WHY BE KIND?

It’s been described as an underground movement – a new approach to medicine attracting followers from across the globe.

It’s a radical concept that demands change in the way we treat one another and lead our organisations. Kindness is making a comeback.

This is not feel-good, fluffy stuff. Its advocates are making big claims about kindness’s potential to improve everything from staff performance to patient outcomes.

A growing number of organisations are prioritising kindness as an organisational strategy as well as a value. Hywel Dda University Health Board in West Wales, for example, now recruits to its nurse apprenticeship scheme based on applicants’ kindness, not their qualifications.

‘When we’re kind to people, it creates better relationships, we get better information from each other, we make better decisions, we perform better,’ says Chris Turner, the doctor behind the Civility Saves Lives campaign. ‘And if we treat patients compassionately, they do better too.’

But how can you ask an overstretched workforce to be kind? And how do you nurture kindness in a system that many feel has lost its heart?

The ‘business case’

Bob Klaber is director of strategy, research and innovation at Imperial College Healthcare NHS Trust and a consultant general paediatrician. He helped set up the monthly online ‘Conversation for kindness’ which now attracts healthcare professionals and leaders from some 30 countries.

He believes that kindness is ‘at the heart of outstanding care’. ‘Pretty much everything else flows from it,’ he says.

The ‘business case’ for kindness is compelling, backed by a growing body of evidence.

Kinder care has been associated with better outcomes in cancer patients in a study by US professor Leonard Berry into healthcare service quality.1 It has also been linked with faster healing of wounds, shorter hospital stays, and reduced pain, anxiety and blood pressure, according to research by Stanford University and Dignity Health. 2

And kindness need not take long: a study by Johns Hopkins University found that giving just 40 seconds of compassionate care – even a simple message such as ‘We’ll go through this together’ – can measurably lower a patient’s anxiety.

It can even save time: a randomised trial among homeless adults attending an emergency department found that those receiving compassionate care made a third fewer repeat visits within the month. 3

But there’s another reason why Bob advocates treating others in a way that values and respects them. He believes a focus on relationships and the relational has the potential to transform workplace culture and, by extension, staff morale.

‘Our country’s healthcare leaders’ dominant focus on policy, systems and processes, to the detriment of the emotional needs of our workforce, has persisted for too long,’ he says.

‘We have a massive workforce crisis whose roots are multifactorial but the way we’ve treated people is absolutely key,’ he says. ‘I’m not prepared to spend the rest of my career working in a system that’s inherently not psychologically safe, that is unkind.’

He cites a Google study, part of its Project Aristotle, which found psychological safety to be the most important condition needed for a team to be high performing.

‘I have found no better tool in creating that condition than a strong focus on kindness,’ he says.

Trusting environment

A regular contributor to the ‘Conversation for kindness’ is Dr Turner, a consultant in emergency medicine at University Hospitals Coventry and Warwickshire NHS Trust. He helps explain how kindness builds psychological safety.

Kindness, Dr Turner says, creates an atmosphere of trust that allows people to be vulnerable and ask for help when difficulties or dilemmas arise.

The more people can exchange feelings and ideas, the less they become isolated in their stress or distress. And the better the flow of information, the better their decisions, he believes.

‘In medicine, we’ve been absorbed in a culture of personal mastery. “I need to be able to cope, I need to be able to answer this straightaway.” But the answers don’t come from me on my own: they come from us collectively.

‘When we as individuals are viewed positively, particularly when we’re not seen as somebody who’s going to weaponise information or think “What a fool,” we help other people to turn on the flow of information and we can feed it back to them, to help them make sense of things or make decisions.’

But Dr Turner adds a word of warning: don’t make assumptions about how others perceive you. In his training with senior staff and health leaders, he often asks: ‘What’s your theme tune? What music do people hear when you walk in the room?’ Dr Turner was horrified to learn that at one time younger colleagues associated him with the soundtrack to Jaws –because of a miscommunication.

‘We need to think: “What theme tune would I like to have?” then “How should I behave so people hear that theme tune?”’

