News: Trusts have improved because they have strong, visible leaderships that is compassionate and inclusive, says Dr. Paul Lelliot, deputy chief inspector of hospitals

 Strong leadership is vital to deliver improvements in mental health trusts, according to the CQC. As they call for improved leadership.

The commission has today published a report exploring how seven NHS mental healthtrusts have made significant improvements in the quality of care.

It found that there were common themes driving improvement across the featured trusts, with strong, visible and listening leadership being vital.

Inspectors also found that good leadership and good governance “go hand in hand,” and most of the trusts had made changes to their systems and processes to drive improvement.

The report features specialist mental health trusts that have achieved significant improvements on re-inspection, as shown by their CQC ratings.

The featured trusts were Oxleas NHS Foundation Trust (FT), Somerset Partnership NHS FT, Lincolnshire Partnership NHS FT, South West Yorkshire Partnership NHS FT, North Staffordshire Combined Healthcare NHS Trust, Calderstones Partnership NHS FT, and Sheffield Health and Social Care NHS FT.

For many trusts, a poor CQC rating was a stimulus for improvement, with CQC reports used as a ‘springboard’ to make changes.

The report found that good leaders engage and empower staff, and that cultural changes support improvement.

It notes the importance of an environment where staff feel empowered to speak up, as well as the benefits of looking outward, working with other organisations within the local health and care system and voluntary sector.

Good and improving trusts recognise that lasting improvement depends on organisations working together, as well as taking into account the views and experiences of patients and the public.

Dr. Paul Lelliot, deputy chief inspector of hospitals and lead for mental health, said that it is “encouraging” that these trusts have demonstrated their ability to improve, whilst the mental health sector struggles with challenges including an unprecedented demand and workforce shortages.

He said that these trusts have improved because they have strong, visible leaderships that is compassionate and inclusive, which engages and empowers front-line staff, unlocking their full potential to develop and improve care.

“In this report, we give examples of how these trusts have worked hard to strengthen their leadership through training, mentoring and development; including through working with NHS Improvement.

“In particular, the report emphasises the essential role of strong clinical leadership that ensures that medical and nursing staff are fully at one with the trust’s ambitions,” he added, encouraging others to learn from the case studies to help them in their improvement work.

Original source:

A Journey Through Leadership Using Empathy

A journey in Leadership using empathy

Key Learning Outcomes:
– Who are we? Understanding & developing the human connection
– How to identify and understand emotionally focused thinking and practice and staff focused leadership
– How lack of empathy in one-on-one encounters has the potential to cause psychological harm, how to respond to others using empathy
– How to cultivate empathy and inclusive leadership- communicate at a deeper level
– How to use your new skills to enhance the human connection and handle difficult conversations
– How to manage empathy to prevent burn out and improve retention
Understand reflexive leadership and how to use these skills for staff well- being and productivity


Description: This one-day course examines, in a unique, thought provoking and human way, the important role empathy and emotional awareness plays in inclusive leadership, staff well-being and productivity, and what erodes it. Delegates will develop understanding of the psychology of emotionally focused thinking and outcomes and learn essential skills to understand and implement effective relationship focused work, underpinned with empathy and emotional development.

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C&C Empathy Training packages:

Click on link to see the full range of packages that C&C Empathy Training can help you with embedding empathy into your organisation.



News: Nursing Times highlights a ‘bullying culture’. Managing harmful behaviour.

An article published in the Nursing Times talks of a ‘bullying culture between accident and emergency department nurses at a hospital trust in Merseyside has led to “tribal divisions” between staff and has been perpetuated by bosses failing to intervene, an independent report has found’. It goes on to say….

‘The behaviour has been going on for many years and is aimed at newly promoted band 6 sisters, according to the report on Arrowe Park Hospital, which is run by Wirral University Teaching Hospital NHS Foundation Trust.

Unedifying” comments were made by staff about colleagues, which suggested they did not understand one another’s role, expertise or personal circumstances, said the researchers.

It includes nurses undermining colleagues in front of less experienced staff, “aggressively” challenging their decisions, withholding information, and making comments suggesting they did not deserve the promotion, said the report.

They warned that these behaviors had been allowed to persist due to senior staff failing to address the issues.

