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Should NHS Staff really ‘have’ to be resilient?

Firstly, I was very happy to see the issue of NHS staff stress and burnout recognized within the Lancet this week

Trawling through the literature this week and talking to colleagues, I find the word ‘resilience’ being thrown around as an offerable solution to stress. Resilience training has seemingly been offered as a tick box exercise to ‘equip’ staff with the right weapons to defend themselves, but should they have to be at war with the system?

‘Resilience is essential now for a nursing leader; you just won’t survive without it,’

Are we to be on guard at all times?

The word ‘resilience’ conjures up images of holding up the fort, guarding the gates and resisting some kind of attack. We are giving our warriors weapons for a fight.

So…after we have received our resilience training, are we expected to then cope?

Following any other form of NHS training, this would be the case. Training day = See one, do one, teach one…..right?

So, having been to resilience class, we no longer have any excuses NOT to cope…do we?

Suggesting that resilience is the remedy to cope with stressful situations, is to suggest that some people can cope, and others just cannot. ‘You either have it or you don’t’

Can it really be taught?

What if you have been to resilience training and you are still struggling?

With the stigma associated with ‘not coping’, the majority of clinicians will not feel able to seek help (Munro, 2011).

I am concerned that the focus of remedy seems to be based upon the resilience of clinicians and their abilities to cope rather than the fact that some of the things they have to deal with on a daily basis, should not be occurring in the first place. (Bullying, stigma, name, blame and shame cultures, punitive action and burnout etc..)!

There are obviously daily events which put a strain on our NHS workforce that are outside of any control. Can we ever prepare ourselves for coping with such things?

Sometimes, no amount of armor will protect us from the pain of experiencing a traumatic incident. Therefore, suggesting that there is a magic weapon to protect us from such things may be a dangerous thing.

One cannot fix the pressures of NHS work with training alone.

We all suffer from the condition of being ‘human’ – Should we ‘have’ to be resilient to a toxic work environment?

Or should the NHS be remedied to care for us when no amount of resilience training can catch us when we fall?

Resilience is a dangerous word with many connotations. There should be no bar set for what it takes to ‘cope’…the price of expectation is too high.

I would be interested to hear your thoughts on this – please see the support page if you have been affected by anything discussed within this article.

Munro, R (2011) Sick day scrutiny: as the NHS seeks to slash its 3 billion [pounds sterling] annual staff absence bill, nurses are facing tougher checks on leave taken; Nursing standard [0029-6570] Munro, Robert yr: 2011 vol:25 iss:18 pg:24

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7 Tips for Implementing culture change within the NHS: Contributions from Occupational Psychology

A shorter post from me today as I focus on a new report I have come across in my research. The British Psychological society has an amazing group of Occupational psychology experts which I felt would bring to light a new perspective on NHS staff well being.

The new report: Implementing culture change within the NHS: Contributions from Occupational Psychology presents a series of chapters by occupational psychologists, each drawing on evidence and expertise from the field to address the question of how this culture change can be implemented within the NHS. These tips are taken as a general overall structure of recommendations from the report.

  1. Implement a values-based recruitment for patient-centred care
  2. Effectively manage staff experience to improve organisational culture
  3. Ensure you have a work design for compassionate care and patient safety
  4. Effectively lead and manage high performing teams 
  5. Foster a continuous learning culture within the NHS
  6. Trust boards and governance: Improve Composition and behavioural styles
  7. Build cultures of transparency and openness  

Ultimately, the report embraces the concept that the psychological safety of NHS staff is critical for patient safety. The report clarifies the development of negative cultures within the system that erodes trust, openness and a just culture.

It suggests that the current NHS system drives organizational behaviour, and the tone of this behaviour is set at a senior level. Negative tones may lead to undue pressures and stresses within the NHS, which may in turn lead to NHS staff behaving counter-productively.

“Leadership predicts staff satisfaction, which in turn predicts patient satisfaction.”

The more staff we can empower to lead change and positive cultures, the better the outcomes will be. These staff want to set a positive cultural tone and promote positive organizational behaviours, but this must happen from the ‘edge’. key areas are still in need of improvement if we are to increase the levels of staff psychological well being.

Picking apart these organizational cultures seems to be filling up my thesis as I see it becoming a large part of why staff are broken and battered. New reports are being released almost on a weekly basis, illuminating new failings and seeing organizational cultures as the cause of poor behaviour.

These cultures are becoming viruses within our NHS, and whilst we are swamped by a fear of blame and failure, the NHS will not recover.

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Am I too late to the ‘NHS staff wellbeing research’ party?

I began this research journey because I saw an opportunity to make a positive contribution to the healthcare community (and gain a PhD)! I believed that NHS Staff wellbeing was an under researched and undervalued subject (and it is to a large extent). When I began my time at Coventry University, I presented my research proposal to a group of peers at the West Midlands Health Informantics Conference just before Christmas 2014. My ideas were met with enthusiastic conversations and praise for my work, people were excited that it was happening, it was ‘new’.

