Who cares for the professional Carers?
How do we look after ourselves and each other, in order that we can offer the safest service possible to the people in our care? This was the challenge posed in the recent Wellbeing during COVID: what have we learned? webinar (includes slides and video) hosted by three Q community Special Interest Groups and their conveners:
- Simon Gill, convenor of Organisation Resilience & Safety-II
- Julia Wood, convenor of Improving Joy in Work
- Hilda Campbell, convenor of Staff Wellbeing and Quality Health Care
Some really interesting themes emerged and there was great energy in the chat box, so thank you everyone for making it such an animated session!
There was a really great mix of people with various skills, experience and focus of work from primary care, to community, to education, to improvement, to secondary care and more. This shows that wellbeing and the wellbeing of professional care givers is a universal concern.
The 10 key themes that emerged
We identified a number of themes which are summarised below:
- Wellbeing overview
Wellbeing means different things to different people, but includes feeling comfortable, healthy, happy, being resilient, and having a sense of meaning/purpose. Many factors impact on wellbeing including work, relationships, how we look after ourselves, and of course how we are managing the impacts of COVID-19.
2. Adapting and learning
Many of the participants reflected that getting the simple things right can have a massive impact on staff wellbeing. The concepts shared included being mindful of what our colleagues have been through, considering the tone we use in our engagements, focussing on giving time to members of our teams to talk and employing active listening to understand how they are really feeling.
We must not rush into this without giving our colleague’s time to process and grieve, to accept these changes and to co-create this ‘new’ normal
Simply being kind was mentioned many times with an acknowledgement that we need to find ways of offering random acts of kindness in a virtual world. We must make sure we truly connect despite often not being present together. “Liberating Structures” as a tool and virtual teamworking technology can help provide different ways of interacting, with breakout rooms, chat boxes, polling, emojis and so on. (There is a Q SIG on Liberating Structures so please join if this is of use.) There is also a recognition of the fact that many of our teams have changed, with new staff joining and old being re-deployed. Fully integrating new team members and fostering relationships with them is critical to ensuring overall team wellbeing.
It is clear that many things around us have changed, we have changed. We must not rush into this without giving our colleague’s time to process and grieve, to accept these changes and to co-create this ‘new’ normal.
3. Challenges to feeling included
It’s important to think of the different dimensions through which there can be exclusion: gender, race, ethnicity as well as character and experience. Staff who are shielding can feel particularly left out too; and others whose sense of purpose is now challenged, as their work has stopped.
For some, use of Microsoft Teams has led to a culture of instant responding – which may be quite different to the previous norm. Work is needed to build bridges between each others’ worlds and experiences, even more so with the sensitive stuff that needs time and careful facilitation.
It is critical we keep exploring how individuals in our teams are doing and allow a more open conversation about wellbeing. Three participants shared ideas – weekly surveys to find out how everyone was feeling, how valued they felt they were and how they were being supported, and encouraging blogs from individuals in the team to explore these issues.
Many people have suffered from grief for numerous reasons during COVID-19. Normal comforting behaviours, such as holding a grieving person’s hand or giving them a hug is currently not possible for many. However, reaching out in other ways (phone, virtual calls using Skype or WhatsApp, social distancing face-to-face contact, sending cards etc) can still be very comforting for those going through the grieving process.
6. Remote working
Participants shared various dimensions to the rapid adoption of remote working. Some recognised the flexibility it allows, the minimisation of travel time and improvement in work life balance. However, others saw challenges in maintaining personal boundaries, the requirement to invite colleagues into their private spaces and the breakdown of normal rules of when meetings can be held. Some embrace the flexibility and want to fit their work around other priorities and others prefer to stick to their normal working hours.
With remote working likely to continue into next year and potentially beyond there is a recognition that we must be proactive in dealing with the challenges and implementing a solution that takes into account this diversity of views in our teams, and the effective blending of virtual and physical presence.
Many comments made during the workshop outlined the negative effects of the use of technology and how to overcome these. It was felt that online meetings (through forums such as Zoom or Microsoft Teams) can be improved by building in time for virtual social activities, having regular breaks between meetings, establishing small group check-ins, and using the breakout room facility (Zoom). Some stated that emails should be sent only during working hours to reduce stress to the recipient/s. Also, people were asked to consider whether a phone call would be more appropriate than an email, particularly if the email is lengthy or if the content might cause stress to others.
