Chapter 6: Building and Sustaining Compassionate Leadership

"A true leader has the confidence to stand alone, the courage to make tough decisions, and the compassion to listen to the needs of others. He does not set out to be a leader but becomes one by the equality of his actions and the integrity of his intent."

Douglas MacArthur, American World War II General

Leaders, both formal and informal, have an important role in creating the culture of an organization, a department or a nursing unit. In healthcare organizations, leaders should work to create a culture of compassion and psychological safety. Psychological safety climates are characterized by open discussion of errors, healthy and productive conflict resolution, and compassionate leadership behaviors (Edmondson & Lei, 2014; West, 2020). Psychological safety climates have been linked to better patient outcomes, more teamwork, lower levels of workplace bullying and improved staff health (Dollard, et al., 2017; Han & Roh, 2020). In this chapter we will explore how to be a compassionate leader who advances psychological safety. We will specifically examine how leaders can create compassionate policies and procedures that normalize compassionate actions, and impediments to compassionate leadership.

I encourage every reader, whether you consider yourself a leader or not, to at least skim this chapter. I have taught leadership classes for years to both undergraduate and graduate level nursing students, and it is my contention, and a belief that most of my students share, that all nurses are leaders – even those who do not have a formal leadership position in their organization. I never aspired to be a nursing manager, but during my years of both bedside nursing and academic nursing, I have had many opportunities to use leadership skills. I have lead teams that consisted of licensed practical nurses (LPNs) and nursing assistants. I have been a charge nurse who was responsible for staffing decisions and for assigning admissions during a given shift. As a professor I have been asked to lead committees that play a major role in how the school of nursing is run and what courses we teach. I have also taken a role in leadership in nursing organizations such as Sigma (the international honor society for nurses) and have served on the board of directors for a professional organization. While your career goals and trajectory may look very different from mine, I am confident that there will be times in your nursing career where you need to assume a leadership role.

Before you read any further, I want you to explore your thoughts about what it means to be a leader, and about compassionate leadership. At the end of this chapter, I will invite you to revisit these thoughts, so I suggest that you write down your thoughts.

EXERCISE: Exploring the Concept of Compassionate Leadership

You can do this exercise either alone or with a group. If you are doing it by yourself, I encourage you to write your thoughts down (or record them orally). As a group you can take some time to reflect on the questions individually and either record your individual thoughts, make a record of what the whole group thinks, or both. At the end of the chapter, I will invite you to revisit your initial impressions of compassionate leadership.

1. First think about your personal definition of leadership. What qualities come to mind when you think of leaders? Think of as many words or short phrases (positive, negative, and neutral) as you can that describe leaders. Looking at your list, which of these words do you associate with compassion? Mark them in some way. If you did not find any word or phrase that you could associate with compassion, just sit with that thought for a moment.

2. Why do you think leaders are not (or cannot be) compassionate? What has been your experience with leaders who did not demonstrate compassion? Where were they on a continuum from compassionate and supportive to abusive and tyrannical? What was your experience like working with (or for) this leader who did not demonstrate compassion?

If you had a negative experience with an abusive boss, please do not feel the need to dwell on this experience. Take some time to notice any emotions that might have come up when thinking of this person. If you are experiencing distress, you may want to end this exercise and practice some self-soothing techniques. You might revisit Chapter 3 for suggestions. When you return to this exercise, you may skip this step if it is too distressing.

3. If you identified some words that you associate with compassion, think about whether you have witnessed these qualities in practice. What did that look like? What did it feel like to work with (or for) this type of leader? If you have not worked with a leader who had these qualities, what do you imagine it would be like to work with (or for) them?

4. You may have recalled working with a leader who was sometimes compassionate, and at other times was lacking in compassion. What compassionate actions did this leader take? When compassion was absent, what do you think blocked their ability to be compassionate?

5. Finally, think about times when you have been in a leadership position, both informal and formal, both in your nursing career or in another part of your life. Were you able to practice compassion when you noticed other people were suffering? What blocked or impeded your ability to lead with compassion? What facilitated your ability to lead with compassion?

