Developing and Using a Toolkit for Cultivating Compassion in Healthcare: An Appreciative Inquiry Approach


  • Charlotte Ramage University of Brighton
  • Kathy Curtis University of Bournemouth
  • Angela Glynn University of Brighton
  • Julia Montgomery University of Sussex
  • Elona Hoover University of Brighton
  • Jane Leng University of Surrey
  • Claire Martin Brighton and Sussex University Hospital
  • Catherine Theodosius University of Brighton
  • Ann Gallagher University of Surrey



appreciative inquiry, compassion, healthcare workforce, train-the-trainer


This article describes the process of developing and evaluating a ‘cultivating compassionate care’ toolkit of evidence-based training resources designed to be cascaded through a ‘train-the-trainer’ approach in three healthcare organisations in Southern England. The purpose of the project was to develop an awareness of compassion, and to investigate how compassion can be recognised, developed, and sustained within the healthcare workforce. The study was based on appreciative inquiry and a train-the-trainer model, using focus groups to generate evidence-based training tools designed with the staff in the participating organisations. Questionnaires evaluated the first wave of Cultivating Compassion workshops delivered by trainers, while semi-structured interviews and focus groups evaluated the experiences of those using the toolkit. The findings demonstrated that a cultivating compassion toolkit, co-created with the healthcare workforce, can develop confidence in engaging in discourse on the meaning of compassionate care, and provoke a focus on self-compassion and compassion towards colleagues. Thematic analysis of interviews and focus group data with participants involved in cascading the toolkit activities revealed the value and usability of the toolkit resource, and the leadership factors influencing its implementation. We conclude that cultivating compassionate practices requires leadership to clearly articulate their values and vision for compassion, ensuring these are clearly supported and integrated throughout the organisation as part of changing culture and practices to support compassionate care. The limitation of the study was that we were unable, due to the project timeline, to measure impact of the project on patients, their families, and carers.

Author Biographies

Kathy Curtis, University of Bournemouth

Associate Professor and Head of Department Nursing and Clinical Sciences

School of Nursing and Clinical Sciences, Faculty of Health and Social Sciences


Angela Glynn, University of Brighton


Dr  - Deputy Head of School (Quality Assurance and Enhancement), Principal lecturer Physiotherapy

School of Health Sciences

Julia Montgomery, University of Sussex

Dr. - Senior Clinical Teaching Fellow (Department of Medical Education)

Brighton and Sussex Medical School

Elona Hoover, University of Brighton

Research Officer, Values and Sustainability,

School of Computing, Engineering and Mathematics, College of Life, Health and Physical Sciences

Jane Leng, University of Surrey

Senior Lecturer, School of Health Sciences

Claire Martin, Brighton and Sussex University Hospital

Head of Nursing and Midwifery Education

Catherine Theodosius, University of Brighton

Dr - Senior Lecturer, Nursing 

School of Health Sciences

Ann Gallagher, University of Surrey

Professor - International Care Ethics Observatory, School of Health Sciences


Adamson, E., Dewar, B., Donaldson, J. H., Gentleman, M., Gray, M., Horsburgh, D., …Waugh, A. (2012) Leadership in compassionate care programme: Final report. Edinburgh: Project Report. Edinburgh Napier University/ NHS Lothian. [online] available from [31 January 2017]

Atkins, P. and Parker, S. (2012) ‘Understanding individual compassion in organisations: The role of appraisals and psychological flexibility’. Academy of Management Review, 37 (4), 524–526

Barac, R., Stein, S., Bruce, B., and Barwick, M., (2014) ‘Scoping review of toolkits as a knowledge translation strategy in health’. BioMed Central Medical Informatics and Decision Making, 14 (121)

Bloor, M., Frankland, J., Thomas, M., and Robson, K. (2001) Focus Groups in Social Research. London: Sage Publications

Braun, V. and Clarke, V. (2006) ‘Using thematic analysis in psychology’. Qualitative Research in Psychology, 3 (2), 77–101

Brunero, S., Lamont, S., and Coates, M. (2010) ‘A review of empathy education in nursing’. Nurse Inquiry, 17 (1), 65–74

Burford, G., Hoover, E., Stapleton, L., and Harder, M.K. (2016) ‘An unexpected means of embedding ethics in organizations: Preliminary findings from values-based evaluations’, Sustainability, 8 (7), 612

