmers a little bit. And I was thinking as I anticipated this conversation, that it’s one of those words that appears in poetry and it can be can be seen as something a bit amorphous and a bit vague. But how would you describe what compassion is and why it’s so important in human experience? 

Dr. Deborah Lee: Yes, that’s a good first question, Michael. For me, compassion is rooted in a motivation and a basic human motivation to want to care for ourselves. So for me, I contextualise that motivation and our human experience, and it’s therefore rooted in a very biological neurobiological part of our minds and our bodies. And it gives us the capacity to be deeply caring for ourselves and for others, and to allow others to care for us. So we’re kind of primed and set up to allow our human nature to flourish through the kind of the the underpinnings of our neurobiology. But it’s the capacity and that to me, is important because what that says is it’s something that we need to develop, and we need to pay attention to developing it. So we have the capability and we need to nurture it within us. And. Throughout all of our lives, whoever we are, whether I’m working with my patients, whether I’m working on myself, where I’m with my family and friends at the heart of our human nature ought to be this sense of being caring for others because on the other side of that, of course, there’s the other part of our human nature, which is cruel and unkind. 

Professor Michael West: So your understanding of compassion is that it’s in some sense hardwired into us neuro biologically. 

Dr. Deborah Lee: The capacity, I think, is I mean, the way I like to describe it to people is it’s rooted in caregiving. It’s the human capacity to notice distress and to want to care. And it’s the glue that keeps us working and functioning and flourishing without compassion. I don’t believe we can psychologically flourish. And the extraordinary thing, I suppose when we think about human beings in our day to day lives is we’re often taught how to, you know, eat healthily. In fact, we’re all taught how to eat healthily at school. These days. We’re taught about exercising, but we’re not talked about how to look after our emotional wealth. And it’s so central to the human experience and the more that we can foster our capacity to be compassionate, to engage with suffering and distress, and to be motivated to want to do something that’s helpful. The more that we can benefit from much more safer, closer nurturing relationships in our worlds. 

Professor Michael West: And so compassion is about, I suppose, is a collective value. It’s about creating safe conditions for people in their human experience, whether it’s children growing up feeling safe, warm adolescents or adults. 

Dr. Deborah Lee [00:05:59] Yes, I mean, for me, it’s rooted in attachments. And when we understand the motivation of caregiving and we understand the attachment systems that humans need in order to be looked after and to grow, then we kind of see a system approach where we learn to care for ourselves by being cared for by others and we care for others the way that we have learnt to care for ourselves and we allow others to care for us. So the system then becomes compassionate and at the root of our attachments, we find the story of human distress, but we also find the hope and the solution for human connectedness. 

Professor Michael West [00:06:37] But can you say a little bit more about that, about that concept of attachment and distress and connection and why that’s been so important? And I’m also reflecting that you talked about and there’s another side to us, too, which is about threat. So could you could you just explain that a little bit more? 

Dr. Deborah Lee:Yes. So if we start with the idea of attachment, you know, very, very basically human babies are so vulnerable when they’re born and they need to be looked after and they need to be protected. They can’t survive without protection from a caregiver and a primary caregiver. And as they grow and as they are fed and as they’re educated, they will develop, you know, drive capacity and goal focussed behaviour. But what they also need, which is the golden experience of psychologically being human, is emotional nurturing and emotional nurturing, as found in our attachment. So we look to others, our primary caregivers, to teach us how to regulate our emotional worlds. And that creates safeness and safeness is a biological physiological felt sense. It’s a sense of connectedness in the minds of others. So for instance, we think if we just think in this moment who out there is holding us in mind, is wishing as well, is hoping our day is going the way we want it to go? This notion that we matter, that we’re held in mind, that we’re important to others, that we’re safe in their minds, is this for me, this golden experience of human connectedness because it becomes the template of which we understand that other people’s minds are safe and that we can find in other people’s minds help and comfort when we’re in need. So that is a golden human experience, but unfortunately, we don’t all get it and we get various cocktails of it or various experiences of it was different, you know, ingredients mixed into it. So when we’re looking at our attachment histories, we’ll find lots of information about who we are, how we conduct ourselves, how we walk in other people’s hearts and minds and lives, and how we expect them to walk in our lives. And, you know, just basically how we treat each other and is all on a continuum. It’s all on a continuum. My daily life, I work clinically with people who have been really hurt and harmed by others. They’ve experienced such human cruelty and they’re traumatised and they have lots of complexity around their difficulties. They also have technically something that’s preventable because they’ve been hurt and harmed by others. Other human beings have walked into their lives, and at the other end of this continuum, somewhere we are. And on daily basis, we may hurt and harm others just by our actions and our thoughtlessness without even realising it. And if we can really contextualise the human experience in our evolutionary social context, we can see we’re all on this continuum and we all need to do a little bit of self work. We all need to take stock of the version that we are and the version that we launch ourselves into other people’s lives and hearts and minds. 

