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What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

During COVID-19, clinical teams faced disruption, having to respond to challenging circumstances and high uncertainty, whilst providing quality care to patients. We know that staff psychological wellbeing affects team effectiveness and patient experience (Maben, 2012; Paparella, 2015), and resilience is fostered by connections between (not just within) individuals.

New collaborations between clinical, service improvement and psychology teams recognised the value of introducing the psychologically-informed ‘Start Well>End Well’ team procedure into routine team processes. This evidence-based approach consists of 1) an enhanced safety briefing, 2) peer-to-peer debrief guidance and signposting for trauma-focused support, and 3) team check-out.

Initially launched as a general procedure across all wards with variable uptake, a more tailored co-design and coaching approach was then piloted on 2 neurology wards over 3 PDSA cycles. Formative evaluation (focus groups and written feedback) demonstrated staff felt “cared for” whilst achieving “positive impact” through improved ways of working within new teams.

What does your project aim to achieve?

As the healthcare workforce continues to be restructured throughout and beyond the pandemic, the next phase will redesign and rigorously evaluate the procedure alongside scaling up for implementation beyond NBT.

The programme will deliver psychologically-informed support for team wellbeing, psychological safety and effectiveness (Edmondson, 2018), embedded within hands-on coaching enabling the procedure to be tailored to the needs of specific teams. Its objectives are to:

1.       Co-design an adaptable version of the ‘Start Well>End Well’ procedure with Q Community & NHS Improvement input

2.       Scale up for implementation across clinical and non-clinical settings within and outside of NBT. NHS Improvement is keen to support this approach nationally.

3.       Evaluate the impact of this adaptable approach in various clinical and non-clinical settings within and outside of NBT

4.       Evaluate its impact on specific staff groups to ensure equitable distribution of wellbeing outcomes (e.g. minority ethnic staff, agency workers, night shift workers)

How will the project be delivered?

The project will be jointly led by the NBT Staff Wellbeing Psychology Team and service improvement teams. NHS Improvement will support resource dissemination and invite other NHS Trusts to participate in evaluation. An Evaluation Lead will assist with evaluation design, primary data collection using validated survey tools and write-up. NBT Business Intelligence will assist with secondary data extraction and analysis.

Intervention-control design will be used in NBT division/directorates for evaluation. A similar approach will be used where possible for teams external to NBT. Team ‘champions’ will collaborate with the NBT team to adapt the procedure, monitor implementation fidelity and manage unintended risks/consequences. Data will be collected pre, during (≥2 PDSA cycles), post, and 3 months post intervention to measure sustainability.

Outcome measures will include staff wellbeing & collaboration (validated questionnaire/interview) and human resource metrics, including cost implications for economic evaluation. Community of practice. Process measures will include experiences of co-design and implementation.

How is your project going to share learning?

Communication channels between the project team and Q Community will flow both ways. We will share the adaptable ‘Start Well>End Well’ resource through the Q Community and NHS Improvement, and host 2 webinars to explore the programme’s alignment with other local and national priorities in order to take the programme beyond NBT and plan for roll-out beyond NBT. We will also use the Q Community as a key network to invite other organisations to participate.

Following implementation and evaluation, findings and learnings from different clinical/non-clinical areas across various Trusts will be shared through Q Exchange project page updates.

The team will write-up the evaluated aspects of the project for publication in peer-reviewed journals (e.g. BMJ Open Quality), submit conference abstracts to national and international conferences (e.g. IHI International Forum), and participate in other Q Exchange virtual events, Special Interest Groups and Twitter.

