In conversation with…

Helen [00:00:00] Thank you, Zoe. And I’d just like to welcome everybody to this session. There are so many of us taking part and there are over 500 of us on the WebEx. Another big gang of people on YouTube as well. And really, I would like to welcome everybody. And when we were designing this session now, we wanted it to feel like a conversation. So we’ve got Neil and Sonya who have rejoined us. And I’d like to welcome Professor Michael West. I’m getting quite a lot of background noise so what I’m going to suggest is our conversation panel, can you actually mute yourself unless your speaking. That’s great. So I’m going to start with Michael, just to say I’ve got a few questions to start with. As Zoe said we said we’d like you to put your questions in the chatbox. And this is where I’m going to rely on our three chatbox monitors. So, Karen, Louise and Rosanna, in that order, I would like you to pick out some that some questions to ask our panel. 

Helen [00:01:16] So, I’m going to start with Michael. Michael, it’s fantastic to have you as part of this work. I think that your perspective on compassionate leadership is very valuable. And I think we’ll make such an impact over the next period. Michael, what I want to ask you is that every time you know, I’m in a conversation with you and, you know, you remind us around slowing down and having time to reflect, you know, even in situations of crisis. But what I’d like to ask you to do first, Michael is to say some things that get him to the spirit of this conversation. So, you know, how do we need to be now? 

Michael [00:02:06] I think compassion, Helen, is the core value for us. So people are incredibly busy, they’re incredibly concerned, incredibly frightened. Compassion is the most important intervention we know of in health care. Compassion is how we humans connect with each other. And connection is more important now than anything. It’s the most important we have after our basic biological needs. So connection now is hugely important. Feeling that we belong feeling we’re cared for. Especially in a time of great fear, great uncertainty is absolutely fundamental. So now, more than ever, we need to be compassionate and that means four things. 

Michael [00:02:53] We need to learn to be present with each other, to listen to each other with fascination. With all of this going on around us just practising being present and deeply listening to each other. Second is we have to understand each other’s challenges, the difficulties, the fear, the concerns. Not by imposing an understanding, but by deeply being present with each other. We have to third emphasize, we have to care for each other, we have to understand each other’s feelings at this difficult time. We have to have the intention to help each other. I’m just practising those four behaviours not only helps the other, but it helps us. We know this, that it helps people themselves to cope with these difficulties. 

Helen [00:03:38] Thank you, and I think that’s and that’s carry on in a practising role modelling that way of thinking in that way of leading. 

Helen [00:03:48] I’ve got a question for Sonya and then one for Neil. After that, I’m going to then hand over to our and our chatbox monitors to pick up the questions from all participants. So my question for Sonya is… I think your life has changed profoundly in the last three weeks in terms of the work that you’ve been doing. Given what Michael is just saying around being present and connecting, tell us how it felt to be part of this work for the last few weeks.

Sonya [00:04:25] I think it’s an immense privilege to have been invited to lead on the work, so there’s that sort of responsibility. I think the pace of delivery, the number of people who want to be updated and involved and has meant that times it’s chaotic. It’s hard work. It’s meaningful work. But it is hard. And I recognise the piece about I’ve been saying to a lot of my colleagues in NHS England and improvement that because we see our colleagues on the frontline, who are absolutely delivering all day can, it can lead to us overworking because we want to make a difference too, we want to be right there alongside you guys. So, I think that level of being able to switch off, especially because we’re all at home. So it’s much easier to kind of be going beyond what is a normal working day anymore. And I think one of the values for me that Michael absolutely helps us with is to, is just to stop, and recognise and think and connect. And I’m really privileged that I reside in a team who reach out to me. I don’t think I’m very good at doing stuff myself right now, so they’re constantly in touch and talking to me about how I am and what do I need, which I really value. 

[00:05:50] Right. Thank you, Sonya. My question to Neil… You talked about resilience as being a team sport. So I’d like to say a little bit more around how can we be resilient as teams and what do teams need to do? 

