Embedding compassionate care in local NHS practice: a realistic evaluation of the Leadership in Compassionate Care Programme

Abstract

This thesis offers an original contribution to knowledge through providing a rigorous longitudinal examination of a complex intervention known as the ‘Leadership in Compassionate Care Programme’ (LCC) which was designed to embed compassionate care within local NHS practice in a large Health Board in Scotland. To date there has been little research into the impact of dedicated programmes aimed at enhancing compassionate care on an organisational basis. Through the use of Pawson and Tilley’s (1997) realistic evaluation framework this study takes the form of a critical exploration of what did and did not support a sustained focus on compassionate care within the participating settings. The findings have important implications for both policy and practice, and the thesis culminates in a series of recommendations for healthcare organisations at macro, meso and micro levels.
Concern about the delivery of compassionate care in the NHS has become a major focus of political, public and professional debate during the last ten years. There has been long standing recognition of the clinical and financial pressures within the NHS; however, the scandal of poor care in Mid Staffordshire NHS Trust brought the issue of compassionate nursing practice into sharp focus. This study makes reference to the findings of the original Francis Inquiry (2010) and subsequent recommendations (Francis 2013) and there is no doubt that the current and future landscape of compassionate care is very different to the one encountered at the outset of this inquiry in 2007.
This longitudinal qualitative study provides insight into nurses’ experiences as they engaged with the LCC Programme and it provides an important understanding of how best to recognise and support existing good practice and achieve sustainable improvements. Data collection was conducted over three years and primarily involved 46 semi-structured interviews with 33 key participants. This led to the development of eight detailed case studies of participating wards and the generation of an analytic framework based on ‘level of adoption’ of the LCC Programme. The eventual synthesis of findings across all eight study sites permitted the development of a conceptual model for strengthening organisational capacity for the delivery of compassionate care. The ‘compassionate core’ of this model recognises compassionate care as focussed on meeting the needs of patients, of relatives and of staff. My findings point to the fact that embedding and sustaining compassionate care demands a strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development, and effective leadership at all levels.