1. Intelligent Kindness Health care as relational practice
Restoring the balance
John Ballatt

2. The health care task

3. How do we nourish this practice?

4. Kinship – a relational system
Cynd, OE, noun…the modern noun ‘kind’ = ‘nature’, ‘family’, ‘lineage’ – ‘kin’
Kindness is kinship felt, understood and expressed
Kindness – recognition of being ‘of a kind’ with the other; of common interest, equality and interdependency; inclination to cooperate and help, drive to attentiveness, concern and action
Compassion (suffering with), fellow feeling, ‘brotherly’ love, thoughtfulness, gentleness, generosity
Individual and collective
‘Productive’
Hard work, and problematic

5. Kinship in action – a virtuous circle
Attentiveness
Directs
Enables
Kindness
Attunement
Promotes
Builds
Kinship
Trust
Whole process
reinforces conditions
for kinship/kindness
Produces
Generates
Better
Outcomes
Therapeutic
Alliance

6. Ethics meet technical excellence
When staff are ‘recruited’ to this relational system
When that system is congruent with and fit for purpose to support relational practice
When the system is organised and cultivated as a positive kinship system
When the members of that system understand how to manage themselves to sustain ‘intelligent kindness’

7. Helpful perspectives
Personality and psychodynamics (Freud/Klein/Jung; John Bowlby; etc)
Neuroscience and compassion (eg Paul Gilbert)
Group -> individual (Solomon Ashe)
Authority –> individual (Stanley Milgram)
Role –> groups and individuals (Philip Zimbardo)
Group dynamics (Wilfrid Bion; Stanley Foulkes; etc)
Organisational and system dynamics (Isobel Menzies-Lyth; David Armstrong; Anton Obholzer; Vega Roberts; Andrew Cooper; Julian Lousada; Tim Dartington)
Complexity Theory (eg Ralph Stacey)
Anthropology/Ethology/Evolutionary thinking (eg Peter Boehm; Michael Chance)

8. Everybody’s work Self in society Relationships in team Relationship
Relationships in organisation
ANXIETY
MISTRUST
Relationships in team
Team dynamics
Relationship
with patient
& Ill-being
COMMODIFICATION/
INDUSTRIALISATION
REGULATION
(OVER)
EXPECTATION
COMPETITION
Team in organisation
Organisation in society

9. Intelligent kindness in training
Accord due status to kinship, attentiveness and quality of relationship in the ethos and skills of medicine
Promote and expect self-awareness and continuous individual and group reflective practice in trainees
Be explicit about the intrinsic horrors, anxiety and cost involved in meeting ill-being, and of the need for ‘self-overcoming’
Be explicit that healthcare involves emotional work

10. Teach trainees about stress and burnout, helping them recognise the signs in themselves and others and facilitate access to appropriate help
Ensure trainees are exposed to and reflect upon real narratives of people needing and using services – not just of illness, diagnosis and treatment
Help the trainee understand the dynamics of industrialised, commodified and performance managed services

11. Help the trainee understand the ways teams and organisations work and help them learn how to contribute positively
Set up and support case-based discussion groups (eg Balint Groups and Schwartz Centre Rounds)
Recognise that the cultures of medical school, training scheme, placement and supervision need to model intelligent kindness
Counteract perverse incentives by being more explicit about values as integral to professionalism