Work pressures

Yet, many will say, today’s NHS is not conducive to kindness. Dr Turner’s the first to admit that we can’t demand kindness of people in an unkind system.

‘We are hostage to our environment,’ he says. ‘You cannot expect people to be kind when you are driving them into the ground, when you get no space to be humane to each other.

‘At the moment, we’ve got a system that sometimes creates burnt-out cynics and that’s then role-modelled to others. Many very senior people are so burnt out they can’t see the impact they’re having on others. Kindness isn’t always achievable but we need to provide environments where people can be kind.’

But Dr Turner also believes that, despite the pressures, senior colleagues and health leaders have a responsibility to lead by example.

‘The more senior you are, the more influence you’re having, the greater the responsibility on you to set the behavioural tone within the organisation. Seniority doesn’t come with the privilege to behave as you like without accepting the impact this has. Our leadership behaviours are key to creating cultures of decency and kindness.’

Creating the culture

Maria Battle, chair of Hywel Dda University Health Board, says that the kindness movement in her organisation was born out of

BOB

KLABER: Kindness at heart of quality care staff values and pre-dates her arrival four years ago.

The health board’s HR department has led the charge, with a deliberate focus on recruiting for kindness and building ‘strong, understanding relationships’. The new organisational development relationship managers, recruited within the past year, embody this ambition.

Mrs Battle recognises that a compassionate culture is not built on wellbeing retreats, listening rooms, commendations and activebystander training alone, though these are all things her health board has instituted and they matter.

For her, it’s about creating a culture of care and kindness, and she takes her role championing this very seriously. She starts every job interview with the same question: ‘Give me an example of a spontaneous act of kindness that you’ve undertaken recently.’

‘It’s so important that leaders live their values, not preach them,’ she says. ‘We need to reach out, listen and keep listening, show we care and be visible.’

Translated into action

Bob Klaber at Imperial goes a step further: he believes that everyone – no matter their role or grade – has the power and potential to influence workplace or departmental culture. But they sometimes need reassurance that they have permission to live out their values.

‘I say to medical students on the wards, “People are watching you all the time for how you behave. They’re looking for your leadership.” Maybe we can’t change the political environment but think about what you can directly control and influence, and start there.’

Bob is keen to help colleagues translate values into practical action. Kindness features at the very top of the ‘organisational ethos, values and behaviours’ on Imperial’s website, and among the kindness habits listed are simple acts such as ‘making eye contact and smiling’ and ‘noticing when someone needs help’.

He is personally challenged by Prof Berry’s practical behaviours that can lead to better outcomes in cancer patients. These include ‘deep listening’ and ‘generous acts of discretionary effort that go beyond what bma.org.uk/thedoctor patients and families expect’.

One important practice that Bob is encouraging is being an active bystander, someone who challenges bad behaviour and stands up for values such as inclusiveness. This might mean asking people who are behaving unkindly, ‘What’s really going on for you?’

‘When we talk about kindness, people may say, “That’s all very well, but have you been down to Theatre 4? It’s toxic down there.” So, we’ve got to get down to Theatre 4 and say: “That behaviour is not acceptable.”’

Bob and his fellow kindness advocates are determinedly optimistic about the power and potential of kindness to change the culture – not least because it’s contagious. Kindness leads to more of the same.

‘You can teach it, you can learn it, you can practise it: everyone’s capable of it,’ says Bob. ‘Having a bad day might be context for how one is feeling, but ultimately, however one is feeling, kindness is a choice of action we can all choose to take.

‘Try it: hold the door open for somebody, rediscover a bit of joy by holding a patient’s hand, and see what happens.’

1 The Role of Kindness in Cancer Care, Journal of Oncology Practice, 2017 www.researchgate.net/publication/320439113_Role_of_Kindness_in_Cancer_Care

2 www.dignityhealth.org/about-us/press-center/press-releases/scientific-literature-review-with-stanford

3 www.thelancet.com/journals/lancet/article/PIIS01406736(95)90975-3

‘You can teach it, you can learn it, you can practise it: everyone’s capable of it’