Teresa Jennings, Consultant Clinical Psychologist in Occupational Health at Northumbria Healthcare NHS Foundation Trust, discusses how to engage staff across a large organisation and empower staff to make positive choices to enhance their health and wellbeing.
This presentation was given at The King's Fund's event, Encouraging staff wellbeing in health and care, on 14 January 2016.
The brief I was given was to talk a little bit about our journey and some of the challenges that we've had along the way, and maybe some tips and bits of learning. Because, it's slightly embarrassing to keep hearing we are in the top five, and we've still got a long way to go, and the bar is quite low on some of these things anyway and it doesn’t mean that we are doing them perfectly. But we are just trying to give you some of our experiences and some of what's worked and some other things that we find quite a challenge.
But I think, just to focus on background a little bit, we've been around a while in the Trust, well I have personally, with different hats on. I do manage our staff psychology and counselling service, and really at the inception of that there was always this idea that it's not just about bums on seats and managing people that come into occupational health downstream, we needed to be doing some upstream working around managing stress, so there's always been that bit of framework there, which has morphed into the whole health and wellbeing programme of late, which is great to see.
A little bit maybe about our model and approach hopefully might be quite helpful to you, and as I said, just some of the struggles that we've had along the way, and what's worked. Just a little bit about us, we are a huge organisation, I think we’re the largest employer in the North East, 9,500 staff, and we provide health care to over half a million people. We are one of the largest geographic areas as well, so there are quite a lot of struggles associated with geography.
We've got acute and community settings, and particularly in Northumberland we also provide social care as well as health care. We've got three district general hospitals, and we've recently developed a new specialist emergency care hospital, which I don't know if people are aware of or heard about, in Cramlington, which is the first purpose built type of hospital of it's kind in the UK. It's already been mentioned a little bit about challenges and supporting people through organisational change, and we are in tough times, there's massive change, there's lots of pressure, and I think trying to keep these programmes going is quite a challenge when you’ve got these contextual issues.
So, I'm not going to go through all this again, it's all been mentioned and it's all been critical, and it's all … I suppose the leverage has gathered pace, in terms of being able to support the business case for developing health and wellbeing. We were saying on our table earlier about how in the past we used to have a special interest group in stress, and it felt a little bit like a nice to have, and if you had an interest you participated in that group. Whereas, it now feels very much like it's part of core business, yet the growing evidence base, I think, really helps with that, and particularly linking the staff and patient experience, which I think has been quite critical.
As I said, we were already utilising stress frameworks, like the health and safety executive framework around stress, and the management standards. I think personally those have been really key, in terms of being able to develop the health and wellbeing programme further, because the management standards were all about how can managers look at the working environment and manage stress and wellbeing in their teams in a preventative way. And I think that goes back to the idea and some of the discussion that we've had so far, about the fact that it's important not just to have a health and wellbeing programme in isolation, and a range of activities for staff, it's also important to look at how do we do with organisations, what are our structures like, what is leadership like, what is our culture like. And we need to do all this together. I think things like bullying and harassment, how people speak to each other, what are relationships like, that’s all really key and critical to address as well, and it's bring all these strands of work together.
We already had a steering group around stress, and that amalgamated with the health and wellbeing programme, and we were fortunate to be able to have a dedicated health and wellbeing post developed, and I'd like to acknowledge that post holder, who is not here today, who was going to be doing this presentation, whose name is Kylie Morell, and she is actually our health and wellbeing coordinator. She's literally just had a baby at 5 0’clock this morning, otherwise I was threatening to wheel her in, pram and all, to do the presentation. And the other thing, I suppose the last bullet point on here, is the links with the health improvement service, because as a Trust we amalgamated with community services around 2011, and that helped to increase the resource as well that we had.
The health improvement services were obviously working already with patient populations, in terms of health and wellbeing programmes, they were doing things like the Better Health at Work awards, and helping local businesses to achieve good health and wellbeing strategies. So, of course we made use of that when they actually joined forces with us as an organisation.
Just turning to engaging with staff, the health needs assessment is quite critical, because I suppose what's running through our ethos is that we are wanting to provide what staff are asking for, but as well as what are their health needs, and we try to link this very much with the public health agenda, and very much in the forefront has been work around mental health, obesity, healthy eating, and probably as mentioned earlier, MSC, muscular skeletal linked to physical exercise. Those are probably the three big areas that have come out top, in terms of asking staff what they want more help with.
The staff survey, coming up with this as well, because we've got separate questions, local questions if you like, that ask people about what support they need. But as well, critically, that we need to link this with the public health agenda, and the other guidance that has been out there for a while, which is the guidance around public health in the workplace, and the NICE guidelines. Several areas developed within that, around physical activity, obesity, smoking, sensation, alcohol. But a critical part of that, as well, about managers and leadership, and I think that’s quite key to all this as well, and I’ll come back to that a little bit later on.
