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Much has already been written about living through Covid-19 and its impact on health and care staff. Among the harrowing tales, many positives have been captured about the experience, including the speed with which changes were adopted; how people coalesced around a shared sense of purpose; and how decisions were taken at the front line, closer to the patient. It is easy, and perhaps sloppy, to conclude from this that everyone has debriefed, that life is already moving on, and that some improved version of past reality can now be restored. But is that really the case?
For the past five years The King's Fund has been running a programme for advanced organisation development (OD) practitioners working across the health and care system. The alumni of the programme met regularly from March 2020 to explore the impact of the pandemic on their local systems and the nature of OD interventions that had positive impact in this context. In June this year the alumni undertook a series of semi-structured interviews within their own organisations to find out more about what people need to start a process of healing as they continue to live with and work through the pandemic, and how the OD function could support this. The 30 interviews included leaders, managers and clinicians from secondary care, community services, mental health, and emergency care.
What we found
When the alumni and I looked at the interviews, the stories brought us up short. The generosity with which they were given, the emotion they held and the unique quality of each experience brought us back to the reality of a pandemic that for so many has never gone away. When asked about ‘healing’ many of the interviewees said that this moment is a critical juncture; what leaders choose to acknowledge and choose to ignore now will have an impact on the system and the health and wellbeing of health care staff for many years to come.
'It was an unequal experience.'
People expressed a range of emotions from exhilaration at having been stretched professionally - 'that is what I trained for' - to anger at what they saw as failures to protect staff and patients. For many, resentment sits just beneath the surface, in many cases generated by the necessary response to the pandemic. For example, community nurses said they undertook more home visits when other parts of the system could not provide services; staff were redeployed, away from their regular teams and expertise; others were at home shielding or home schooling, working hard via Microsoft Teams, yet set apart from the frontline action. Some expressed frustration and guilt about the roles they were obliged to take up. One said, 'We're full of should/shouldn't have... did/didn't do.'
Each individual felt multiple situations and factors had affected them over a protracted period. Most felt worse off now, mentally and physically.
'Inclusion is fragile'
One of the most reported issues was the distress respondents experienced at seeing the extent of the systemic inequalities, unfair and avoidable differences in health across populations. They singled out the impact of Covid-19 on those from ethnic minority groups, including health care colleagues. They also noted the intergenerational impact of living through Covid-19 - who sacrificed what for whom. They sit with an overriding horror at the scale of deaths. This narrative was strong, unified, alive and present in the lives of all the interviewees.
One wish
When interviewees expressed their one wish for the future, two clear themes emerged. The first reflected the need to pause and process what has happened.
'Please someone PRESS THE PAUSE BUTTON now.'
'Find the circuit breaker.'
One described the current situation as '...coming out of a forest into a firebreak, with another fire ahead' and no way to catch their breath.
The second related to learning from the pandemic.
'Not to feel what we’ve done has been forgotten.'
There was despair that leaders, managers, politicians, just don’t seem to want to learn anything from the experience, or don't know how to put the learning into practice, that it is already too late. It was a heartfelt plea to create the space to simply listen.
Where to start
We asked about the conditions needed for healing to start. Most said anything but the conditions they are in now: multiple competing operational and strategic priorities; trying to do too much with poor infrastructure (eg, IT); desperate workforce shortages and budgetary constraints; some people still not having the basics, such as water fountains or access to food in breaks. One said: 'Your question brought a tear to my eye, because the honest answer is [what we're doing] is inadequate.'
However, we also heard about the following areas that need to be prioritised.
The diversity of the workforce and diversity of experience means leaders and OD managers need to be more proactive about who they hear from, rather than settling for the views of the usual contributors. Prioritising this is the only way to learn.
There are systemic issues to work with and interviewees wanted leaders acknowledge the extent of race inequalities across the health system. There also were strong and clear views about the urgency for leaders to address the workforce gap now, the shortages will not be wished away. The enormity of both issues must not prevent action.
Alongside the systemic, it is the small things that matter. One said, 'Start by accepting the abnormal way we have been working is NOT normal.' Respect and value staff; bring compassion. Get 'stuff' done, eg, access to meals when working shifts; change the underlying (12-hour) assumptions that rotas are built around; remove the language of 'so busy'.
The role of organisation development
When the OD alumni group and I met, we agreed that we had heard a call for people working in OD to step up, and to act now. So how can OD practitioners take action?
There is a gap between the rhetoric and the reality of supporting staff, between wellbeing initiatives and what people really need. That gap should be where OD sits. OD practitioners can send strong messages about what is really happening and what needs to happen, ensuring issues don't get trapped in processes and committees. OD can be the bridge across the system, between chief executive and staff on the front line, across all parts of an organisation. OD practitioners can spearhead processes of inquiry and sensemaking in new and fertile ways. There are many examples of this already happening, but there is so much more to do.
OD needs to be clear what its practice stands for against the horrendous backdrop of inequalities and racism, what it can do to address systemic racism. To do this OD practitioners must be comfortable with the uncomfortable. Some interviewees questioned the influence of the OD function and suggested that it needs to stay close to the chief executive or equivalent, to maximise its power to create change.
OD as an integral partner in the process of healing. OD practitioners need to be visible, hands on, focusing on day-to-day culture, and issues of physical and psychological health, to support line mangers in recognising trauma. To 'do some doing' and role model respect and compassion.
The question the alumni are left holding is what it really takes for OD to be connectors, translators across systems in the new health and care world.
OD practitioners can never have all the answers, but can experiment to see what’s possible. Healing is the job of everyone, and OD practitioners have a crucial role to play in enabling it.