The art of door slamming: Compassionate care and leadership

Yvonne Sawbridge, Senior Fellow, HSMC

I was collecting a parcel from a post office sorting office and watched a receptionist engaged in emotional labour.* She was signing four workmen in, all of whom were belligerent because they were unable to access the site through the most convenient entrance. Each expressed their frustration individually to the receptionist as they signed in, as well as collectively whilst waiting for their colleagues. On each occasion the receptionist met their eyes, smiled appropriately whilst acknowledging their feelings and calmly explained it was for security reasons. Their anger had nowhere to go, and it left with them. The receptionist removed herself from public view by going into the sorting room, and firmly closing the door behind her (some might say slamming?!) I hope she found a colleague to vent to, or some means of releasing the tension so that her emotional bank account was topped back up, ready for the next withdrawal required for future interventions with the general public or contractors.

This type of encounter is even more commonplace in health and social care services, where patients and their loved ones are facing anxiety, distress, pain and sometimes death. If frustration can surface when access to a building site is difficult, how much more acute would this be when you are waiting for test results, or discharge arrangements? To exhibit compassion and kindness in the face of anxiety and anger demands a huge amount of skill and emotional resilience, and the support and understanding of leaders is crucial. If you then factor in a demoralised workforce, some of whom have taken strike action for the first time for 32 years (and first ever for Midwives) imagine this perfect storm of frustration when the ability for the staff to calmly smile and meet the eyes of their patients may well be compromised unless they have leaders who understand the toll of emotional labour, and work to create a compassionate environment for staff and patients.

Compassionate leadership is particularly difficult in a command and control environment, obsessed with targets and “heads will roll” accountability measures. Imagine Jeremy Hunt’s personal  call to every Chief Executive in a hospital Trust failing to achieve their  four hour A&E waiting times target. Was this interaction compassionate I wonder, demonstrating empathy and a desire to help someone in their suffering?  In my years as a Director in the NHS I witnessed bullying behaviour at numerous meetings that I would never have allowed my children to exhibit at home. I saw experienced directors shaken and in tears when told to “just do it”- the “it”  being unpalatable -such as reducing the workforce head counts which some believe was a precursor to some of Mid Staffs failures. I heard language similar to that at football matches, and less well intentioned. Given all this, I find it intolerable at times to hear leaders  extol the need for staff to be compassionate, when they show no signs of being able to role model this behaviour, or support their staff to act in this way.

Back to the post office worker- I hope they had a compassionate leader –or at least a non-judgemental approach to fixing door hinges!

*Emotional labour defined  by Hochshild (1983, p7) as “the management of feeling to create a publicly observable facial and bodily display.”

References

Hochshild, A.R. (1983) The managed heart: commercialization of human feeling. University of California Press. Berkley