Professor Michael West: And so the notion that this is a capacity that we have in that capacity can be developed and that it is so fundamentally important in human experience in human society, and yet we haven’t really focussed on developing that other than in religions, in philosophy. But it’s not something that we’re focussed on in developing and maybe children, young people in education every day. And I’m also struck by the idea that the fundamental to this understanding of compassion is the sense of interconnectedness that our attachment, our safety flourishing, is dependent on the interconnections that we have and that when we conceptualise ourselves as interconnected rather than separate, that changes, in a way our perspective. And I suppose the other theme that seemed implicit in what you were saying is that that connectivity is also about the relationship we have with ourselves. Can you say a bit about that? 

Dr. Deborah Lee: Yes. I mean, we talk about this in our compassionate leadership programme. You know, the sense of we know we’re better together. We were never meant to do this alone. And you know, if we can form safe connections with each other, we can help each other. We can’t stop the pain of life. We can’t orchestrate our lives to avoid being hurt. What we can do is help and support each other while we are hurting. And while we’re struggling and that requires a sense of connectedness, that’s safe. And it does go right back to the heart of the number one relationship that we have, which is the one we have with ourselves. I sometimes make this joke at the workshops, you know, tell me how long is your longest relationship? And then, you know, everyone’s, you know, um-ing and ar-ing, and I just say, well, just tell me your age. That’s the answer. You know, that’s the longest relationship you’ve had. And it’s the most important one, actually, because wherever you go, you know, guess who’s coming to? And if you could work on that relationship, if you could really foster a sense of self-compassion, then you begin to nurture something, your glow, your fire. Then everybody feels the resonant sort of warmth from you. And to me, that’s so important because if we forget to look after ourselves, forget to have that connection with ourselves, then the idea of abundance is just depleted. You know, we are. We’re running on empty. You know, we get into dangerous states of burnout, especially in health care, unless we really foster this need to develop our own relationship with ourselves. And it is extraordinary, Michael. We’re just learning now in recent decades the need to teach our children these core messages about emotional nurturing and fitness is central to physical health and our diet and everything that holistic approach to the humanness within us. 

Professor Michael West: And so that brings us on to the question of compassion in health care and the rather depressing statistics that in 17 out of 18 studies, compassion amongst medical students in training declines. And it’s the sort of obvious question to ask you, but it feels important to ask it anyway. Why is compassion so important in health care? 

Dr. Deborah Lee: Well, because health care is caring for others who aren’t in your gene pool or in your kinship. Health care offers us the opportunity to demonstrate this wonderful capacity of humans to care for people outside the gene pool, and kinship, extended caregiving. Health care embodies compassion and allows us to really foster our deep motivation, and it’s extraordinarily touching health care. It really is extraordinarily touching, and it links back to your points around connectedness and this sense that if we see ourselves as connected and interdependence, the notion of caring for people that aren’t actually immediately genetically linked to us begins to make sense. And I think it’s the real tragedy that we’re even asking the questions like. Do we need compassionate leadership? You know, that or, is effective. That quite extraordinary questions to be asking, actually. And the other thing that I just sort of always baffles me is the workforce and health care. You have got a committed group of people who have dedicated the careers, the working lives to help others, they already have deep humanitarian motivation. Extraordinary. And the question we ought to be saying is one earth, have we done to create conditions where we are disenfranchising and disconnecting people who want to do something that is extraordinary and deeply touching and just plays to the beautiful nature of humanness to extend our caregiving to those who are in great need? 

