Last week I had the wonderful opportunity to be part of an interactive event in Dundee. It was the 2nd Scottish Improvement Science Collaborating Centre (SISCC). A wonderful liberating and inspiring day. I just want to share some insights that came during the day which focused on care and compassion.
I was confronted by a series of questions that arose both within myself and in communication with others: 

• What is compassion? 
• Where does it come from? 
• Does it dwell within us or outside of us? 
• Can compassion be taught and learnt? 
• Is compassion an innate human quality?
• How can compassionate care be spread to places where it may not yet be realised?

My personal life experience is that compassion is a quality and energy that manifests, and awakens between us within relationship. Such relationship is born of communications both silent and spoken. It is in the richness of a reciprocal dialogue that the possibility of empathy and compassion awakens. For me it is a way of being in the world and being with others. 

Following last week I am left wondering how do institutions and organisations in which we work enable and disable the potential for compassion to be revealed? Do our organisations ensure relationships can flourish? I am thinking of organisational structures that resonate at a particular tone or mood of fear and control that may not value human connection in which compassion can thrive. 

What does the organisation you work for value most? I’m not speaking of written policy, guidelines and organisational rhetoric but coalface interactions between and through all layers of an organisation. Does the context you work for allow the magic between people to unfold and energise compassion? Are the the conversations we have with colleagues and users of services based on a democratic dialogue, that is to say, does our use of language create a level playing field between us? 

For compassion to thrive and inform our connections with others a particular mood is required. A mood of congeniality, openness, transparency, care and tenderness. If we understand that we have to be in one mood or another and that we cannot be without a mood then the mood of a places and persons are significant. If a mood permeating your place of work is largely fear based then that is how that environment comes to be understood and how all interactions in that environment become interpreted. I would contend that in that mood a maternity (or any health environment) unfolds into a risk orientated experience. That can feel threatening and stressful.

I remember transferring a women into a hospital from community. I was happy to see an old colleague on duty in the hospital yet the communication between us was uneasy. I was confused and disoriented. I was met by a host of questions about the care I had provided prior to admission. This was all necessary yet it was the tone of the communication that left me feeling uneasy. The obstetrician then entered and the mood drifted into antagonism which translated into a barrage of risk discourse that awakened anxiety both for me and the family I was working with. I remember becoming overly judgemental of my own decision making, second guessing myself and feeling defensive. I was on guard and felt no sense of connection between the staff and myself. I went quiet. 

My relationship with the mother and partner became challenging as they too were being pulled into this new mood since being admitted. Suddenly everything became dangerous and risky. We transferred in for slow progress of labour and maternal request for analgesia. It felt we had arrived just in time to stop a terrible outcome! I felt that no one was having a good day in that environment. 

On the other hand I have admitted from a homebirth with a woman having a retained placenta and been met with congeniality, respect and a listening ear. The admitting midwife made me a coffee whilst I admitted the woman and spoke to the doctor. The admitting doctor was friendly and professional. The mood on both occasions was startlingly different. Although the outcomes both times were positive for mother and baby in terms of physical needs there was a tangible felt difference postnatal in my relationships with the mothers. In the first story I went home exhausted, questioning my abilities and feeling frustrated. The postnatal care did not flow easily in the way I had hoped. In the second story I felt connected to my colleagues and went home feeling part of a team and that I had done a good job. The compassion in the second story left me sustained and nourished my relationship with the mother throughout the postnatal period.

Compassion is a quality awaiting a fertile ground to awaken and grow. Once compassion and care takes root it can nurture the possibility of compassionate connections in each moment. So for me compassion requires the right ground, a freeing type of resonance. Once the mood of an organisation shifts from one that narrows potential, for example when fearful, to one that opens to possibility something enlightening between us awakens. A spark of compassion, once a spark of a potential flame awakens it can be fanned into a roaring fire warming and bringing brightness to all our encounters.

Let us think about how our leadership is attuned? Our colleagues? Our policy makers? Our researches? Our educators? Our new graduates? 

Maternity and midwifery have been shown repeatedly to be based on relationships. Indeed it is the relationships that keep care safe. Midwives are the ambassadors of maternity care and have a responsibility to safeguard what is precious in childbirth and ensure its continuance is holistically orientated. Facilitating and turning to moods that enable compassion to flourish between us is therefore worthy of our efforts. We may or may not have innate compassion, in a certain sense that does not matter. However we can be accountable to the moods which we contribute to and choose to awaken and we can also decide the moods we choose to turn away from. We just need to be aware of moods and take notice of the affects certain moods have on ourselves and others.

For me the good news is that compassion awaits us all. It is not dependent on whether you or your colleague next to you has a good amount of innate compassion! The notion of compassion being inside or outside creates a kind of false objective -subjective dichotomy that is antithetical to compassion. Compassion wants to gift us all those wonderful experiences that come from giving and yielding to each other. Compassion is thus realised and expressed in our relational encounters. Compassion for me is thus unfolding moments between us in the reciprocal play of our interactions. Without the play between us compassion finds no ground to take root and grow. Compassion only asks for a fertile ground to grow and come forth. The delight of feeling compassion once awakened between us reminds us of our shared human needs of wanting to be understood to feel loved and to feel safe.

It may only take a kindly moment of eye contact, perhaps a smile and some gentle verbal acknowledgement of the others you meet and work with. Such moments can be the fan that ignites the flame of compassion between us.

taken from collective notes board at SISCC in Dundee 2016:Sept