Wednesday 20 October saw the publication of a new independent investigation by Dr Bill Kirkup: Reading the Signals: Maternity and Neonatal Services in East Kent. The report is harrowing to read and lays out the devastating consequences of failings and harm and the indescribable loss experienced by families. We have all been asked to review the content, noting the expectations and actions that should be taken. Locally, with colleagues, I have discussed the wider potential for learning across all services. As senior nurses and midwives, we must consider what actions we may need to take to assure ourselves of the cultures in which we are leading and operating in.
The Kirkup report identifies four areas for action, stating that the NHS could be much better at:
- Identifying poorly performing units
- Giving care with compassion and kindness
- Teamworking with a common purpose
- Responding to challenge with honesty.
Nationally, in reviews of leadership and culture, and, sadly, from my own local experience, the absence of civility and kindness is a common theme. The consultancy team at A Kind Life (https://www.akind.life), who have been developing ‘Kindness Into Action’ masterclasses for delivery with NHS England, state that around 25% of NHS staff say they have experienced bullying in the past year (A Kind Life, 2022). The team's research shows colleagues' poor behaviour is the number one cause of disengagement in the NHS. They reflect that it is these unkind behaviours, often seen daily, that break down the teamwork that is essential for high-quality care. These behaviours, they say, make mistakes and errors more likely, in turn making colleagues miserable - and sadly, these behaviours spread and influence a wider culture of behaviours.
The improvement area that my colleagues and I have recently focused on is civility and kindness. If I am honest, the notion that we need to attend or indeed send staff on training to be more civil or kind in the workplace upsets me – it is distressing that there is a need for this. On the other hand, it is better to face up to this distress than be in denial that it is required.
According to NHS England (2022), in its simplest form, civility and respect is about how we treat each other at work. Both the NHS Long Term Plan and NHS People Plan (NHS England/NHS Improvement, 2019; 2020) recognise that levels of bullying and harassment must come down if the NHS is to achieve its aim of becoming the best place of work and being an employer of excellence, placing a compassionate and inclusive culture at the very heart of the NHS.
So, when considering what might seem to the outside world to be ‘soft’ kindness training, the evidence base cited by the team at Civility Saves Lives (2022) speaks for itself. They ask: ‘What happens when someone is rude?’ and argue that when someone is rude to us, it reduces our mental ‘bandwidth’ and ability to effectively juggle multiple tasks and conscious thoughts. Therefore, rudeness reduces our ability to do our jobs, which must then impact on both staff and patient safety and experience. They point to how, drawing on data from the NHS staff survey, West and Dawson (2012) identified numerous benefits present when staff perceived themselves to be in a good team:
- Reduced hospital standardised mortality rates
- Reduced patient complaints
- Improved staff satisfaction
- Improved staff performances
- Better reported health of staff.
Given the strength of the evidence base, with colleagues, I am fully promoting the NHS England (2022) Civility and Respect programme, which more recently has commenced the delivery of Kindness into Action masterclasses to create and sustain kinder cultures in the NHS. The masterclasses, which I personally have found highly impactful and have heard similar opinions from other colleagues, are made up of five modules that consider the following areas:
- Module 1: Kindness into Action: animation of the evidence
- Module 2: Cultivating Kindness: practical kindness in healthcare
- Module 3: Undoing Unkindness: how and why to mind your impact
- Module 4: Kinder feedback: speaking up safely (with the BUILD method)
- Module 5: RECOVER: 7 conversations to improve wellbeing.
I think it is important that, as leaders, we accept that incivility and unkindness are in play across the workplace. The impact of improving our cultures, with time out to reflect and understand the implications for the safety and experience of our patients, as well as for staff, could be profound if supported at scale.