Neil [00:06:13] So in an ideal situation, you want a team to kind of know each other and to feel that they’ve got each other’s back even before the crisis hits. Of course, the challenge is that might have been your intention but then the crisis is here and then it seems to be a bit late. So actually the key elements of resilience within teams are feeling that you are able to go and speak to another staff member, somebody who you know. Someone you’re able to share stuff with them. And importantly, actually, it’s a reciprocal thing that they come to you and you come to them. And another important aspect is about sharing of information. So at times, we get bits of information that are really critical to either to do your job properly or might be related to your own personal safety. Actually, we need to share those really proactively with each other in order to feel part of that team and protected. An important aspect from a supervisor’s position is about the desire sometimes the supervisors to say, yes, my team can do that. We can do that. We can keep going even when actually it probably isn’t the best thing for the team. So the supervisors need to do that difficult balance of saying, yes, we can deliver, but at the same time making sure they don’t overdeliver as which doesn’t protect their teams health and their own psychological resilience. And I guess the other last key element to that is about looking out for each other. So the advantages of working in a team where, you know, people, as you begin to change, you become more shouty or you become more introverted or you appear to be less on the ball and doing your job than normal, that actually people of you can spot that. And that goes back to that psychologically savvy conversation. I’m not expecting that. How are you doing? I’m fine being the truth. 

Helen [00:07:58] I’m going to break my own rules because of one other thing I wanted to ask you and I’ll ask you one of my questions. So, it’s really interesting Neil that you’re saying, one of the jobs of supervisors is around getting the balance between, offering to do things but don’t over-deliver. 

Helen [00:08:20] How does that tie in with what you said, Michael? Because, you know, one of the things that I hear from you a lot is about how people have a need for autonomy. So how do balance at this really difficult time that need for autonomy and make their own choices around what they are doing and supervisors protecting people. 

Michael [00:09:03] So the team is enormously important, as Neil said, in terms of being a source of resilience. And I think one of the most important things that teams need to do during this time is making sure that they’re taking time on a regular basis to have time together. Whether it’s 10 minutes, the beginning of a shift, fifteen minutes at the end of the shift or once a week coming together to review. It’s absolutely critical not only to their well-being but also to their productivity and effectiveness. And that’s an opportunity also for all voices in the team to be heard to reflect on how they’re functioning. In the context of a crisis Helen, in relation to your question, we know that from much previous research said in a crisis like this, there is a tendency for leaders to react by adopting a sort of threat, rigidity style. And we do need clear structures and processes. But at this time, more than ever, it’s vital that people within teams and within our organizations feel that their voices are being heard, that they’re able to have influence in this situation because, in a high demand situation, we need to give people a clear sense and clear control. They need to have a sense of autonomy and control because high demand and low control is the toxic cocktail of stress. So we also need to recognise that we have the most motivated, skilled workforce anywhere in almost anywhere in industry. And at a time like this, when there are so many uncertainties, we need to be hearing their voices to give us the guidance in this critical situation. 

Helen [00:10:46] And thank you so much, Michael, and I knew I should let you speak as well before I just get a question from Karen. Anything to add to that? 

Neil [00:10:59] No, I would just add that is what Michael said. I think the important thing is, although we would like teams to be able to get out and go to the pub together or to the park and play sport that’s not where we are now. Ten minutes beforehand, ten minutes afterwards. And actually just someone saying, how are you? But meaning it. I think can make an awful lot of difference this time. 

Helen [00:11:20] Fantastic. Thank you so much. And so, Karen. Would you like to ask a question and tell us to ask the question? And Sonya, I’ll get you. I’ll get you to go first. 

Karen [00:11:32] Thanks, Helen. Yes. And there’s been lots of that. Lots of good sharing of practice and lots of questions in the textbook. And thanks to everyone. We’ve had quite a few questions, say, from Vinny and (xxxx) about will their resources be available more widely than health care staff? So they will be available for social care staff? How about family members? From Fatima from Community Pharmacist.

