Abstract
The aim of this study was to critically analyse the impact of the ‘Leadership in Compassionate Care Programme’ and offer a conceptual model of factors that can embed compassionate care in contemporary health care environments. This three-year initiative (2008–2011) was designed to embed compassionate care in both practice and pre-registration education. Using a realistic evaluation approach this longitudinal qualitative study involved data collection in eight participating wards. The ‘level of adoption’ of the Programme varied across the wards, which pointed to key context and mechanisms that were influential in embedding compassionate care. Contextual factors that promoted adoption of the Programme were stability, support and leadership. The most important mechanisms were appreciative inquiry coupled with skilled facilitation. Powerful practice development techniques focused on articulating and demonstrating values; giving patients, relatives and staff a voice to express their experiences and emotions; and instituting effective feedback mechanisms. In the high adopting wards the main outcomes included personalisation of patient care, an increased sense of involvement for relatives and ‘caring conversations’ becoming an accepted part of working practice. Embedding and sustaining compassionate care demands strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development and effective leadership at all levels.
Highlights
Concern about the delivery of compassionate care in the UK National Health Service (NHS) has become a focus of debate (Patients Association, 2011; Holmes, 2013) and internationally there has been similar alarm about patient experience in hospitals and care homes (Clarfield et al, 2001; Youngson, 2008; Lown et al, 2011)
The aims of this paper are to present a critical analysis of the ‘Leadership in Compassionate Care Programme’ (LCC Programme) and offer a conceptual model of factors that can enhance organisational capacity to develop and sustain a culture of compassionate care
Conceptual Model The findings have led to the development of a conceptual model of factors that can enhance organisational capacity to develop and sustain a culture of compassionate care (Figure 2)
Summary
Concern about the delivery of compassionate care in the UK National Health Service (NHS) has become a focus of debate (Patients Association, 2011; Holmes, 2013) and internationally there has been similar alarm about patient experience in hospitals and care homes (Clarfield et al, 2001; Youngson, 2008; Lown et al, 2011). At the inception of the LCC Programme in 2007 the term ‘compassion’ was not strongly linked to patient experience, ‘dignity’ was a key concept for the expression of concern about the care of older people (Agnew, 2007; Reed and McCormack, 2007) and the focus of a number of initiatives (Healthcare Commission, 2007; Department of Health, 2009). More recent research has sought to define compassionate care from the perspectives of patients, staff and students (Van der Cingel, 2011; Curtis, Horton and Smith, 2012; Bramley and Matiti, 2014), develop a conceptual model for compassionate relationship-centred care (Dewar and Nolan, 2013) and identify educational approaches to enhance compassionate interactions with patients (Betcher, 2010; Sheild et al, 2011; Adamson and Dewar, 2015)
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