Wellbeing and looking out for one another

The wellbeing of our members and wider colleagues is an important issue for the BOA at this difficult time. In December we held a webinar, and this can be watched again here. The participants in the webinar have now kindly provided either a short slideset or write-up, to provide some useful nuggets of ideas for others to use.

• Musings of a ‘Wellbeing Newbie’ by Tony Clayson
• Supporting Doctors by Joanna Maggs
• Post Burnout by Ben Caesar
• SAK (Showing Acts of Kindness) and POW (Pearls of Wisdom) by Raju Ramesh

Musings of a ‘Wellbeing Newbie’ 

by Tony Clayson
Orthopaedic Surgeon and Consultant Lead for Staff Wellbeing, Wrightington Specialist Orthopaedic Hospital
Corresponding author e-mail: [email protected]

MSK services and all staff groups involved in delivering MSK care, along with other health care colleagues, are currently struggling with their mental health wellbeing and as a professional group, traditionally, we have not been great at talking about such matters.

As a professional group MSK staff were and are currently again being redeployed widely in response to the pandemic, they have had their normal services disrupted and are struggling to reactivate quality MSK care across primary, intermediate and secondary care with rapidly escalating waiting times, distressed patients and greatly reduced operating capacity and now the ‘new variant/second surge’.

As a result I believe it is essential for us to establish pastoral care services to support all MSK staff groups who, evidence from other countries suggests, are at high risk of suffering from 'Moral Injury'. If this is not recognised and measures are not taken to support colleagues, moral injury can progress to severe mental health issues which will not only affect an individual’s personal wellbeing on a long term basis but will prevent us re-establishing quality MSK services for our population.

While not traditionally regarded as a strong point in the skill set of an orthopaedic surgeon, it has been my own experience that with appropriate guidance from psychology colleagues and a commitment to learn, all orthopaedic surgeons can have a pivotal role in establishing effective systems of pastoral care and in particular some of our 'Senior' colleagues (or older like me!) can have an influential role, learn new psychological wellbeing skills and can engage with our Senior Trust Executive colleagues to encourage them to invest resources in the essential psychological wellbeing staff to support such pastoral care. 

For those wishing to learn a bit more, why not look at the attached presentation and/or contact me at [email protected] for further advice on how to support your colleagues and yourself.

Tony Clayson Wellbeing Presentation

Supporting Doctors’ Wellbeing through COVID-19

By Joanna Maggs, Trauma Fellow, Southmead Hospital
Corresponding author e-mail: [email protected]

As the first wave of COVID-19 approached and we braced for impact, I was asked to support the welfare of orthopaedic doctors and surgeons due to be subsumed into new mega-team armies. Having no background in psychology and no similar previous experience, I started by seeking to understand the challenges we were likely to face. I read as much literature as I could, including papers about working in extreme environments and war zones, and I spoke to some psychologists.

The basic understanding I came away with was this:

• People who work through extremely challenging situations can experience so called 'moral growth' or 'moral injury'. Moral growth occurs when people are well-supported to perform their role, and emerge from a challenge with new skills, confidence, and the feeling that they did a good job, despite the constraints or hardship they faced.
• The oppsite, moral injury, occurs when people are under resourced and unsupported. Three key psychological needs are important in ensuring moral growth (Teoh and Kinman):
  • Autonomy (a sense of control and that our suggestions and ideas can influence or contribute to decision making),
  • Belonging (feeling part of a team) and
  • Competence (feeling prepared).

Along with my colleague Alistair Jones, I set up a programme aimed at supporting and strengthening these.

Our project had three main aspects: Buddy groups, Audio diaries and Zoom pubs.

Buddy groups: Each doctor was assigned to a buddy group with two or three colleagues. We asked everyone to check in with each other person in their group at least once a week and highlight concerns and advocate for their colleagues.

Audio diaries: We asked everyone to take five minutes out of their week, to consider how they were feeling, and to record a reflective audio diary on their phone. We asked them to think about what had been particularly challenging that week, how they had coped, what they were doing to look after themselves and whether they needed any further support.