Because I feel that in order for this to work we need to support our managers and leaders, we are asking them to do more and more, we are asking them to be compassionate, to listen and to be attentive, but we need to give them something as well in order to be able to do that. So, engaging with managers as well is very critical. We've had really good support from the top, our Chief Exec has always been very passionate about health and wellbeing, so we've got that championship from the top, which I think has really been helpful. And an ongoing presence, as well, within internal comms, because if you're engaging staff … we've talking a lot about nurses and clinical staff, but there's whole rafts of other staff out there, kitchens, portering, catering and admin staff, and it's trying to engage all those people to see the value of their work, and sometimes people in those areas of work do feel quite far removed from the frontline and don't often feel as valued.
So, internal comms, we do a lot of work with them in terms of the branding, branding is key, but it's not about sending everything out by email, we've got a network of health advocates as well that we've trained up, because we've got multiple sites, so it's been important to have people on different sites that can spread the message as well and go into team meetings et cetera.
This button represents empowering staff, that’s obviously the on/off button of a PC, but that was very much our sort of ethos and philosophy, it was about not ramming messages down people’s throats in a dictatorial style about you must do this for your sake, and you need to improve your health. It's been very much about having a range of activities available, information and education for people when they are ready to turn to that, so in order to make an informed choice. And I think that’s what that button represents, when you are ready press the button and here is what you can do, and we’ll give you support with that.
So that links very much with responding to staff needs and requests, you said you want this and here is what we are going to provide. So, a supportive turn has been really important, as well as already mentioned having a menu of options, not just one size fits all. We find case studies very helpful, and a selection of those I've sent through already that might be available on the app, just to give you an example. Some of them are very personalised case studies, but that helps as well, for people to, I suppose, reduce the stigma. So, an example of that is we had a member of staff who suffered from bipolar disorder, and she actually offered to do some presentations in one of the education centres, people came along to hear her speak about her issues, how they impacted on her at work.
But we have other case studies, I think one of them that’s in the pack there was beat the board, which was a really useful workplace challenge where people were actually doing a range of activities, and it set up a little bit of competition between different teams and the Trust board, and about 18 of the teams actually did better than Trust board, so that goes to show what their levels of fitness was. But it was bringing in a bit of fun to it all as well, reducing stigma, and as I mentioned earlier the training and support for line managers which is really key.
So, we do a lot of training with managers around mental health awareness, we've got a health at work training programme where we get managers to think about campaigns as well. So, every year we put on two or three health campaigns and we may ask managers for ideas about what could go into those campaigns. It was mentioned a bit earlier about helping managers to do good appraisals, one of the things that we do in our appraisals is we have a health and wellbeing section, so it ensures that managers ask their staff, that they are seeing how they are, how are you doing, and here’s what's available if you do need some help. So, the training and support has been critical.
This pyramid just represents really the model that we use, and what we have at the bottom of the pyramid is that we have a whole range of initiatives for all staff that are available, and one of the handouts that will be available on the app is all the different types of things that we do, ranging from looking at the food environment in the canteens, right through to self help resources and health promotional campaigns. But that just really is something that’s available for all staff, and it again highlights that we need to put information and choice of activities out there.
But then we need to do a little bit more targeted support for people that need a bit of extra help. I've put there, for example, that we have the stress hotspots, we know where our hotspots are, but sometimes we don't and we make assumptions that areas are doing okay. We have a stress hotspot too where we look at a number of indicators to highlight where there may be areas that are experiencing problems. In the mediation service we know that there are areas where relationships aren’t good, and we may do some team presentations in there. Right at the top of the pyramid, where we’re trying to help really in an intensive way facilitate behavioural change, because we’re very much using a model of change here, where people are at different stages in that cycle of change, some people are more ready than others. When people are ready, we then have got expertise available for them, such as physio, dietetics and psychological therapies to help with that.
That slide just gives an example of some of our campaigns, I won't go into that just now, but there are a whole range of different things, and we try to keep a variety of different campaigns going, not to have too many because overload is just not going to work either, but have two or three good ones that respond to staff needs.
The challenges. Again I've mentioned, and I’ll say it again, is geography, keeping things fair and equitable, so you haven’t got one site saying, you're doing this on that site, what can we have? So, we try and do individually tailored stuff for sites, but we also try to link people in with activities in their local areas.
Changing culture. That’s ongoing work there really, I think we’re getting there with that, but there are competing priorities. The more everyone signs up and knows that health and wellbeing is a good idea, we are operating in a difficult context, we know that we've got challenges with pressures, staff shortages and organisational change, so keeping this work going through difficult times, it's been really important. Reactive vs proactive, you get caught up with the fire fighting and the reactive stuff downstream invariably, so I think keeping the promotional side, the upstream working, is really critical. Having a health and wellbeing coordinator has really helped with that, with a public health background, but we’re also doing some preventative work ourselves within occupational health.
