This chapter focuses on systemic factors in healthcare systems and how these can promote qualities such as mindfulness, awareness, resilience, and compassion. Too often, health systems do not promote these values at the organisational level despite the best efforts of individual healthcare workers. With attention and awareness, however, this can be remedied. This chapter examines the themes of compassionate leadership in healthcare organisations, resilience in these settings, and specific approaches that healthcare professionals can take to increase compassion across the healthcare systems in which we work. These steps include: (a) leading by example to promote compassionate behaviour for better care; (b) supporting the well-being of colleagues and staff we manage; (c) fostering open communication across clinical and managerial teams; (d) including patients and families in decision-making and valuing their perspectives; (e) promoting teamwork and collaboration that are inclusive, adaptive, and resilient; (f) recognising and rewarding compassionate care, both formally and informally; and (g) making self-compassion a key organisational value: health care is challenging, we are all human, and self-compassion is the basis of compassion for others.

This chapter focuses on resilience and compassion, starting by examining the relevance of resilience in healthcare, especially during the Covid-19 pandemic. The chapter notes that while a certain amount of resilience is helpful and even essential, resilience depends on not only the personal characteristics of each healthcare worker, but also the conditions in which they work. Relevant factors include the structure and function of teams, models of organisation, quality of leadership, and resources. These matters have an enormous influence on individual experiences, attitudes, and behaviour, and on the levels of resilience that are required and accessible in the workplace, as well as compassion. This chapter considers the concepts of ‘compassion fatigue’ and ‘burnout’, and outlines barriers to, and facilitators of, compassionate care. Systemic challenges include competing system demands, time constraints, inadequate resources, communication issues, poor emotional connections with the broader healthcare system, and the perception and/or reality of staff not being valued for the care they provide. These are themes that resonate with many people who work in large healthcare systems where organisational challenges loom large, often distracting focus from day-to-day patient care. This chapter also examines the roles of mindfulness and meditation in navigating these challenges.

Awareness is the quality of knowing and understanding that something is happening or exists. It means bringing conscious attention to whatever is arising, with as little judgement as possible. On a subconscious level, we respond to what is happening in the moment by applying existing information in our brains to the external event. This response is often habitual or unaware, as we tread well-worn grooves in our brains and follow heuristics which help us to manage the vast amount of information that comes our way every moment. These cognitive shortcuts can be helpful, but they can limit our understanding, undermine our confidence in new situations, and diminish the attention we pay to what our bodies and minds tell us. Deepening awareness involves developing mindfulness, which means paying careful attention to the present moment, simply and directly, rather than being distracted by thoughts, judgements, or interpretations. Traditionally, there are four components or foundations of mindfulness. This framework allows us to develop awareness of all aspects of our experience. These are: (a) mindfulness of the body; (b) mindfulness of feelings or feeling-tone; (c) mindfulness of states of mind or emotions, and (d) mindfulness of thoughts. This chapter offers exercises and guidance for developing deeper awareness and mindfulness in day-to-day life.

The purpose of this ‘Handbook of Compassion in Healthcare: A Practical Approach’ is to help make compassionate care a day-to-day clinical reality for everyone: patients, families, and healthcare professionals. We do not suggest that current health systems are entirely lacking in compassion. All around the world, clinical care is provided by staff who seek to be professional, compassionate, and patient-centered at all times. The very existence of health centres, doctors’ surgeries, outpatient clinics, acute hospitals, daycare centres, dental practices, physiotherapy centres, and many other healthcare facilities is a testament to basic human compassion, to society’s commitment to help the afflicted, and to our fundamental desire to support each other in times of difficulty. We care. At the same time, it is clear that healthcare settings vary widely in relation to compassion, with some already excelling in compassionate care, but others in need of a more conscious or sustained focus on compassion. Many services do well, but most could do better. Improvement is always possible. Health systems are operated by people, for people. Compassion matters deeply. Compassion can be the key value that improves services further and makes our fundamental caring impulses more apparent, more effective, and more human. Always and everywhere, compassion matters.

This chapter explores the concepts of self-compassion and moral injury, and ways of navigating complex healthcare roles with self-awareness, kindness, and greater compassion. Self-compassion involves recognising our suffering, being moved by it, and offering kindness and understanding towards ourselves. Human beings can be our own worst enemies and toughest critics. Cultivating self-compassion helps to address this tendency, increase resilience, and empower us to show greater compassion towards others. Moral injury stems from situations in which a person must make choices that go against their core values and can corrode compassion. There are many kinds of moral injury, ranging from a single large, conflictual decision to a sustained pattern of smaller but still conflictual decisions that arise on a day-to-day basis. The latter is common in large healthcare systems owing to rapid decision-making, inadequate resources, outsized expectations of healthcare providers, and working conditions that are often not conducive to clear thought: long hours, sleep deprivation, inadequate personal support, and lack of compassion for staff. This chapter examines how to manage the risk of moral injury in these situations, how to boost self-care for staff, and the importance of self-compassion when managing or living with difficult experiences or situations, especially on a recurring basis.

