‘There are big challenges for NHS staff at the moment, with increasing demand for health care and a system requiring modernisation that’s under a lot of economic strain. So we’re trying to promote resilience and give our people the skills and knowledge to be able to cope better with the day-to-day pressures of working in a fast moving medical environment.’

Dr Anne-Marie Doyle is a consultant clinical psychologist at the Royal Brompton Hospital. She’s been leading a project funded by our Innovating for Improvement programme, with ambitious aims to improve the health and wellbeing of patients and staff in the Royal Brompton Hospital and Harefield Hospital.

Adopting an integrated approach to your health

The Integrated health: optimising strength and resilience project, is run by Royal Brompton and Harefield NHS Foundation Trust in partnership with King’s College London. Staff and patients take part in workshops that encourage them to adopt a more integrated approach to their health, one that considers both physical and psychological factors. 

The project aims to address the problems of psychological distress in patients, occupational stress in people working in the NHS, and organisational culture issues. Staff can receive further training and act as advisors to help embed the intervention across the organisation.

The workshops use tools and theories from cognitive and behavioural science, including resilience and compassion training. They aim to increase knowledge and understanding of normal psychological experiences such as stress, worry, anxiety, grief, low mood and depression. Recognising these and the everyday situations in which they arise, alongside an approach that supports people in talking about them, helps to reduce associated stigma and discrimination, which then helps to create a more supportive work environment.

‘The factors that influence our health and wellbeing are biological but also environmental, social, cultural, economic and psychological, so we use that as a framework’, explains Anne-Marie.

‘We look at the foundations of health and wellbeing: nutrition, sleep, exercise and the quality of our relationships. We also do a lot about understanding stress and how we can manage it, helping people learn about their thoughts, their feelings and their behavioural choices. We look at people’s current ‘best ways of coping’ in the context of their current and past experiences, and how to improve these.

‘We want people to know that the emotions that they have are normal and understandable in relation to the context they are working in and the experiences they have had. This helps people to be compassionate towards themselves and each other, encourages them to reflect on and adapt their ways of coping with painful emotions, and helps them to make valued behavioural choices going forward. The project team helps people explore their values and set goals for themselves in line with these.’

Breaking down taboos

The workshops have brought in content from online national campaigns to reduce stigma around mental health, including Only Us and Time to Change.

‘We’re trying to break down the idea that it’s only patients who have mental health issues. It’s not a ‘them and us’ scenario, although we did encounter some resistance to the idea that both patients and people working in the hospital would benefit from these workshops. It raised some anxieties for people, as traditional organisational structures maintain these two groups quite separately. This resolved quite quickly though as overall there was a lot of interest in the project. The bottom line is that everyone deals with stressful things at times in their lives, and the techniques and tools we use can be used by anyone.’

The team will soon have delivered the workshops for a total of 80 members of staff. Separate workshops have also helped over 80 patients and carers to develop additional knowledge and skills to help them cope with chronic health problems.

‘We’ve had very good feedback from staff so far. People’s knowledge of stress management, confidence in managing their own stress, and feelings of resilience have all significantly improved. Staff said they found the mindfulness and relaxation techniques particularly useful, and liked the ways the workshops reminded them of the values behind their decision to work in health care in the first place.

The knock on effect

As well as supporting individuals, the project aims to promote a positive, compassionate organisational culture by placing patient, family and staff health and wellbeing at the heart of health care.

‘There’s a lot more awareness now that if you support staff and improve organisational culture, they are better placed to deliver higher quality and safer care’, says Anne-Marie.

In fact, evidence from the NHS shows that higher staff engagement correlates with greater patient safety, lower mortality, improved care quality, and reduced staff absenteeism and turnover. Engaged teams are more likely to collaborate effectively and have enthusiasm for their work, which in turn improves performance and productivity.

As well as gathering feedback from the workshops, the team are hoping to use the annual NHS staff survey to look at whether they’ve achieved any improvement in staff stress levels.

‘We work within an acute medical trust, and it’s very medically focused… staff are fantastically well trained and provide brilliant care, but they don’t have a lot of psychology incorporated into their health care model. The workshops are supporting staff with their own health and wellbeing, but also helping them develop skills they can use with patients and families they meet with every day, particularly those experiencing stress and distress.’

Anne-Marie’s team is considering how to sustain the work at the trust once the funding finishes.

‘We’ve had some interest from other trusts. One idea is to develop the workshop material to a point where we can share it as an intervention package for patients and staff in other primary and secondary trusts, as well as more widely.’


P J Rees (not verified)

Well done the Brompton, to be honest, and proactive enough to recognise one of the most important challenges facing our workforce today and try and find solutions. At present, it is now accepted after denial has been the norm for many years, that we have a workforce crisis in most of the healthcare professions. Dr Doyle writes, "the project aims to address the problems of ....., occupational stress in people working in the NHS, and organisational culture issues".

In my mind, these two problems are inextricably linked, with the positive link of "staff contentment" usually around strong effective leadership in the environment the staff work.

If one reflects on another of her statements: "there’s a lot more awareness now that if you support staff and improve organisational culture, they are better placed to deliver higher quality and safer care". It is extraordinary that NHS professionals need to be reminded of this simple truth. It is even more extraordinary but necessary that such statements need to be repeated ad nauseum, until it is an accepted norm in health care.

I would also suggest that resilience and self-care need to be an integral part of the curriculum of all NHS professionals, throughout both pre-registration and post-graduation for continuing professional development. We are developing this in our medical school, starting with our year one students. It is a voluntary module and the challenge for us is that it is always the assessment tail that wags the learning. However, we have a 75%+ attendance, which suggests that then students recognise the need for resilience and self-care. The unbalanced media stories of poor care and lack of compassion for our patients reinforces the need in the students' minds for such a module.

Congratulations to Anne Marie, the Trust and the University for grappling with one of the most difficult but probably the most important issues which would impact on patient and staff care.

Anne-Marie Doyle (not verified)

Thank you very much for your positive comments PJ Rees. I agree with you about the link between staff stress and organisational culture - good leadership is undoubtedly a key influence on staff engagement and team effectiveness.

There is increasing awareness of the emotional impact of healthcare delivery on staff - e.g. Riley & Weiss (2015) http://onlinelibrary.wiley.com/doi/10.1111/jan.12738/abstract - plus multiple wider system factors impacting too e.g. increasing healthcare demand, need for modernisation and sustainability, austerity policies and financial constraints, new digital technology, landmark report 'To Err Is Human', high profile organisational care failures and growing awareness of mental health issues. All of these, impacting on staff psychological health and professional morale, as you recognise. Important too to take a critical look at the current rise of resilience and its application to healthcare staff i.e. not to support programmes that act to sustain people in unhealthy systems.

I agree that the need for resilience and self-care is growing with potential benefits across a professional lifetime from pre-registration to post-graduation. Great that you are developing this and achieve a 75% attendance within the medical school already.

Wishing you well in your ongoing work, congratulations to you and your team too.

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