Professor Michael West: And it is extraordinary when you have conversations with patients and service users. What they recount to you is the times when they’re treated with compassion, and that makes such a difference. To to their experience, how profoundly that affects them, and it affects, of course, health outcomes as well. And it is tragic that with this amazing workforce, as you say, so skilled, so so motivated, so caring that we have sufficiently yet created compassionate cultures, but also focus on caring for them, ensuring their wellbeing, their flourishing. And I know the work that you’ve been doing in the Compassionate Mind Foundation over the years has been really powerful in shaping our understanding of the role of compassion in in society and in health and social care. Can you tell us a little bit about the Compassionate Mind Foundation, its genesis and what’s happened over the years? 

Dr. Deborah Lee: Well, I’ve been very fortunate to have had the significant majority of my career shaped by knowing Paul Gilbert, my friends and colleague and the work that Paul has done pioneering compassion and compassion focussed therapy has transformed my clinical practise. So although I’m here talking about compassionate leadership, my day to day job is as a clinician working with compassion focussed therapy and experience of going to a workshop actually and just being transformed by listening to Paul talk, I’m thinking, my goodness, this just resonates with some of my core values and my spiritual and philosophical frameworks about engagement and therapy. And over the years, we’ve been able to really disseminate compassion not only into human suffering through therapy, but into fields of compassionate leadership and compassion in schools. And the foundation now, has a whole new kind of organisational underpinning. It’s now a charity and it has a wonderful, committed team that it’s their job to to run the foundation. And it has an international reach. And it is so wonderful to see all our international colleagues all beating and wanting to beat to the same drum of alleviating suffering, whether it be in therapy, whether it be in schools, in politics and in leadership throughout various organisations. 

Professor Michael West: And I think that the Compassionate Mind Foundation has been very effective in disseminating research evidence, demonstrating that the most powerful intervention there is in health care is compassion. Whether we’re looking at long term disorders like diabetes and HIV or therapist behaviours in the treatment of mental health problems or palliative care. The evidence is clear that compassion is the most profound intervention and that that, I suppose, relates to the point you made earlier. That connection attachment, feeling safe, are fundamental to human experience and flourishing. Yeah, and I’m always struck by the epidemiological evidence that social isolation or loneliness has a much more powerful negative effect on health than smoking, excessive drinking, obesity and so on. We’re more likely to die from loneliness, and we are from the effects of smoking heavily. And you’ve been a pioneer in Berkshire Health, which is a mental health learning disability, NHS Trust, a pioneer in developing compassion as a core value of that organisation. And I’m sure people listening to this. We’re really interested to know what you’ve done, what that process has been and and maybe a little bit about the outcomes of that as well. What’s changed? 

Dr. Deborah Lee: Hmm. So the story of compassionate leadership in Berkshire health care goes back to 2015/16, and the then head of psychological therapies had put on a one day conference called Angels and Demons. If I remember correctly. And it was really in the light of the outcome of the Francis report and some kind of platform of which we could look at ourselves and our care. 

Professor Michael West: So the Francis report was the report into the scandal at Mid Staffordshire of poor quality care for patients and avoidable deaths that occurred. 