“By allowing them to go unchallenged, people have at least been given passive permission and at worst, inadvertent encouragement to behave badly.’                                           Carolyn

It is very sad to read an article about bullying in nursing, indeed bullying in any environment, as nurses are no different from anyone else, human beings, capable of immense care and also uncompassionate behaviour.

With the work that I do with healthcare professionals on developing and communicating empathy and their own emotional awareness, alongside my background of counselling, people are always interested in understanding where bullying behavior comes from. The unconscious processes often play emotionally and how often we don’t understand the psychological damage it can do to the person on the receiving end.

Although my training is not about bullying specifically, the areas looked at explores the power and lack of empathy toward another, along with a lack of emotional awareness, both individually and organisationally. However, it does this through analysis of a case study, my story, that in fact has elements of the above but in a situation whereby my openness and honesty, allow people to feel empathy, and challenge their own thinking and biases, in a supportive, non-threatening environment. 

We all carry around many influencing factors in how we communicate and behave. We all have the ability to be manipulative and defensive, as well as kind and open. We all catch emotions from another (why culture is so important). Leaders often screenshot-11ask me the best way to develop empathy in their organisation, and my answer is, for it to be demonstrated from the top. With empathy being one of the most crucial skills in leadership, it is vital that the message is loud and clear in the cultural vision.

We all have our own ‘Funnel of Life’ to contend with. It’s why honesty from others about their vulnerabilities and unhelpful emotions, as well as helpful ones, speak again and again to the many people I work with in training workshops, or conferences. Screenshot (236)

woman-2696408_1280Behaviour that causes psychological harm to another, must always be challenged, I have suffered psychological harm from healthcare professionals myself, and bullying attitudes. The change though comes in people the most when they actually understand why they act as they do, and start to recognise the impact they are having on another and desire to act differently. Empathy and emotional awareness are key factors in this. Often to get to that point, however, you need to create the right environment to for people to start to examine themselves and who they actually want to be in a supportive way.  

Carolyn Cleveland, C&C Empathy Training #empathyenvoy 

original news source:

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“You’re the best physician I’ve ever worked with.”

Oncology fellow at Duke University Medical Center, Jeremy Force, who had never met this particular female patient but, was assigned to stop by her room to discuss her decision to enter the hospice.

Having just attended a course on using empathy to benefit clinical outcomes through understanding patient stories, Force used new found skills to try and understand the emotional experience of this patient at a point where clinical skills were not going to cure her. As he listened intently, not always an easy thing to do as we so often want to ‘fix’ things, the female patient cried. She expressed that she was exhausted and worried about the impact her death would have on her two daughters.

Force acknowledged how hard what she was going through was during the 15-minute conversation they had and shared with her he also had two children and that the hospice was designed to provide her additional support. When he saw her a few day later in the corridor, this patient said to him, “You’re the best physician I’ve ever worked with,” Force remembers her telling him. “I was blown away,” he says. “It was such an honour.”

This story is a couple of years old but it is worth telling again as empathy in communication and the importance of listening to what I refer to in my empathy training as the emotional data to understand the emotional experience of another. Whether I am working with complaints and serious incident teams, patient experience teams, clinical frontline staff or those in leadership roles, it is the emotional experience that they are supported to hear, feel and understand. Missing this vital thing is to carry out often procedures in an exemplary manner, yet leaving someone feeling unheard and sometimes uncared for; the total opposite of what most in the healthcare system who go through rigorous training and grueling workloads, to achieve.

There is now such overwhelming evidence that has linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout, and a lower risk of malpractice suits and errors. Understanding another’s experience is an important part of making a human connection. A human connection that not only supports and gives to the patient but supports and gives back to the medical staff.

Being a good healthcare professional means understanding people not just clinical skills, but I would argue too that being a good patient, requires understanding your healthcare professional too. Empathy is part of communication and communication is not one way. The doctor, for example, building an empathic human connection, allows for this to develop from both sides.

I experienced this from my GP who cared for me, and I do not use that word lightly, because that is exactly what I felt, cared for, when my adopted daughter died unexpectedly in the hospital, leaving me with many tormented questions. His clinical skills were needed to support me as a non-medical person to understand, but his recognition of my emotional experience was vital and communicated in words, body language time and his eyes.

