Enabling compassionate and collective leadership among regional medical leaders, for co-created strategic system solutions to enhance compassionate approaches in governance around the management of doctors with professional standards concerns: initial outcomes from part of a system-wide project series in the ‘growing compassion, NHS England Northwest initiative'

Context‘Growing Compassion' is a regional system wide initiative led by the NHS England (NHSE) System Improvement and Professional standards (SIPS) team in the Northwest (NW) of England.The target audience were Medical directors (MDs) who fulfil the statutory Responsible officer(RO) functions as per the RO regulations in England across primary, secondary and independent care sectors and key external stakeholders (General Medical Council-GMC, Health Education England NW(HEENW), NHS Resolution(NHSR)).Issue/ChallengeThis was launched in response to the impact on healthcare professionals by Covid19 pandemic and the inequities it unveiled.NHSENW challenge and vision were to enable and grow, compassionate collective leadership in the management of professional standards concerns regarding doctors while ensuring governance and reducing inequities., outlines early outcomes of one of the projects within the range of regional series of initiatives on ‘growing compassion' to nurture a compassionate and inclusive culture.Assessment of issue and analysis of its causesStakeholder engagement event was held in September2021.Exploratory intervention through ‘humble inquiry and compassionate listening' to realise the NHSENW vision through Safe space conversations were facilitated through 10small focus groups over RO network events in April/May2022, attended by 71key leaders comprising MD/ROs(90%) and other stakeholders(10%).Talk on Compassionate leadership by NHSENW/GMC/NHSR teams preceded focus groups, aligned all in the definition of compassion and its integral components1 and set the scene for the expectation on collective leadership(2) with, co-created, strategic system solutions, as outcome from focus groups.ImpactEach focus group had a single moderator and 7-9 participants. Two key questions were shared, and outcomes collated.What resources do you have in your organisations to enable a compassionate approach to managing concerns regarding doctors?What can be done collectively to enhance compassionate leadership?InterventionFocus group suggested interventions to enhance compassionate approaches collectively yielded 135 responses categorised under 4key themes.Visible leadership to influence cultures(n=42)Reviewing Systems/processes to embed compassion(n=56)Compassionate language in policies(n=11)Supportive resources: education/training(n=26)Involvement of stakeholders, such as patients, carers or family members:All 71 key audience were NHS users as patients.Key MessagesNHSENW succeeded in demonstrating 6 key effective leadership outcomes achieved at this phase of the project.Effectively transformed compassionate listening into demonstrable co–created, strategic system solutions, for compassionate actions fulfilling fundamentals of compassionate leadership1Effectively laid the foundational elements of collective leadership through setting direction with clear vision, enabling alignment with values and commitment for prioritising/progressing compassionate leadership collectively as regional network of leaders (2,3).Developed a kindness/compassionate pledge and effectively demonstrated how user views can be powerful for value alignment as guiding principles.Compassionate leaders don’t have all the answers and don’t simply tell people what to do, instead they engage with the people they work with to find shared solutions to problems (3)When a leader as NHSENW launches an initiative to realise the vision of ‘Growing Compassion', it paves the way for other organisations/leaders to follow with peer support.System leadership encourages leaders to embrace uncertainty and to get started with initiatives from where you are, with what you have even if whole path is not charteredLessons learntInvestments on qualitative approaches with additional moderator and Patient representation for future.Measurement of improvementNHSENW succeeded to collectively translate ‘compassionate listening to action' and the outcome was a series of co-created strategic system solutions developed in readiness for regiona launch in November 2022.Compassion/kindness pledge as a set of value aligned guiding principles.Compassionate tool kit for supporting doctors/governance/HR teamsEducation/training package for compassionate conversations in challenging situations when managing complex performance concerns by NHSR with NHSENW input.Compassionate Policy updates with people focus more than process focus.Prioritising compassionate leadership &Sharing good practice to spread compassionate ripple furtherOnboarding support package for new International Medical Graduate Doctors awaited from HEENW.NHSENW risk assessment template for objective assessment on thresholds for formal investigation to reduce bias/enable consistency/transparency shared.(4)NHSENW investigation closure template updated to capture system/contributory factors/organisational learning to ensure a compassionate approach beyond human factors and shared.Strategy for improvementAll co-created strategic system solutions developed as outcome from focus groups is to be launched regionally at the RO/MD network event in November2022.These outcomes from initial phase form the interventions for next phase of cycle. NHSENW will continue to monitor impact, through Quality Improvement methodologies including further focus groups in autumn2023, leaders interviews &next PDSA cycle (Plan-Do-See-Act).