Dr. Deborah Lee: That’s right, yes. And I was asked to give a talk on human behaviour and why do people end up doing bad things and really to sort of contextualise our behaviour? So I gave a talk on human behaviour and the capacity of us to be deeply caring, but equally deeply cruel rest within the evolutionary context of understanding our human history. And then I talked about compassion and the fact that it’s within us all to be motivated in terms of which side we choose to feed, you know, a competitive, cruel nature or a compassionate caregiving nature. And I asked the audience how they felt Berkshire health care was. A lot of them thought it was very threat focussed at the time. I asked whether they had compassion for their management. I think there was a groan, actually, and there was a kind of disgruntlement around that. And I thought, you know, that’s just really sad to hear because we’re all trying to do our best to. And, you know, even our managers have got really difficult jobs. And it struck me that it wouldn’t be a very helpful place that I imagined it to as a ship really in stormy waters that actually what we can’t have is this dissent within the crew. We need to be together to navigate our way through stormy waters. And it struck me that the one thing that is free is how we treat each other. You know, as the cavalry isn’t coming, loads of money isn’t coming, loads of resources and coming. We’ve got terrible crisis in recruitment. But what we do have is a choice about how we treat each other on a daily basis and how we hold in mind our managers. Yes, there are hierarchies. We need structures. But there is an emotional engagement, which is equality. There’s an emotional equity in all of us that we could bring to our daily interactions a sense of inclusiveness and collectiveness in the way that we conduct ourselves. So the outcome of this talk was the audience going basically, well, this is very nice, nice day. But you know, it’ll be a distant memory next week. And I said, Well, maybe, maybe it won’t. Maybe what happens if we could do something different? What happens if we could go to our Exec and say, you know, can you give us a chance to do something different here? And I did, myself and head a psychological therapist, managed to get a very prised moment on the exact board where we’ve had a 15 minute slot to present our ideas around compassionate leadership. And I think I managed to make it last 45 minutes. And that was the strategy, so they’d say yes, so get me out the door. I mean, one of the reasons it took 45 minutes is I’m very passionate about compassion. So it’s hard to and that’s, you know, an important thing to convey the hope, the hope of change, the hope that we can inspire people to want to develop their capacities to look at themselves. So the timing was right at the moment where they said, yes, yes, let’s go for it. And they gave us the backing to develop a compassionate leadership programme, and I was seconded out to run it initially for 18 months. And it’s been five years in the making of to try and create a culture of change. And it’s been a lovely eye-opening and delightful and challenging experience. 

Professor Michael West: So how many people have gone through that programme, Deborah? 

Dr. Deborah Lee: Well, we were trying to find the stats. We’re a trust of four thousand five hundred, roughly so not not a huge trust. The initial rollout programme, we got over 1200 people through it and positions of, say, management supervision kind of influence. We then moved to a business as usual model where we integrated compassionate leadership within our excellent managers programme. And we then put on workshops for the workforce. So we had these one day workshops for everybody because that’s, you know, compassionate leadership is a groundswell, actually. So we went up down, so everybody was exposed to the principles of compassionate leadership. And then we got it into our induction programme. And I think I come on fairly soon after Julian Emms CEO, welcomes everyone to our trust so that every new starter hears about compassionate leadership and Berkshire’s commitment to to create compassionate leadership as an atmosphere and emotional atmosphere of which people will come to work. So we’ve had a big rollout and I saw last count, we were tipping the balance of over 50 percent of people have been exposed to the principles. One thing I do remember, one day workshops, which we do for everybody, are about self-compassion, so we can talk about that in a moment the way that we approach the actual programme. But the one day workshop is all about self-compassion. So people sign up to the compassionate leadership one day, and they’re a little bit baffled to discover it’s all about them. They weren’t necessarily expecting the focus to be on their wellbeing and how they can foster compassion habits, really. And we ended up being one of the most popular training courses, as such, we ended up developing a waiting list for this one day course, which is just marvellous because, you know, it was through its reputation. And, you know, I was sort of feeling really kind of chuffed that my goodness were getting there. And then someone said, Well, Deborah, the competition, it’s not hard. It’s compassionate leadership or hand-washing and information governance. Oh yeah, you’re right. Fair point. But it is a context, but it’s been wonderful to do.  

Professor Michael West: So, Deborah, can you say a little bit more about the self-compassion workshops and what they involve? You know, briefly, what are the kind of key themes that you cover? 