Helen [00:11:54] That’s a very good question for Sonia. So, Sonia, tell us about how the resources aspects of the offer are going to be made available more widely than just for people in the NHS. 

Sonya [00:12:11] Sure. So we’ve got to get the access up from a standing start. So I’m sure you’ll appreciate it. We’ve been doing this over the last three weeks. We started off today releasing them for all NHS staff in England. That includes community pharmacists. We’re absolutely clear about today. We’re having conversations with our colleagues that are set in Ireland, Wales and Scotland. So we know that there is stuff coming down the line. Just wait for that. And we’ve got discussions in the next seven to ten days. What we’re hoping is that some Department of Health and Social Care are also working with us to put resources into that. So the whole offer is accessible to our social care colleagues as well. And the chat service, the 24/7 chat service is absolutely available today for social care colleagues. And it is just a case, though. We want to make sure that we’ve got enough volunteers in place, that those volunteers have been through the training so that when social care colleagues call, they are getting the best service as well. 

Helen [00:13:21] Thank you. Thank you very much. And so the next person to ask the question is Louise. Louise, can you take a question from our panel? 

Louise [00:13:30] Thank you. Yes. There’s lots of great conversations going on in the chatbox in reply to some questions, also something up and so thank you, everybody for engaging in that. And in particular, there’s a question that came from Abigail… giving that variable levels of PPE and testing are having big impact on psychological well-being currently. Are there any thoughts on how we can best support them in that situation? 

Helen [00:14:03] OK. Neil, Neil, would you like to start with that? Did you did you hear the question? 

Neil [00:14:12] So clearly, if you’re looking around a sort of Maslow’s hierarchy of needs in the current (xxxx) the best way to psychologically protect staff is to give them the right equipment and to give them the right number of staff to job. That’s obviously ideal. I guess no one asked for COVID-19 and it’s hard to prepare for every single eventuality that might happen. And whilst I you know, I’m not a government spokesman by any means, it strikes me by listening and by working around different hospitals, that there’s an awful lot of effort going on to get the right things to the right places as quickly as possible. And so in many senses, whilst it’s easy to feel that they let me down, this isn’t happening. I think this situation is one where actually things are not going to be perfect. And as long as people work as hard as they can to make that right, hopefully psychologically we know that people looking out for us. Underneath that once you’ve got the right equipment, the next best psychological thing that we need is a decent roster and decent sleep. And again, the situation at the moment says it’s a bit of a crisis and we have to keep going and get that balance right. We can’t give people every single amount of time they want to offer and just say, don’t come to work if you think that it might be a little more challenging. You know, we need all hands to the pump. So I think whilst the crisis is ongoing and yes, those points about sleep, rest, rotas and equipment are really important, but actually behind that, knowing that actually people are doing the best that they can for you. I think is psychologically protected and hopefully, staff in this incredibly difficult situation will appreciate that. 

Helen [00:15:54] Yeah. Michael, would you like to add anything to that? 

Michael [00:15:58] I think it’s really important as well that leaders are honest with those they need in this situation. People are afraid about BPE. And I think as long as they understand that everybody is working in the background, but also that they’re being dealt with honestly and openly. That builds trust.

Helen [00:16:20] And Sonya, any reflections? 

Sonya [00:16:23] The level of fear. You know, the level of fear that is out there right now and from people who are both working with patients, in COVID wards and surrounding wards. I absolutely agree the best thing we can do is to get the equipment to people as and when they need it, but also have open and honest, transparent conversations about what we can do, how can we protect ourselves, how people feel, and that the risks that they’re taking are warranted risks. And that that’s ok.

Helen [00:17:01] Thank you. Let’s take a question now via Rossana. Have you picked a question for our panel?