Note: the goal of this exercise is not to introduce judgement of your past leadership style – perhaps it never occurred to you that leaders could be compassionate, or perhaps you did not notice suffering that you needed to respond to. Rather the goal is to get you to think about what factors facilitate or block compassionate leadership.

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Building a Compassionate Leading Style

It is quite possible that you have never been explicitly taught leadership skills, even if you currently occupy a formal leadership role. Many nurses step into positions of formal leadership because that seems to be the next progression of their career, or because they are the most senior member of their team, and there is no one else to fill that position. If you did have a class or workshop on leadership, it is unlikely that the concept of compassionate leadership was discussed. I have been teaching leadership classes for years, and until this year I was unfamiliar with the concept, and therefore did not discuss compassionate leadership with my students.

The Center for Compassionate Leadership (2019) says that compassionate leaders

“create a new culture in their organizations that empowers everyone to live authentically on purpose, valuing individual contribution, and appreciating our common humanity. They are the leading edge of a new age of connection, creativity, and cooperation by acting with kindness, empathy, compassion and concern for others.”

Note that this description emphasizes that compassionate leaders appreciate the common humanity of everyone within the organization, and they act with kindness and empathy. These concepts should be familiar to you as core components of compassion.

A leadership style that is congruent with compassionate leadership is servant leadership (Vogus & McClelland, 2020). The servant leadership style has been embraced by many in the nursing profession (Neville et al., 2021), so it is a concept you may be familiar with – it is certainly one I have discussed in the leadership classes I have taught. Servant leadership can be defined as, “an other-oriented approach to leadership manifested through one-on-one prioritizing of follower individual needs and interests, and outward reorienting of their concern for self towards concern for others within the organization and the larger community” (Eva, et al., 2019) p. 114. Servant leadership requires a change of focus from “these people work for me” to “these people work with me” (Savel & Munro, 2017)

People who embody a servant leadership style exhibit mindfulness and humility (Savel & Munro, 2017; Verdorfer, 2016). As we have explored in this book, a mindfulness practice can help you manage your emotions, can help you become self-reflective while letting go of self-judgement, and can help you access compassion when it does not arise spontaneously. All of these skills are useful for compassionate servant leaders (Verdorfer, 2016).

Servant leaders also practice humility (Zinan, 2021). Humility is “a willingness to view oneself accurately, a displayed appreciation of others’ strengths and contributions, and teachability” (Owens, et al., 2013). While humility is often associated negatively with low self-esteem, it is more accurately described as a view that we are no better or worse than anyone else – in other words, an attitude of humility involves recognition that all people have the same worth (Savel & Munro, 2017). An attitude of humility allows us to recognize our shortcomings and strengths, as well as the shortcomings and strengths of others, without seeing them as deficits. Leaders who practice humility can be open about their own gaps in knowledge, and can tap into the expertise of others to fill in these gaps (Zinan, 2021). When leaders acknowledge and appreciate the strengths, skills, and specialized knowledge of the people they work with, morale is improved, there is better teamwork, and workers feel their contributions are valued (Owens et al., 2013). Leaders who practice humility can also recognize when there are gaps in knowledge or skills of the people who work with them, and can create opportunities for these employees to address these gaps.

While servant leadership has sometimes been characterized as a weaker leadership style, true servant leadership requires great courage (Van Dierendonck & Nuijten, 2011). One of the roles of a leader is to advocate for their team, and nursing leaders have increasingly found themselves advocating for greater resources for their departments in the face of budgetary constraints and scarce resources (Iles, 2016; Neville et al., 2021). Advocacy requires tenacity, strength, and the courage to speak up, qualities that are far from servile.

Leaders also have a crucial role in helping co-workers resolve conflicts, in stopping bullying and harassment, and in establishing an ethical climate within their department or unit. Consider the example of a unit where bullying or unethical behavior has been tolerated. Instead of allowing these behaviors to continue, leaders need to not only set an example for how members of the group should behave but should actively intervene when behavioral standards are not met. Research shows that the servant leadership style can be effective in difficult situations such as conflicts between team members. Servant leaders are more likely to engage in constructive, collaborative problem-solving rather than avoiding intervening in the conflict or forcing a solution (Obi, et al., 2020).