Dr. Deborah Lee: So for me, one of the most important parts of the workshop is education. So I like to start with educating people about the science of being human, so they have a context to understand their behaviour. We didn’t mention this earlier on, but it’s probably really important to say that compassion is an antidote to a state of disconnection and shame. And shame is a threat focussed state where we are focussing on social threats, so the minds of others and and in our own minds. So I think that’s quite important to mention for a moment because if we are in a state of social threats, we behave in all sorts of ways that aren’t necessarily that helpful. We behave in safe ways as opposed to pro-social flourishing ways. And those threat states can take on an individual premise in our own minds and bodies, but then they become team threats and then become system threats. So going back to the workshop on self-compassion, for me, it becomes really important to de shame and to bring in common humanity to the human experience, to shed light on private processes that, you know, we know that we’re all thinking and doing because we’re all human. And so I like to start with a big sort of section in the morning around the likeness of human nature and, you know, shame states and if they can be light, but you can bring lightness to these things and all ways that we behave in order to kind of hide our shame states. And then I like to link that in to the antidote to those threat focussed, disconnected states being compassion and explain how compassion is a basic human motivation that we’re all capable of developing. And that sometimes we just don’t know what to do because it hasn’t been on our family curricula for whatever reasons, the language of compassion we haven’t been exposed to, we haven’t been taught it, but we can develop the capacities. So the next part of the workshop really hones in on what I call the kind of compassion habits. And there are four habits that I particularly focus on helping people develop. And the first is awareness, mindful attention to become aware of yourself, to see yourself rather than be yourself, if that makes sense. So rather than us sort of getting through our days phonetically with our 10 tasks to do, got 10 does tasks to do, got 10 taskst to do. How do we notice we’ve got 10 tasks to do? And how do we engage in each one of those tasks with sort of mindful presence? So mindful attention and awareness of our psychology and what we get up to and all our shame states actually and our vulnerabilities becomes really important. And then the next compassion habit is learning how to regulate, regulate our physiology, you know, physiology rules the humans shows, referring to threat state. It will colour the way we think and the way we behave. But if we’re in a a calm, settled, compassionate state, a soothing caregiving state, our physiology changes and there are very basic things that we can do to help that physiology. One of them is breath practise. So we teach a particular type of breath practise, resident breathing, soothing rhythm, breathing in order that our staff learn to do something really of the moment to settle their breathing. And then the third compassion habit is using compassionate imagery to bring online that caregiving state to just be mindful of what it feels like to be the best version of you. The version that you want other people to experience you today that when you go through your daily business, you want people to notice your ability to pay attention or to listen, or to be curious or to bring kindness to that work today. So this idea of paying attention to our best version and we use imagery exercises to kind of bring that system online. And then the fourth compassionate habit that we teach is what I call the compassionate lens so that we begin to see our day to day business, our day to day conflicts, even with the lens of compassion. How can I be helpful? How can I use my knowledge, my understanding and my wisdom and courage to be helpful to you in this moment? So there are four habits we teach on the self-compassion course, which we hope that people then kind of take off and kind of like infuse into their own lives as well as their lives at work. 

Professor Michael West: That’s really helpful to have those four themes that inform us about how we can help to develop compassionate behaviours and leadership and orientation in organisations. I suppose one of the obvious questions people will ask is how is it affected Berkshire Health? All of this? How has it greened the organisation? I mean, I have to look at your staff survey results in Berkshire over recent years, and it is amazing to see what a positive culture there appears to be there. Are there other indications of how this is greened, the organisation? 

