Organising through compassion: The introduction of meta‐virtue management in theNHS

Abstract

This paper investigates the comprehensive compassionate care reform programme within the National Health Service (NHS) in England. Through a synoptic reading of policy documents, we show how ‘compassion’ is introduced as an overarching meta‐virtue designed to govern relationships and formal positions in health care. Invoking an ‘ethics of office’ perspective, mainly drawing on the thinking of Max Weber, we evaluate the promotion of compassion as a managerial technology and argue how seemingly humanistic and value‐based approaches to healthcare management might have unintended consequences for the quality of care and the conduct of health professionals that in some ways resemble and in some ways exceed those of the more traditional New Public Management measures, which the new compassion paradigm is expected to outdo. In the paper's final sections, we turn to the original work of the nursing icon Florence Nightingale to argue that compassion and other virtues should continuously be formulated and re‐formulated in relation to the role‐specific skills and duties of particular offices in the healthcare sector.

The idealization of ‘compassion’ in trainee nurses’ talk: A psychosocial focus group study

“…As a consequence, the ideal influences trainee nurses’ valuations of their own and others’ behaviour (see Handy and Rowlands, 2017). Our first contribution is to the compassion literature (Pedersen and Roelsgaard Obling, 2019; Simpson et al, 2014), which is to explore the unconscious reasons for the persistence of the ideal of compassion, despite practical difficulties healthcare workers experience in exercising compassion in their work. We show that the process of idealization, splitting and blame is internalized by trainee nurses and unconsciously protects them from anxiety evoked by the vulnerability of their position as those who need to gain access to the profession and when being unable to conduct compassionate nursing work, because of practical difficulties.…”

“…It is not only viewed as a feeling that may or may not be present when nurses conduct their work, but has emerged as a dominant discourse within the nursing profession that influences and shapes employee subjectivity (Simpson et al, 2014). Despite appearing as a more humanistic means of managing healthcare, compassion is a continuation of the control and target culture of New Public Management and its preoccupation with measuring individual conduct and performance (Pedersen and Roelsgaard Obling, 2019). The approach to compassion in the nursing profession in the UK healthcare system is very much about the identities of the nurses who carry it out (Pedersen and Roelsgaard Obling, 2019).…”

“…Despite appearing as a more humanistic means of managing healthcare, compassion is a continuation of the control and target culture of New Public Management and its preoccupation with measuring individual conduct and performance (Pedersen and Roelsgaard Obling, 2019). The approach to compassion in the nursing profession in the UK healthcare system is very much about the identities of the nurses who carry it out (Pedersen and Roelsgaard Obling, 2019). This is reflected in the report of a national inquiry into the failures at Stafford Hospital in the UK (Francis, 2013) which led to a renewed promotion of 'Values Based' recruitment of nurses (Department of Health, 2013).…”

“…The trainees in this study draw on this ideal as a moral trait that all nurses are 'supposed' to have. They talk less about compassion and care as something that drives their interest in the nursing profession or as significant in the effective execution of nursing tasks (Pedersen and Roelsgaard Obling, 2019), and more about it being an imperative and a trait that nurses inherently possess or not. This reflects the dogmatic and stereotypical thinking that characterizes the basic assumption state.…”

“…While caring and compassion have long been claimed as distinctive moral characteristics of the nursing profession (Benner and Wrubel, 1989), as a result of a series of well-publicized nursing failures and patient-care scandals in the UK, notably poor care and high mortality rates in Stafford Hospital, nursing leaders have been compelled to restate an emphasis on compassion within the profession (Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser, 2012). The same failures have contributed to compassion becoming an enforced and overarching virtue designed to govern all levels of British healthcare (Pedersen and Roelsgaard Obling, 2019). This reflects a wider research and policy agenda that increasingly looks to compassion as a key to improving the quality of services, organizations and relationships (Fotaki, 2015; Lilius et al, 2011).…”