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Optimising impact and sustainability: a qualitative process evaluation of a complex intervention targeted at compassionate care
  1. Jackie Bridges1,2,
  2. Carl May1,2,
  3. Alison Fuller3,
  4. Peter Griffiths1,2,
  5. Wendy Wigley1,
  6. Lisa Gould1,
  7. Hannah Barker1,
  8. Paula Libberton1
  1. 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
  2. 2 NIHR CLAHRC Wessex, Southampton, UK
  3. 3 Institute of Education, University College London, London, UK
  1. Correspondence to Professor Jackie Bridges, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK; jackie.bridges{at}


Background Despite concerns about the degree of compassion in contemporary healthcare, there is a dearth of evidence for health service managers about how to promote compassionate healthcare. This paper reports on the implementation of the Creating Learning Environments for Compassionate Care (CLECC) intervention by four hospital ward nursing teams. CLECC is a workplace educational intervention focused on developing sustainable leadership and work-team practices designed to support team relational capacity and compassionate care delivery.

Objectives To identify and explain the extent to which CLECC was implemented into existing work practices by nursing staff, and to inform conclusions about how such interventions can be optimised to support compassionate care in acute settings.

Methods Process evaluation guided by normalisation process theory. Data gathered included staff interviews (n=47), observations (n=7 over 26 hours) and ward manager questionnaires on staffing (n=4).

Results Frontline staff were keen to participate in CLECC, were able to implement many of the planned activities and valued the benefits to their well-being and to patient care. Nonetheless, factors outside of the direct influence of the ward teams mediated the impact and sustainability of the intervention. These factors included an organisational culture focused on tasks and targets that constrained opportunities for staff mutual support and learning.

Conclusions Relational work in caregiving organisations depends on individual caregiver agency and on whether or not this work is adequately supported by resources, norms and relationships located in the wider system. High cognitive participation in compassionate nursing care interventions such as CLECC by senior nurse managers is likely to result in improved impact and sustainability.

  • health professions education
  • humaneness
  • implementation science
  • organizational theory
  • teamwork

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Funding The CLECC study was funded by the National Institute for Health Research Health Services and Delivery Research programme (project number 13/07/48)

  • Disclaimer The views and opinions expressed are those of the authors and do not necessarily reflect those of the Health Services and Delivery Research programme, NIHR, NHS or the Department of Health.

  • Competing interests None declared.

  • Patient consent No patient data reported in this paper.

  • Ethics approval Social Care Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data are not available for sharing.

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