‘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
‘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.’