The focus in the NHS needs to move from targets and processes to a fair and just system that values the workforce, write Alex Till and Rammya Mathew

Alex till

Alex Till

Alex Till

Shame, blame and punishment are incompatible with a compassionate culture that delivers high quality healthcare.

On the contrary, they are the ingredients for a toxic culture – a culture which stifles innovation and disenfranchises the people who are at the heart of our NHS.

Dedicated professionals are being regarded as mere “cogs in a machine”, and yet we wonder why we cannot break free from a system shackled by low morale

These people are none other than our workforce; the doctors, nurses and allied healthcare professionals who entered their respective vocations with the noble aspiration of supporting and caring for people at their greatest time of need.

However, as pressures on the NHS have mounted, the focus has shifted to targets and processes. We have lost the perception of a fair and just system and neglected the need to nurture and cultivate a compassionate culture in our NHS that values ourselves and our colleagues.

Rammya mathew

Rammya Mathew

Rammya Mathew

Dedicated professionals are being regarded as mere “cogs in a machine”, and yet we wonder why we cannot break free from a system shackled by low morale.

What matters most

New research from the London School of Economics has highlighted that what matters most for our happiness and wellbeing is not our income levels but our health and relationships.

“People don’t remember what you said or did but the way that you made them feel” and this applies at the workplace just as much as it does at home.

Whilst caring for patients, and meeting the demands of an overstretched system, we must also remember to treat our fellow colleagues with subjective needs and emotions.

To recognise and respond to this is not a sign of weakness, nor should it be seen as a homeopathic attempt at remedying the current state of the NHS. It is a basic human need.

The thoughtfulness of buying a coffee, a team breakfast, to organise a social, or to simply rest a hand on someone’s shoulder and say thank you is incredibly powerful

Whilst many of us feel powerless in the face of current pressures, we must remember that the one thing that we have autonomy over is our own behaviour and failure to reinstate a sense of pride, cohesion and respect for each other, will be a failure on all our parts.

The question is, how do we collaboratively lead change, rebuild a compassionate culture in our NHS and begin, as encouraged by the Declaration of Geneva, to consider our colleagues as our family?

The answer is not complicated, it is simple. It is about finding out who we are working with, looking beneath the surface, and identifying what matters to each individual within our team, why that matters to them, and most importantly, reassuring them they can make a difference.

Of course, we are all pressured, and building relationships takes time, but it starts with the simple things and we all have the ability to take that first step. The thoughtfulness of buying a coffee, a team breakfast, to organise a social, or to simply rest a hand on someone’s shoulder and say thank you is incredibly powerful.

But why do we find it so difficult to achieve what seems to be so simple? – Well, hierarchy and tribalism are factors that certainly don’t help the situation.

What makes it difficult

The need for hierarchy has long been defended for its perceived ability to maintain order but we see barriers within teams hindering effective communication. Similarly, the tribal nature between disciplines is often dismissed as just banter and we brand our colleagues using archaic stereotypes: “the brash surgeon”, “the useless GP”, “the lazy psychiatrist”.

For a moment, let us reimagine a system that says no to hierarchy, where no role is perceived as being too small, where tribes work collaboratively and we respect each other enough to take the time to find out a little bit more about the family we work with

These can be personal, damaging for the profession, and deeply disempowering. They are counterproductive to the collaborative spirit required to deliver integrated high quality care for our patients.

It is up to each of us to “call it out”, defy these underlying assumptions, and not allow this rhetoric to go unchallenged under the guise of good humour. Respect for each other is not a nicety, but a necessity.

Wouldn’t it be nice if the senior consultant encouraged team members, as they would do their peers, to use their first name? This doesn’t mean they will respect them any the less; in fact in a world where first names are so commonly used, it may have the opposite effect.

For a moment, let us reimagine a system that says no to hierarchy, where no role is perceived as being too small, where tribes work collaboratively and we respect each other enough to take the time to find out a little bit more about the family we work with.

This isn’t hard to do, and it costs nothing. Through these simple actions, a team can be built and a sense of purpose and mastery restored, among even the most junior of staff.

Ultimately medicine is challenging, but brilliant. It sometimes doesn’t feel that way, but the ability to touch someone’s life and make a difference, no matter how small, is an incredible privilege that our profession holds.

What we must not forget is that this starts at home.

It is up to each of us to be the change that we want to see, flatten the hierarchy, show respect for our colleagues, and demonstrate through strong leadership and positive role modelling that we can rebuild a compassionate culture in our NHS.

What are we waiting for?

Alex Till and Rammya Mathew, national medical director’s clinical fellows 2016-17