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Creating a Compassionate Subculture Under Pressurised Circumstances

Updated: Jan 15, 2020

A couple of months ago I wondered whether this were even possible. I had speculated about it briefly in my book Compassionate Leadership, but the thinking behind this piece was informed by my recent podcast interviews with two outstanding leaders: Tracy Allen, Chief Executive of Derbyshire Community Healthcare NHS Foundation Trust, and Professor Michael West of Lancaster University and The King’s Fund..

When I reflected on my interviews with Tracy and Michael (you can find the podcasts on Spotify and Apple), it became apparent to me that three capabilities were required of the leader of a division or team in order for them to be able to promote a compassionate culture under pressurised circumstances — we are going to make the assumption that such a culture does not already exist: most (though not all) organisations under pressure typically develop an obsession with targets, operate a command and control style of management, and scapegoat the outliers within their community.

So how does someone like Tracy Allen, who leads a 4,000 strong primary care trust within the 1.4m strong NHS, manage it?

“What is your leadership for?”

This is Tracy’s favourite question to the aspiring NHS Trust Chief Executives that she mentors. She encourages them to develop a deep sense of purpose, one that is personal and therefore might well be subtly different from that of the organisation itself. Her own answer to the question is “For social justice,” a reply rooted in the life work of her parents. That’s what drives her decision making and provides the foundation for the other two essential capabilities.


This was the term used by Dan Goleman when he popularised emotional intelligence in his 1996 book of the same name. In this day and age I might have used ‘mindfulness’, but in any event I mean the ability to pay attention to our thoughts and feelings.

This is critical because it buys us time. Recognising our thoughts and feelings allows us to put the brake on and resist an instinctive reaction. ‘Instinctive reactions’ are just that and normally coloured by our self-interest, prejudices and fears.

Instead we can respond in a considered way; for example with curiosity, or sensitivity, or non-judgement. (I am smiling as I write this. In my own leadership practice there were numerous occasions when I pre-judged situations and found myself having to rapidly engage reverse gear. I learnt to stay curious through hard experience.)


A clear sense of purpose and self-awareness are not enough. There are plenty of people with both of these that choose to live in what an existentialist would call ‘bad faith.’ Standing up for what we believe in requires the courage to take the road less travelled, to be questioned by head office (at least until the Care Quality Commission describes your Trust as ‘Outstanding’, as they did in Tracy’s case), and to let go of what people think.

Tracy sees the role of the Trust board as acting as a buffer or filter for what comes down from the centre. Their role is in part to prevent the pressures, financial imperatives, targets and policies from defining the Trust. It can’t all be about counting things and negotiating contracts. But this takes a compassionate approach — time, patience, exploration.

Paul Arden was advising art directors at the time he wrote the following, but it could be addressed to any divisional or team leader wanting to put people first, create a convivial work environment, and support individual and team fulfilment.

“All will respond if you show them a better way. But you must show no fear… This is your job. Don’t refer back to those in authority, they will play for safety. You’re on your own. Fly or die.” It’s pretty stark, but for me it captures the courage required to create a compassionate subculture.

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