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The do’s and dont’s of providing support to frontline staff

Prof Neil Greenberg: The Dos and Don’ts of supporting frontline staff.

Outline: Nothing substitutes better than having a good team. Really good supportive relationships are essential, especially the supervisor who must understand what you are going through. Resilience lies not [primarily] within individuals but between individuals. 

4 general principles

  1. Proximity – keep them close and redeploy to reduce stress not send away. Helps them feel they are useful and not feeling bad about what everyone else is thinking about them, even when they are not.
  2. Immediacy – get in and find out so you know how best to help them.
  3. Expectancy – make it clear that an end is to be expected.
  4. Simplicity – just even a short break can make a big difference. 

The above are commonsense principles which have been tried and tested in many situations. 

Zoe [00:00:00] Next, I’d like to introduce you to Professor Neil Greenberg, who’s going to talk about the dos and don’ts of supporting frontline staff. And as Sonia said in her introduction as well, this has been a real team effort. And Neil has been a wonderful partner to the NHS. So over to you, Neil. 

Neil [00:00:24] Thanks very much indeed for allowing me to speak a little bit on this really important first webinar. 

Neil [00:00:37] So the first thing to really try and emphasises is all the support mechanisms and processes that Sonia’s talked about, which are great, are no substitute for having a good team. We know that from looking at all the evidence about military personnel, about media professionals, diplomats and a whole range of other people who work in challenging places, that consistently the best way to protect your mental health is to have really good supportive relationships with the people who are closest to you at work. That may well be your colleagues. And importantly it’s your supervisor. 

Neil [00:01:16] And so what we really think needs to happen and indeed I think from my experience is happening lots anyway is for supervisors to have what we’re going to call, a psychologically savvy chat. And that basically means that they feel confident enough not just to say, how are you doing? And then when someone says I’m feeling fine, they say, that’s great, because we all know that fine doesn’t always mean you are fine. But psychologically savvy conversation is one in which you overcome that reluctance to speak about your mental health and supervisor is able to draw out information about how you really are. What are you worried about? Why were you a bit emotional? What are you thinking about doing later? Are you going to come back to work tomorrow? 

Neil [00:01:58] And we know that all scientific evidence studies that we’ve done over the years have shown that actually if you look at people who are really, really tough positions, having a supervisor who is able to really understand what you’re going through and offer reassurance and advice makes a huge, huge difference. And everything else that we might put in place probably is not as important as making sure that team works. It’s a rather cheesy way of putting it but we know that actually resilience often doesn’t lie in individuals, it lies between individuals. So make those social bonds between the teams really strong. And actually that would pay really important dividends for how people will manage to cope with adversity over time. 

Neil [00:02:44] We also need to make sure that we don’t let people who have difficulties and begin to deteriorate over time. And then by the time they ask to help them in a real crisis. So, therefore, we also need to make sure that NHS organizations are adopting a ‘nip it in the bud’ approach. So one of the important principles here is that if you see someone who’s not doing well, then you shouldn’t just think, oh, well, that’s their business, not mine. At this time in particular, given the stresses and strains that we’re under. It’s really important to have one of those psychologically savvy conversations. 

Neil [00:03:20] However, it’s also important for all of us to be aware that if you are doing really challenging work and people may be dying and the shifts may be long, and they may be quite emotional, that actually feeling some level of distress is completely normal. It’s not an indication that you are having the onset of serious mental health problems. It doesn’t mean you can’t do your job. It doesn’t mean that there’s something wrong with you. Of course, the important thing here is we want to be looking out for normal distress and listening to it. But at the same time, we want organisations to try and spot abnormal distress. And in that case, make sure we get people the right sort of help. 

Neil [00:04:04] So what is abnormal distress? Well, simply put, the two key factors about it is it’s very, very intense and impairs how you are able to get on with your life. So impairs your job, impairs your social life, it overtakes you all your life and your thoughts even when you’re trying to sleep. And the other thing about it is its persistence. So intense distress for a short period of time, quite normal.  Not such intense distress going on for a long time whilst a crisis is going on, not necessarily abnormal, but intense and persistent. Those are the indicators that really you want to be helping that person to get to professional care. 

Neil [00:04:46] Now, in the military, we’ve learned lessons over more than 100 years now. Actually, there are four general principles that make a big difference in managing staff and in very challenging situations. 

Neil [00:04:59] The first principle is the principle of proximity. And what that means is that when someone’s having a tough time, you shouldn’t just send them away or send them home. Instead, you should keep them within the team and try and redeploy them or changed their role a little bit to reduce their stress in the short term. We know that the evidence is that keeping people within the team helps them build that, that they are useful. And also he seven people away and what happens over time is they begin to wonder that everyone else is thinking badly about them, even if that’s not the case. 

Neil [00:05:31] The second principle is the principle of immediacy, which is very much going back to that, ‘nip it in the bud’ approach. If people are having difficulties make sure that you get in there and have a proper psychologically savvy conversation in order to really find out how they’re doing. And that will allow you to plan how to help them. 

Neil [00:05:49] The third principle is the principle of expectancy, so the expectation in the current world that we live in, particularly if you’re a health care member of staff is that things are going to be a bit tough for a while. And that doesn’t mean you’re ill, it doesn’t mean you’ve got the problem necessarily. And the expectation is also that things will get better. And we know from all the guidance and the information we’ve heard from the government, Public Health England, the NHS and scientists. That however difficult this crisis is, an end is to be expected. 

Neil [00:06:20] And the last principle is the principle of simplicity. This principle says that if you’re in a real crisis and you’re having a difficult time and you get emotional, often simple things like a good night’s sleep and a few decent meals, a chance to speak to a loved one particular if you’re worried about them, and maybe even just to have a shower or something as simple as that can make a very big difference. Now, those five principles have been used time and time again in military forces around the world and also applies very much to other organisations that predictably put people in harm’s way. And the good news is, from the evidence point of view there are studies that show that the more these principles put in place, the better the outcome is 20 years later. It might seem like common sense and a good idea which it is, but actually, if you put those commonsense principles into practice and actually you’re going to have a really good impact on both staff wellbeing and also on people’s ability to carry on performing their role.