Then of course I begin to delve into the literature and start to see a plethora of papers and super duper academics who have introduced me to this wondrous world. I see TV snippets, twitter conversations, national and local conferences, action groups and new research on the topic. Am I too late to the party?

What I plan to do has never been done before, but I know that many people have had the same idea. Will it be a race to publish? I hope not. I hope I can find similar minded people to drive forward this positive movement forward, collectively. We should all be in this together, making change happen through collective leadership and a shared passion for the wellbeing of NHS staff. I do worry that I am not really contributing towards new knowledge, but I must keep focussed on the end goal (and beyond the PhD)!

The most refreshing thing is the open discussions being generated through twitter – The next one I will be involved with is on the 11th March, 2015 hosted by WeDocs using #WeDocs – Preventing suicide in NHS staff

This new research is inspiring and I would like to share it:

Wilkinson, M (2015) UK NHS staff: stressed, exhausted, burnt out. The Lancet Volume 385, No. 9971, p841–842, 7 

Sheen, K, Slade, P, Spiby, H (2014) An integrative review of the impact of indirect trauma exposure in health professionals and potential issues of salience for midwives. Journal of Advanced Nursing. Volume 70, Issue 4, pages 729–743, April 2014

Implementing culture change within the NHS: Contributions from Occupational Psychology

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The Founders Network – The Birth of Creating a healthier NHS

The Founders Network was founded in July 2014 on the initiative of Clare Gerada, Lambeth GP, Medical Director NHS Practitioner Health Programme, and Rex Haigh Medical Psychotherapist and Institute of Group Analysis Board Member. I am a proud member of this network and I can see it growing from strength to strength.

The collective network recognizes that there are serious problems with working life in the NHS and these must be urgently addressed if the NHS is to have a secure future. This sentiment provides the basis for my PhD work, and I am extremely grateful to Clare Gerada for advising me on my project as it moves forward. The infamous paper compiled by Clare introduces the succinct notion that “If the NHS were a patient, it would have Depression” and as such, we have much work to do in order to ‘fix’ this.

It became apparent that action was needed. A series of active listening events collectively named as the Creating a healthier NHS project, facilitated by the Founders Network and the Institute of Group Analysis were arranged as a platform to hear NHS staff and explore solutions to remedy the toxic cultures within the health care system. I attended three of these listening events and as a result, have met many inspiring people with illuminating stories to tell!

The most poignant idea that stemmed from these for me personally was this:

(I have added some extra thoughts to this!)

  • The NHS is the burnt out and overworked mother of the nation, her internal struggles are endless.
  • She is not kind to herself.
  • The father of the nation is our government.
  • Father may well want a divorce, but the alimony payments would be too high to bare.
  • Mother is having to care for more and more children with more complex needs, but with less resources. She is constantly adjusting her purse strings, but someone always loses out.
  • The father is frustrated and entertaining a mistress (Privatization) – shes alluring and dangerous, so he keeps quiet about her.
  • The children continue to tug at mothers apron strings, demanding more and more.
  • There is only so much more mother can take before she breaks. SHE is the one who needs to be cared for.

And that is why I feel passionate about this drive to value NHS staff. They need to be cared for if the patient is to receive quality care. Staff may not be very good at caring for themselves, and therefore it is imperative that we keep this conversation going, take action via the Founders Network and move towards appointing a national lead for NHS staff health and wellbeing. Please consider joining this network if you feel able to.

Here are some of the videos from the listening events if you could not attend, I will share the outcome of these listening events as soon as they become available to me and open to public viewing.

If you have been affected by any of the issues discussed within this post, please visit the support page.

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#mybluelight Campaign

Today, Mind Charity published its Blue Light Campaign to provide mental health support for emergency services staff and volunteers from police, fire, ambulance and search and rescue services across England.

One quarter of a million people who work and volunteer in the emergency services are even more at risk of experiencing a mental health problem than the general population, but are less likely to get support.

As usual, they found that it was stigma that was the biggest issue in staff seeking help. Stigma truly is the real killer, and I will be writing a blog on it soon. The campaign will do the following to help our emergency services:

  • An anti-stigma campaign, working together with Time to Change, and guidance for employers to improve the way they support their staff
  • A bespoke mental health training package for managers as well as frontline staff and volunteers across the emergency services
  • A pilot approach to build the mental health resilience of emergency services staff and volunteers
  • An information helpline and resources just for emergency service staff and volunteers, and their families.

The support will be available from April 2015 and the Blue Light Programme will run until March 2016. It is being developed in consultation with individuals from across the emergency services.

The Twitter hashtag for this campaign will be #mybluelight

It is so refreshing to see this issue (which as you know I feel super passionate about) being addressed. Although I hope this project will extend to all health workers who may all at some point be exposed to the same psychological traumas. A great perspective on other Blue Light professions is given by The Mental Health Cop who was also part of the advisory board for this campaign.

