Christmas 2019: Shiny Happy People
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6099 (Published 16 December 2019) Cite this as: BMJ 2019;367:l6099
- R E Klaber, consultant paediatrician1,
- S Bailey, director of leadership and organisational development2
Cultivation of kindness is a valuable part of the business of healthcare
When we reflect on the past decade, it feels as if we have made a big mistake in healthcare. We have allowed the dominant narrative to be around money, taking the focus, energy, and leadership away from our core purpose of delivering the best care possible. Balancing the books is important, especially in a tax funded system, and we have a duty to drive value for every pound we spend—but money is not the most important thing.
Purpose and meaning
One of the most enduring leadership stories from the 20th century is US President John F Kennedy’s encounter with a janitor when he first visited the NASA space centre. When the president casually asked him what he did for NASA, the janitor replied, “I’m helping put a man on the moon.” This story tells you everything you need to know about purpose and meaning in work. While putting a man on the moon is clearly an exciting mission, in healthcare we have an even better one—to improve health and wellbeing—that is at the core of humanity and is about inspiring hope, compassion, and kindness across communities and populations.
Evidence is growing on the importance of kinship and kindness for health and wellbeing.12 In a report for the Carnegie UK Trust arguing for public policy to be more centred on relationships,3 Julia Unwin describes kindness as disruptive—changing relationships between people, institutions, and organisations. She describes the need to be bilingual in the “rational” and the “relational,” and for the two to be balanced. Achieving this requires a big shift away from the dominant focus on scrutiny, value for money, evidence, targets, organisational and professional boundaries, quantitative data, and accountability to a more balanced approach emphasising relationships, connections, challenge, and trust.
One major barrier is the inherent bias of our measurement systems, which value quantitative data far more than qualitative story-focused measures and outcomes. Kindness has for too long been described in apologetic terms and people are reluctant to use it as a tool because “it’s seen as soft and fluffy.”4Perhaps we need to start valuing kindness for what it really is—the hard edged, mission focused, business end of healthcare.
A study on the role of kindness in improving outcomes for patients with cancer identified six types of kindness5: deep listening, clear empathy, generous acts of discretionary effort that go beyond what patients and families expect, timely care that reduces stress and anxiety, gentle honesty in discussions and conversations, and thoughtful support for families and carers. All should be at the heart of healthcare, giving us purpose, meaning, and satisfaction and joy in our work.
Young people starting careers in healthcare often have a clear view of the healthcare mission and a determination to keep that focus. But it’s easily lost in the busyness of daily work, which clouds that clarity of purpose. The consequences for clinicians, families, patients, and communities are far reaching.
We have a global workforce crisis in healthcare, with projections showing that an additional 40 million health workers will be needed by 2030.67 If current trends continue, healthcare services worldwide will be 18 million short—with more than one in five posts unfilled.67NHS providers in England report a shortage of almost 100 000 “working time equivalent” healthcare staff,8representing 1 in 11 posts. The causes are complex and multifactorial, but how healthcare workers treat each other feels key and is something we can influence and improve.
Drawing on his experience of working in 77 countries, Mark Britnell, chair and senior partner in global health for the professional services company KPMG, argues that despite our enthusiasm for technical innovation, “the kind touch and warm heart of a human being is the essence of care.”9 He suggests that urgent and sustained action to reconnect staff with patients and with each other will help develop the fulfilled, productive, and motivated workforce we need.
Kindness is an essential ingredient in healthcare because the emotion experienced by individuals when receiving or giving kindness can provide the necessary courage to take action. As Marshall Ganz, senior lecturer in leadership, organising, and civil society at Harvard University, says, “Hope inspires us and, in concert with self-efficacy (the feeling that you can make a difference) and solidarity (love, empathy), can move us to act.10 Or, as Samuel Johnson, the 18th century writer, explains, “To cultivate kindness is a valuable part of the business of life.”
- Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
- Provenance and peer review: Commissioned; not externally peer reviewed.
- Ballatt J,
- Campling P
- ↵Ferguson Z. Kinder communities: the power of everyday relationships. Carnegie UK Trust, 2016.Google Scholar
- ↵Unwin J. Kindness, emotions and human relationships: the blind spot in public policy. Carnegie UK Trust, 2018.Google Scholar
- Haskins G,
- Thomas M,
- Johri L
- Berry LL,
- Danaher TS,
- Chapman RA,
- Awdish RLA
- ↵World Health Organization. Dublin declaration on human resources for health: building the health workforce of the future. 2017. https://www.who.int/hrh/events/Dublin_Declaration-on-HumanResources-for-Health.pdfGoogle Scholar
- Beech J
- ↵NHS England. The NHS long term plan. 2019. https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/Google Scholar
- Britnell M
- Ganz M