So, I’ll come on to just a quick example of that before I finish, but we, I suppose, feel like everyone else, that this has got a higher profile now, and it's seen as part of core Trust business. I don't want to mention these stats again because they’ve been mentioned already, but we have noticed that our engagement scores have improved, and that particularly for the questions around the manager taking a positive interest in health and wellbeing, and the organisation taking positive action, we know that we've scored very well on those, and we’re really pleased with that because we do have a very high return rate on the staff survey. But we also know because there's increasing levels of engagement in the initiatives that we provide.
We've got very positive patient experience results in the Trust, and those continue to improve, and we link them very much in with staff experience, so we’re doing work around patient experience and teams on the wards, we will talk to teams about their own experiences, how staff feel about their work as well, and what support we can give them.
We’re coming on, I know, to a talk about being part of the exemplar employer pilot project, but we’re very excited about that because it means there's further investment in the programme.
The resilience groups, I want to just give a quick mention to that, because it can be a contentious word, for all it's an attractive one, but sometimes people feel that it can be a little bit of a default mode for if things aren’t working, just give someone some resilience training and send them into a group. But, this work really we've been doing for about two or three years in the organisation, it's been externally evaluated, and what we’re really excited about is the significant changes in GHQ scores which are a measure of physiological morbidity, pre and post intervention, and that’s after a relatively short term intervention of only two or three sessions, as well as a whole range of improvements on work related measures such as burn-out scores and things like work limitations.
So, we know that this sort of intervention is helping people to feel better and perform better at work, and that is really quite important because we know that that then links to sickness absence, so we’re helping people to keep healthier at work and to perform better at work, that’s going to have a really good impact, in terms of reducing absence, we hope. So this sort of work we are continuing to roll out, and we’re actually doing some with senior leaders in the organisation as well. And I think one thing just to mention on that, is that because I've just myself facilitated a group this week, the interesting thing hearing Michael West speak about compassion is so important in leadership.
We had a group of very senior leaders coming in to this group that we ran, and one of the things that they were saying is it's actually quite hard to listen, and they know when they’re asking people how they are, they don't always want to hear the answer because it is very difficult when they are feeling under pressure, when they’re feeling that they are fire fighting themselves, to actually have that authentic approach where they are actually being their true selves out there. So, they actually benefit, and I feel that this has come through in the groups that we've done, not just in terms of improvement in wellbeing, but a chance to sit down together, to share things with other people, and some of that stuff we talked about earlier, where there is lack of supervision and lack of an opportunity to debrief and just speak to people about how it feels out there, there's an opportunity to do that in these groups.
So, just finally some tips and learning, and some of this I've mentioned already, keep it core part of your business strategy, make sure it's in the annual plan. We've got various key groups that run like workforce committee, and a health and wellbeing steering group, and those reports are fed regularly into Trust board, to keep the agenda going. Partnership working involved, as was said by previous speakers, not just HR, it's not just a occ health owned thing, it's comms, it's managers, it's everybody actually, it states, it's facilities, because it's about hospital design, it's about food environment, it's about IT. So, it's trying to keep that shared approach, and everyone to have some ownership in it.
To keep this sort of multiple communication method going, that’s been learning for us, because not everyone has internet access, not everyone has a chance to sit down and turn on a PC in their working day, so just to have different methods of communicating with people. Don't overload or bombard, it will turn people off, they disengage. Supportive tone is important, and a focus on long term behavioural change, not quick fixes and ticked boxes, but things that we know are working towards a longer term behavioural change. And I think our next challenge, really, is looking at the hard to reach groups and trying to extend this programme of work to people that we know we’re just not getting out to out there, how can we actually target those areas on a supportive way?
We've mentioned about campaigns, but multi-faceted initiatives, have a range of things. Keep them fun, not in a trivial way, but actually make it fun and give a positive message. But these campaigns are all based on an evidence base, and we know that that’s important too.
And evaluation, well that’s probably a topic for another day, but we use a range of methods, and we want to keep going with this, so we use individual validated tools, but we also look at our staff survey results year on year, we use Survey Monkey to actually assess people satisfaction with the campaigns that we’re doing, do we need to be doing more, and we run focus groups. So, I think it's trying to keep all those levels of things going, evaluation is a challenge, because I think when you're running a service and you're operationalising things, sometimes you are very close to it to do the evaluation, so we always very much value when we get help from external resources, and hopefully being part of the exemplar programme will help with that.
So, I think I’ll just end it there really, that’s the end of this presentation.