What Supports Creating Compassionate Trauma-Informed Healthcare Cultures?
Compassionate trauma-informed healthcare does not emerge from policies, training sessions or good intentions alone. It is created through the everyday actions, relationships, practices, self-compassion, understanding of trauma and cultures that shape how we meet ourselves and one another. While this blog is focusing on healthcare the principles apply to social care and other sectors.
There are many factors that support compassionate, trauma-informed working including:
- Presence and awareness
- Understanding trauma and embodying trauma-informed principles
- Nervous system awareness and regulation
- Self-compassion
- Somatic and embodiment practices
- Compassionate leadership
- Effective team working, psychological safety and safeness
- Reflection and shared learning
These elements are deeply interconnected, and together support compassionate trauma-informed ways of working, relating and being.
Presence and Awareness
Presence and awareness are foundational in compassionate healthcare. Compassion begins with noticing suffering and being willing to turn towards it. Presence is not passive, it invites awareness and inquiry.
When we aren’t aware of suffering, we can’t take action to try and alleviate it and when we can’t tolerate discomfort, we will either avoid it, jump into trying to fix it, or become overwhelmed by it.
This can be supported by mindfulness-based practices, which trains awareness and attention — learning to notice experience moment by moment with greater clarity, steadiness, and openness. Supporting presence, listening, and the ability to respond rather than react.
Everything is relational, compassionate healthcare is not simply about what we do, but about how we are with ourselves and others. Presence supports us in listening deeply, understanding experiences, building trust, and responding wisely rather than automatically.
Empathy helps us understand and resonate with the experiences of others, while compassion adds the motivation and courage to respond wisely to suffering.
Professor Michael West describes the first behaviour needed in compassion as attending — being fully present with another person and listening with fascination. This is something that resonates with me perhaps it does with you too.
Compassionate Questions
Compassionate healthcare is supported by simple but powerful questions that help us remain connected to ourselves and others. Questions that support compassionate awareness, understanding and wise action, include:
- What is needed right now?
- What would be supportive right now?
- How can I help you? (something Professor Michael West often highlights the importance of asking)
- What matters most right now?
These questions shift us away from assumptions, fixing and rushing, and towards understanding, collaboration and more trauma-informed compassionate responses.
Presence alone is not enough. Compassionate presence also requires care, curiosity, courage, humility and enough regulation to remain open to another person’s experience rather than making assumptions, or controlling the conversation. Like compassion, presence is a lifelong practice.
Understanding Trauma and Embodying Informed Principles
As discussed in part one of this blog, compassion and trauma-informed practice are deeply interconnected. Alongside the elements that support compassionate heathcare, trauma-informed healthcare is also supported by understanding the wide-reaching impact that adversity and trauma can have on individuals, relationships, organisations and systems and society.
This includes understanding the different types of trauma and how trauma can affect the brain, body, nervous system and whole person. It is also helpful to consider how trauma has shaped communities, systems and society. It’s important to recognise that there will be people who have experienced trauma within healthcare teams, as well as among those using healthcare services.
Being trauma-informed is not simply about having knowledge of trauma or embedding trauma-informed principles into policies and procedures. It involves embodying the principles of safety, trustworthiness, choice, collaboration, empowerment, and cultural, historical and gender awareness in everyday interactions, leadership and organisational culture. Like compassion, trauma-informed practice is something that needs to be lived and embodied, not simply understood intellectually.
Trauma-informed working recognises that experiences throughout life can influence many things, including: health and wellbeing, behaviour, our ability to be present for ourselves and others, how we experience healthcare, connection, relationships, and stress.
Together with compassion, these principles shape how people communicate, how decisions are made, how conflict is managed, and how individuals and teams respond when people are distressed or struggling. They invite us to ask not “What’s wrong with you?” but “What has happened to you?”, “What is happening for you?”, and “What is needed right now?”