Carter, B. (2006) ‘“One expertise among many” – working appreciatively to make miracles instead of finding problems: Using appreciative inquiry as a way of reframing research’, Journal of Research in Nursing, 11 (1), 48–63

Cole-King, A. and Gilbert, P. (2011) ‘Compassionate care: The theory and the reality’. Journal of Holistic Healthcare, 8 (3), 29–36

Cooperrider, D. (2000) ‘Positive image, positive action: the affirmative base of organising’. in Appreciative Inquiry: Rethinking Human Organization toward a Positive Theory of Change. ed. by Cooperrider, D., Sorensen, P., Whitney, D., and Yaeger, T. Ilinois: Champagne, IL: Stipes, 29–54

Cooperrider, D., Sorensen, P., Yaeger, T., and Whitney, D. (2001) Appreciative Inquiry: An Emerging Direction for Organization Development. Champagne, IL: Stipes

Crawford, P., Brown, B., Kvangarsnes, M., and Gilbert, P. (2014) ‘The design of compassionate care’. Journal of Clinical Nursing, 23 (23-24), 3589–3599

Curtis, K., Gallagher, A., Ramage, C., Montgomery, J., Martin, C., Leng, J., … and, Wrigley, M. (2017) ‘Using Appreciative Inquiry to develop, implement and evaluate a multi-organisation ‘Cultivating Compassion’ programme for health professionals and support staff’. Journal of Research in Nursing, 22 (1-2), 150–165

Curtis, K., Horton, K., and Smith, P. (2012) ‘Student nurse socialisation in compassionate practice: A grounded theory study’. Nurse Education Today, 32 (7), 790–795

Darbyshire, P. (2014) ‘Character assassination? Response to John Paley, “social psychology and the compassion deficit”’. Nurse Education Today, 34, 887–889

Davis, D., Evans, M., Jadad, A., Perrier, L., Rath, D., Ryan, D., … and, Zwarenstein, M. (2003) ‘The case for knowledge translation: Shortening the journey from evidence to effect’. British Medical Journal, 327 (7405), 33–35

Davis, D., O’Brien, M., Freemantle, N., Wolf, F., Mazmanian, P., and Taylor-Vaisey, A. (1999) ‘Impact of formal medical education: Do conferences, workshops, rounds and other traditional education activities change physician behavior or health care outcomes?’ Journal of American Medical Association, 282 (9), 867–874

Dewar, B. and Christley, Y. (2013) ‘A critical analysis of Compassion in Practice’. Nursing Standard, 28 (10), 46–50

Dewar, B. and Cook, F. (2014) ‘Developing compassion through a relationship centred appreciative leadership programme. Nurse Education Today, 34 (9), 1258–1264

Dewar, B., Pullin, S., and R. Tocheris (2011) ‘Valuing compassion through definition and measurement’. Nursing Management, 17 (9), 32–37

Department of Health (2012) Compassion in Practice: Nursing, Midwifery and Care Staff. Our Vision and Strategy. London: The Stationery Office. [online] available from [31 March 2017]

Department of Health (2013) Delivering High Quality, Effective, Compassionate Care: Developing the Right People with The Right Skills And The Right Values. A Mandate from the Government to Health Education England: April 2013 to March 2015. London: Department of Health [online] available from [31 January 2017]

Department of Health (2015) The NHS Constitution: The NHS Belongs to All of Us. London: Department of Health [online] available from [31 March 2017

Epstein, R. (1999) ‘Mindful practice’. Journal of American Medical Association, 282 (9), 833–839

Firth-Cozens, J. and Cornwell, J. (2009) Enabling Compassionate Care in Acute Hospital Settings. London: King’s Fund. [online] available from [31 January 2017]

Francis, R. (2010) Independent Inquiry into the Care Provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. London: The Stationery Office

Francis, R. (2013), Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office

Gazarian, P. (2010) ‘Digital stories: Incorporating narrative pedagogy’. Journal of Nursing Education, 49 (5), 287–290

Goodrich, J. and J. Cornwell (2008) Seeing the Person in the Patient. The Point of Care Review Paper. London: The King’s Fund [online] available from [31 March 2017]

Hammond, S.A. (1998) The Thin Book of Appreciative Inquiry. 2nd edn. Plano, TX: Thin Book Publishing Company.