In the next section I will discuss specific behaviors that formal and informal leaders can adopt that will help them lead with compassion. Before reading that section, I invite you to complete the exercise: Servant Leadership Self-assessment.

EXERCISE: Servant Leadership Self-assessment

The following self-assessment is based on the Servant Leadership Survey, short version (Van Dierendonck et al., 2017). The Servant Leadership survey was designed as a research tool that can be used to assess follower’s ratings of their leaders. I have adapted it to be used as a self-assessment tool. It can be used by both formal and informal leaders.

Note that this adaptation has not been empirically tested (in other words, I have not done rigorous scientific testing to see if it is a valid instrument). I suggest that you use this self-assessment as a way of exploring your current leadership style, and a means of identifying possible areas for growth. Higher scores indicate higher levels of servant leadership. If you are in an informal leadership role, your scores may naturally be lower as you may not have the capability to carry out all of the leadership behaviors described in this survey.

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Compassionate Leadership in Action

Most people who study and write about leadership believe that people learn to be a leader by watching and copying the behaviors of leaders they admire. You may never have had the opportunity to observe compassionate leadership in action. To help you learn how to become a compassionate leader, this section will focus on specific actions that leaders can take that demonstrate compassion. At the end of the section, I will invite you to explore which behaviors or actions you already do and which behaviors or actions you would like to do more of. Since this section is only intended to provide some examples of compassionate leadership behaviors and is not meant to be an exhaustive list of all compassionate leadership behaviors, you may also identify other ways leaders can or do display compassion in your workplace.

Nursing managers’ caring behaviors have been grouped into the following categories: mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, facilitating a healing environment, attending to basic human needs, and affiliation needs (e.g. work-life balance and team development) (Kostich, et al., 2020). These themes came from a synthesis of research with nurses (Kostich et al., 2020). They provide a useful way of discussing compassionate leadership, and I will use them as a framework for the discussion in this section.

The first theme, mutual problem solving, which is also a characteristic of the servant leadership style, involves encouraging participation from staff in decision making (Furunes, et al., 2018). This may be done informally by asking for feedback from individual staff, or formally through a mechanism such as a practice council or committee. By displaying an encouraging manner, compassionate leaders can indicate support for the decisions that their team makes, and can assist in these decisions by helping them obtain the resources they need to enact these decisions (Morsiani, et al., 2017). Leaders can also demonstrate compassion by encouraging individual team members to further their careers, to seek additional educational opportunities, and to work on their strengths (De Zulueta, 2015).

Leaders who display attentive reassurance are physically present on the unit and are able to offer support during times of crisis (Kostich et al., 2020). Sometimes the mere presence of a leader in the unit can be an act of compassion (Shuck, et al., 2019). It is even more compassionate when the leader pitches in to help! Attention implies noticing, which as we have discussed previously in this book, is the first step of a compassionate response. Leaders cannot notice suffering if they are not physically present on the unit, or if they do not take the time to check in with their staff on a frequent basis (Vogel & Flint, 2021). Leaders can offer attentive reassurance by maintaining an air of quiet competence during crises. In a crisis or an emergency, being a compassionate leader means giving orders, establishing boundaries, and helping staff to put aside their emotions to get the job done. Attentive reassurance also involves listening to the concerns of team members, and allowing them to express their full range of emotions (Vogus & McClelland, 2020).

When leaders facilitate a healing workplace environment, they also display human respect, and attend to basic human needs. A healing workplace environment is one in which staff are able to discuss their emotions after difficult encounters with co-workers or patients, or after a traumatic patient outcome (such as an untimely death or unfavorable patient outcome) (Kostich et al., 2020). In cases of workplace bullying or unresolved conflict between team members, compassion enables leaders to see the humanity in “both the perpetrator and victim of harm and thus allows [them] to intervene in abusive situations in a balanced, thoughtful way.” (The Dalai Lama & Chodron, 2017 p. 54-55). 

Human respect and attention to basic human needs go hand in hand. Specific behaviors in these categories include making sure all team members get adequate breaks – both during work and between shifts, making sure working conditions are safe (e.g. safe staffing, lift aids to prevent musculo-skeletal injuries, and programs to address workplace violence), and attending to team members’ psychosocial needs. A respectful and healing workplace environment is protective against compassion fatigue and burnout, supports workers’ safety, and leads to quality patient care (Shea & Lionis, 2017).

