Nate Regier PhD is Founder and CEO of Next Element, a global advisory firm specializing in leadership communication, and author of Beyond Drama: Transcending Energy Vampires, Conflict Without Casualties: A Field Guide For Leading With Compassionate Accountability and Seeing People Through.

Nate was a guest on episode 17 of the Compassionate Leadership Interview in February 2020. Since then Nate has been reinventing, rebuilding and realising new opportunities for sharing compassionate accountability.

Nate is launching a new book in July - Compassionate Accountability: How Leaders Build Connection and Get Results. A year ago, he was planning a second edition of Conflict Without Casualties but his team changed plans in order to respond to the challenges faced by companies coming out of the pandemic.

The book reflects the tension leaders experience between paying attention to relationships and getting things done. Nate’s understanding of compassionate accountability was in its infancy when he wrote Conflict Without Casualties. Since then, his team has developed the three switches of the compassion mindset, a framework for activating the behaviours required within a culture of compassionate accountability.

Nate’s latest book complements the many excellent books on Compassionate Leadership, as the only one with ‘accountability’ in its title. He contends that ‘accountability’ is an essential component of compassion, reflected in the latin root of the word, which means ‘struggle with.’ We live in community with one another and that involves affirming human capability and being accountable to one another.

In the book Nate establishes the relationship between the interactions connecting people, organisational culture, and brand. Culture is fundamentally the sum of the interactions between your people and, as Nate’s friend Bobby Herrera has observed “brand is a lagging indicator of the quality of your culture.”

Part 3 of the book is about implementation. It recognises that you have to “address common systems and processes that reinforce behaviour.” It starts with identifying behavioural norms, and then identifies the functional areas where processes need to reflect those norms. There is a tool for assessing compassion within the culture of an organisation.

Nate maintains that onboarding, performance reviews, promotions, and reward systems in particular need to be aligned with compassionate accountability. Regular in-house training and practice are required to keep the materials alive.

He acknowledges that “everyone is different, everyone comes on board from a different place, and it’s not easy.” Sometimes the assumptions we hold can create barriers for us. The notion that compassion is soft can be prominent among these.

Nate believes compassion can change the world. For example, he believes compassionate accountability is the next evolution of inclusion.

Eleanor Rutter is Assistant Director of Public Health at Sheffield City Council, and Leader of Sheffield’s Compassionate Sheffield programme.

A talented mathematician as a child, Eleanor went to medical school out of a need to seek the approval of other people. Following a complicated pregnancy, she was away from work as a hospital doctor for 18 months, after which she went into public health. She had a further two children and time off through mental ill-health, and the training programme, nominally five years, took her 12 years to complete.

She had a false start in an authority with what she feels was an ‘over-medicalised’ model of public health, but has now found her feet in what she describes as her “dream job.”

In her current role, Eleanor leads the Compassionate Sheffield programme. It is in fulfilment of the city’s 2018 public health objective to ensure that everyone has a dignified death in a place of their choice. She soon found out that there were a lot of compassionate communities doing good work in this area.

Eleanor’s approach is informed by the academic work of Professor Allan Kellehear at the University of Bradford. It recognises dying as a social and spiritual process first and foremost, rather than a medical one. She says that communities and neighbourhoods are best placed to allow people to live the complete lives they choose to value.

Eleanor’s team comprises two community development workers, one of which is an end-of-life doula, a communications officer, a clinical lead, and a programme manager. They are funded by Public Health Sheffield City Council, the ICB (Integrated Care Board), and St Luke’s Hospice. She says the team is an enabler, building capacity, confidence and connections within and between communities.

The main strands of the team’s work to date have been advance care planning, developing training to help people navigate the end of life, building ‘death literacy’ through death cafes, and leading Sheffield’s covid memorial project.

Atul Gawande’s book ‘Being Mortal’ has also had a strong influence on Eleanor’s thinking. She says that by not listening to people and over-medicalising their problems we are at risk of stripping away their humanity.

