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Hands up for a kinder, more caring health system

The Gathering of Kindness is an annual event that brings together people from inside and outside the healthcare sector to imagine a system where kindness, trust and respect are fundamental.

The COVID-19 pandemic shifted the discussions online this year; these were live-tweeted by Jennifer Doggett for the Croakey Conference News Service on World Kindness Day (13 November), as reported below.

The sessions were:

  • Kindness in Practice, in Policy, and Within a Pandemic, with Simon Anderson, co-author of Kindness in Public Policy in Scotland, an independent research consultant, and an Honorary Fellow in the School of Social and Political Science at Edinburgh University.
  • An exploration of wisdom and styles of leadership, with Dr Chris Turner, Consultant in Emergency Medicine, NHS University Hospitals Coventry & Warwickshire.
  • Resilience at a Time Like Now and What’s Next for Healthcare? Expert panel with Dr Julia Harper, College of Intensive Care Medicine, David Clarke, Australian Institute of Health Safety, and Dr Carmel Crock, Royal Victorian Eye and Ear Hospital.

To stay in touch with the #KindnessWorksHere conversations and participants, follow this Twitter list from @CroakeyNews.


Jennifer Doggett writes:

Scottish researcher Simon Anderson is speaking to us from North Berwick, which is a small town on the coast near Edinburgh, about a paper he wrote with Dr Julie Brownlie on kindness in policy in Scotland.

Brownlie is a sociologist at Edinburgh University with a background in sociology of emotions and personal relationships. Anderson is an applied social researcher.

A few years ago they were commissioned by a large charitable trust to do some work looking at experiences of low-level help and support in a community setting in Glasgow.

After that project, they started to think that the language of kindness was a very useful framing and that despite the fact that it’s a very accessible lay concept it wasn’t being talked about much in academic circles or in policy.

They started to use the language of kindness in their work, which got picked up by others including the Carnegie UK Trust, which organised the Kindness Innovation Network 2018, bringing together people from across Scotland with an interest in these issues.

They also were very engaged with the Scottish Government around its refresh of the National Performance Framework for Scotland. As a result in 2018 that included a reference to kindness as a central core value.

It’s a program of work that’s been going on for a few years now. It’s had both academic and applied dimensions to it, and it’s one we’re very committed to.

Understanding kindness

Anderson says kindness has a kind of unstable character – the same act done on different occasions doesn’t have the same meaning and it may tip into some other kind of relationship.

He identifies that what is distinctive about kindness is that it has a kind of unobligated character and that this gives it its emotional charge. Once something is expected or required it becomes duty or obligation – not kindness.

He adds that they have been critical of people in policy and academic settings who don’t say what they mean by the term – he feels it is not just an intangible value or an individual character trait but can be made much more concrete.

For example, the things that we do for one another, both practically and emotionally, in response to moments of perceived need, when there is the option to do nothing.

This means that you can’t just focus on the acts or the behaviours that might considered kind – it’s also about measuring whether you’ve created the conditions for those things to occur, and whether you’re able to measure the likely outcomes from them.

The navigation of kindness from an organisation perspective is complex and the focus should be on creating opportunities for kindness and relationships to develop. It’s much easier to accept kindness if you’ve had an opportunity to give it.

Organisations should recognise that this stuff is complex and can be emotionally fraught and risky. People can be about being seen as weak or needy on the one hand, or about being seen as a martyr or overstepping the mark on the other.

Pandemic questions

He also thinks that the pandemic has strengthened community and local relationships and increased civility.

They describe how hospitals have been intentional about supporting staff through the pandemic and enabling frank conversations about how they are coping

Lots of questions and comments about the impact of the pandemic on kindness, one participant says wearing masks makes it harder to read people’s expressions.

Anderson says kindness is definitely a gendered discourse and it is difficult to disentangle gender from the roles traditionally undertaken by women.

Another question on how kindness can help moving out of the pandemic – he says managers and leaders have a crucial ongoing role.

Unfortunately there is no app which measures kindness in an organisation! Like all forms of performance management it is challenging to measure kindness.

There is no straight line between kindness and patient outcomes but there is good evidence that these two things are connected.

Trust is also essential and allows people to take the leap of faith to increase kindness.

Participants emphasise the importance of music and art in supporting kindness in hospitals. One comment describes how music made families and staff feel more calm in hospital. Small things can make a big difference!

There are many different relationships within healthcare sessions which could all potentially be full of kindness – there is no question that healthcare is a realm in which kindness is incredibly important.

Healthcare is much more than the processes and the procedures and the medicines and treatments. It’s embedded in much wider networks of care, both within and outside those formal settings.

To questions about organisational frameworks for supporting staff – Simon Anderson says there is no specific tool for this. A participant comments that this needs to be developed, and should focus on modelling and supporting kind behaviours.

