How acts of kindness can improve care and strengthen teams
Dr Bob Klaber is a passionate advocate for the importance of kindness in providing care and in working in teams. Here, he shares some of the evidence on how kindness can lead to better outcomes and how he puts kindness into practice at work.
There are plenty of things in life that I feel somewhat unsure about but, working within our organisation, I am very certain that our business is care. And at the heart of outstanding care, is kindness. Not kindness as a soft and frivolous thing, nor as a state of being that belongs only to optimists, but as actions and decisions we choose to make every single day. There is nothing more important than this, and if we get this right pretty much everything else can follow.
I have long been interested in kindness, but over the last couple of years, I have been having conversations with colleagues working in healthcare across the globe to try to learn more about it. What I have found has given me some real clarity about the importance of kindness in how we relate to each other and our patients.
First, there is strong evidence that kind and compassionate care leads to better patient outcomes. There is also strong evidence that the highest performing teams create ‘psychological safety’ within their work, and that unkind behaviors wreck this and so need challenging. Finally, kindness multiplies: acts of kindness often trigger more kindness.
Improving outcomes through kindness
One of the people I have been lucky enough to meet is Professor Len Berry, an oncologist practising in the USA. His research, “The Role of Kindness in Cancer Care,” published in the Journal of Oncology Practice in 2017, demonstrates that kinder care leads to better outcomes in cancer patients. He and his co-authors suggest six practical behaviours that can improve outcomes for people with cancer:
- Deep listening (and recognising that if you are really truly listening you cannot be doing anything else at the same time)
- Clear empathy (putting yourself in the shoes of the person you are listening to)
- Generous acts of discretionary effort that go beyond what patients and families expect
- Timely care that reduces stress and anxiety (recognising that waiting with uncertainty can been deeply painful and stressful)
- Gentle honesty in discussions and conversations (including being really open about when we have made mistakes, missed things or said something we should not have)
- Thoughtful support for families and carers
I really love the language Prof Berry has used to describe these actions; they feel encouraging and practical. As I read them it makes me reflect on some of these that I think I do quite well, and others that I could do more of, or be better at. I have also found they really help in interactions with my colleagues, particularly where at first glance we might have quite different ideas or opinions.
Cultivating psychological safety in teams
I first learned about psychological safety through the work of Amy Edmondson, and also spent some time reading about Project Aristotle, which was research commissioned by Google to help them to understand what makes high performing teams successful. They studied around 200 teams and 40,000 employees over a two-year period. While they observed a number of pretty obvious things – in the best teams everyone was clear about what they were being asked to do and had a sense of purpose and meaning to their work – the standout finding was that in the best performing teams every single member of the team felt ‘psychologically safe’. In practice this means that even the most junior people can freely speak out, can voice left-field ideas, and can show vulnerability and be honest about their circumstances, without worrying about what other people might think.
There is no better way to grow psychological safety in your team than by being kind. And unkind behaviours – ignoring others, being unhelpful, name-calling, eye-rolling and making others feel excluded – all undermine the sense of psychological safety that is required for teams to thrive. My take is that these are almost never people being deliberately bad or difficult; they are usually driven by people’s own anxieties or issues, but they need challenging in a kind, empathetic but firm way.
In my time working in the NHS I cannot remember a tougher time than this; extraordinary pressures on staff, heightened anxieties in patients and deeply concerned relatives. There has also never been a more important time to try to act with kindness in everything we do, and indeed to challenge behaviours that are unkind. None of this is easy, and we all sometimes get it wrong, but doing it makes us as individuals, and the people around us, happier, safer and more productive.
Taking control of our actions
As we approach the winter ahead with a fair amount of trepidation there is plenty we have little or no control over. But we can influence how we behave and how we act. At our organisation, we pride ourselves on our strong science and research credentials. Acting with kindness – towards our patients and colleagues – is one way of demonstrating our commitment to providing evidence-based care.
There are three things I will try to do more, this winter and beyond: listen harder and better to colleagues and patients around the organisation; reflect, apologise and try to learn if ever I spot myself doing something that others might feel is unkind; and take some deliberate actions to make sure that the teams I work with are as psychologically safe as they possibly can be.
Please do get in touch and share what you are doing and learning, and what difference it is making – we would love to hear from you at imperial.communications@nhs.net
Bob is one of our children’s doctors, doing his clinical work at St Mary’s and out in local GP practices. He is also a member of the executive team at the Trust.
Review the Trust’s behaviours framework for more examples of kindness in action.
