Fostering compassionate public healthcare leadership towards sustainability: Evidence from Bihar, India

Abstract

Introduction. Compassionate leadership, a critical driver for healthcare development, performance, service quality and citizen satisfaction, remains less cultivated in Indian public healthcare. Embedded in Piramal Foundation’s philosophy of Sewa Bhaav (spirit of service), globally recognized models of compassion-based ethics were integrated in Compassionate Leadership & Personal Transformation Training (CL-PTT). Collaborating with Emory University, United States and the Government of Bihar State, India, this multi-pronged omnichannel approach facilitated leadership unlocking “Agency to Serve” among healthcare professionals.

Methods. The CL-PTT intervention was assessed in a cross-sectional study of 949 healthcare workers at 35 district hospitals, of which 18 received the intervention. Key objectives were: (1) to assess leadership competencies and correlate them with citizen experience; (2) to understand provider attitudes and behaviours; (3) to identify gaps and inform course correction. A co-designed, scenario-based, field-validated Leadership Assessment Tool measured 16 personal, social and people leadership competencies. The Citizen Experience Feedback Tool captured citizen-provider interactions from 702 citizens across both outpatient (OPD) and inpatient (IPD) departments. The development of both tools was guided by extensive literature review, established frameworks and tacit knowledge captured through iterative expert consultations.

Results. Significantly higher odds of ‘good’ (uppermost tertile) leadership competencies were found among healthcare professionals in the intervention facilities compared to non-intervention (adjusted odds ratios (aORs) for personal=3.7, social=6.0, people=6.5, and overall=5.4 categories), and measures of self-awareness, emotion management, non-violent communication, team development, and providing feedback were significantly higher. Compared to control facilities, citizen experiences in the OPD were better in intervention facilities for active listening (93.5% vs. 85.2%), adequate consultation time (90.6% vs. 76.5%), and encouragement for questioning (81.2% vs. 68.2%). Overall, CL-PTT was associated with better leadership competencies and improved citizen-provider interactions.

Conclusion. Findings validate the transformative potential of integrating compassion-based ethics into leadership development programs for healthcare delivery and citizen-centered care.