Compassion, presence, nervous system awareness, self-compassion, effective team working and compassionate leadership all help create the conditions in which trauma-informed principles can be embodied and sustained. Together, they support environments where people feel safer, more valued and respected, more able to heal, collaborate, learn and flourish with greater connection and shared wisdom.
Nervous System Regulation
Nervous system awareness and regulation are essential components of compassionate trauma-informed healthcare.
When we are overwhelmed, stressed or operating beyond our capacity, it becomes more difficult to stay present, think clearly, listen deeply and respond wisely. We may become reactive, defensive, controlling, avoidant, or rush into trying to fix problems before fully understanding them.
Regulation does not mean remaining calm all of the time. It means developing enough awareness and capacity to stay present with difficulty, respond rather than react, and reconnect and settle enough when we become activated. We need enough capacity to stay present with suffering without becoming overwhelmed by it. We need to understand our own nervous systems and how to stay regulated enough in the face of suffering, along with the challenges of lack of time and resources that are so often present.
When we can remain regulated enough in the face of suffering and challenge, we also support others in regulating. This process of co-regulation has ripple effects within teams, services and organisations. Also, beyond this as people carry the compassion out into their world. In the same way that stress and threat can spread through systems, compassion, steadiness and connection can also spread.
Self-Compassion
Compassionate healthcare requires self-compassion as well as compassion for others, it’s something that is essential.
Many healthcare professionals are highly skilled at caring for others whilst finding it difficult to extend the same understanding, care and kindness towards themselves.
Self-compassion supports awareness of our own suffering, helps us recognise our limits, and encourages us to respond wisely rather than pushing endlessly through exhaustion and distress.
Far from being self-indulgent, self-compassion supports our ability to be present with our own suffering and challenges and to take wise action, along with remaining present and compassionate with others over time. It is a foundation for sustainable healthcare.
Self-compassion can be supported in a number of ways, including through gentle inquiry. In moments of stress, overwhelm or self-criticism, we might pause and ask:
- What is needed right now?
- What is helpful right now?
- What can I do for myself out of kindness in this moment?
These questions are not about avoiding difficulty, they help us respond to ourselves with the same care, understanding and wisdom that we would offer to someone else who was struggling.
Somatic and Embodiment
Compassion is more than an idea or intention, or something to be ticked off a list, it is something to embody and to make away of being over time.
Somatic and embodiment practices help us develop awareness of our internal experience, recognise signs of activation earlier, strengthen our capacity for presence, support nervous system regulation, and choose what to embody.
They can help move compassion from something we understand intellectually into something we genuinely embody and enact in our relationships, leadership and everyday life.
Embodiment also helps us recognise when our words, actions, values and organisational practices are aligned — and when they are not.
Compassionate Leadership
Compassionate leadership is essential for creating compassionate trauma-informed cultures.
Research has consistently demonstrated the importance of compassionate leadership in staff engagement, wellbeing, team performance and quality of care.
Compassionate leadership is not soft, passive or about avoiding difficult conversations. It requires the courage to lean into suffering, challenge and uncertainty, and act with wisdom and care.
It involves creating conditions where people can flourish, removing obstacles that prevent people from doing their jobs effectively, listening deeply, valuing diverse perspectives, and supporting people to contribute their skills and ideas.
Compassionate leadership is not only the responsibility of formal leaders. Everyone working within healthcare influences others and the culture around them. We are all leaders in how we show up, relate to others and contribute to the environments we work within.
Self-compassion is an important foundation of compassionate leadership, along with awareness, presence and nervous system regulation. Compassion needs to be practiced in all areas of life and embodied over time to become genuine compassionate leadership.
Compassionate leadership is not soft; it takes great courage to lean into the suffering, challenge, and uncertainty. It includes advocating for the resources, time and conditions people need to do their work safely and effectively. It also includes addressing conflict and unacceptable behaviour with courage, care and clarity. Ultimately it can help to create environments where people can flourish rather than merely survive.