When leaders display appreciation of unique meanings they recognize that team members are valuable contributors to the team, and that they are not replaceable “cogs” in a corporate machine (De Zulueta, 2015; Kostich et al., 2020). Appreciating team members’ uniqueness also involves seeing and honoring the diversity of staff, and actively seeking out the contributions of team members who may have felt marginalized for any reason (Sims, 2018). Compassionate leaders also need a degree of flexibility. They need to understand that rigid policies and procedures may harm some employees. For example, a policy that limits the number of sick days an employee can use will cause more harm to a parent with young children, an employee with a chronic health issue, or an older employee with aging parents or an aging spouse than a single, healthy, young worker. This type of policy does not take into consideration the unique needs of each employee and is inherently lacking in compassion (Worline & Dutton, 2017).

Finally, and probably most importantly, leaders can demonstrate compassion by attending to team members’ affiliation needs (Kostich et al., 2020). Simply put, an affiliation need is the very basic human need to belong to a group (Gilbert, 2015). Leaders can attend to affiliation needs in the workplace by conducting team building exercises and by making sure that no one is deliberately excluded from committees and work-related social events. Leaders also need to be aware that team members’ affiliation needs extend beyond the walls of the organization. Leaders need to be aware of their own, and their team member’s, needs for work-life balance. Since staffing requirements in many healthcare organizations mean that some people will have to work holidays, and since weekend shifts may be part of their regular rotation, leaders need to make sure that the burden for working these days is shared equally among all staff. Finally, supporting work-life balance is easier when policies are drafted with consideration of the affiliative needs of employees. In the next section I will discuss the creation of policies, procedures, and ways of doing work that facilitate compassion.

EXERCISE: Exploring Compassionate Leadership Actions

This exercise can be done with a group or on your own. If you are doing it with a group, you might replicate the table that is below this paragraph on a white board or other large surface. If you are doing it alone, you can replicate the table on another sheet of paper or print this page and write on it. On the left-hand side of the table, I have listed the broad categories of compassionate leadership behaviors that I discussed in the previous section. In the right-hand side of the table I invite you to list some specific ways that compassionate leaders, both informal and formal, can exemplify these behaviors. Circle, or place stars by the ones you have observed (or which you yourself do). Feel free to use the examples I listed above as a starting point. I am confident that you can think of many more examples than I offered. Also note that I have listed an “other” category at the end of the list since it is possible that you think of compassionate leadership actions and behaviors that do not fit into any of the categories that I discussed.

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Building Compassionate Systems and Processes

It is easier for employees and leaders to express compassion in organizations that have policies and procedures that center compassion (Worline & Dutton, 2017). It is beyond the scope of this chapter to discuss these processes in detail, and it is possible that many of the readers of this book are not in a position to affect change in the way work is done on a systemic level within their organization. I recommend those of you who are interested in learning more about how to build compassion into the architecture of your organization to read Awakening Compassion at Work by Monica Worline and Jane Dutton. For the rest of you, I will briefly outline some compassionate processes that can be enacted at a unit or department level. If you are in a formal leadership position, perhaps you have the power to enact these processes. If you are in an informal leadership position, perhaps you have the power to advocate for these processes.

Organizations as a whole, and smaller units within organizations (such as a department, a unit, or a ward), operate through an interwoven system of routines, roles, networks and cultures (Worline & Dutton, 2017). When compassion is built into these systems, it is easier for members of an organization or sub-set of the organization to act with compassion. Routine practices in most nursing units consist of events such as hiring, onboarding, shift hand-offs, performance reviews, and daily staffing. When making hiring decisions, managers can make their decisions based on their perception of an applicant’s compassion competence. During the onboarding process, care should be taken to make sure that new hires understand how to incorporate compassion into their role (this is easier to do if compassion is actually written into the job description) (Worline & Dutton, 2017). Effort should also be made to help new hires develop a network of coworkers they can depend on for help, for example via a formal mentorship program (Salmond, et al., 2019). Incorporating discussions of self-compassion, compassion for co-workers and patients and how to address compassion fatigue into such a program would be ways of emphasizing the importance of compassion to the organization. Efforts to build compassionate communities and networks should not end with onboarding, but should be part of the regular practice of all workplaces (Hofmeyer, Taylor, & Kennedy, 2020). Take a moment to reflect on what your workplace does to build community.