The next stage for Compassionate Sheffield is to build on the work that people did in the pandemic as compassionate neighbours. In the longer term, Eleanor feels that compassion runs through everything we do and its potential is far greater than transforming the end of life. For example, in Sheffield’s economic anchor organisations many people are in a conversation with Michael West concerning compassionate leadership. She says “I don’t think it’s just a silly pipe dream, this idea of Sheffield becoming a compassionate city in its entirety.”

Sheffield has not intentionally diverged from the Frome Model, which is the basis of Compassionate Communities UK. Rather, Sheffield’s Health and Wellbeing Board, aware of the compassion that was already manifest in Sheffield’s communities, wanted to grow Compassionate Sheffield using an asset-based approach.

As white and middle class, Eleanor is very conscious of her privilege. Therefore, she has a problem with the term ‘achievements’ and feels that often she has just needed to “scoop up the opportunities that were given to me.” Only two or three times in her career has she been faced with making a genuinely tough choice, which on one occasion involved insisting on doing the right thing even though her position was unpopular with some very senior colleagues.

Through therapy Eleanor has learnt to see life as a learning process. One of the things she has learnt is the power of saying sorry and actually meaning it. Eleanor credits therapy as being the experience that has changed her the most. She put herself “heart and soul” into it. It was gruelling, but she is “massively transformed” and no longer driven by self-loathing.

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Ben Allen is a GP at Birley Health Centre, and Sheffield Clinical Director for Primary Care, with a special interest in elderly medicine and service improvement.

Birley has bucked the national trend in patient satisfaction. Over the past two years while patient satisfaction nationally has declined from 68% to 38%, at Birley it has increased. He compares his initial impressions of Birley to the experience of riding a bike where all the components are high quality but they haven’t been assembled particularly well.

He realised that his first efforts to intervene were merely addressing the symptoms and not the underlying culture, so he started a process of self-education reading books by Patrick Lencioni, Jim Collins, Brene Brown, Simon Sinek and Nancy Kline for example. This led him to develop three main principles: finding and nurturing potential, team dynamics, and being purpose and values driven.

He observes that “everybody has so much more to them than their professional role and their professional training.” The organisation needs a clear plan for how it is going to bring out the best in staff, including providing a mentor for each person, who has an ongoing day-to-day relationship with the individual.

Most of his thinking on team dynamics draws on the work of Patrick Lencioni. It’s firstly about creating an environment of psychological safety which allows people to voice their best ideas, and confess their mistakes without fear of censure. Secondly its about the quality of debate. Finally, if the first two have been done well, then people should be more prepared to commit to a decision, even if it isn’t the one that they would have made personally.

Ben has done less work on crystallising the purpose of the organisation than he has done on the other two principles, but he thinks that is a question worth asking all stakeholder groups, including patients. He observes that “we can often go to work with our own purpose” and that purpose may conflict with the goals of others. And in the absence of a larger purpose, the aims of individuals can boil down to “getting through the day.” It’s only when you have that overarching purpose that you can ask “How are we doing?”

Ben thinks that the type of leadership that the NHS needs is evolving. At present the principles he has outlined are not as understood and valued as they need to be. The ‘top down’ model is not fit for the complexities of modern healthcare.

Meetings have changed fundamentally at Birley since the start of the improvement programme. They no longer have meetings that are about conveying information, for which an email or whatsapp would do. Instead, team meetings are about engaging people, obtaining ideas, debating issues, and building consensus.

Ben says there’s lots left to do at Birley, but that he really does feel that it’s a self-improving place now. Things Ben would like to see happen going forward include a “blurring of the boundaries between the practice team and the public”, more work on purpose and values, and rotating the leadership of meetings so that younger staff are involved.

Ben feels that with increasing workload and declining staff numbers there is a real risk of changing things “out of desperation to make something different.” In his view, the right question is how do you sustain the people who are currently in primary care, while you train up the next generation of GPs? He also thinks that the nation needs a wider debate about the purpose of the NHS.

In his role as Clinical Director for Sheffield he sees himself helping general practice to thrive. He is still working on the best way to achieve that. One of his approaches has been to get people from general practice with energy and ideas together in order to build solutions.

Recently Ben has read ‘Reinventing Organisations’ by Frederic Laloux. This charts the cultural journey from top down to purpose driven with self-managing...