Rosanna [00:17:09] Yes. Let’s pick a question from Byron. Byron asks about whether the panel can recommend any wellbeing measures that we can be using with frontline staff.

Neil [00:17:29] So actually, one of the interesting aspects is to me as an academic is clearly we’re in the middle of a pandemic of COVID-19. We’re also beginning to get towards an exponential growth in the number of surveys that are coming out to try and find out what’s going on. Now, good science is absolutely essential. But I think it’s really important to think about trying to get coherence with good quality studies going, and not to floods staff who are otherwise busy delivering frontline care with too many surveys. So with that in mind, a limited number of good-quality studies I think is really important. I think if you’re going to look at the impact of this, you need to look at a few domains. One is about sleep and shift patterns. Another one’s about mental health. So measures like that GHQ Twelve are quite useful. There’s no perfect measure. We can spend a long time arguing one is better than that one, and that one is not good. But the GHQ 12 is good because many other national studies have used that so it allows comparisons. Another good useful one as well as the Warwick Edinburgh Mental Wellbeing scale. Again, that’s good because it looks more than just mental health. And then the last thing I would suggest in terms of scales if you’re going to do a study, is to look at something that looks more injury. There’s quite a few moral injury scales out there. EMIS is a good scale. Because I think the challenges that staff face at moment as well as being slightly mental health and traumatic, also very much down to the moral decision making that we’re having to undergo at the moment. So hopefully that’s useful. 

Helen [00:19:09] Yeah. Thank you. Thank you, Neil. Michael, would you add to that? You know, what metrics should we be using? 

Michael [00:19:16] Yeah, just to add in, the other one to consider is the short form of the health and safety executive measures of stress, which is widely used across organizations in the UK. 

Helen [00:19:27] And Sonya, I know you’ve been thinking about measurement. 

Sonya [00:19:31] Oh, yeah, I just think god don’t. Don’t put in any measures in at the moment. One of the things we’re getting is overwhelmed by amazing offers of help and support from industry. And we’ve got a whole team working through some of the app based measures or simple indications of well-being. I’ll just take you back to what Neil said. You know, they’re active watching and monitoring of our staff… “who needs what”, is the best type of measurement you can do right now. And then beyond our active phase where we’re looking at recovery. Let’s think more intelligently about how we might measure who needs help, but in what form.

Helen [00:20:12] So we’ve just got a couple of minutes left. And, um, and we did advertise this as being in conversation. So the last thing I would ask you to do… having heard what each other said, is there a point that you’d like to build on, something that appeals to you or that you felt a connection with. Let’s start with Neil.

Neil [00:20:47] Thank you. I think one of the things i’d like to build on from Sonya’s great description of this outline offer that’s available. Just to recognise that actually things need to be built over time and that at the moment, quite rightly, everyone is thinking about how do we prepare people? How do we sustain in the active phase? And the planning, I think, for going ahead to the recover phase is really important, because we’re not going to get back to a new normal. I don’t think any of us know what the next normal will look like. But we actually now can put in place, I think a lot of things which will make getting back to the new normal better and easier. And I think we shouldn’t just be aiming for the for not being ill. I mean, Sony put it in her slides. I think we should be able to growth, and actually if we can come out this stronger and more resilient that’ll be a good thing. So my point would be I think the work we’ve done so far is very important. But we keep in mind what’s it going to look like six months afterwards, which I appreciate we’re all very busy and there isn’t necessarily time, but that’s something worth giving some consideration to. 

Helen [00:21:56] Thank you Neil, and Sonya. 

Sonya [00:21:58] Yeah, I’ve been reflecting actually on how this situation can evoke a sense of helplessness in us. As leaders of the workforce, we instantly want to jump in and help. What we absolutely know is that psychological intervention is contraindicated. It can be more harmful than good and that actually 70 percent, I think we were talking about Neil, of people will be absolutely OK given the right level of support. So let’s not feel we need to rush in, let’s make sure we put our arms around people and make sure that they’re supported in their usual teams and they will be okay. And let’s make sure that we’ve got those offers ready and waiting for people who need that further support. 