I clearly remember one day, driving to the surgery in a grief-stricken haze. I actually don’t know how I got from my house to the surgery. I was then sitting in front of him in his room, barely able to string two words together. He started fairly clinically and then all of a sudden he stopped and just looked at me. I knew at this point he was seeing what I was feeling and he was not feeling sorry for me, but starting to empathise and feel with me. He saw that day, my torment, pain, sadness, shock. And the reason I know he saw these emotions was because he mirrored them back to me. His face started to change and he too had a look of torment, pain, sadness, and shock. Maybe for different reasons, but in that silent moment, I felt completely understood. It shocked me a little even to see myself reflected in his facial expression but gave me a huge sense of safety at a time that I felt I had little emotional safety to anchor myself too. It consolidated the trusting relationship I had with him as my GP. There are interactions you remember forever and this is one of them. A very good interaction in a very bad situation.

It’s part of why I do what I do now. Why I believe in learning through narratives and total openness and honesty. Yes, study after study is backing up the benefits of training empathy in healthcare, but alongside that, I have felt its benefits, just as Force and his female patient did.

Empathy: the POWER of understanding and imaginatively entering into another person’s feelings

Collins English Dictionary

The original source for Jermey Force story:

To see more on the empathy training I do see:


Empathy: The soft skill that gets hard results

Empathy has long been embedded in counselling practice and as such not always been given the credit as the powerful attribute it should. Along with the battle to get mental health taken seriously, despite overwhelming evidence, both for individuals psychological well-being, but the economic workforce of having people off ill when it all gets too much, empathy gets put on the back burner too. Yet, this ‘soft skill’ of empathy gets hard results.

Within medical settings, empathy positively impacts on patient satisfaction (meaning less complaints), better patient recall of medical information and less repeat visits to the GP, helping both the financial as well as the emotional aspect of care in the health system. It doesn’t stop there either, teachers see pupils with higher motivation and effort when empathy is used. And  Marshal Rosenburg, found with his work on Non Violent Communication, understanding the ‘needs’ of another is the key to conflict resolution, from personal relationships to war torn communities, with empathy being a key skill in hearing and understanding those needs. In study after study in leadership, empathy comes out as the number one skill to possess.

So this so called soft skill really impacts. But why? Well there are 100’s of studies on why and, a fair few out there discrediting them. However, working with the people I work with, primarily in the NHS but also other organisations, I often see people come in feeling a little defensive and burnt our, as they are often already feeling that they are empathic. But what they realise as they travel on a journey with me, connecting on a human level and dealing with some of the less comfortable emotions, is a comonality. As we together identify what empathy means to them and what it feels like when someone really listens and understands, what they identify as good for someone else, corresponds with what they would want also, often recognising when this has not been present and the positive impact when it has. Identifying, validation, compassion, understanding, time, to be seen and heard, to be valued, they realise it is not just about what is good for others, but what we all seek.

It is no coincidence that patient experience is better when the patient feels validated. That the pupil is more motivated knowing they are valued and understood. That conflict is less exacerbated when we can get to the emotional needs someone has. Staying consciously aware of the need for empathy, in organisations, to offer best practice and look after staff well being,  means putting empathy and emotional awareness higher up on the agenda, both culturally and individually. This is from leadership and throughout organisations, investing in it and in the hard results that can be gained from it.

Courses run by C&C Empathy Training and suitable for anyone working in the public sector.

A Journey Through Complaints Using Empathy

“Hospital Trusts must listen well to complaints” Rob Behrens, Parliamentary Health Service Ombudsmen, 17th August, 2017

‘Investigation teams must be compromised of staff who have the skills to apply the Duty of Candour compassionately, and the skills to support individuals at a time of complex bereavement’ CQC Learning Accountability and Candour.

Description: A one-day course ideal for those working with families raising an initial concern or following the official complaints procedure. Delegates will develop the confidence to handle such conversations with reasoned empathy, aiding honest investigations and preventing prolonged psychological harm (Duty of Candour). This course promotes staff mental health and well-being as well as patient focused communication. This course can be adapted for non health and social care professionals.

 “I would highly recommend this course to anyone working in the Complaints sector. The information conveyed on the day was invaluable to gaining a deeper understanding of the role of empathy in dealing with complaints. It also helped elicit a desire to connect more fully with those offering feedback on the service, and really understand their story”

Maddie Bettess, Complaints Manager, Barchester Healthcare

A Journey in Leadership Using Empathy

A multitude of skills are required and one of the most important skills is empathy. The 2015 Global Empathy Index identified that the top 10 businesses (among 160), that had effectively empathic leaders and managers generated 50% more net income per employee, than the bottom 10 businesses.