Dr. Deborah Lee: Well, I think just to sort of note about self-compassion. One of the things that’s really helped green it is team compassion. It’s funny when you say the word greens, you know, you know, compassion, focus therapy. And we have a holistic model of the three circles and the green one is soothing and caring and the red one is threatened. The blue one is drive. So we do use the language of I’m in the red zone. I’m in the green zone because that was language we taught on the compassionate leadership programme. There is something really important about team compassion of course, the version of yourself that you turn up with in the team is then consolidated through the lens of team compassion, and part of the programme was to help teams develop compassionate pledges. This is how we do things around here. This is how we treat each other. This is how we commit to treating each other. And then a little bit like the group rules once we’ve stated our commitment to the rules. We give each other permission to call each other out, you know, whether that be as basic as, you know, finding ourselves inadvertently chatting about a colleague rather than to them. You know, we have permission to say, Hey, we agreed we wouldn’t do this. Let’s not do this. You know, let’s just move back to the core, you know, value that we have as a team. So team pledges have been a really helpful tool to keep compassion alive in the organisation. And we did do some qualitative research at the time. We took teams and we evaluated the before and afters really with the impact of the flow of compassion. And we did demonstrate quite clearly an improvement, a dramatic improvement in self-compassion and allowing others to be compassionate and receiving that care from others. And over time, six months later, there was a slight fall off of it. And that, to me, was a really important feature around compassion habits in order to really bed down this, this culture change, we need to keep compassion habits alive in the Aether and have reminders everywhere around our compassionate commitments to each other. Our staff survey, as you know, Michael, is incredibly impressive. I think we’ve got 75 percent engagement and the talk on the ground from the people that I come across is how different they feel that Berkshire is from other trusts that they’ve worked in. And I myself have worked with other trust, and I’ve got many friends who work in other trusts and Berkshire does feel different. We have a very available and reachable exec team. We have a real sense of presence of our exec team. We feel held in mind and I think we have an openness. We have a lot of structures and methods within that framework of compassionate leadership that allow for open, authentic engagement with stuff that’s difficult. So you’d have to ask the people that are leaving Berkshire. Actually, I think I’d be interested to ask those that leave what we could do better. But certainly those that stay notice a difference in the commitment and the emotional landscape of which we all kind of conduct our business. 

Professor Michael West: And so in relation to the difficult, one of the questions that I think always arises when we talk about compassionate leadership is does it just mean that we are nice to people and we skirt around performance problems? We don’t deal with abusive behaviours or difficult behaviours. And I think my sense is that compassionate leadership actually takes quite a lot of courage and quite a lot of self-awareness. But can you say a little bit about then in Berkshire health and in your experience, how we deal with difficult behaviours, inappropriate behaviours or with poor performance in a compassionate context or in a compassionate way? 

Dr. Deborah Lee: That’s a very big, pertinent question. And it’s probably the question that comes up the most when we’re doing our workshops, which is, what about this? What about if your manager is not compassionate? What about this team member that seems to be on a completely different page to everybody else? And you know, I would not want to suggest that I have the golden answer for these experiences, but I can talk about some of the processes that I think can help. And going back to your point about courage, I am absolutely in agreement with you. Courage is at the heart of compassion. Courage, the courage to engage with difficult, painful stuff, difficult painful experiences, interpersonally with our colleagues and with the suffering of our clients that we work with and the courage to do something different. And so often I see a confusion around what people think is compassionate, which is actually a kind of a subjugated appeasement it’s actually driven by threat. People that want to be liked as opposed to kind of lead, if that makes sense. So we have sometimes people at the workshop, they say, I couldn’t have done more for this person. I’ve bent over backwards to accommodate them. And when I say, But what’s your motivation? What’s your motivation here? And is it because you want to be liked or is it because you want to do the right thing for the greater good? And when you ask that question, oftentimes people are able to say, actually, it’s my fear of not being liked. It’s, you know, my fear of, you know, my team thinking that I’m not very nice person. And that, of course, goes back to self-compassion because if we develop our self-compassion, the fear of not being light starts to reduce because we’re motivated by a very different system. We’re motivated to do the right thing for the collective, the greater good. So when you’ve got a team member who isn’t seemingly on the same page as everybody else. The question is, what’s for the greater good here? And how can we engage with that person in a way that’s kind, and understanding and curious, because nobody really turns up at work going, You know what I’m going to make everyone’s life a misery today. You know, I’m coming to work today. And you know what, Michael, you’re my target. I’m going to make this absolutely miserable for you today. That’s not the motivation. People come with lives, you know, home life stuff going on for them, and they are often behaving in difficult ways because they’re frightened, actually. In essence, if that makes sense. And if we can engage with what’s the fear and if we can shame people and this is so important, this is why compassion is so important in the landscape of engagement, because it’s about being curious and being helpful and not being hierarchical and looking down. And, you know, would, you know, sort of judging. It’s about saying, Let me help you. What can we do to help? How can we make this better for you? And within conflict, there’s always opportunity, there’s opportunity. Someone’s got a viewpoint. So let’s listen to it and let’s seek to understand how we can make that better. That would be my starting point. And in the the team compassion day of our compassionate leadership programme, we teach a compassionate problem-solving model developing the compassionate lens for these interpersonal conflicts that emerge. And that’s why courage has to be at the heart of that, because we have to be compassionately assertive in our interpersonal dealings. And I think that sometimes really hard for health care workers because we think we’re being mean or we’re being horrible by being assertive. I think we’re a bit vulnerable actually to burnout and extending ourselves and not taking on difficult behaviour because we don’t want to be mean or seem to be cruel, but ultimately the rest of the team suffer. So there is something really courageous about compassionate engagement with difficult behaviours and difficult managers. What’s going on for you? How can we help? How can we understand? How can we make this better for everybody? 