He says we need to leave those spaces in healthcare organisations and healthcare settings, as elsewhere, to allow kind behaviours to come through.

In practice people are operating with a huge amount of organisational discretion all the time, but organisations don’t often recognise that or reward it or enable it.

Healthcare traditionally is a setting which is very hierarchical and role-proscribed – there’s a lot of focus on what you must and mustn’t do. But less of a focus on what your role allows you to do.

Potential risks

Simon Anderson says that kindness in any setting carries risks, both to individuals and the organisation. People risk being seen as stepping outside of their role, or that their offer might be misconstrued or penalised or exploited.

There are more progressive and disruptive and radical versions of kindness, and more conservative ones – it’s important to have conversations about what exactly is meant by kindness in the context of your particular workplace.

In practice, people are operating with a huge amount of organisational discretion all the time, but organisations don’t often recognise that or reward it or enable it.

But those stories or narratives need to be authentic – it’s not enough for an organisation to declare we are now a kind organisation. The staff and the service users need to feel that that’s consistent with their experience of it.

One of the things we’ve said that organisations can do about kindness is to listen to and tell stories that are supportive or enabling or permitting of kindness.

Paradoxically, he thinks some people have discovered during the pandemic that they’ve had more time to rediscover the relational possibilities of their jobs.

So there’s been a kind of focus on the fire-fighting and getting the basics done.

Another issue is time. For many people in healthcare settings the time they have had to engage in the relational and the interpersonal and the more human aspects of their jobs has been radically cut in recent years, along with funding for services.

Whether those are coffee rooms, chill out spaces, or even just general architecture that allows flows of people through buildings to encounter one another, and maybe to get outdoors and to talk and relax in the course of their working lives.

Organisations are communities in their own right, and having spaces within them which bring people in to accidental, unstructured contact with each other that aren’t wholly geared towards the delivery of organisational goals is really important

Also important are physical spaces that leaders can attend to in healthcare settings.

Civility can be life-saving

Dr Chris Turner, an emergency medicine consultant in Coventry, and Dr Catherine Crock, founder of the Hush Foundation on civility in leadership, put the focus on wisdom and styles of leadership.

Turner is a musician who once won Battle of the Bands and got to support the Hoodoo Gurus which he describes as the pinnacle of his musical career

He started looking at the evidence and it became clear that an awful lot of the reasons why people aren’t performing at their peak is because of how they feel they’re being treated by the people around them.

He said this was not talked about as the focus was on people who’d gone off process or gone off protocol.

A huge part of that is the civility of the interaction and that manifests itself frequently as kindness.

One of the ways that we can help people to perform at their absolute peak is by being supportive, making sure that they feel as safe as possible.

Turner and Joe Farmer started Civility Saves Lives, which got its own legs very quickly, and has been invited to be part of all sorts of different things and Turner got a chance to do a couple of TED talks and has presented to the House of Lords.

A win-win

Civility is a useful term to use when arguing for around outcomes or reputation or finance and Turner says if we’re going to go down those routes then it was easier to use civility as a word.

Executive boards care about reputation and finance – the organisations with the highest levels of civility and respect spend on average $2 to $3 million US  less per year on equal opportunities legislation and $26 million less on sickness absence.

He said: We’re talking about creating cultures where people feel respected and where they want to go to work and they then feel engaged and when people are engaged you get extra discretionary effort for them so they put in more time when they get to work.

It’s a win, win. This isn’t about squeezing work out of people, this is about the people going to work feeling the best they can and the organisation getting the benefit of all the extra work that people do when work is a good and a worthy thing

Healthcare is extremely creative – on a good day we have five to seven things in our bandwidth, but when people start to treat us disrespectfully that bandwidth gets squeezed by our natural cortisol fight or flight response.

People go into something called the freeze state where they just stand there and all they can do is just breathe and stand there.

When we treat each other well we keep our bandwidth as open as possible and that creates the possibility of the best possible answers.

There’s 30 years of research about how you stress-inoculate yourself to hostile seniors and the bottom line is it doesn’t really work.

In the moment when somebody is treating you poorly or you perceive that they’re treating you poorly it’s going to have an impact on you and that’s not your fault, that’s just you being a human being.

There are two people who can do things about it, though. The first one is bystanders and the second is leaders,

If you think about your good days at work and you think about your less good days at work, on good days how are people around you treating you and on bad days how are people around you treating you?

What people find is that on good days they were treated well by the people around them, on bad days they didn’t feel like they were treated well by the people around them.

It turns out that the second most important factor determining our level of engagement at work, and that closely correlates to wellbeing, is how we feel our immediate line manager is treating us.

When our immediate line manager treats us respectfully, they listen to us and we feel like they care about us, we are much more engaged.

When they treat us poorly we are much less engaged.