Description: This one-day course examines, in a unique, thought provoking and human way, the important role empathy and emotional awareness plays in inclusive leadership, staff well-being and productivity, and what erodes it. Delegates will develop an understanding of the psychology of emotionally focused thinking and outcomes and learn essential skills to understand and implement effective relationship focused work, underpinned with empathy and emotional development.

“Sometimes it is not the drugs, training, or skills – sometimes all you need is empathy to make a difference!”

A beautiful article published in The Telegraph tells of a paramedic in Queensland, Australia who used empathy to make more difference to a patients life that any drugs could do at that time. Enjoy reading this lovely article:

Screenshot (212)‘A touching photo of paramedics helping fulfil a dying woman’s final wish to see the ocean one last time has touched hearts around the world.

Queensland Ambulance Service (QAS) paramedics went “above and beyond” to bring the palliative care patient, who was lying on a stretcher, to the beach.

The photo shows Queensland Advanced Care paramedic Graeme Cooper standing next to the woman, who passed away days later, looking out towards the picturesque Fraser Island from Hervey Bay.

“A crew were transporting a patient to the palliative care unit of the local hospital and the patient expressed that she just wished she could be at the beach again,” explained Hervey Bay officer-in-charge Helen Donaldson.

“Above and beyond, the crew took a small diversion to the awesome beach at Hervey Bay to give the patient this opportunity – tears were shed and the patient felt very happy.

“Sometimes it is not the drugs/training/skills – sometimes all you need is empathy to make a difference!”

Paramedic Danielle Kellan captured the touching moment and it was later shared on the QAS Facebook page where it has been shared more than 10,000 times.

The team told Daily Mail Australia they brought the patient to the beach for the first time two weeks ago as they were transporting her from the palliative care unit back home so she could be with her husband.

Ms Kellan said the photo was taken when they stopped at the beach for a second time on her final journey back to the palliative care unit.

“I said to the patient: ‘What are you thinking?’” she recalled. “And she said: ‘I’m at peace, everything is right’.”

The team’s kind actions have been praised on social media, one wrote: “As someone who recently lost a parent to cancer, this moved me to tears. Quite literally! Your compassion, your empathy – I can’t quite even put into words what amazingly beautiful people you are.”

Jen Boynton wrote: “This is absolutely beautiful! Such an amazing thing to do for that person. How beautiful that would [have] been to have a moment like that.”

Ms Donaldson praised the team’s “great work”, adding: “The service is very proud of you.”

original source:

For more about Carolyn: Carolyn Cleveland


Short Term Pain Vs Long Term Gain…Extract #1 from my book

Now Several chapters into my book, and already feeling like it is my companion coming back to life after many years of all those original diary entries being written 14 years ago. What kept me sane then, writing, analysing and feeling is being revisited by me as I look back, construct, cry sometimes, and connect it into my impassioned work today as founder of C&C Empathy Training

237339-Tony-Robbins-Quote-Remember-anything-you-want-that-s-valuableI have decided that I am going to write blogs with extracts from this book of mine, and here is the first one. As the title of this blog suggests, it is about how we sometimes have to face pain in order to have any peace further down the line. This extract is discussing this very subject that I battled with after losing a child in hospital and suddenly being in the extraordinary position of feeling full responsibility for a full account being heard by the coroner and the emotions I went through as it took its toll.

Book extract #1:

“So much of me wanted to be someone who could just let all this go and make it easier on myself, after all I didn’t even know if the coroner would even be interested in what I was compiling for him? But the truth was, I couldn’t just let it go. I had no real choice. I knew choosing not to do it would make it easier short term and my logic sometimes told me to do just that. Make it easier on yourself Carolyn. But that same logic as well as strong emotional fear, would say and where exactly do you think you will be at the end of it?

So, here was one of my dilemmas, would that ‘easier’ road lead me to a place of peace? Or, would it in fact take me to a place that would be the hardest destination of all, a soul in torment, defined for all time, for letting the truth die with my child. Conversely, as well as revealing a different version of events, would taking this harder, more soul-destroying road, ultimately lead me to a place that was gentler on my future existence?