Hardy, P. and Sumner, T. (2014) Cultivating Compassion. How Digital Story Telling is Transforming Healthcare. Chichester, UK: Kingsham Press

Herbst, A., Swengros, D., and Kinney, G. (2010) ‘How to teach human caring: nurse educator role in transformational learning for a large healthcare system’. Journal for Nurses in Staff Development, 26 (4), e6–e11

Irons, C. (2013) ‘The science of compassion: Evolutionary, neurophysiological and physiological perspectives’. Journal of Holistic Healthcare, 10 (3), 10–15

Kitzinger, J. (1995) ‘Qualitative research: Introducing focus groups’. British Medical Journal, 311 (7000), 299–302

Lambert, J. (2013) Digital Storytelling: Capturing Lives, Creating Community. 4th edn. New York, NY: Routledge

Levine, S., Brett, B., Robinson, B., Stratos, G., Lascher, S., Granville,, L. Goodwin, S., … and Barry, P. (2007) ‘Practising physician education in geriatrics: Lessons learned from a train-the-trainer model’. The Journal of American Geriatrics Society, 55 (8), 1281–1286

Maben, J., Peccei, R., Adams, M., Robert, G., Richardson, A. Murrells, T., and Morrow, E. (2012) Exploring the Relationship between Patients’ Experiences of Care and the Influence of Staff Motivation, Affect and Wellbeing. Final Report. National Institute for Health Research. London: HMSO. [online] available from [31 January 2017]

McClelland, J.W., Irving, L.M., Mitchell, R.E., Bearon, L.B., and Webber, K.H. (2002) ‘Extending the reach of nutrition education for older adults: Feasibility of a train-the-trainer approach in congregate nutrition sites’. Journal of Nutrition Education and Behavior, 34 (1), S48–S52

Mullen, K. (2009) Patients not Numbers. People not Statistics. 2nd edn. Harrow, UK: Patients Association. [online] available from [31 January 2017]

Neff, K D. (2003) ‘The development and validation of a scale to measure self-compassion’. Self and Identity, 2 (3), 223–250

Neff, K.D. and Pommier, E. (2013) ‘The relationship between self-compassion and other-focused concern among college undergraduates, community adults and practicing mediators’. Self and Identity, 12 (2), 160–176

Paley, J. (2014) ‘Cognition and the compassion deficit: The social psychology of helping behavior in nursing’. Nursing Philosophy, 15 (4), 274–287

Pearcey, P. (2007) ‘Tasks and routines in 21st Century nursing: Student nurses’ perceptions’. British Journal of Nursing, 16 (5), 296–300

Polit, D. and C. Beck (2012) Nursing Research: Generating and Assessing Evidence for Nursing Practice. 9th edn. Philadelphia, PA: Lippincott Williams and Wilkins

Raab, K. (2014) ‘Mindfulness, self-compassion, and empathy among health care professionals: A review of the literature’. Journal of Health Care Chaplaincy, 20 (3), 95–108

Richardson, C., Percy, M., and Hughes, J. (2015) ‘Nursing therapeutics: teaching student nurses care, compassion and empathy’. Nurse Education Today, 35 (5), e1–e5

van der Cingel, M. (2014) ‘Compassion: The missing link in quality of care’. Nurse Education Today, 34 (9), 1253–1257

von Dietze, E. and Orb, A. (2000) ‘Compassionate care: A moral dimension of nursing’ Nursing Inquiry, 7 (3), 166–174

Weng, H., Fox, A., Shackman, A., Stolda, D., Caldwell, J., Olson, M., … and Davidson, R. (2013) ‘Compassion training alters altruism and neural responses to suffering’. Psychological Sciences, 24 (7), 1171–1180

White, L. (2014) ‘Mindfulness in nursing: An evolutionary concept analysis’. Journal of Advanced Nursing, 70 (2), 282–294

Youngson, R. (2011) ‘Compassion in Healthcare’. Journal of Holistic Healthcare, 8 (3), 6–9




How to Cite

Ramage, C., Curtis, K., Glynn, A., Montgomery, J., Hoover, E., Leng, J., Martin, C., Theodosius, C., & Gallagher, A. (2017). Developing and Using a Toolkit for Cultivating Compassion in Healthcare: An Appreciative Inquiry Approach. International Journal of Practice-Based Learning in Health and Social Care, 5(1), 42–64.