Our NHS People

Resilience-based approaches to wellbeing

As human beings, we are capable of amazing things even in the face of dire adversity. Resilience is about recognising that, at times, life will present difficulty and this will sometimes come with intense negative emotions and feelings. Knowing how to manage these and not just push them away is the core of resilience. It is the ability to adapt and grow following adversity.

Health and Wellbeing Conversations are centred on promoting that ability to adapt and grow. They provide a structured approach to identifying individual vulnerabilities to stress, assessing the impact of that stress and developing strategies to boost protective factors within the individual and their team.

The first aspect of a resilience approach is understanding what makes us vulnerable to stress. Research has highlighted key factors that can increase our risk of stress and negatively impact our resilience. Staff working in the NHS may be exposed to these risks under normal circumstances, but COVID-19 has created an added level of exposure.

  • The commitment we have to our jobs – this could mean a focus on the demand of the job over and above our own needs
  • Over working
  • Unclear or conflicting expectations
  • Threat or change to job role
  • Challenging working environments, including remote working
  • Social isolation
  • Lack of personal control
  • Working in a hostile, unethical environment or one with a defensive atmosphere
  • Lack of communication
  • TV and social media where there are mixed or conflicting messages
  • Societal concerns and anxieties

Knowing what these are can help us to be attuned to our own and others’ risks. When risks are compounded, there is even more reason to be proactive about the protective steps we take.

The second component is an understanding of the impact of stress. The model below shows that a healthy amount of pressure, or stress, can bring us into the zone of peak performance. However, when our stressors and pressures increase too much, it can push us towards feelings of anxiety, unhappiness and reduce our ability to perform well.

This image shows an arc that identifies the impacts of no-low pressure on the left, moves towards healthy pressure and peak performance through the middle and onto the impacts of stress and over-pressured on the right. Words associated with each are: No-low pressure – unaware, bored, too comfortable. Healthy pressure/Peak performance – interested, motivated, creative energetic. Stress and over-pressured – tired, indecisive, fuzzy mind, exhausted, irritable, anxious, burnout. “Stress occurs when perceived pressure on an individual exceeds ability to maintain resilience.”

Most, if not all, of the risks for and effects of stress will already be known and lived experience to leaders in the NHS.

The last, critical element is nurturing the factors that help us to maintain our resilience in the workplace, particularly when times get tougher:

  • Trusting, supportive relationships – with line managers and colleagues
  • A sense of being valued and recognised for work well done
  • Supportive and visible management – where there’s also clear communication, roles and responsibilities and accurate information available
  • Workplace self-esteem or identity – supported through the encouragement of autonomy and the freedom to act and take responsible risks
  • Emotional support outside of the workplace – through family and community
  • Hope/belief that things can change
  • Perception of being able to cope is high

It is important to note that many of the interventions are organisation and team based – not just actions for the individual to take. This is rooted in strong NHS evidence. Data from successive national NHS staff surveys shows that ‘real’ teams i.e. those which have common objectives, need to work collaboratively to deliver those and reflect regularly on how they can have lower levels of error, stress and injury. Resilience comes together when our working environment and the choices we make support us to be the best version of ourselves. Health and Wellbeing Conversations provide the space to look for opportunities for enjoyment and balance, particularly when there are areas of our life and work that are extremely difficult.

Health and Wellbeing Conversations will focus on the six domains of resilience below:

(Wallbank, 2017) This image shows the six domains of resilience, as described below

  1. Vision – looking to our life goals, purpose and how we are working towards these
  2. Reasoning – our ability to problem solve, anticipate, plan and be resourceful
  3. Adaptability – our persistence, realistic optimism, flexibility and adaptation
  4. Responses – how we regulate our emotions and our feelings of competence and control
  5. Health – physical, financial and basic needs
  6. Relationships – with our support networks at work and socially