Professor Michael West: So there is so much in what you say, so many themes that it would be wonderful to explore, including that amazing phrase subjugated appeasement that we don’t want to be mean or we want to be liked. And you referred quite often to shame as being. Kind of quite a big star in the constellation that we need to be aware of and the importance also of compassion being grounded in self-awareness in the moment of being aware of what I’m feeling and this interaction here and now. And I think the other concept that seems to me really important in what you’ve said is what you’ve said is the concept of the team. I’m very often asked by people, What do we do if we’ve got a leader or a manager who isn’t compassionate? And I suppose when I think is, well, we all have it in our control to regulate our own behaviour so we can choose to be compassionate to ourselves and to those around us. And I think there is something about the team as an entity, being an important vehicle to be able to deal with the problem of when there’s a manager or a leader who’s not behaving compassionately because it can be actually quite perilous for individuals, I think, to pursue maybe a difficult conversation with a manager alone. I think we need to do a lot more about developing a really good team working in health and social care so that the team becomes much more the unit of analysis and the people within the team develop their relationships with each other. Is that an observation that you would concur with from your work in Berkshire? 

Dr. Deborah Lee: Yes. I mean, we’ve very much had at the heart of our leadership programme team compassion and fostering that within various settings, and we very much encouraged, say, for instance, team away days to be committed to looking at compassionate practises. But what that means, of course, is having the courage to go to where it hurts, and that is difficult for people if they fear repercussion. And it’s incredibly difficult when you have a manager who isn’t on board with compassion. But you’re right, there is something that’s powerful about a team cohesion and sticking together and staying with each other and being motivated by what is morally the right thing for the greater good. So when we do our teamwork, what we do is invite people to actually shed light on the threats. What’s the threats? What’s the fear within our team? What are our external threats and what are our internal threats? And how can we find collective solutions to this? How can we help each other now? Of course, managers are involved in those discussions because the team is in all of it. So we bring managers on board with the idea that there is to be equally as committed to the team pledge as the team members. When you have something like a compassionate pledge or it becomes like a group brawl, it becomes a marker in the sand that you can then call it everybody’s behaviour out against you. You effectively giving permission to say, come on a minute. We thought we weren’t going to do it this way. Now your manager may not like it or react to be involved in the process of discovering it’s they’re going to be more engaged with the process of keeping it alive in the team. And I always go back to what’s the threats? What’s the threat? As I say, people don’t come to make life miserable for people. People end up behaving in ways that aren’t their finest moments because they’re stressed, because they’re threatened, because they’re up against it and our behaviour becomes reductionist. Get safe, get safe, get safe in those environments so we can always remember that and think, how can we move ourselves to a physiological state of calmness? Then we will be accessing much wiser capacities to navigate through our daily work. 

Professor Michael West: That notion of team pledges, I think, is really powerful. One of the techniques I was use with teams was to agree three things we must never do and three things we must always do. And compassion always was very visible in those pledges, and it provides a powerful handrail for teams in terms of their behaviour over time. One of the questions I’m also asked is, well, it’s fine to introduce initiatives, but could we sustain change in teams and organisations over time? 

