is the priority.7

Where all staff have clear

objectives and where there is enlightened people management, there are high levels of staff engagement, learning and quality improvement are embedded, and good team and inter-team working is endemic. There were interviews given during the creation of the report where compassionate and collective leadership has become the new normal. Leaders have been listening and doing things with staff rather than to them, being more supportive, appreciative and being proactive by unblocking barriers. In some organisations this new style has replaced command and control. It is to be hoped that it can remain. It is a recommendation of the report that health and care organisations regularly review their cultures to ensure that they are continuously developing cultures of high-quality, continually improving and delivering compassionate care for patients and staff.


The final chapter of evidence whether examples of good practice, direct from interviews or from the literature, explores Contribution. It is defined as the need to experience effectiveness in work and deliver valued outcomes. Evidence from the NHS England staff survey in 2019 is that excessive workload is the primary factor leading to low levels of patient satisfaction, low levels of staff engagement, and failure to innovate. It is also the key factor determining nurses’ and midwives’ stress levels and intention to quit.8

Previous research has

identified workload as the most consistent influence on strain among health and care workers.9

Unmanageable workloads are

References 1 Woodhead K . 2020 Supporting Nurses to deliver High-Quality Care Accessed at https://www.

damaging nurses’ and midwives’ health and thereby exposing patients to potential harm. It is therefore evident that despite the current COVID pressures and demographic change, that health and care organisations must take some drastic actions to reduce chronic and excessive workload demands which exceed the capacity of nurses and midwives to sustainably lead and deliver safe high-quality care – damaging their health and wellbeing. Leadership within nursing and midwifery should be able to support their team members to work and develop effectively, with particular emphasis on staff at each end of their careers. They have different but no less important individual needs to maintain effective and satisfying work.


It has always been an irony that those who are caring for the sickest and most vulnerable in society are not cared for themselves. The phenomenon is not new, but stress and pressure has increased exponentially in recent years leading to damage to the health and wellbeing of health and care staff. The core value of compassion in effective teams and organisations, which fosters integration, nurtures trust and respects the emotional lives of staff, must not be ignored. In organisations where it is present, nurses and midwives become more competent, confident and empowered. These are surely characteristics to be nurtured, developed and highly prized.

CSJ nurses-to-deliver-high-quality-care

2 The Kings Fund. London 2020 The courage of compassion. Accessed at uk/publications/courage-compassion-supporting- nurses-midwives

3 Ibid 4 Guillaume YRF, Dawson JF, Otaye-Ebede L, Woods SA, West MA (2017). ‘Harnessing demographic differences in organizations: What moderates the effects of workplace diversity?’, Journal of Organizational Behavior, vol 38, no 2, pp 276-303.

5 Bliese PD, Edwards JR, Sonnentag S (2017). ‘Stress and well-being at work: a century of empirical trends reflecting theoretical and societal influences’. The Journal of Applied Psychology, vol 102, no 3, pp 389–402.

6 Lyubovnikova J, West MA, Dawson JF, Carter MR (2015). ‘24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations’. European Journal of Work and Organizational Psychology, vol 24, no 6, pp 929–50.

7 Dixon-Woods M, Baker R, Charles K, Dawson J, Jerzembek G, Martin G, McCarthy I, McKee L, Minion J, Ozieranski P, Willars J, Wilkie P, West M (2014). ‘Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study’. BMJ Quality & Safety, vol 23, no 2, pp 106–15.

8 NHS England. NHS Staff Survey results, 2019. Accessed at: national_breakdowns_FINAL/dash?:display_ count=y&publish=yes&:toolbar=n&:origin=viz_ share_link:showVizHome=no&:embed=true .

9 Wall T, Bolden R, Borrill C, Carter A, Golya D, Hardy G, Haynes C, Rick J, Shapiro D, West MA (1997). ‘Minor psychiatric disorder in NHS trust staff: occupational and gender differences’. British Journal of Psychiatry, vol 171, no 6, pp 519–23.

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