Zoom pubs: Every Friday we ran a zoom pub. As well as having a big social element, at the pub we would discuss issues from the week (including those highlighted by the reflective audio diaries) and practical issues such as rota clashes and concern re parental leave. These would then be immediately addressed or escalated.

Two other helpful initiatives developed during the course of the project: 

Positive WhatsApp Group: The group we initially set up for admin purposes soon became a repository of messages of support from the community, encouraging memes, amusing gifs and alerts about delivery of meals from local companies. Lots of uplifting messages dropping into pockets regularly throughout the day.

COVID-19 teaching: The doctors who found themselves self-isolating in the early weeks decide to use their time to review the literature relating to covid and understand it better. They presented their detailed work in a fantastic virtual teaching session at lunchtime. After that other self-isolating doctors followed suit, supporting their colleagues on the clinical front line with information and updates, and strengthening team bonds.

The feedback regarding this project was good. My feeling was that the strong team spirit forged underpinned peoples’ enthusiasm to contribute, and it was this buy-in from team members that made it successful.

I am, by no stretch of the imagination, an expert on this subject, but very happy to discuss with others keen to set up something similar. 

I found the following resources useful:

• Teoh and Kinman. Looking after doctors' mental wellbeing during the covid pandemic. BMJ. 26/03/2020 (https://blogs.bmj.com/bmj/2020/03/26/looking-after-doctors-mental-wellbeing-during-the-covid-19-pandemic/
• Greenberg et al. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 26/03/2020 (https://www.bmj.com/content/bmj/368/bmj.m1211.full.pdf)
• Farquhar and Unadkat. Doctors' wellbeing: self care during the covic-19 pandemic. BMJ. 16/03/2020 (https://blogs.bmj.com/bmj/2020/03/16/self-care-during-the-covid-19-pandemic/)
• Kinman and Teoh. What Could Make a Difference to the Mental Health of UK Doctors? A Review of the Research Evidence. Society of Occupational Medicine. Sept 2018
• Brooks S, Amlot R, Rubin GJ, Greenberg N. Psychological Resilience and Post-Traumatic Growth in Disaster-Exposed Organisations: Overview of the Literature. BMJ Military 2020; 166:52-56
• Lai J et al. Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 JAMA Network Open2020:3(3):e203976
• World Health Organisation Document: Mental Health and Psychosocial Considerations During the COVID-19 Outbreak 18 March 2020 (WHO/2019-nCoV/MentalHealth/2020.1)
• Williamson I, Leeming D, Lyttle S, Johnson S. Evaluating the audio-diary method in qualitative research. 2015. Qualitative Research Journal 

Post Burnout

By Ben Caesar
Consultant T&O Surgeon, Brighton

As the NHS faces another significant challenge in the ongoing pandemic, it is essential to remember that healthcare workers were facing a pandemic of burnout even before the COVID-19 virus struck. The stresses this has placed upon workers across the NHS has compounded the problem and brought it to the fore.

The drivers of burnout were described by Christina Maslach in her paper 'Job Burnout' (Maslach et al. 2001). The six drivers are excessive workload, lack of control, lack of reward, loss of community, lack of fairness and a mismatch in values. Therefore, when we discuss ways of managing burnout, we must not simply focus on workload alone. It is quite possible for people to tolerate a high workload, if they feel they have appropriate autonomy to get the job done and that they are appropriately rewarded for this work, which may not necessarily be financial. However, if the work is demanding and there is a perceived lack of fairness or a mismatch between the work and one’s moral or ethical values then this can drive burnout.

Medical education and career structure has within it a hidden curriculum that contributes to these drivers of burnout. It has been described by Dr Dike Drummond, a physician burnout expert, as the four horsemen of the burnout apocalypse. It manifests as the perfectionist, the workaholic, the lone ranger and the superhero. These compel us to overworking, isolation, and a belief in our own invincibility, when in fact what we should be looking to do for our own and our patients wellbeing, is working collaboratively and with compassion for each other.

