Supporting staff wellbeing during COVID-19: Inspiration from those working directly with patients | 16 June 2020

By the Evidence and Evaluation for Improvement Team (EEvIT) at Healthcare Improvement Scotland's Improvement hub (ihub).

In a recent article by the Pediatric Intensive Care Unit (PICU) staff of The Royal Hospital For Children in Glasgow, the team shares their own experiences to provide valuable insights and practical strategies for other seeking to improve well-being as staff work in the challenging circumstances of delivering healthcare in the unfamiliar environment of COVID-19.

The importance of supporting staff well-being when working during a pandemic has been a challenge faced by healthcare providers worldwide. As part of Healthcare Improvement Scotland's commitment to supporting NHS staff, we have been collecting and publishing stories and resources about person-centred care from the frontline to inspire others.

We take a look at the innovative initiatives and strategies outlined in the article and provide further examples of innovation we have gathered from NHS. For all the examples we present here today, it is important to keep in mind that these are done in a sensitive and appropriate manner for staff. The King’s Fund COVID Trauma Response Working Group has produced clear guidance on the Do’s and Don’ts to consider before providing psychological support for staff which you may wish to refer to.

1. Create structures to prioritise staff well-being
Firstly, the authors highlight how in September 2019 they created a PICU Well-being team focussed on facilitating the creation of 'a safe and supportive environment' for all staff. A subsequent PICU Peer Support team was also formed to establish 'a reactive supportive structure' for staff experiencing crisis. Whilst these were established prior to COVID-19, during these new pressurised circumstances, having a specialist team responsible for staff well-being and providing peer support is invaluable.

2. Create physical spaces for well-being
The authors highlight the need for physical non-COVID and non-clinical environments. With their 'Making Space Safe' initiative they are ensuring staff have somewhere to take a breather from their clinical work and 'lift the clinical armour'.

To help enable this they have created four boards which range from covering updates of changes and plans by the well-being team and national help for staff during COVID-19 to a technology board with apps, podcasts and other resources for well-being support. They even have a fun board with posters and a 'thing to talk about that don't begin with C' conversation starter. Creating spaces which allow staff to leave their work at the door is essential and we are hearing how teams such as those in NHS Greater Glasgow and Clyde have done the same with Relaxation and Recuperation hubs for all staff.

3. Promote compassion and celebration
PICU's Reinforcing the Positive initiative is an idea we have seen spread across the healthcare services with staff being #mugged (receiving a mug of goodies from an anonymous and appreciative colleague) to creations of 'positivi-trees' in wards such as that by the PICU team with laminated leaves for staff to share positive thoughts and messages with colleagues. Teams in NHS Grampian have also been using positivi-trees. Sharing all achievements and spreading compassion is a really uplifting way to promote well-being.

We have heard of other inspired ideas from staff such as those that encourage staff to think about post-COVID positivity, a wall of hope created by the children, grandchildren and friends of NHS Greater Glasgow and Clyde staff and even this happy code from healthcare staff in New York to share positive news across the hospital.

4. Stay healthy and hydrated
Promoting healthy eating and hydration is proven to improve well-being therefore the PICU team have initiated Supporting Tea Breaks. They have fresh water filters for fridges and have received donations of healthy food for staff from local retailers. Also they gave purchased special spry cushions so staff can feel comfortable on their breaks. Elsewhere, well-being and health have been supported through initiatives such as pop-up shops to ensure staff get all their essential supplies despite working long hours and including dedicated non-COVID café spaces away from work environments.

5. Check in with one another
For the PICU team, checking in with one another and providing support was essential and they have established two initiatives called 'At the End of the Day' and 'At the End of the Week'. The team realised that it was important that staff finish their shifts feeling prepared for life outside of work. Therefore they have 'Thank You NHS' cups so staff finish shifts with a cup of tea and a positive thought. They have also provided more showering facilities and toiletries (some have been donated) as well as a 'Going Home Checklist' so staff have peace of mind that they are not endangering their loved ones. These checklists are proving to be invaluable across the NHS and provide piece of mind for staff so they can leave COVID-19 at work.

With the 'At the End of the Week' initiative the team have created sociable down time and have created Friday 'coffee and chat' sessions so staff can share any difficulties they have faced whilst also having some light-hearted moments (even a weekly quiz) in a safe space with colleagues. All staff are invited and some psychology colleagues have attended and are looking to roll out further initiatives to support staff using similar tools. Teams are checking in with one another using many different techniques. NHS Louisa Jordan staff have established a daily check-in, check through, check out system for staff well-being whilst NHS Lothian have created posters to check how their staff are as they finish shifts and North Bristol NHS trust are using Compassion Circles methodology as one way to support staff well-being.

The authors have extended their check-ins beyond staff still on the ward to their colleagues that have been redeployed elsewhere. They have created a 'Maintaining That Team Feeling' initiative by distributing PICU team badges to every member of their team to ensure no-one felt forgotten and line managers are having phone calls with all their redeployed staff to ensure they feel supported. Conversely, we have also heard of teams helping make newly redeployed staff feel more welcome with I am new here badges.

6. Provide peer support and rescue strategies
The PICU team stress the need for allowing staff a place to adjourn and have a quiet moment (whilst also providing resources and comforting items like a recliner chair) and have established a 'Taking a Minute' strategy. For them this is their 'Take a Minute' room, however we have seen rooms of many different names with a similar purpose, for example a wobble room in NHS Bradford. The team have a Peer Support strategy with a critical care peer support network currently being created with support from colleagues in the ED, theatres and anaesthesia who are trained in providing crisis management and peer support. Similar offers of support and resources are also being offered by occupational therapists, psychology colleagues, cognitive behavioural hypnotherapists and even using Near Me to create new services for supporting staff.

Lastly, the authors end with a key final strategy they call 'When It Is All Over'. For this they emphasise the need to look beyond the now and into a recovery phrase to ensure that 'a period of debriefing and reflection' can be facilitated. They are collaborating with other teams to ensure sessions that focus on the issues staff may have post-COVID-19 as they readjust.

Final thoughts
We in EEvIT would like to reiterate the authors note of how "inspiring to see how well-being is becoming an integral consideration in many institutions" and the opportunity that the current circumstances have presented to design services centred on caring for staff. Whilst working in a pandemic is difficult and complex, finding positives and encouraging staff well-being yet again highlights the resilience and adaptability of healthcare staff, something that should be celebrated.