When they treat us well, our wellbeing is good; when they treat us poorly, our wellbeing is less good.

Turner discusses consequentionalists (outcome-focussed); deontologists (rule followers); and those who practice phronesis (taking into account a broad range of issues in decision making).

Phronesis is making decisions based on what we feel is the right thing at that time in that situation for that person but doctors are often not able to do this.

Nobody deliberately makes the wrong decision. It’s too dissonant. Unless you’re engaged, we can’t cope with that. We make the decision that we’re forced to make most of the time.

Listening matters

Catherine Crock asks Turner if it’s about coming to an understanding of other people, particularly those that you’re working with and the patients and families.

He says we can only get there when we stop and take the time to ask people about their perspectives, when we don’t assume that we know better, when we listen to them and actually properly listen.

Listening to people is crucial.

If we actively listen to each other we get better decisions – not easier decisions, they often get harder because you get more information but it’s part of our responsibility to our patients and those around us and how we get to the best results.

He also stresses the importance of diversity saying that we need to be listening to different voices, we need to be making it safe for different voices to talk.

Turner says we can only get there when we stop and take the time to ask people about their perspectives, when we don’t assume that we know better, when we listen to them and actually properly listen.

Crock discusses how medical culture works against people admitting they don’t know everything and creates stress.

Turner adds that there is tremendous pressure on senior doctors to have all the answers – it shouldn’t be a sign of weakness to admit you are wrong or made a mistake.

Turner says it’s fantastically empowering to know that how we treat the people who directly report to us is going to determine their day.

We can make somebody else’s day better by the simple act of treating them with respect, listening to them and making sure that they feel heard.

Crock describes how flattening her team’s structure helped everyone get to know each other and increase the trust and sense of safety – which lead to better decisions.

Chris Turner talks about how important it is to foster a sense of shared purpose and create environments where people have opportunities.

Phronesis of wisdom is hard to identify but one criteria for clinicians is those who make wise choices – identified by peers and subordinates.

Responding to a question about the role of clinical and non-clinical roles in health care, Turner says all relationships are important; goal alignment and communication are key.

Communication in stressful environments can be facilitated by discussion beforehand and giving permission to others to question decisions.

Crock describes setting up a positive team environment every day. Checking in with everyone really helps create a feeling of safety.

Turner says that when things need to happen quickly we need to trade on our reputation. We are all in control of our reputations and they can help or hinder us.

He discusses how to deal with problematic communications, which can be difficult in asynchronous relationships, such as senior/junior doctors.

One useful technique is to ensure there is someone to care for the perpertrator and ensure they have an opportunity to know how their behaviour has impacted others.

And this is the soundtrack Chris wants to have when he walks into a room (Deeply Dippy).

On resilience

For the expert panel discussion on resilience, Andrew Gill introduced panel members Dave Clarke, Dr Carmel Crock, Dr Julia Harper and facilitator Sharee Johnson.

Johnson outlined the session focus on resilience at the system rather than individual level. She acknowledges some pushback from health care workers one the term ‘resilience’.

She Johnson says the Gathering of Kindness focuses on how the social and cultural environment of health care supports kindness and resilience.

Carmel Crock describes how her team at the Eye and Ear hosp has coped during the pandemic – there were strong emotions, fear, anxiety and terror.

She also describes ‘robust disagreement’ around personal protective equipment (PPE) and social distancing – which led to a positive outcome of increased openness and honesty.

Carmel Crock says that many of the usual barriers were broken down as doctors had to deal with being terrified of seeing patients.

Julia Harper agrees that there was a lot of stress within the intensive care setting in the early days of the pandemic.

Part of this was that many of the usual supports, such as meeting in the tea room, were taken away. Also doctors missed having family and friends of patients visiting.

Despite all these stresses, Julia Harper has noticed some amazing examples of creativity that have flourished in response to the constraints of the pandemic

She says achieving kindness in the workforce is the same in all areas – it’s to do with leadership and the values you bring to it, such as empathy and understanding

Sharee Johnson describes the myopia of the health sector where work practices are tolerated that would not exist in any other sector.

Dave Clarke says the health sector can learn from other sectors how to look after workers.

He says one positive of the pandemic is getting to know the children of his co-workers. It’s no substitute for face-to-face interaction though.

One of the myths in the health sector during the COVID-19 pandemic, according to Dave Clarke, is that infection control is workplace health and safety.

He says other high risk industries like mining and construction value people more highly than health.

Dave Clarke says resilience needs to be built into the systems of health care – doctors and nurses can’t care for patients if they aren’t being cared for themselves.

Dave Clarke says it is a myth that hospitals focus on health and safety; in reality this is quite weak.

Dave Clarke describes his role as a father is to raise resilient and capable young adults – it’s a mistake to focus on individuals, the organisation has responsibility for fostering resilience among employees.

