Embedding compassionate care in local NHS practice: developing a conceptual model through realistic evaluation
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The aim of this study was to critically analyse the impact of the ‘Leadership in Compassionate Care Programme’ and offer a conceptual model of factors that can embed compassionate care in contemporary health care environments. This three-year initiative (2008–2011) was designed to embed compassionate care in both practice and pre-registration education. Using a realistic evaluation approach this longitudinal qualitative study involved data collection in eight participating wards. The ‘level of adoption’ of the Programme varied across the wards, which pointed to key context and mechanisms that were influential in embedding compassionate care. Contextual factors that promoted adoption of the Programme were stability, support and leadership. The most important mechanisms were appreciative inquiry coupled with skilled facilitation. Powerful practice development techniques focused on articulating and demonstrating values; giving patients, relatives and staff a voice to express their experiences and emotions; and instituting effective feedback mechanisms. In the high adopting wards the main outcomes included personalisation of patient care, an increased sense of involvement for relatives and ‘caring conversations’ becoming an accepted part of working practice. Embedding and sustaining compassionate care demands strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development and effective leadership at all levels.
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MacArthur et al. (2017) generated a dynamic, practice-based model for strengthening organisational capacity for compassionate care.
“Generated a dynamic, practice-based model for strengthening organisational capacity for compassionate care”
From Whither compassionate leadership? A systematic review (2024) · cites this paper as MacArthur et al. (2017)
Cites
(1998) · Cited by 13,501 · see citing works
The Space Between: On Being an Insider-Outsider in Qualitative Research
Dwyer, S. C., & Buckle, J. L. (2009) · International Journal of Qualitative Methods · doi:10.1177/160940690900800105 · Cited by 2,681 · see citing works
Aiken, L. H., Sermeus, W., den Heede, K. V., Sloane, D. M., Busse, R., McKee, M., Bruyneel, L., Rafferty, A. M., Griffiths, P., Moreno‐Casbas, T., et al. (2012) · BMJ · doi:10.1136/bmj.e1717 · Cited by 2,060 · see citing works
Qualitative research in health care: Using qualitative methods in health related action research
Meyer, J. (2000) · BMJ · doi:10.1136/bmj.320.7228.178 · Cited by 596 · see citing works
Luxford, K., Safran, D. G., & Delbanco, T. (2011) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzr024 · Cited by 509 · see citing works
McCormack, B. G., & McCance, T. (2010) · Wiley eBooks · doi:10.1002/9781444390506 · Cited by 387 · see citing works
Theories of Change and Realistic Evaluation: Peas in a Pod or Apples and Oranges?
Blamey, A., & Mackenzie, M. (2007) · Evaluation · doi:10.1177/1356389007082129 · Cited by 383 · see citing works
Lown, B. A., Rosen, J. A., & Marttila, J. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0539 · Cited by 376 · see citing works
Dewar, B. J., & Nolan, M. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.01.008 · Cited by 308 · see citing works
Person-centred Nursing: Theory and Practice
McCormack, B. G., & McCance, T. (2010) · Medical Entomology and Zoology · Cited by 283 · see citing works
Bramley, L., & Matiti, M. R. (2014) · Journal of Clinical Nursing · doi:10.1111/jocn.12537 · Cited by 231 · see citing works
Bridges, J., Nicholson, C. J., Maben, J., Pope, C. J., Flatley, M., Wilkinson, C., Meyer, J. E., & Tziggili, M. (2012) · Journal of Advanced Nursing · doi:10.1111/jan.12050 · Cited by 181 · see citing works
Relational Practice and Nursing Obligations
Doane, G. H., & Varcoe, C. (2007) · Advances in Nursing Science · doi:10.1097/01.ans.0000286619.31398.fc · Cited by 149 · see citing works
Clarfield, A. M., Bergman, H., & Kane, R. L. (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.49285.x · Cited by 148 · see citing works
