Kindness in a world where ‘teaching by humiliation’ is a thing
By Cat Harrison
When I was a child, my mum would tell stories of her school days when children would be made to stand up and recite their rote learning of poetry. When their minds drifted, or they forgot anything, they’d be shown up, shouted at and occasionally walloped with a ruler. So far so 1950s.
Mum can still remember some of those lines she was made to remember, so job done some would say. But the words are meaningless – they could be any words. She remembers the humiliation itself with more understanding, clarity and passion. She left the world of education as quickly as possible and has lost the chance to build on what she learned through brutal means. Those words of poems, the potential to ignite a lifelong passion wasted, were filed away in the ‘best forgotten’ pile because of the association they came with.
To many, it’s the stuff of Evelyn Waugh. The past. The memory a relic of an education system long gone.
But reading a stream of tweets from young surgical trainees recently made it abundantly clear that the equivalent is entirely present and happening in some NHS theatres today, with trainees. I’m now wondering how many other trainees are experiencing this in other areas of medicine? And what about nurses, and as my mind keeps going this way, I’m wondering now about healthcare assistants, porters, admin staff, managers and everyone else who helps keep the NHS working day to day?
I was aware already that day to day incivility is sadly too common in healthcare, but this is different and shocks me, as this is a strategy. This has a recognised name and is used as a way to – I can only assume – attempt to create the best workforce possible to care for patients.
As an occasional patient and as someone who has worked in and around patient safety and healthcare for 10 years, every fibre of my being screams: ‘In what decade do these teachers think they live?!’ To teach by humiliation may seem like toughening up for a tough job to some, but evidence completely undermines its efficacy. It’s been abandoned elsewhere for decades for many reasons.
Civility Saves Lives is a great source of data that evidences the fact that rudeness, belittling and embarrassing others in healthcare has consequences, not only for the recipient, but for bystanders, team members, patients and relatives, as shown below.
What isn’t on this infographic is the likelihood that the person delivering this humiliation looks weak to most modern eyes, in my opinion. You may feel powerful and you may have an effect, but celebrated leadership and teaching today in most other fields focuses on gravitas, collaboration and inspirational skills.
I have the luxury of only experiencing teaching by humiliation second hand, through stories via social media. Yet it has pulled me up short when I think of our focus on the importance of kindness in healthcare. It has both reinforced my commitment to keep pushing this message out, to shout it again and again with evidence and context that could help shift perceptions, whilst making me worry that in such a context, are we doing enough?
Our website includes information and evidence that shows the clear link between positive values and behaviours and safer care, and how the very people who must be empowered to speak up, can be silenced by the behaviour of those around them, as well as the critical importance of strong, positive relationships to work safely.
We know that behaviour such as that suggested by ‘teaching through humiliation’ stands in the way of patient safety and a just culture. If you want to help people work safely, you must help them talk to each other and do so in a way that helps them to speak, to listen, to be heard and understood.
We work nationally, we aren’t there in your local context, so we hope that what we say and do is helpful and applicable. And I follow now with some key points and resources in that spirit; but the door is always open for comments – email anytime at email@example.com. Please tell us what you think, what would help you to cope and even to lead by example in your organisation;
- You could use any chance you get to talk with your colleagues and leaders in your organisation about the impact of any rudeness, belittling or humiliation, using evidence from CivilitySavesLives and the other resources below – a kitchen table is a potential place for this or you could talk to your Speak Up Guardian
- If you’re a leader, whether of a team, department or organisations, use your influence up and down to state clearly what behaviours and values are acceptable. Articulate the behaviour you expect and hold people to that
- Whether you are a leader or not, role-model the behaviour that you wish to see. This makes you look powerful and capable; this blog by Suzette Woodward articulates this beautifully
- If you’re a board member, develop, select, promote and empower leaders that help to nurture the right sort of culture, and display the sorts of behaviours and values that promote safe working and high quality care. This is particularly important when things go wrong. This blog reflects on the experiences of Mersey Care, who are far ahead in creating a just and learning culture
Resources to help you;
Civility Saves Lives – a treasure trove of evidence to highlight the importance of civility in healthcare
Sign up to Safety – why helping people talk to each other with kindness matters
Hammer It Out – a campaign to create a positive workplace culture that is free from bullying, harassment and undermining behaviours backed by the Joint Committee on Surgical Training, Health Education England, Academy of Royal Medical Colleges, the Royal College of Surgeons of Edinburgh, COPMeD, ASiT, Patient Liaison Group, Royal College of Surgeons, Royal Australasians College of Surgeons, AOA Registrars, NHS Education for Scotland.
IHI Framework for improving joy in work – Relevant because teaching by humiliation undermines joy, this paper includes plenty of evidence as to why joy in work matters – it is not a nice to have but directly linked to lower staff turnover and sick days amongst other key aspects – and the steps that could be taken to help engage staff.
Kaleidoscope, Beyond Burnout – a short report by a Canadian GP that identifies the conditions and practices that enable joy to flourish in the NHS.
About the author;
Cat Harrison is the communications and engagement lead for the Sign up to Safety team, and has advised numerous FTSE100 companies as well as national charities and health-related organisations. Her expertise lies in the development of impactful campaigns, the importance of language and tone in connecting with people, and engagement approaches that motivate and excite people to take action to make care safer. She tweets @catharrison4