Helen [00:22:46] And Michael, you get the last word in this conversation. 

Michael [00:22:52] Well, that’s a real privilege, Helen. Thank you. I think it’s really important in this most difficult time we’ve all faced is that compassion is at the core and compassion is about our connection with each other and that sense of belonging. It seems it’s important that it’s in all of us, it’s not just advocating for those out there on the front line. All of us try to spend quality time with the people we love and who love us. In our work, in our teams, that we are kind to each other, we support each other. We do the little things that make a difference, like giving someone a cup of tea. It’s important that we connect with ourselves as well through just having quiet time practising mindfulness meditation if we can, spending a little time just looking at nature around us whenever possible and connecting with all our wider environment. Self-compassion in all of this is key because it creates that that sense of safety, that sense of stillness, that safe refuge which will help us collectively come through this together, to be a better society and a better healthcare service for it.

Helen [00:24:04] You know, I think that’s a beautiful place to end. And I was going to summarise, but I’m not because I just think, you know, just in terms of what all three of you have and said that I think is so profound and so right. And I certainly look forward to working with all of you over the next period. Thank you so much for that conversation. 

Summary points

Helen asks Prof Michael West – Where do we start, how do we need to be now? 

Michael emphasises the need for Compassion as a most important intervention and has to be at the core of what we do. Connection is our most important need – to belong and feel we are cared for. Micheal identifies four key behaviours: 

  • Be present with each other and listen deeply; 
  • understand each other’s challenges and concerns -don’t impose; 
  • Empathise – care for each other; 
  • Intention – to help each other. 

Helen asks Sonya: How has this changed your work and how does it feel?

It’s a privilege: Meaningful work but hard. Remember to Stop, Think and Connect – accept others reaching out to you and reside in your team.

Helen asks Neil and Michael: How can we be resilient as teams, and what do teams need to do? 

Neil: In an ideal team they know each other already so they have each other’s back before the crisis hits. Key elements are knowing you are able to speak to another staff member; being able to share and its reciprocal. Being able to share critical information or something about your personal safety pro-actively; Supervisor’s position must balance and not over-deliver on the psychological resilience of the team. Finally, looking out for each other: Being able to spot problems for each other. 

Michael: The team is an enormous source of resilience – making sure time-out together either at the beginnings or ends of shifts happens. It’s critical for wellbeing but also team effectiveness. Each member can have the opportunity to reflect and contribute. In the crisis context the leaders can be drawn into “threat rigidity” but while a clear sense of autonomy and control is essential, high-demand and low-control is the “toxic cocktail for stress”. Recognise we have the most motivated and skilled workforce so we need to hear their voices to give us the guidance in this critical situation.

General Q&A based on questions from the audience:

Will resources be widely available? 
Yes, for all NHS staff in England. H&SC to be added. Chat available to all already. 

Psychological support for those with a lack of PPE? 
A good (fair) rosta and sleep; knowing people are doing their best to get it to the frontline. Being honest and transparent.

Recommended measures we should/could we be using? 
Coherent studies but not too many surveys; good quality studies use reliable and comparable standards. The following were mentioned:

  • GHQ12 
  • Warwick-edinburgh mental wellbeing scale.
  • Moral injury scales e.g. EMIS. 
  • Short form of the health and safety executive measure of stress

Other Measures? 
Don’t feel you have to! Engage in active watching: noticing “who needs what?” is probably the most effective activity right now. 

Summary – building on what each other’s contributions

  • Recognise things need to be built over time. We can put in place things that will help getting back to the new normal easier. Aim for growth – to come out stronger and more resilient afterwards.
  • Don’t rush in – make sure our mutual team support is in place and working well.
  • Being compassionate – spend quality time to be kind to each other; a little mindfulness to look after a safe refuge.