Compassion in care: A qualitative study of older people with a chronic disease and nurses
van der Cingel, M. (2011) · Nursing Ethics · doi:10.1177/0969733011403556 · Cited by 140 · see citing works
Implementing the 4D cycle of appreciative inquiry in health care: a methodological review
Trajkovski, S., Schmied, V. A., Vickers, M. H., & Jackson, D. W. (2013) · Journal of Advanced Nursing · doi:10.1111/jan.12086 · Cited by 139 · see citing works
Student nurse socialisation in compassionate practice: A Grounded Theory study
Curtis, K., Horton, K., & Smith, P. A. (2012) · Nurse Education Today · doi:10.1016/j.nedt.2012.04.012 · Cited by 136 · see citing works
Dewar, B. J., Mackay, R., Smith, S., Pullin, S., & Tocher, R. (2009) · Journal of research in nursing · doi:10.1177/1744987109352932 · Cited by 119 · see citing works
Compassionate Care: Student nurses' learning through reflection and the use of story
Adamson, E., & Dewar, B. J. (2014) · Nurse Education in Practice · doi:10.1016/j.nepr.2014.08.002 · Cited by 99 · see citing works
Post, S. G., Ng, L. E., Fischel, J. E., Bennett, M., Bily, L., Chandran, L., Joyce, J., Locicero, B., McGovern, K., McKeefrey, R. L., et al. (2014) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12243 · Cited by 90 · see citing works
Valuing compassion through definition and measurement
Dewar, B. J., Pullin, S., & Tocheris, R. (2011) · Nursing Management · doi:10.7748/nm2011.02.17.9.32.c8301 · Cited by 87 · see citing works
International Practice Development Journal
(2017) · International Practice Development Journal · doi:10.19043/ipdj · Cited by 79 · see citing works
(1921) · BMJ · doi:10.1136/bmj.1.3144.500 · Cited by 77 · see citing works
Learning – The Heart of Practice Development
Clarke, C. L., & Wilson, V. (2007) · doi:10.1002/9781444319491.ch6 · Cited by 74 · see citing works
Delivering compassionate care: the enablers and barriers
Christiansen, A., O'Brien, M. R., Kirton, J. A., Zubairu, K., & Bray, L. (2015) · British Journal of Nursing · doi:10.12968/bjon.2015.24.16.833 · Cited by 74 · see citing works
Betcher, D. K. (2010) · PubMed · Cited by 71 · see citing works
Crowther, J., Wilson, K., Horton, S., & Lloyd‐Williams, M. (2013) · Journal of the Royal Society of Medicine · doi:10.1177/0141076813503593 · Cited by 64 · see citing works
Shield, R. R., Tong, I. L., Tomas, M., & Besdine, R. W. (2011) · Medical Teacher · doi:10.3109/0142159x.2011.586748 · Cited by 62 · see citing works
Smith, S., Dewar, B. J., Pullin, S., & Tocher, R. (2010) · International Journal of Older People Nursing · doi:10.1111/j.1748-3743.2010.00224.x · Cited by 50 · see citing works
Connecting Relational Work and Workgroup Context in Caregiving Organizations
Parker, V. A. (2002) · The Journal of Applied Behavioral Science · doi:10.1177/0021886302038003002 · Cited by 44 · see citing works
Using creative methods in practice development to understand and develop compassionate care
Dewar, B. J. (2012) · International Practice Development Journal · Cited by 34 · see citing works
Williams, S., Nolan, M., & Keady, J. D. (2009) · Quality in Ageing and Older Adults · doi:10.1108/14717794200900024 · Cited by 33 · see citing works
International Practice Development in Nursing and Healthcare
(2007) · Wiley eBooks · doi:10.1002/9781444319491 · Cited by 29 · see citing works
Mid Staffordshire scandal highlights NHS cultural crisis
Holmes, D. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60264-0 · Cited by 28 · see citing works
Smith, S., Gentleman, M., Loads, D., & Pullin, S. (2014) · Nurse Education Today · doi:10.1016/j.nedt.2014.03.003 · Cited by 25 · see citing works
A discussion of approaches to transforming care: contemporary strategies to improve patient safety
Burston, S., Chaboyer, W. P., Wallis, M. C., & Stanfield, J. (2011) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2011.05706.x · Cited by 22 · see citing works
Bradshaw, A. (2010) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2010.03374.x · Cited by 21 · see citing works
Inspiring senior nurses to lead the delivery of compassionate care
Masterson, A., Robb, E., Gough, P., & Machell, S. (2014) · Nursing Older People · doi:10.7748/nop.26.8.26.e622 · Cited by 5 · see citing works
A practitioner's guide to service development.