Another routine practice in organizations is the annual performance review. In organizations that are serious about developing and sustaining a culture of compassion, compassion competence should be an area of discussion during the annual review. However, rather than approach the subject in a punitive manner, which would block compassion, the review could include questions such as: “Tell me about some of the ways in which you have acted with compassion towards patients, their families, and your co-workers during the past year,” and “how has the organization helped/hindered your ability to act with compassion towards patients, their families and co-workers?” If an organization is serious about compassion, they also need to reward formal leaders’ compassionate actions, just as they reward other performance metrics such as fiscal responsibility or positive patient outcomes (Worline & Dutton, 2017).

Policies that center worker health such as flexible time off, discouraging overtime and generous family leave policies are other examples of compassionate practices at a systemic organizational level (Hofmeyer et al., 2020). While you may not be able to change these policies, you may be in a position to affect how they are enacted. In one nursing unit where I worked it was very easy for nurses to get time off to care for a sick family member, the nursing manager took them off the schedule and found a replacement for their shift. In another unit, we were expected to find our own replacement if we had a family emergency. Imagine how stressful it is to simultaneously deal with a family emergency while trying to find someone to cover your shift! It was no wonder that that particular workplace was chronically short staffed.

Policies and procedures that emphasize root cause analysis of errors rather than blaming and shaming are another way in which healthcare organizations can demonstrate compassion (De Zulueta, 2015). These policies also contribute to an atmosphere of psychological safety and actually lead to fewer errors in the long term (Ridley et al., 2021). Threats and punishments trigger our threat /self-protection and incentive/reward systems and block neuroendocrine pathways towards compassion, and can also hinder learning. When people make mistakes, we want them to learn from their mistakes, so hindering learning can actually lead to more mistakes.

Building a culture of compassion takes time and energy. Compassion cannot just be a part of an organizations’ mission statement, it needs to be part of the everyday culture of an organization (Worline & Dutton, 2017). In healthcare, one of the ways of doing this is by providing formal support for practitioners who are experiencing grief or trauma related to patient care or personal circumstances (Vogus & McClelland, 2020). Providing time for decompression and establishing a supportive team that allows for expressing grief and actively works to counter compassion fatigue are important features of a culture of compassion (Salmond et al., 2019). Formal intervention programs such as a “code lavender” which provide real-time support after a traumatic event or stressor (Davidson, et al.i, 2017; Stone, 2018) are ways in which an organization can operationalize compassion.

EXERCISE: Building Compassion into your Unit’s Operations

You may do this exercise alone, but ideally it would be done with a group from your organization. Consider bringing the questions below to the whole unit – as part of an in-service, a workshop or a unit level meeting. Ideally, this exercise would be done on a regular basis in order to gauge the unit’s progress towards creating compassionate operational procedures. Questions were adapted from (Worline & Dutton, 2017). In this exercise you will assess the following areas of organizational life: networks, culture, roles & routines.

Networks:

1. Do we currently bring groups of people together with the mission of supporting the spread of compassion in our unit?
2. Do co-workers support each other in ways that are compassionate? Do they support expressions of compassion?
3. How can we either build new networks of people, or strengthen existing networks, with the goal of supporting the spread of compassion in our unit?

Culture:

1. In what ways do we demonstrate and act on our values of shared humanity and the belief that people are good, capable, and worthy of compassion? [If these values are not in the mission statement of the organization, consider adding them to your department’s own mission statement or code of conduct.]
2. What else can we do to demonstrate and act on our values of shared humanity and the belief that people are good, capable, and worthy of compassion?

Roles:

1. Looking at the various roles within our unit, do they all explicitly include responsibility for compassion?
2. How can we redefine and reimagine the various roles within our unit to include a greater and more explicit responsibility for compassion?
3. How can we reinforce, in a compassionate manner, that kindness and compassion are core values of our unit?