This chapter looks at ways of building personal resilience as a foundation for compassion. The chapter starts by presenting relevant learnings about resilience from the Covid-19 pandemic; outlines positive behaviours that promote individual physical health, mental health, and resilience; presents a guided imaginative practice focusing on resilience and inner solidity, and, finally, draws together key themes of resilience, equanimity, and compassion towards the end of the chapter. The overall message is that self-care is (a) an act of radical self-compassion, (b) the basis of compassion for other people, and (c) a vital foundation for resilience, among other qualities. We cannot care for others, or become more resilient, unless we care for ourselves, so it is essential that healthcare workers pay attention to their physical and mental health. This includes optimising levels of physical exercise, sleep patterns, and dietary habits, as best as possible. It also includes specific steps to improve mental health, both in our own lives and in relationship with other people. Physical and mental health are intimately related with each other. Both are vital foundations for learning greater resilience and cultivating deeper compassion for ourselves, our patients, their families, and our colleagues in the healthcare professions.

As we cultivate mindfulness, we can develop and deepen our compassion skills, both for ourselves and for others. Without self-compassion, we will struggle to look after other people compassionately. This chapter explores ways to build self-compassion and how to extend this compassion to other people in our lives. This includes our patients, their families, and our colleagues, as well as our own families and circles of friends. These are important tasks that find their roots in the theoretical and research foundations of compassion, and build on the awareness skills that we develop through mindfulness practice. This chapter presents exercises for deepening self-compassion, growing compassion for other people in our lives, and extending that compassion to everyone. By focusing on common humanity, we move towards a more stable, engaged response to other people, less informed by our own situation and more informed by theirs, less shaped by our judgements about them and more shaped by what we can achieve together. Developing compassion for everyone can be challenging, especially for people whom we anticipate will be difficult, but, with awareness, we can move in the right direction. This chapter concludes with an exercise that focuses on generating feelings of compassion towards other people by encouraging mindfulness of our connection with all beings and the planet as a whole.

Self-awareness brings the person to deeper levels and within new realms of understanding social and emotional intelligences because the perception is focused on the contexts and meanings in which feelings or emotions arise. This chapter offers readers a multicultural perspective on what awareness means and how it can help to explore the social and emotional phenomena of a person’s world. Taoist and Buddhist perspectives open up the perspective on what awareness entails. This chapter explores how self-awareness is more than a cognitive endeavor, and is a phenomenal feature of the social and emotional intelligences.

Mindfulness has evolved from a psychological intervention to a transformative lifestyle practice, offering profound benefits for mental health and cognition. By focusing on the present moment, mindfulness cultivates self-awareness and effective coping mechanisms, thereby reducing stress and promoting emotional regulation. Evidence suggests that structured mindfulness training enhances emotional wellbeing, mitigating anxiety and depression, and improving sleep quality, even during periods of heightened stress like the COVID-19 pandemic. In educational settings, mindfulness contributes to reduced depression and anxiety while enhancing academic performance. Moreover, it fosters resilience and job satisfaction among professionals in high-stress environments. Cognitive benefits of mindfulness include improvements in executive function, attentional control, and working memory, even in neurological and neuropsychiatric disorders. Neuroscientific studies reveal structural and functional brain changes in regions involved in attention and emotion regulation. Embracing mindfulness as a regular practice empowers individuals to navigate life’s challenges with resilience, promoting mental health, creativity, and overall quality of life.

The primary focus of this chapter is chronic pain. Treatment approaches discussed include cognitive-behavioral therapy and acceptance and commitment therapy. Credible components of treatment include behavioral goals, exposure, activity pacing, cognitive skills training, acceptance, relaxation, mindfulness, and psychological flexibility. A sidebar describes somatic symptom disorder.

Broad approaches to treating attention-deficit/hyperactivity disorder in adults include cognitive-behavioral therapy and dialectical behavior therapy. Credible components of treatment include an emphasis in learning theory, time estimation, temporal discounting, prioritizing/planning, self-instruction, cognitive refraining, and mindfulness. A sidebar discusses co-occurring conditions such as anxiety and depression.

Global Leaders in the 21st Century examines the current context of international management and looks at the noteworthy changes in the business and leadership contexts of globalization. A major shift appears to be taking place in the global political economy. The predominant system characterized by global economic agreements, free trade, global supply chains, and multilateral institutions is being challenged by an increase in the primacy of national interests and security. In this volatile, uncertain, complex, and ambiguous (VUCA) environment, traditional ways of managing are not entirely adequate, and global leaders need to develop new skills. This chapter introduces the concept of Mindful Global Leadership and its components of context sensitivity, perspective taking, and a process orientation. It also presents a global leadership typology-based task complexity and relationship complexity.

The role and importance of cognitive factors in the development and maintenance of insomnia have been well recognised for some time. Indeed, insomnia is characterised by several types of challenging thoughts, and these, coupled with hyperarousal, lead to difficulties sleeping. This chapter describes the role of cognitive factors in insomnia and describes in depth a range of cognitive techniques, their background, and the evidence for them. A number of cognitive techniques are described, including cognitive control, paradoxical intention, articulatory suppression, imagery-training, mindfulness, cognitive restructuring, and problem-solving. For each therapeutic, the reader is provided with specific instructions and narratives to follow to aid in their implementation when working with a patient.