How you can contribute

  • Our team is keen to network within the Q Community to develop our idea, particularly with regards to scaling up the programme for wider implementation outside of our own Trust. We are looking for the following types of contributions:
  • The critical friend: We would like your honest feedback to tell us your thoughts about our idea and how we can improve it.
  • The networker and promoter: Help us to brainstorm ways that we can promote our idea and reach individuals/organisations in health and social care who may be interested in participating in wider implementation and evaluation.
  • The strategist: Assist us to explore what other similar initiatives (local or national) are out there, how it relates to our work, and what we can do to align our project with existing work and priorities

Plan timeline

15 Mar 2021 Webinars and recruitment of external teams
5 Apr 2021 Finalisation of participants and evaluation plan
12 Apr 2021 First round of co-design group sessions; Data collection
19 Apr 2021 PDSA cycle 1 commencement
17 May 2021 Cycle 1 review, second round co-design group sessions; Data collection
24 May 2021 PDSA cycle 2 commencement
21 Jun 2021 Cycle 2 review, third round co-design group sessions; Data collection
20 Sep 2021 3 months post-intervention data collection
4 Oct 2021 Being write-up of evaluation for dissemination
4 Oct 2021 Share final findings, learnings and resources with Q Community
1 Nov 2021 Consult and finalise plans for sustainability of ongoing roll-out (Nov-Jan)
24 Jan 2022 Complete final data analysis and write-up (Jan-Mar)
7 Mar 2022 Project completion and submission of reports, manuscripts and conference abstracts


  1. Guest

    Sebastian Kraemer 5 months, 4 weeks ago

    Peer engagment in health and care is an idea whose time has come:

    The key is to ensure that all points of view are equally respected. Group process tends to favour the most articulate and confident, but it is the less audible voices that can supply the missing pieces of the jigsaw.

    In this way colleagues learn from each other. This is more than staff support, it is staff professional development.

    Without a facilitator it is much harder to achieve and maintain the fuller picture,  always "other than the sum of the parts".

  2. Thanks for sharing this.  I work at the Oxford AHSN as a senior workforce programme manager and having evaluated staff health and wellbeing recently - this looks like a great introduction to any team.  I think the importance of it for non-clinical teams is also vital as their role is critical to the clinical arena.  Happy to link with you and our ICS.


  3. Love this - would be happy to be a critical friend

  4. What a brilliant idea and one that melds well with our Psychology 4 Improvement Q Exchange 2019 project.  I would love to learn more and see how this develops in the future.

  5. Dear all, This looks fabulous, I am in the final year of my Doc Professional Practice study looking at psychological safety for RNs and would love to either be involved or have access to your work

    Kind regards


  6. Guest
    • Thankyou this looks really interesting As human factors lead in my trust Ii have been linking with our wellbeing lead tocombine our thoughts on how best to achieve the aims this project has . Would love to learn more and contribute where possible exciting !
    1. Guest

      Victoria Handford 7 months, 3 weeks ago

      Dear Sue,

      Thank you very much for your kind comments. If you email me at, with your NHS contact details, then I can send you a copy of our implementation pack.

    2. Guest

      Victoria Handford 7 months, 3 weeks ago

      Hi Sue,

      Thank you very much for your positive comments. If you email me at then I can share our implementation pack with you and details of a webinar that we are intending to run with NHS E&I in early March.

  7. Guest

    Lorna Stewart 11 months ago

    Hi team, I really like this idea and the process that you've been developing; it looks like you've already had some great team engagement. We'd be keen to learn from each other. Check out our bid as well at:

  8. Hi Pete, Thank you for your reflections, support and feedback. You prompted a few discussions within the team and helped us clarify a few things. In particular we discussed how passionate we are that teams take the Start Well >End Well framework and adapt accordingly to their needs and environment. As you suggested, we have since looked at other projects related to the same theme with the view to see how this tool could compliment existing services specialising in this.

  9. Hi Vardeep,

    Myself and Emma Adams are supporting the Health Foundation this year by fostering conversations between Q members and encouraging collaboration. We were Exchange applicants last year, so we’re hoping that our experience will help us to help others, as their ideas take shape.

    Your idea is highly compelling, well-articulated and good example of COVID-related innovation. You might have seen that there are a number of ideas describing efforts to improve staff wellbeing. I've been reading through these and thought it would be helpful to highlight in particular the project, 'Supporting staff with prompt, easily accessible psychological and wellbeing support.' Whilst the support they are offering has as delivery model to the one you are proposing, I believe that it may be helpful to connect with them (perhaps commenting on their idea and vice versa), conscious that - for instance - you are looking for others to play a critical friend role.

    If I can help foster other connections over time, I will. In the meantime I wish you all the best with your idea.



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