Although this work is amazing, it also involves empowering staff with resilience, and this concept concerns me. It may suggest that there are some who can cope and others who are weak. It may imply that if you have resilience, then you will not be affected. In other areas of work based psychological distress, you shouldn’t have to be resilient. For instance to bullies, blame and scapegoating cultures, it should just stop. We will always be affected by traumatic incidents, and I know that this anti stigma campaign and valuable resource guidance will improve the mental health and well being of NHS Staff.

Why not ask your NHS Trust to sign the Blue Light Time to Change pledge and develop an action plan. Commit to support better mental health in your workplace – get in touch with Mind and give your name, job title, the service you work for and your contact details.

Email bluelight@mind.org.uk with your name, organisation and contact details and Mind will send you updates on the programme.

If you have been affected by anything discussed within this post please see the support page on this blog.

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Whistle blowing post Francis…A time for change.

Whistleblowing Helpline

Whistle blowing can cause a prolonged and prominent assault upon health care staff well being. Whistle blowers speak of overwhelming and persistent distress, alcohol problems, and paranoid behaviour at work, acute anxiety, nightmares, flashbacks and intrusive thoughts (Peters et al, 2011). So naturally, I felt this was an important issue to blog about. I recently contributed to the Wikipedia entry for the psychological impact of Whistle blowing along with David Drew and Minh Alexander, although I am still on a learning curve with this concept as it forms a significant part of the background work on my thesis.

Whistle blowing improves the quality of care for patients as lessons are learnt from failure. Health care professionals suffer from the interminable condition of being ‘Human’ and we must understand that whenever we enter the health services, we take on the risk of human error. Yet ‘Whistle blowing’ as a term has such negative connotations, perhaps we need a more friendly rhetoric for it? Whistle blowers should not be seen as the problem, but as the solution to better care as they become a part of every day conversation. But I do not believe that an open culture exists just yet.

Positive rhetoric and good intentions do not always result in positive change and we still hear stories about the negative consequences of whistle blowing in the NHS.

“I was pulled into a side room and questioned as to whether I would ‘Blow the Whistle'”

“I was told that the conversation had ‘Never Happened'”

Many more stories can be found here on the poor experiences of whistle blowers.

In 2013 Sir Robert Francis’s report into care failings, warned that secrecy and an acceptance of poor standards had emerged at all levels of the NHS (Francis, 2013). As a result of this, the government pushed for an explicit professional duty of candour, so that any avoidable or unintended patient harm must be reported. Despite this, where front line staff attempt to address concerns about abysmal care, they are often met with a wall of silence and hostility by management (Drew, 2015). These silencing cultures are evidenced by the fact that at least 45 staff spanning 50 organisations have signed confidentiality clauses, some with payment deals in return for silence since 2011 (Sprinks, 2014).

In 2015, Sir Robert Francis released his report of his review into whistleblowing in the NHS: The freedom to speak up review. Among a multitude of recommendations proposed by this report, the most important ones that stand out to me are creating a cultural change towards open, transparent and learning cultures which value communication and engagement, and the appointment of Freedom to Speak Up Guardians, supported by a national Independent National Officer (INO). Cultural change and normalizing conversations about risk, error and poor practise will be essential to producing a healthier work environment for all, and better patient care. Blaming and scolding really have no place here, and if we are to move forward and improve, we must continuously learn from all actions and omissions. There is damage caused by denial, to both the health service and the health and well being of NHS staff. I fear that any Freedom to Speak up Guardian may have an insurmountable hill to climb and may themselves become more at risk of work based hostility. These guardians will require protection and support for their own well being if they are to ignite change and protect the duty of candour.

A guide for the new duty of candour regulations can be found here. This duty controls what NHS staff say as well as what they do, through the threat of criminal sanctions. Criminal sanctions is something I feel very uncomfortable with. I am a keen advocate for alternatives to discipline and in a culture of fear, I do not believe that front line staff are going to work with the intention to damage patient care through a wall of silence.

This is a time for change, and I have to believe that better times are on the horizon because “The NHS is blessed with staff who want to do the best for their patients”. – Sir Robert Francis.

Drew, D (2015) Francis NHS whistleblower report: a new beginning? Guardian Healthcare Network available from http://www.theguardian.com/healthcare-network/2015/jan/29/francis-review-nhs-whistleblower-report?CMP=share_btn_tw

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

Francis R. (2015) Report on the Freedom to Speak Up review. London: The Stationery Office, 2013.

Peters, K., Luck, L., Hutchinson, M., Wilkes,L., Andrew, S., Jackson, D (2011) The emotional sequelae of whistleblowing: findings from a qualitative study. Journal of Clinical Nursing, 2011; 20 (19-20): 2907

Sprinks J (2014) Survey highlights slow progress in increasing staff whistleblowing. Nursing Standard Feb 12-18;28(24) P14-5

If you have been affected by the content of this blog, please visit the support page for help and support for health care professionals.