Effective Team working, Psychological Safety and Safeness
Compassionate trauma-informed healthcare cannot be created by one individual. Individual presence, behaviour and compassionate action matter, yet compassionate cultures are created collectively.
Effective team working is fundamental to compassionate trauma-informed healthcare. It is difficult to work truly compassionately when teams are fragmented, communication is poor, and/or people do not feel psychologically safe.
Research has consistently shown that effective teams are associated with higher staff engagement and wellbeing, better service user outcomes, greater innovation and higher quality care. Having a shared purpose, clear goals, supportive relationships, compassionate leadership, psychological safety and a number of other factors, are essential for effective team working.
Psychological safety is essential; however it alone is not enough as human beings need more than the absence of threat. People also need to experience a sense of safeness — feeling valued, cared about, respected and supported. This helps people explore, learn and contribute more freely, and it supports a sense that people matter and belong. This helps core human needs to be met, nervous system regulation, and cultivation of conditions where people are more able to collaborate, innovate and work effectively together.
Compassion helps create these conditions and effective team working supports compassion. When people feel listened to, understood and cared about, they are more likely to speak up, share ideas, learn from what didn’t go well and support one another.
Compassionate cultures are built through nurturing relationships and teams. Compassion is not simply an individual quality; it is something that is expressed collectively in how people work together.
Reflective Practice and Learning
Teams need time and space to reflect, share experiences, learn together and discuss challenges openly. This requires environments that support psychological safety and safeness, compassionate challenge and genuine collaboration. Research has shown that teams who take regular time to reflect together are significantly more productive than those who do not. Reflection is important both within and between teams to help create a more effective, compassionate and sustainable healthcare system.
When people feel safe enough to contribute ideas, raise concerns and learn from mistakes, organisations become more adaptive, innovative and effective.
Collective intelligence is one of the most underused resources in healthcare systems. The solutions to some of the challenges facing healthcare already exist within the collective wisdom of the workforce. Creating opportunities to access this wisdom is a vital part of compassionate leadership and culture change.
Creating Compassionate Trauma-Informed Cultures
When compassion and trauma-informed principles are not embodied throughout an organisation and woven into leadership, policies, procedures and everyday practice, they risk becoming a tick-box exercise.
Culture is not only reflected in leadership teams, organisational documents and strategies, it’s shaped moment by moment through how we meet ourselves, how we relate to one another, how decisions are made, and how people are treated when they are struggling.
Creating compassionate trauma-informed healthcare requires commitment at every level of an organisation and the wider system. It involves individuals, teams, leaders and organisations working together to create environments where people feel safe and have a sense of safeness — where they feel valued, respected, supported, and able to contribute. It requires compassion and trauma-informed principles to be woven into leadership, team working, reflective practice, policies, procedures and everyday interactions.
This is not only beneficial for healthcare professionals and service users, it contributes to healthier workplaces, stronger communities and, ultimately, a more compassionate, trauma-informed society. Compassionate cultures are created collectively through the relationships, behaviours and systems that shape how people experience work and care.
Summary
Compassionate trauma-informed healthcare is more than words or isolated practices; it is an integrated way of being and working. It is supported by many interconnected elements, including: presence, awareness, understanding trauma and embodying trauma-informed principles, nervous system regulation, self-compassion, mindfulness-based practices, somatic and embodiment practices, compassionate leadership, effective team working, psychological safety and safeness, and reflection and shared learning. When these are woven into individual ways of being, teams and systems, they help create cultures where people can meet challenge with greater steadiness, connection, shared wisdom and compassion. This supports environments where staff and services users feel heard, valued and supported, contributing to more compassionate, effective and sustainable healthcare and, ultimately, a more compassionate society.
You can find part-one of this blog here, which explores what compassionate trauma-informed working is and why it matters: https://unityphysio.co.uk/?p=8390&preview=true
You can find out more about my work in this area here https://unityphysio.co.uk/services/compassionate-trauma-informed-working/