Lees, L. (2010) · PubMed · doi:10.7748/cnp.v1.i6.pg18 · Cited by 3 · see citing works
Editorial: The importance of dignity
Reed, J., & McCormack, B. G. (2007) · International Journal of Older People Nursing · doi:10.1111/j.1748-3743.2007.00094.x · Cited by 2 · see citing works
Dignity in care: a genuine commitment?
Agnew, T. (2007) · Nursing Older People · doi:10.7748/nop.18.12.7.s10 · Cited by 2 · see citing works
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Compassion in healthcare: an updated scoping review of the literature
Malenfant, S., Jaggi, P., Hayden, A., & Sinclair, S. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-00942-3 · Cited by 235 · see citing works
“(2017), centering on ‘compassionate care’ where the needs of patients, relatives and staff are viewed as being distinct, and on the other hand, inter-related, in which sustainability requires a focus on relationship-centred care mediated through relational practice and relational inquiry, and a need for investment in…”
BackgroundInfluentialWhat Is This Thing Called a Mechanism? Findings From a Review of Realist Evaluations
Lemire, S. T., Kwako, A., Nielsen, S. B., Christie, C. A., Donaldson, S. I., & Leeuw, F. L. (2020) · New Directions for Evaluation · doi:10.1002/ev.20428 · Cited by 88 · see citing works
Whither compassionate leadership? A systematic review
Ramachandran, S., Balasubramanian, S., James, W. F., & Al Masaeid, T. (2024) · Management Review Quarterly · doi:10.1007/s11301-023-00340-w · Cited by 76 · see citing works
Sinclair, S., Kondejewski, J., Jaggi, P., Ordons, A. R. D., Kassam, A., Hayden, A., Harris, D., & Hack, T. F. (2021) · BMC Medical Education · doi:10.1186/s12909-021-02863-w · Cited by 65 · see citing works
“Offering compassion training in an organizational culture that was not supportive, did not emulate compassion, foster a safe learning environment or nurture a clinical culture of compassion, was a futile endeavor [86].”
BackgroundInfluentialThe impact of compassionate care education on nurses: A mixed‐method systematic review
Coffey, A., Saab, M. M., Landers, M., Cornally, N., Hegarty, J., Drennan, J., Lunn, C., & Savage, E. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.14088 · Cited by 63 · see citing works
“The barriers identified to compassionate care delivery were related to lack of available resources, lack of time, and lack of support (Bridges et al., 2017; MacArthur et al., 2017; O'Driscoll et al., 2018).”
BackgroundInfluentialImpact of a compassionate care leadership programme
Saab, M. M., Drennan, J., Cornally, N., Landers, M. G., Hegarty, J. M., Savage, E., Lunn, C., & Coffey, A. (2019) · British Journal of Nursing · doi:10.12968/bjon.2019.28.11.708 · Cited by 34 · see citing works
Obstacles to compassion‐giving among nursing and midwifery managers: an international study
Papadopoulos, I., Lazzarino, R., Koulouglioti, C., Aagard, M., Akman, Ö., Alpers, L., Apostolara, P., Araneda-Bernal, J., Biglete‐Pangilinan, S., Eldar‐Regev, O., et al. (2020) · International Nursing Review · doi:10.1111/inr.12611 · Cited by 28 · see citing works
“…resonate with recent evidence (Coffey et al. 2019) and describe organizational challenges and failures resulting from the need of more resources and training, and, in some cases, the need of support for the promotion of compassionate work cultures (Bridges et al. 2017; MacArthur et al. 2016).”