Routines:

1. In what ways do our current work routines, policies or procedures attend to basic human needs and allow responses to human pain and suffering?
2. How can we rearrange or change our work routines, policies or procedures so they allow us to attend to our basic human needs and facilitate responses to human pain and suffering?

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Common Roadblocks to Compassionate Leadership

In this section I will discuss some common myths about compassionate leadership. I will also explore some organizational and personal blocks that impede compassionate leadership responses. As you read this section, I invite you to think about whether these apply to you, and how you can overcome them. In the exercise accompanying this section I will invite you to explore these thoughts and will also invite you to explore any roadblocks to compassionate leadership that I did not identify or discuss in this section.

There is evidence that as people gain power (and wealth), they become less compassionate (Gilbert & Mascaro, 2017). It may be that the competition and drive that is required to rise to, and keep, a position of power leads to an overdevelopment of the incentive/resource seeking and threat/self-protection neural pathways and an underdevelopment of the soothing/contentment pathways (Basran, et al., 2019). Additionally, people in formal leadership positions may have authoritarian tendencies, which can also block compassion (Gilbert & Mascaro, 2017). To counter authoritarian tendencies, leaders should work to nurture a relational, collective approach to leadership (De Zulueta, 2015; West, 2020). Learning more about relational styles of leadership, such as servant leadership which I discussed earlier in this chapter, is one way leaders can counter any authoritarian tendencies they might have.

Within healthcare organizations, a market based business model can also block compassionate leadership (De Zulueta, 2015; Iles, 2016). In a market-based approach managers are rewarded for meeting productivity goals and operating within tight budgets. The emphasis of market based healthcare changes from caring about patients to caring for patients, a subtle switch that can block compassion (Iles, 2016). A focus on finances and productivity goals creates organizations that devalue individual employees, and can create an environment in which employees are seen as interchangeable cogs in a machine (De Zulueta, 2015). This mindset leads to a feeling that if an individual employee leaves, they can be easily replaced. Ongoing and recurrent world-wide shortages of nurses, which have been exacerbated by the COVID-19 pandemic, illustrate that it is not necessarily easy to replace nurses. While unit level leaders cannot change the focus of an organization (indeed it may even be hard for top-level leadership to affect this type of change), they can create an environment in which individual employees feel valued. Nurses who feel respected, valued and supported by their management are more likely to stay in their jobs (Loft & Jensen, 2020).

Compassionate leadership can also be blocked by the real need to manage the performance of employees. There are quality standards that need to be upheld, particularly in healthcare. Employees who are embroiled in conflicts may violate the norms for professional and civil workplace behaviors, and managers will need to address these performance issues. There is a myth that if a leader shows compassion, they will not be able to discipline their employees nor will they be able to maintain professional workplace boundaries and standards of conduct.

However, managers can address performance deficits or behavioral issues with compassion. They need to take the time to get to the root of the difficulty – perhaps there are personal stressors that are affecting performance, perhaps there are conflicts between workers that need mediation, or perhaps the person who is struggling is not suited for their position. Compassionate management requires a generous interpretation of whatever difficulties employees experience, as well as providing them ample opportunity to correct their performance issues (Worline & Dutton, 2017). However, compassionate management does not require unlimited opportunities for improvement, and ultimately, managers will need to terminate employees who do not show improvement within a reasonable amount of time (Shuck et al., 2019). Terminating employees who do not fit into the culture or who do not live up to the standards of the unit is an act of compassion (Worline & Dutton, 2017). When the employee who was terminated was engaging in toxic or disruptive behaviors, terminating them can be the first step in creating a new environment of civility, respect and compassion within the workplace. When an employee who is not living up to performance standards is terminated, it is an act of compassion for the people they worked with, and the patients they cared for.

EXCERCISE: Identifying Mental and Organizational Blocks to Compassionate Leadership

This exercise can be done individually or with a group. Think about the following questions. You may choose to write your answers down. If you have worked in several settings, it might be useful to think about the differences between them, especially if one was more compassionate than the other.

