Managing implementation alongside COVID-19 demands

The rationale for introducing a national programme of Health and Wellbeing Conversations is clear. However, we know the NHS is still dealing with the impact of COVID-19, recovery of activity which stopped or was scaled back in Quarter 1 and planning for winter. The time to plan and carry out these discussions will be constrained. We therefore wanted to include some pragmatic advice on implementation, particularly for the period September 2020-end March 2021.

1. Prioritise quality over quantity. These are important, potentially sensitive conversations. Done well they could make a significant impact on the individual and their team. Done poorly they may feel like a tick box exercise. We recommend executive teams launch Health and Wellbeing Conversations as an improvement initiative using the Plan, Do, Study, Act (PDSA) methodology. If you have access to quality improvement specialists, use their expertise to help support the design and testing process. Make iterative improvements over the course of the first six months

2. Be guided by risk and potential benefit. Use your own data and soft intelligence to determine where early implementation of the conversations may have real and timely benefit. Current evidence suggests that there are likely to be five groups of staff with particular resilience risks:

• Staff who had weak local management and low levels of psychological safety pre-COVID-19
• Staff in training
• Clinical teams disproportionately affected by caring for COVID-19 patients, especially if this is not team members’ usual place of work. Emerging evidence also suggests high levels of mental health risk in ICU, Anaesthetics and Theatres teams specifically
• Staff with significant concerns raised through the COVID-19 risk assessment process, including BAME staff and staff with disabilities
• Staff working at home for a protracted period of time and struggling with the environment

We recommend fine tuning the PDSA cycles of implementation to take account of signals from the organisation:

• Hotspots of concern identified by the NHS staff survey or local pulse surveys particularly in relation to
  • Satisfaction with support from local line manager
  • Health and wellbeing support
  • Raising concerns and reporting errors 

• Hotspots of concern emerging from the COVID-19 risk assessment process
• Trends in sickness absence due to stress or Occupational Health referrals
• Trends complaints about attitude or behaviour from other staff or patients
• Hot spots of concern identified by the Freedom to Speak up Guardian or Freedom to Speak up champions about culture, behaviour or morale
• Concerns and exception reporting via Guardians of Safe Working
• Unusually poor performance in a service or team, including spikes in safety indicators such as clinical incidents

3. Make use of the skills you have in house and in your partners. Health and Wellbeing Conversations are, in effect, a coaching conversation about resilience and its drivers. Most organisations will have people who already have coaching skills and experience within their clinical and corporate leadership teams and these staff may be well placed to train and mentor others in simple coaching approaches e.g. applying the GROW model to the six areas of resilience.

Classic GROW Coaching Model questions might include:

• Goal – What problems are you trying to resolve? What would make a difference?
• Reality – What’s happening now? How does this make you feel?
• Options – What does your ideal outcome look like? Who else could help with an alternative perspective?
• Wrap-up – What do you think the next step is? What support might you need?

Consider how coaching expertise might help to:

• Support your design and implementation approach
• Pilot the first conversations
• Mentor other staff to cascade the approach
• Develop health and wellbeing coaching expertise through existing leadership programmes

If your own organisation has limited coaching capability, explore what might be available through local partners in your system – health, local government, academic, commercial and third sector. This might include exploring whether you can establish a buddying arrangement with an organisation where this is a strength. The current goodwill towards the NHS has prompted pro bono offers of help for initiatives to support staff welfare and wellbeing and you may be able to secure some support without needing funding.

4. Be pragmatic about finding the time to hold the conversations. We know finding an hour for two staff to participate in the discussion can be challenging and that may be particularly the case in winter 2020/21. Existing appraisal slots can be used to hold the wellbeing conversation if there is a good, trusting relationship between appraiser and appraisee where open discussion of wellbeing challenges can occur without the fear they may have negative consequences e.g. used to deny progression or prompt disciplinary action.  Where relationships are more fragile, other existing 1:1 meetings could be used e.g. clinical or educational supervision slots