BackgroundLeading with compassion in health care organisations
Hewison, A., Sawbridge, Y., Cragg, R., Rogers, L., Lehmann, S., & Rook, J. (2018) · Journal of Health Organization and Management · doi:10.1108/jhom-10-2017-0266 · Cited by 29 · see citing works
Compassionate leadership in palliative and end-of-life care: a focus group study
Hewison, A., Sawbridge, Y., & Tooley, L. (2019) · Leadership in Health Services · doi:10.1108/lhs-09-2018-0044 · Cited by 26 · see citing works
Implementing interventions to improve compassionate nursing care: A literature review
Robinson, J., Raphael, D. L., Moeke‐Maxwell, T., Parr, J. M., Gott, M., & Slark, J. (2023) · International Nursing Review · doi:10.1111/inr.12910 · Cited by 20 · see citing works
Sinclair, S., Harris, D., Kondejewski, J., Ordons, A. R. D., Jaggi, P., & Hack, T. F. (2022) · Teaching and Learning in Medicine · doi:10.1080/10401334.2021.2017941 · Cited by 20 · see citing works
A Leadership Model for Social Work: Drawing on Health Care to Inform Social Work Leadership
Schaub, J., Hewison, A., Haworth, S., & Miller, R. J. (2021) · The British Journal of Social Work · doi:10.1093/bjsw/bcab185 · Cited by 19 · see citing works
Nurses’ and midwives’ views of the “Leaders for Compassionate Care Program”: A qualitative analysis
Landers, M. G., Hegarty, J. M., Saab, M. M., Savage, E., Cornally, N., Drennan, J., Bassett, G., Lunn, C., & Coffey, A. (2020) · Collegian Journal of the Royal College of Nursing Australia · doi:10.1016/j.colegn.2019.03.005 · Cited by 18 · see citing works
Nielsen, C. L., Lindhardt, C. L., Näslund-Koch, L., Frandsen, T. F., Clemensen, J., & Timmermann, C. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16484 · Cited by 16 · see citing works
Geuens, N., Franck, E., Verheyen, H., Schepper, S. D., Roes, L., Vandevijvere, H., Geurden, B., & Bogaert, P. V. (2019) · Canadian Journal of Nursing Research · doi:10.1177/0844562119876777 · Cited by 16 · see citing works
“For example, MacArthur, Wilkinson, Gray, and Matthews-Smith (2017) stated that in high adopting wards of Leadership in Compassionate Care, staff were working in environments where they had shared values, were reflective, respected each other’s contribution, were open in their exploration of ways to enhance care, were…”
BackgroundHussien, R. M., Khalil, T. A., Almegewly, W. H., & Khedr, M. A. (2025) · Nurse Education in Practice · doi:10.1016/j.nepr.2025.104546 · Cited by 6 · see citing works
Galica, J., Alsius, A., Jemal, K., MacDonald, D. G., Awol, M., Oluwole, O., Lilius, J. M., Ross-White, A., & Snelgrove‐Clarke, E. (2026) · Health Care Management Review · doi:10.1097/hmr.0000000000000480 · Cited by 2 · see citing works
“The most common location of published studies was the United Kingdom ( n = 6; Ali and Terry, 2017; Chiumento et al., 2024; Farr and Barker, 2017; Maben et al., 2021; MacArthur et al., 2016; Ramage et al., 2017).”
Embedding Compassionate Care: A Leadership Programme in the National Health Service in Scotland
MacArthur, J. (2017) · Springer eBooks · doi:10.1007/978-3-319-71042-6_6 · Cited by 2 · see citing works
Self-citationSinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530384
Sinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530390
Sinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530387
Sinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530393
Additional file 1 of Compassion in healthcare: an updated scoping review of the literature
Malenfant, S., Jaggi, P., Hayden, K. A., & Sinclair, S. (2022) · Figshare · doi:10.6084/m9.figshare.19791004
Sinclair, S., Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A., Harris, D., & Hack, T. F. (2021) · Figshare · doi:10.6084/m9.figshare.16530378
Sinclair, S., Kondejewski, J., Jaggi, P., Ordons, A. R. D., Kassam, A., Hayden, A., Harris, D., & Hack, T. (2021) · Figshare · doi:10.6084/m9.figshare.16530381
- Authors
- MacArthur, J., Wilkinson, H., Gray, M. A., & Matthews-Smith, G.
- Affiliations
- NHS Lothian (GB)
- University of Edinburgh (GB)
- University of Liverpool (GB)
- Senior Lecturer, The Business School, Edinburgh Napier University, UK
- Corresponding author
- MacArthur, Juliet
- Venue
- Journal of Research in Nursing
- Publisher
- SAGE Publications
- Published
- 2016-12-19
- Volume
- 22
- Issue
- 1-2
- Pages
- 130-147
- ISSN
- 1361-4096 (ISSN-L)
- 1744-9871
- 1744-988X
- OpenAlex
- W2593746764
- Cited by
- 25
- References
- 43
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 8 · 2020: 3 · 2019: 4 · 2018: 1 · 2017: 1
- FWCI
- 5.53
- Type
- journal article
- Language
- en
- Open access
- Locations
- Journal of research in nursing (publishedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (publishedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- compassionate care, appreciative inquiry, practice development, leadership, relationship-centered care, family involvement, pre-registration education, feedback mechanisms, contextual factors
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