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bloodnsplinters t1_j0giczs wrote

I think compassionate staff are more able to do their job when supported by compassionate management and commissioners. Shouldn't any compassion intervention be applied systematically through the service? Else you risk a "compassion gap", already present ( imo) between patient facing staff and their non-patient facing management structures.

This reminds me of the resilience training for front line staff. I worry that this scapegoated staff capacity, rather than address unreasonable expectations by their managers and commissioners.

Tldr: Don't mistake a symptom for the disease.


UniversityofBath OP t1_j0glq42 wrote

I couldn't agree more! I've got increasingly interested in organisational and systemic elements of compassion fatigue and compassionate care in general. I did a masters in organisational psychology recently and I'm hoping to be able to pull together knowledge about individual level interventions for staff with more organisational level interventional components which tackle work conditions. It's a bit of a tall ask but that's the plan!


UniversityofBath OP t1_j0gl4ld wrote

Yes! Couldn't agree more. I got very interested in the organisational aspects of compassion fatigue. I ended up doing a masters in organisational psychology and thinking about how some of these ideas about workplace conditions might influence staff ability to provide compassionate care. I'm in the very early stages now of a 5 year project but the aim is to develop a multi-level intervention, not something which is just for staff, but which also involves managers and possibly commissioners.


bloodnsplinters t1_j0gnnsh wrote

That's great to hear! I personally feel that the lack of compassion starts at Whitehall and rolls down the hill, ending with a HCA on a 12hr shift, getting yelled at, who then passes the hurt onto the patient.

I'll always remember how one of the Winterbourne view HCAs who was convicted, was voted "most caring" at school, had lots of St John's ambulance experience, wanted to go into nursing. She probably didn't start out abusive, but got there in stages.

What might those stages be? ( Maybe lack of service direction / exhaustion /boredom / suggestiblity?)

It would seem more efficient to start as close to thr top of the pyramid as you can reach (less NHSE /ICB senior leaders to reach, than front line staff).


UniversityofBath OP t1_j0govow wrote

That's an amazing image of it rolling down the hill. The pressures being passed on feels very true. I think there's also the bit about how people who have been traumatised respond to a system around them and how the trauma influences the system too. It's so complex. Important to recognise anyone could be involved in this as a dilemma though, as you say.

There was an article in The Psychologist magazine this week (the British Psychological Society mag) which summarised a book called Hospitals in Trouble by John Martin. I haven't read the book but the authors said certain quite practical aspects of ward location and culture influenced whether care became poor. The factors included ward location, personal and professional isolation of staff and lack of training opportunities. Obviously this is no excuse for abusive practice but I did think it was interesting to think about what factors could act as roadblocks to make abuse less likely.

Thank for your perspective on intervention efficiency - that's a very helpful thing for me to think about.


Own-Tax-2811 t1_j0h8xr6 wrote

By "people who have been traumatised respond to a system around them and how the trauma influences the system too" do you mean that people working in Health & Social Care have often had difficult life experiences which affect how they respond & that can also feed back into a vicious cycle?

I was wondering about a more straightforward or prosaic effect of uncaring/abusive management>systems which reward suboptimal care>having to switch off to avoid moral injury>high likelihood of being uncaring and increased likelihood of being abusive.

I worked for a while in a social care dept where the criteria for receiving social care were being revised. I was an assistant OT, trained in equipment provision only to help make tasks easier where people were struggling (not where they had stopped altogether), but would get referrals like "Due to changes Mrs X is losing her lunchtime meal prep visit, please work with her on food preparation, she hasn't done this for 5 years". I asked for supervision from a qualified OT, which was refused. Management cared mainly about throughput. I left. The only way I could have stayed and not had a breakdown would have been to disengage from caring about the people we worked with.