Dr. Deborah Lee: So I’m particularly keen on thinking about this because so often when we have leadership programmes or we take staff out of their team and to another place for them to learn in a silo and then come back to the team. And you know, the learning is very quickly diluted. So I think if we can learn within a team and we invite teams to our compassionate leadership training, we want them to come in their team so that they’re already beginning to think about it in that way. That, of course, gives rise to another problem. And some people go, What’s the definition of a team? Is it that way or that way, you know, sort of lateral or horizontal? So lots of people have different teams, but coming to the team creating that opportunity for change and then fostering it. We can do that through structures, I think, and the most obvious way of keeping that alive is having some type of reflective practise space. So we’ve developed a compassionate staff reflective practise model. And if I just talk about my own team, which is, you know, it’s incredibly important that we have this space because we’re working with trauma day in and day out. But we have various settings of which we engage in compassionate, reflective practise and that is in part working on ourselves. So we talk about our own journeys of self-compassion, how we’re all getting on with our own practise, and then we talk about the interface between ourselves and our clients. And we also are mindful of what our clients want for us. How are we doing for that? You know, we’ve got to always hold in mind that we just want to provide good care for our population and Berkshire. So we’re only as good as how they experience us. That’s the most important interface. So it’s really important that we hold a mind reflective practises with clients and focus groups so that we can shape how they experience us. The other thing that I think is a really kind of helpful idea, and I’m hoping that Berkshire may be able to think about taking this on board as we emerge from the pandemic is to have compassionate, reflective leadership forums. So across Berkshire that we have a group of people that find themselves in similar roles, having their own leadership reflective practise. We’re very used to doing this as clinicians, but actually, in terms of leadership, compassionate leadership reflect practises will keep alive the notions and the commitment to compassionate leadership as a sea change. I think for me, those kind of structures bringing together methodology under the framework of compassionate, inclusive leadership is going to be really important going forward in terms of really committing to the sustainability of culture change. And of course, with that longevity is so important. Longevity, you know, not tick box, not tick box, but commitment and longevity of seeing it out through the end and learning from it as it evolves, I think, would be a really important point. 

Professor Michael West: So Health Education Improvement Wales has committed to a 10 year strategy for developing and sustaining compassion and leadership across the whole of health and social care. And I know some Native American communities have a timescale for change, which is 70 years or three generations. The other reflection I have is that perhaps the most extraordinary characteristic we have is awareness and consciousness that we have the capacity to stop and reflect on our own experience. And I’ve been convinced over my career that taking time out to reflect on what we’re trying to achieve, how are we going about it, what we need to change? Reflecting on what I’m experiencing in this moment requires courage, but it’s also the opportunity for growth and learning and nurturing and contribution and the development of compassion. Well, what’s the one tactical tip you would give to people listening to this, that one thing they could maybe take away from this conversation that will be helpful to them? 

Dr. Deborah Lee: Start with yourself. The longest relationship you have is the one you have with yourself. So start with looking after yourself. The graveyards are full of irreplaceable people and it’s so important that we look after ourselves. The work we do is so deeply rooted in humanitarian concern. It’s a wonderfully privileged job to have a life serving others and a career serving others. And you matter. So look after yourself, the cost yourself, be the drop in the ocean that creates the ripple that creates the wave and lead by inspiration. 

Professor Michael West: That’s amazing. I feel really inspired and nurtured by our conversation today. Deborah, it’s been a lovely personal experience for me and reinforces for me the importance of self-compassion and self-awareness and recognising that we have to make a difference for the collective good for other human beings around us, for the other species around us, for the planet as a whole looks interconnection is what this is all about and is the basis of our salvation. So it’s been wonderful. I would love to speak with you every day because I think it would make my day profoundly better. So thank you very much for being prepared to give your time and contribute to this conversation. Thank you. 

Dr. Deborah Lee: Thank you so much for inviting me. It’s been a real pleasure. Thank you. 

Paul O’Neill: 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. 

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