The government in the UK has made the ‘implementation’ of compassion a matter of national policy. All NHS staff have been told they must “embrace” the values of patient care set out in the national nursing strategy for England. Known as the “6Cs”, the values are care, compassion, competence, communication, courage and commitment. Is a top-down approach to compassion the best strategy or can we better encourage compassionate caring at the grass-roots level? [this passage moved from conclusion].

‘Hearts in Healthcare’ is a global social movement for compassionate, human-centred healthcare. It’s an informal network of health professionals, complementary and alternative therapists, students, patient advocates, health leaders and many others [1]. In a healthcare system beset with stress and burnout, the founders of the movement sought a process to liberate positive energy and reminded participants of the values, hopes and aspirations that brought them into healthcare. The ‘Reawakening Purpose’ workshop [2] is an effective process for reconnecting health workers to the heart of their practice and strengthening caring and compassion.

The workshop was gradually developed after we were inspired by the results of using appreciative inquiry to explore questions of compassion and caring. When a group of health professionals is confronted with a challenge, their habitual thinking style quickly leads to a focus on problems, risks, lack of resources, and a tendency to blame others. Appreciative Inquiry [3] does exactly the opposite; it asks the question, “When did things work exceptionally well? Tell me a story”. The process typically involves putting participants in pairs to interview each other, then sharing the stories with the bigger group. The facilitator then asks, ‘What were the conditions that allowed this great teamwork or effective working? How can we create more of these conditions?’ Although the use of appreciative inquiry in healthcare is very limited, it’s a promising approach for bringing diverse groups of professionals together to improve patient care. The Center for Appreciative Practice in Virginia has published an inspiring book detailing their experience [3].

The twelve charge nurse managers from a busy NHS hospital in Wales shuffled into the workshop showing every sign of fatigue, stress and demoralization. Nobody made eye contact. The body language spoke of resentment and a wish to be elsewhere: attending to the thousand-and-one demands of a near-impossible job. This is the stark reality of many of our hospitals, beset with overwork, stress and no time to care. How do we even begin the conversation about compassionate caring?

Ninety minutes later, the participants noisily left the room brimming with positive energy, enthusiasm, hope, and many practical ideas for improving the quality of compassionate caring on their wards. The startled Director of Nursing declared that her nurse managers had all had a “personality transplant”. What process led to this transformation?

In a healthcare system beset with stress, cynicism and burnout it’s difficult to initiate conversations about caring and compassion and the potential for intimate connections between health professionals and patients. Furthermore, the spiritual aspects of healthcare, and the feelings and vulnerabilities of health professionals are taboo subjects. Yet our international experience of ‘Reawakening Purpose’ shows these deep conversations can be easily achieved even with groups of very diverse experience and background.

It’s a process that allows young graduates to share meaning and purpose with senior clinicians, either in a mixed group representing the care team, or a single professional group. It builds the bond between diverse participants, of all ages, and strengthens teamwork. The workshop is also suitable for non-clinical staff at the front line of care, such as receptionists and others with direct patient contact. In our latest workshop, we even had patient representatives tell moving stories of extraordinary connection to health professionals. The process has worked equally well in diverse cultural settings, from private healthcare providers in the USA to government-funded healthcare in the UK and NZ.

In our online community we hear many stories from health professionals who have recovered from burnout by reconnect to deeper purpose and adopting daily habits of kindness, compassion, appreciation and gratitude [4]. The Reawakening Purpose workshop inspires practitioners to adopt these practices.

This workshop has become so foundational, at Hearts in Healthcare we no longer contemplate any other process for a first engagement with a group or institution. In New Zealand, it will be incorporated in a Hearts in Healthcare national roadshow and campaign to strengthen compassionate caring in the NZ healthcare system. This campaign is a grassroots social movement, not a government-led strategy.

The workshop is subtly designed using the principles of positive psychology and appreciative inquiry. For that reason, we believe that anyone with a modicum of experience in small group teaching could successfully facilitate the process. Members of Hearts in Healthcare have free access to a comprehensive workshop kitset including a facilitators’ manual, introductory slides, a step-by-step video guide to the workshop process, key point handouts, and a bibliography of supporting evidence.

This case study has limitations. Our report is merely observational, from twenty instances of facilitating the workshop. We would welcome research to assess the attitudes and beliefs of workshop participants and whether the workshop has any lasting impact on health professionals’ practice.

Our experience suggests that the best strategy to achieve compassionate caring is not a top-down series of directives and regulations but rather a grass-roots approach using appreciative inquiry to bring out the very best in health workers and to re-energise their hopes, ideals and aspirations. This is an untested hypothesis we put forward to stimulate further research and experimentation.

Robin Youngson is an anaesthetist trained in the UK but working in New Zealand. As Acting Chair of the national EpiQual Committee and subsequently a founding member of the Quality Improvement Committee, he advised the NZ government on strategies eventually leading to legislation in 2010, which established the New Zealand Health Quality and Safety Commission. He was also the NZ representative on the World Health Organization International Steering Committee for Patient Safety Solutions. In 2011, having quit all leadership roles, Robin resigned his public hospital job to devote all his time and passion to the Hearts in Healthcare movement. He’s a Fellow of the International Centre for Compassionate Organizations.