1. Does your organization value individual workers? How does this value (or lack thereof) manifest?

2. Does your unit or department value individual workers? How does this value (or lack thereof) manifest?

3. What can you do, as a formal or informal leader, to acknowledge the inherent worth of each of your co-workers?

4. When someone is struggling at work with performance issues or behavioral issues, does management (or do you, if you are in a formal leadership position) take the time to explore the root causes for the difficulty? [You may not know the answer to this question – if that is the case think about how you react when someone has performance or behavioral issues. Do you try to understand why they might be struggling, or do you immediately judge them for their behaviors?]

5. What organizational blocks to compassionate leadership do you identify in your organization? How might these be overcome at the level in which you operate?

Conclusion

In this chapter we explored what compassionate leadership looks like. I discussed servant leadership, a leadership style that is inherently compassionate. I also discussed specific actions or behaviors a compassionate leader can engage in. Then I briefly discussed how organizational policies and procedures could be modified to make compassionate actions easier for all workers. Finally, I briefly discussed some organizational factors that might block compassionate leadership.

You might recall that at the beginning of this chapter I invited you to complete the exercise entitled “What are my thoughts on compassionate leadership?” At this point I invite you to revisit your answers. Did your answers to the questions change after reading this chapter, or were your opinions validated? What did you learn about your current leadership style from reading this chapter?

Key takeaways from Chapter 6

• Both formal and informal leaders in healthcare workplaces have a role in creating conditions where workers can act with compassion towards each other, and towards the patients and clients they serve.
• Servant leadership, with its emphasis on taking care of the needs of the team, is a leadership style that is inherently compassionate.
• Leaders can demonstrate compassion by engaging in mutual problem solving, offering attentive reassurance, respecting team members, adopting an encouraging manner, appreciating the unique contributions of team members, facilitating a healing environment, attending to basic human needs of team members, and being attentive to the affiliation needs of the team.
• To develop a truly compassionate workplace, organizations need to adapt routines, roles, networks, and cultures with compassion in mind. While leaders may not be able to change organization-wide policies and procedures, they can work on routines, roles, networks and cultures within their unit or department.
• A block to compassionate leadership might be an association of compassion with weakness. However, compassionate leadership does not mean that behavioral or performance issues need to be tolerated, rather that these issues should be handled with compassion and courage. Terminating and disciplining employees can be done in a manner which is consistent with compassionate leadership principles.

References for Chapter 6

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Davidson, J. E., Graham, P., Montross-Thomas, L., Norcross, W., & Zerbi, G. (2017). Code Lavender: Cultivating intentional acts of kindness in response to stressful work wituations. EXPLORE, 13(3), 181-185. doi:10.1016/j.explore.2017.02.005

De Zulueta, P. (2015). Developing compassionate leadership in health care: An integrative review. Journal of Healthcare Leadership, 1. doi:10.2147/jhl.s93724

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Eva, N., Robin, M., Sendjaya, S., Van Dierendonck, D., & Liden, R. C. (2019). Servant leadership: A systematic review and call for future research. The Leadership Quarterly, 30(1), 111-132. doi:10.1016/j.leaqua.2018.07.004

Furunes, T., Kaltveit, A., & Akerjordet, K. (2018). Health-promoting leadership: A qualitative study from experienced nurses’ perspective. Journal of Clinical Nursing, 27(23-24), 4290-4301. doi:10.1111/jocn.14621

Gilbert, P. (2015). Affiliative and prosocial motives and emotions in mental health. Emotions, 17(4), 381-389. doi:10.31887/dcns.2015.17.4/pgilbert

Gilbert, P., & Mascaro, J. (2017). Compassion fears, blocks and resistances: An evolutionary investigation. In E. M. Seppala, E. Simon-Thomas, S. L. Brown, M. Worline, C. D. Cameron, & J. R. Doty (Eds.), The Oxford Handbook of Compassion Science (pp. 399-420). New York: Oxford University Press.

Han, J. H., & Roh, Y. S. (2020). Teamwork, psychological safety, and patient safety competency among emergency nurses. International Emergency Nursing, 51, 100892. doi:10.1016/j.ienj.2020.100892

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond? Nurse Education Today, 94, 104502. doi:10.1016/j.nedt.2020.104502

Iles, V. (2016). Managing for compassion. In A. Hewison & Y. Sawbridge (Eds.), Compassion in Nursing (pp. 152-171). New York: Palgrave Macmillan.

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