Billy Boland: How do we become compassionate leaders?

An excessive focus on systems, policy, and performance without talking about the people involved can exclude, undermine, and disillusion those we want to bring about change in the NHS, says Billy Boland.

billy_bolandIt’s been a while since I graduated from the Bevan programme at the NHS Leadership Academy, but I still manage to benefit from it in unexpected ways. It’s the relationships that I developed there that I think have been the lasting reward for me. People who are inspiring can have a turn of phrase or a way of putting things that can have real impact on others and how people look at the world around them. Even in a tweet. I was lucky enough to have Mike Chitty (@mikechitty) as my group facilitator on the Bevan programme. Mike has since gone on to become Head of Applied Leadership at the NHS Leadership Academy.

I was scrolling through my newsfeed just before Christmas and came across this tweet from him:

“When we demand change, sustainability, transformation and improvement we risk failing compassionate and inclusive leadership.”

I’ve no idea why he chose to share that advice but it’s been bouncing around my head for ages. Personally, I’m completely committed to quality improvement. It makes perfect sense to me. Who would argue that it’s not the right thing to do? I find it energising, aspirational, and a way to keep motivated and focused on making positive changes. But I know too that being overly evangelical about it can be distancing and off putting for people.

The truth is that most of the real change we are seeking in health services is not about creating new treatments or interventions. It’s about the “how” of delivering the care that we have. Our main NHS resource is our people. And so, if we want to have an impact on the quality of care that we deliver then we would do well to do what we can to enable NHS staff to do their best work.

Given the immense strain that the NHS is under it is common to witness change and transformation done in a way that overlooks the needs of staff, even though it is usually well meant. An excessive focus on systems, policy, and performance without talking about the people involved can exclude, undermine and disillusion those we want to bring about such change. NHS colleagues are intelligent and educated. They work under pressure making difficult decisions and asking tough questions. That is what we want them to do. It serves no purpose to avoid these questions at times of stress and “demand” compliance, or see those who ask questions as trouble makers or not team players.

The beauty and strength of the NHS lies in its diversity. Services evolve positively when they listen to a range of voices, not just those that support the view of those driving change or compliance. Of course, not everything can be agreed, and consensus is not always possible. But we should seek to understand where others are coming from, and reflect on our own approach in light of this. Reflective leaders are amongst the best.

It’s sometimes said that “people come and go,” but in my experience systems and processes seem to come and go more often. We need to remember that our people are our greatest asset. If we force or demand action that does not make sense or excludes people, then we may not achieve the outcomes we seek. Good quality improvement engages others, and lifts people up. I’ve yet to see a change that should not be approached like this. Do your best to bring people with you.

Billy Boland is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter @originalbboland.

Competing interests: None declared. 

  • Dr Umesh Prabhu

    Dear Billy good to read your blog and I know almost everyone in Leadership Academy and they are all trying to do a good job. Leadership is all about delivering the results and not just trying! I am glad you mentioned about diversity in your blog. Sadly this is where NHS is not very good at. 45% of doctors and 25% staff today in NHS are Black and Minority Ethnic and yet, almost all leaders are male, pale and White! NHS Leadership spends lot of money training leadership (in fact they train management and not actual leadership) and those who are trained go back to their organisation where they are not able to make any changes because of the culture and poor leadership and poor team working and so on! Sad reality is NHS has culture of racism, bullying, harassment victimisation and discrimination and in such a culture staff become indifferent even to human suffering!

    In my Trust, we have reduced harm to patients by 90% by focusing on values, culture and appointing value based leaders and implementing good governance and excellent staff and patient engagement. Unless we get all these rights, NHS will not be safer or better and sadly many patients, staff and NHS will continue to suffer.

    Until we get BME issues right and workforce race equality right, we will not make NHS safer or better. I recently attended my own workforce race equality training organised by Leadership

    As you rightly say our staff our people are our best asset and every staff matters including BME. In our NHS where club culture is rife only those who belong to the club matter! Unless these things change sadly patients, staff and NHS will continue to suffer.

  • Mike Chitty

    Thanks for taking the time to comment Umesh. Billy certainly was a tremendous influence on me and helped to widen my own understanding around come aspects of inclusion and diversity. I hope all is well with you!

  • Mike Chitty


    Thanks for this. I suppose I was simply making the point that compassion cant be commanded, dialled up like a take-away a pizza. And, when we pretend it can we are likely to end up with a bit of a mess. I am also hearing stories about a lack of compassion when it comes to understanding why targets might not be met. Sometimes just demanding ‘better’ can model anything but compassion!