Resilience isn’t just about coming to work strong to face the difficulties in the workplace – it’s about reducing these difficulties.

Dave Clarke says that part of the problem is the lack of robust health and safety frameworks within hospitals. Improving these would increase support for workers so they don’t have to be so resilient.

The daily check-in

Carmel Crock describes what she has put in place at the Eye and Ear Hospital, including a daily check-in at the start of the day which includes identifying problems where people can disagree and complain.

She also gave responsibility for the rosters to the junior doctors which gave them more autonomy.

‘Soldiering on’ is part of the workplace culture in health care but we had to stop that during COVID says Carmel Crock.

Taking time to listen to frontline workers is kindness – Carmel Crock.

Kindness is an active choice at the Eye and Ear Hospital; Carmel Crock describes modelling kindness to patients and to each other right across all craft groups.

Questions to the panel about structural framework to support staff from recruitment to leaving the workplace.

Dave Clarke describes how occupational health and safety is not seen as important in hospitals – they are lower in the hierarchy and told to leave infection control alone. Psychosocial issues are often ignored.

The director of OH&S is on the exec team and reports to the CEO in most high risk industries but not in health care says Dave Clarke.

Julia Harper says the College of Intensive Medicine has been discussing how to improve the culture of the organisation; this is complex but does not have to be overwhelming.

COVID has enabled some more diversity and flexibility in teamwork, Harper says.

Also crucial is to ensure values are central to what we do – this will facilitate trust and support people to do their best job.

Julia Harper says looking at structures are important but it is also sometimes the smallest actions that make the biggest difference.

Question to the panel about how to change embedded cultures in health care?

Carmel Crock says modelling kindness is crucial – this includes apologising when a mistake is made. Also sharing successes and failures openly and thanking people when they do a good job.

Julia Harper says measuring workplace cultures is important to enable local discussions and resolution.

Carmel Crock describes how the CEO of her hospital would spend 15 minutes each morning with the handover team listening to them and giving them a broader hospital perspective – this was very valuable.

Julia Harper agrees that the ability to listen and ask questions is crucial – this doesn’t need to take a lot of time it is more of a mindset.

Dave Clarke says the health sector has a leadership challenge – being busy is no excuse, lots of workplaces are busy. It’s about priorities and leadership.

Dave Clarke says that the return on investment for kindness and supportive and positive workplace cultures is not well understood in health care – other industries do this better.

Sharee Johnson thanks the panel and reiterates the importance of looking at resilience at the systems level, citing research from Gallop showing that 70 percent of our experience at work comes from direct line managers.

Believe that you can improve cultures and increase kindness at work – we can learn from other industries to improve our understanding.

Kelli Mitchener describes the health and well-being framework for her organisation, for staff, patients and the community. This means that kindness is part of the discussion about all of their activities.

This year they launched their person-centred care program across the organisation, focussing on empowerment, compassion and empathy.

Kelli Mitchener outlines online resources to promote person-centred care, supported by the ‘hello my name is..’ campaign and other resources highlighting patient and staff experience

Having a conversation about what has worked and has not worked is also important; each Department then comes up with its own plan to become more person-centred.

With thanks

Cath Crock says she is blown away by what the tiny team at Gathering of Kindness has achieved, and thanks sponsors.


More from Twitter


Video releases

A powerful interview with Dr Ivan Zwart concludes the author to author series of the Gathering of Kindness virtual event

Dr Ivan Zwart is the founder and facilitator of Happy Ground Wellbeing whose mission in life is to improve the wellbeing and happiness of others.

Ivan discusses the trauma he experienced after his mother was diagnosed with dementia, compounded by the death of his father shortly afterwards.

He describes feeling let down by the mainstream health system which didn’t give him much hope for his future. Psychiatrists he saw said he would have a mental health condition for life and that there was no alternative to medication.

He was diagnosed with bipolar disorder and told that he had a one in five chance of killing himself. He did not know of any people living well with mental illnesses and didn’t feel like he could talk about it.

After he found heart meditation his life changed. Now he teaches it to others and finds it helps people improve their mood and enjoy their life more.

He says that people who are happier make better decisions and that there is evidence that doctors make more accurate and quicker diagnoses when they are happy.

Aged care

On narratives

At the Narrative Initiative, Dr Lorraine Dickey and Viviane Foulke share their thoughts on ‘all things Narrative’, reflect on stories shared with them, and what ‘The Ask’ means when it comes to kindness.

Other Gathering of Kindness discussions were also held throughout the week.


Twitter analytics

More than 220 Twitter accounts engaged with the #KindnessWorksHere hashtag from November 6-15, sending 852 tweets and creating more than eight million Twitter impressions, according to Symplur analytics. Read the Twitter transcript here.


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