There is a simple framework to help organisations mitigate the risk of burnout. Reduce the demands on your employees, increase the amount of control they have over the way they deliver their results, and support them through both formal and informal mechanisms. The training of all staff to recognise colleagues who are struggling with burnout and other emotional or mental health issues, and to give them the vocabulary and tools to support their peers is part of this strategy. It is essential to destigmatise these issues and allow open and caring dialogue in the workplace. This also provides the supporter an opportunity to act as a giver, within a set of boundaries. This has been demonstrated to decrease burnout, as described in Adam Grant’s book “Give and Take” and is called “otherish” giving.

I hope that as healthcare professionals, we can utilise this terrible pandemic to initiate real changes and post-traumatic growth in the way we learn, teach and practice medicine. I hope for a working environment where “otherish” behaviour thrives, small daily wins are possible, organisations put their people first which will improve that patient experience and outcomes, and that the courage to be vulnerable is encouraged and a just culture exists.

Reference

Maslach, C., Schaufeli, W. B., and Leiter, M. P. (2001), 'Job burnout', Annu Rev Psychol, 52.

SAK (Showing Acts of Kindness) and POW (Pearls of Wisdom) 

by Raju Ramesh
Department of Trauma and Orthopaedics, Torbay Hospital

Corresponding author email: [email protected]

 

In this busy world we live now, we seem to have very little time for our colleagues. Each one of us lives in a bubble almost insulated from others. We fail to recognise a silent epidemic that has spread far and wide right under our nose. Many of us do not seem to recognise this pandemic or if they do, they do not acknowledge it and continue to work through this. I am talking about stress in the work place and its consequence on mental and physical wellbeing. There are a number of opportunities which we could use to break this shell and help others.

In the continuum of stress leading on to burnout or even death, we need a number of tools to address each 'stage' of the problem. Showing Acts of Kindness (SAK) is a very simple easy to do shift in attitude which will break this insulation. SAK is a collection of ideas and an attitude change within our work place which enables team comradery. It will allow the team ethos to bloom and grow, and low-level chatter is addressed regularly.

SAK is universally applicable at all stages and in fact will be an excellent tool to start broaching the subject in an unobtrusive fashion, especially because many of those who suffer with stress are too proud to ask for help. SAK aims to address low levels of unrecognised stress, unhappiness and dissatisfaction in the work place. It is an easy to do act by everyone and benefits both the giver and the receiver.

The SAK campaign started four years ago, well before COVID-19 hit us. As this was successful before, the campaign was continued during COVID-19 with some adaptations. What did SAK in the orthopaedic department consist of? The core message from SAK is to be kind to one another, and the components we used to build the SAK were;

1. Phone numbers of each team member and supervising consultants were exchanged, and juniors were asked to call the seniors directly when needed.
2. Each new junior doctor was buddied with another member of the team as a support person on the floor.
3. An orthopaedic WhatsApp group was created and all members were included. It was used as a medium of communication – alerting about pending work in wards and initiating coffee breaks etc.
4. Rota management was promptly addressed with a responsive Practice Manager.
5. Daily 10min teaching (called Pearls of Wisdom – POW teaching) following TED style talks were delivered by all members of the team. In COVID-19 times we achieved this by uploading the teaching video to our own YouTube channel (POWs of Torbay).
6. A mandatory mid-morning FIKA style coffee break with every team member took place. This break served as an excellent opportunity to probe and interact with all, and usually allowed people to open up and talk about things other than work.
7. Every evening it was mandatory for the seniors to meet the juniors on the ward and make sure that they hand over the problems to the on-call team and not take that burden home.
8. A regular supply of snacks and drinks were provided during the on-call times, especially during weekends.
9. Any good actions, well executed management plans or operations were openly complimented to improve the morale.
10. A clear description of the support structure available in the department and in the hospital was provided at the start of the job. 

Other departments may adopt some or all of these ideas, or bring in their own bespoke actions in their daily practice. SAK does not have to be limited to doctors alone, it can be applied to every team in the workplace and outside.

For us, SAK has worked as a brand identity and even after four years a lot of good practices are still carried out. It has made our department a well liked and enjoyable place to work as a junior which is also evident from the GMC junior doctors survey.