*pivotal for enabling the development and preservation of compassionate health care organizations."*

She goes on to describe how compassionate leadership contributes to healthcare organizations and links most of the elements identified as supporting the type of just culture required for a safe healthcare environment [94]. *"Developing leadership for compassionate care requires acknowledging and making provision for the difficulties and challenges of working in an anxiety-laden context … This means … sustaining high levels of trust and mutually supportive interpersonal connections, and fostering the sharing of knowledge, skills, and workload across silos. It requires enabling people to experiment without fear of reprisal, to reflect on their work, and to view errors as opportunities for learning and improvement. Tasks and relational care need to be integrated into a coherent unity, creating space for real dialog between patients, clinicians, and managers, so that together they can cocreate ways to flourish in the context of illness and dying"* ([93], p. 1).

West, Eckert ([89], p. 17) further explains this process by making explicit links between compassionate leadership and organizational cultures which provide the psychological safety for employees required to foster innovation and high-quality care. Such cultures are marked by compassionate leadership which is displayed via four key elements: "inspiring vision and strategy (i.e. unwavering focus on high-quality continually improving compassionate care; inspiring and meaningful vision; shared understanding; clear, aligned, manageable challenges and tasks; and alignment between workload and resources); positive inclusion and participation (ensuring all voices are heard; creating psychological safety and encouraging teams to be compassionate to one another; valuing diversity including patient groups, positive attitude to differences; and fair resolution of conflict); enthusiastic team and cross-boundary working (i.e. working compassionately with other teams (inter-team compassion); being supportive and collaborative; and having a 'how can we help?' attitude); and support and autonomy (i.e. creation of a positive climate – high levels of engagement, positivity and creativity; freedom to be autonomous, but with support; and treating staff with compassion).

#### *4.3.2 Humility*

West ([95], p. 73) also makes the link between compassion, humility and the quality of care in the following way *"Compassionate team members demonstrate a commitment to mutual support, building cohesion, modelling trust and demonstrating humility (rather than arrogance or directiveness)."* In other words, humility is strongly associated with psychological safety in teams, which in turn is associated with higher levels of patient safety [96, 97], including engagement in quality improvement work [98].

The importance of leaders' humility plays out in several ways. Firstly, as a characteristic of leaders (including of course social work leaders), humility means that the person in charge is able and willing to listen and consider the opinions of others. Humility as a leadership trait associated with effective leadership [99].

Secondly, as West ([95], p. 75) goes on to describe, humility is also a characteristic of organizations with compassionate cultures. In these organizations, *"Leadership strives to be authentic, open and honest, showing humility (a commitment to learning to improve their leadership, for example), optimism, appreciativeness and compassion."*

Thirdly, the idea of humble leadership is a *"… shift to go away from the person, hero, leader to seeing it as a process … to get away from looking at what does the individual need to be a leader, and examining the many, many ways that leadership occurs"* ([100], n.p.) including abandoning the *"… image of the self-reliant, heroic leader in favor of a shared* 

*Social Work Leadership for Patient Safety DOI: http://dx.doi.org/10.5772/intechopen.105535*

*leadership model characterized by humility and partnership"* ([101], n.p.), which in turns creates a positive organizational culture and a joint commitment to organizational goals (including patient safety and quality improvement) [102].

Finally, there is also a significant body of research which addresses the idea of cultural humility. Cultural humility as a way of addressing the needs of people from diverse backgrounds (both patients and staff) has overtaken the earlier concept of cultural competence. This is because, as Fisher-Borne, Cain ([103], p. 165) argue, *"Within social work and beyond, cultural competency has been challenged for its failure to account for the structural forces that shape individuals' experiences and opportunities. In contrast, the concept of cultural humility takes into account the fluidity of culture and challenges both individuals and institutions to address inequalities".* For social workers and all other health professionals, cultural humility *"… incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations*" ([104], p. 117).

Robinson, Masters ([105], p. 162) created what they call a conceptual model for healthcare leaders of the five 'Rs' of cultural humility, which are equal useful as a summary of the behaviors associated with leadership humility in general. The five Rs and their associated questions (which leaders ask themselves) are:

*Reflection Aim: One will approach every encounter with humility and understanding that there is always something to learn from everyone.*

*Ask: What did I learn from each person in that encounter?*

*Respect Aim: One will treat every person with the utmost respect and strive to preserve dignity and respect.*

*Ask: Did I treat everyone involved in that encounter respectfully?*

*Regard Aim: One will hold every person in their highest regard while being aware of and not allowing unconscious biases to interfere in any interactions.*

*Ask: Did unconscious biases drive this interaction?*

*Relevance Aim: One will expect cultural humility to be relevant and apply this practice to every encounter.*

*Ask: How was cultural humility relevant in this interaction?*

*Resiliency Aim: One will embody the practice of cultural humility to enhance personal resilience and global compassion.*

*Ask: How was my personal resiliency affected by this interaction?*