By this, I was not thinking about heaven or hell after I died and my eternal soul. I was, at that time, almost past caring about that. What I was concerned with, was my life whilst I was still physically alive in this world. You see, since being 18, I had always been urged forward by my connection to this child and my need to be there for her as much as I was able. That feeling did not disappear when she died. It was just as strong and, whilst writing my version of her illness, as I have described, was soul destroying, caring for her was like oxygen to that very soul that had been so damaged. A life force that I needed. My soul, or my conscience as some may call it, or even just my ability to look at myself in the mirror and like who I saw staring back at me tormented me: Not wanting to look at my other children’s innocent faces that held such love for her and feel crippled with knowing that I didn’t stand up for their ‘big sis’, haunted me. It was that inner self who I feared for regardless of any afterlife. In truth, I wasn’t even sure I was going to survive this life at the time, let alone worry about the next one!

Following this difficult path and not avoiding it, was in fact, the only way I felt I might pain-is-real-hope-life-daily-quotes-sayings-picturesstand a chance of living the rest of my life and my children’s life, without going into total self-destruct mode. And so that was what I did. The decision made and almost out of my hands. All these years later, for all the doubts that I have had in my life, the one doubt that does not exist, is knowing that this course of action and travelling this painful road, led me to a destination that gave me peace. And once peace came, so did laughter, so did joy, and crucially so did hope. And hope is one of the best feelings in the world.”

‘If you keep hope alive, hope will keep you alive’

Cassandra Clare

Different Perspectives

2. Empathy helps open your mind.

Satya Nadella, CEO of Microsoft says that empathy does far more than just motivating you to volunteer or donate, (as an example) as it primarily opens your mind up to think more about other people’s perspectives.

This is my next piece on an article about Satya Nadella’s thoughts on empathy, as the CEO of Mircosoft. The first piece:

You Need To Embrace Empathy To Excel At Your Workplace And In Life

describes all of Satya’s 3 main benefits of empathy from a business perspective.

The second piece:

Who are we?

is where I start to look into each of them from my perspective, as someone who works with healthcare professionals (predominantly) to optimise their natural empathic attributes.

Today’s piece is about his Number 2 benefit as seen above: Empathy helps open your mind. 

Why is this, because I certainly advocate the same message in my training sessions.

When we do not empathise, we do not allow other people’s view points, perspectives, truths and therefore experiences to enter our consciousnesses. Sometimes, we struggle as our hard wiring is not set up to do that easily. However 98% of the population are hardwired to empathise, to a greater or lesser degree. We may struggle because we are not encouraged to do this in our workplace, or policy and procedure inhibits this ability. We may be struggling with what is happening in our own world and fear being overwhelmed?

c246840a6387d3708b60d27ea98b89bf (1)However, the more closed off we are to others perspectives, the smaller our world gets. But what is key here, is the emotional awareness aspect. Learning about our own biases and perspectives.

Understanding some of our fears and when we are reacting to those fears in an unhelpful way, enables us to know ourselves better. When we do that…recognise our emotional data and language…we are more able to recognise emotional language and data in others. But sometimes we can get stuck in our own thoughts, emotions and experiences. Empathy, which of course focuses on the perspectives and feelings of others, often through imagination, can enable us to grow personally by challenging our thoughts and views, understanding them better and developing what we need to also. We open our mind to look in a different direction and see a different perspective.

I very much wished to only see my perspective after I lost a child in hospital and wanted to feel very angry with the consultant and see him and his actions in a hateful way. Yet empathy helped me. It challenged me to try and see his perspective, what might it be like to be in his position and how might that feel? This did not equate in me agreeing with him, but I was able to acknowledge him as having a different set of feelings and perspectives, experiences and understanding than me. Empathy opened my mind to see 39ba2dbbeyond the initial picture. The difficulty of this process….and trust me…empathising with the clinician was not an easy task! But that difficult process pushed and challenged my mind and how I viewed things. It enabled me to not only see the perspective of the other person, but to understand my own perspective more clearly also. Win win!

Empathy was something that was not reciprocated to me by the hospital, but that in turn, gave me insight to the harm that can be done when empathy is not used. When emotional awareness both individually and culturally is not recognised as important or promoted. This struggle of both sides, 1) trying to exercise empathy and 2) being denied it, gave me a richer picture of the impact the presence or absence of empathy had on interactions, conflict, understanding and compassion. One that I am very grateful to have.

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