Intelligent kindness

The concept of ‘intelligent kindness’ was first developed by John Ballatt and Penny Campling in 2010 (Ballatt 2020).

We will be hearing John Ballatt throughout the course. He will discuss the importance of an environment where intelligent kindness and kinship thrive enabling allyship and being an active bystander in healthcare.

It is not enough to simply be kind. Intelligence must be applied to kindness. In healthcare this is especially true where we need to give the correct advice or treatment to patients, carers, and colleagues. There is evidence that on its own, and without kindness, the correct treatment is less effective, (Weinman J), and equally, kindness on its own is not sufficient without the appropriate knowledge and science.

Examples of intelligent kindness include the following.

• The paramedic approaching the scene of an accident having the knowledge to ensure the neck of the patient is stabilised before putting them on a stretcher and taking them to hospital to ensure they avoid paralysis.
• A nurse finding a collapsed patient would know to check the scene and ensure that there is not an electric cable in water, or they are not on a cliff edge and at risk of falling before starting cardiopulmonary resuscitation (CPR).
• A physiotherapist would have the knowledge that the patient with ‘red flag’ low back pain needs an urgent scan to rule out cauda equina before they treat them, thereby avoiding paralysis.

However a surgeon who is technically brilliant with excellent surgical results who does not listen to the patient or explain the diagnosis and treatment options with the patient, may have poor compliance and negative feedback from their patients.

In our health and social care system we understand that technical and knowledge-based skills are essential. These are taught and highlighted in the training of healthcare workers. However, these need to be taught alongside and integrated with intelligent kindness and kinship, thereby enabling allyship and active bystanding in the system. These ‘relational skills’ are as important as the technical and knowledge-based skills. They need to be an explicit part of the curriculum.

It is not just the effect on the patient. The healthcare worker in a system where there is no understanding or acknowledgement of the cost to them of caring for patients and dealing with death, dying, disease and distress over years is at risk of burnout and loss of the joy of practice.

In their book on intelligent kindness (Ballatt 2020), the authors argue that resilience is not only down to the individual. Self-care, self-awareness and reflective practice are important. However there needs to be a healthy collaboration with colleagues and the wider system we work in. Employing ‘intelligent kindness’ and kinship in our relationships with patients and colleagues results in effective care and staff well-being. Leaders and organisations need to recognise the cost of caring to the individual and must design systems which foster kinship and a healthy environment in which to work. They look at a virtuous circle of therapeutic alliance where attentiveness, attunement and trust lead to better outcomes, kinship and kindness. Their book also looks in depth at issues in the NHS and social care, and current and future challenges.

The NHS Leadership Academy outlines how we can lead teams ensuring a caring environment where everyone thrives. (leadershipacademy.nhs.uk). A leader should be:

• caring of the team
• proficient in recognising underlying reasons for behaviour
• strong in providing opportunities for mutual support
• exemplary in spreading a caring environment.

Exercise

Please think about the following questions and add your responses to the group chat and discussion if you feel able.

1. Think about an example of a patient you have seen where there has been a good balance of technical skills and knowledge alongside kindness in their care.
2. Can you think of a time where the balance was not good? What was the problem and can you remember the effect on the patient or healthcare worker?
3. Are you taught the equal importance of technical skills and knowledge as well as relational skills such as kindness and kinship? Give some examples.

References

Ballat J, Campling P, Maloney. Intelligent Kindness. Rehabilitating the Welfare State. Cambridge University Press. 2020.

Weinman, J., Ebrecht, M., Scott, S., Walburn, J. & Dyson, J. (2008). Enhanced wound healing after emotional disclosure intervention. British Journal of Health Psychology 13 (1) 95-102.