8. Time and space
Many people miss the serendipitous meetings that our workplaces offered: the ‘kitchen conversations’ where you just bump into someone. Here are some of the ways being used to create more time and spaces for staff to connect:
- ‘Wobble rooms’
- Ad-hoc phone call catch-ups, including ‘Walk and talk’ ones
- Facebook and Twitter (usually asynchronous, making it easier to drop in and out)
- Slido, Miro, or using Liberating Structures*, to make engagement in Zoom easier (*Happy offer free training for NHS staff)
- Breakfast club, Daily drop-ins
- Book clubs and quizzes
- Side-by-side walking meetings (less confrontational that ‘facing’ meetings)
We have undoubtedly experienced a period of uncertainty, rapid change and adaptation. Some have relished it but others have struggled. Our personal diversity (e.g. “introvert” verses “extrovert”), the diversity of our roles we play (clinical verses policy) and the area in which we work (community verses acute) leads to this varied response. Some have seen this as a time where command and control was prevalent and opinion was not welcomed, with others seeing it as a time when people are “enjoying a sense of ownership” and “empowerment” with localised decision making. Despite being a “unifying” experience, some feel “guilt”, others “grief”, some enjoying the change, others are struggling. One participant reflected it well: “Recognise diversity of reactions to uncertainty, some of the most seemingly robust people have been toppled recently”.
As we learn from the adaptations we have made, being able to express ones’ mind openly is critical
As we learn from the adaptations we have made, being able to express ones’ mind openly is critical at this time. Psychological safety is a fundamental pillar to how we respond and learn from the pandemic. One participant expressed what we should be aiming for, where speaking up (or out) is not seen as exceptional – high performing teams don’t recognise the concept of “speaking up” as expressing ones’ mind is entirely normalised. Managers have a responsibility to create this safety meeting-by-meeting. Participants shared examples of this in the need to welcome participants into a call, checking in and out to ensure that people feel included, encouraging their participation.
Virtual meetings were shown by participants to be both positive and negative in this regard, they break down power differentials and barriers, ensuring team members are seen as human with a view into their home lives, the messiness, children, pets and partners being part of who we are. However, some find it difficult to participate in virtual meetings, and it is more difficult for managers to gauge team engagement with a lack of body language cues.
10. Wellbeing activities
There is evidence through healthcare research which demonstrates staff wellbeing is linked to improved patient outcomes. There are many wellbeing activities to choose from, and what works for one person might not work for others. There were a considerable number of examples of wellbeing activities shared during the workshop, including walking meetings, exercise classes or running clubs, mindfulness drop-in clinics, weekly zoom lunches/coffee clubs, or receiving a good morning email each day in your inbox.
Critical resources to help us address these challenges as people, as professionals and as organisations:
Join the Improving Joy in Work SIG for further resources. If you are interested in joining the conversation about the adaptation and organisational resilience aspects of this call please visit the Organisational Resilience & Safety-II SIG (and see a blog on the outcomes of that SIG’s previous Zoom on Safety-II and COVID here).
We’ve collated the resources shared on the day, these have been broken into themes to reflect the previous point, of course, some will touch on more than one theme:
Resources that are useful for us as individuals
Cope Scotland’s advice on remembering what matters and a sense of purpose, workbook and affirmations
The Scottish Social Services Council for Care Providers who are providing support to people with palliative and end of life care needs
Iriss – For tips and information for staff resilience as well as the wider public
BASW – Help for key workers during the COVID-19 pandemic
Clear Your Head – Campaign to look after your mental health
Resources which are useful for us as health professionals in teams
Amy Edmondson’s book on her work related to ‘teaming’ which is all about teams that are coming together on a random basis: Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy
Online version of ‘Schwarz Rounds’ called ‘Team Time’ – which could prove very valuable.
Resources which are useful for our organisations
The write-up from the virtual session on COVID-19 and Safety-II hosted by Simon Gill
Book: “Compassionomics” by Trzeciak and Mazzarelli
Book: “The Fearless Organisation” by Amy C Edmondson
Book: “Implementing Patient Safety; looking at culture and conditions for safety” by Suzette Woodward
’Kindness, emotions and human relationships: The blind spot in public policy’’ Julia Unwin CBE