Supporting health workers’ psychological health during the pandemic

Bev Fitzsimons profile picture

17 September 2020

Bev Fitzsimons
Director
Point of Care Foundation


On 17 September 2020, the World Health Organisation, international partners and all countries will commemorate World Patient Safety Day. The objective of this year's event is to raise global awareness about the importance of addressing health worker safety. This may seem paradoxical, but experience shows that the wellbeing of health workers is a prerequisite to patient safety.

We have spent many years working with healthcare organisations, and have come to understand the strong level of interconnectedness between healthcare workers' wellbeing and patients' experience.

Bev Fitzsimons, Director, Point of Care Foundation    

At the Point of Care Foundation, we have spent many years working with healthcare organisations, and have come to understand the strong level of interconnectedness between healthcare workers' wellbeing and patients' experience, including patient safety. We know that staff experience is the antecedent of patients' experience: so by logical conclusion, focusing on staff wellbeing alongside patients' experience is the obvious way to maximise the probability of a positive, safe experience for patients.


Invisible harms

When we talk about health worker safety, what do we mean? The most obvious things that come to mind are physical harms: the risk of a trip or fall; the risk of a damaged back from the heavy physical work in healthcare; a needlestick injury; or even a physical assault in the workplace.

But there are many other harms that are not physical, and may not be visible, but which can be even more insidious in their effects.

Bev Fitzsimons, Director, Point of Care Foundation    

But there are many other harms that are not physical, and may not be visible, but which can be even more insidious in their effects. Healthcare by its nature can pose very real psychological challenges. It deals every day with death, distress and decay. The work is high-paced and high-pressure, with very serious implications if things go wrong. Working in healthcare causes people to reflect on their own mortality and that of their loved ones. The healthcare we provide is almost industrial in scale, yet the NHS is frequently understaffed. Worker burnout is common and increases risks including irritability and impatience with co-workers and patients. It is sapping of energy and affects concentration. It can have knock-on effects on individuals' use of sub-stances and their sleep patterns. Who could argue that these are not issues that are relevant to patient safety?

These issues are not new but have certainly been brought into sharp relief by the COVID-19 pandemic. We have written previously about our work to introduce and support the running of Schwartz Rounds across the UK and Ireland. Rounds are a forum for healthcare staff to come together and reflect on the emotional and psychological aspects of their work, which has direct, positive benefits for staff morale and wellbeing. Independent evaluation shows the strong impact of participation in Schwartz Rounds for individuals, with regular attendees reporting half the incidence of psychological distress of their non-attending colleagues. Beyond this, the 'ripple effects' of Rounds have been to increase levels of understanding between groups of staff and empathy for patients.

The unique challenges of working through COVID-19 have made Schwartz Rounds more important than ever.

Bev Fitzsimons, Director, Point of Care Foundation    

The unique challenges of working through COVID-19 have made Schwartz Rounds more important than ever - ironically, just at the moment when gathering together in groups was precluded because of the risk of spreading the disease. Nevertheless, we at the Point of Care Foundation were keen to respond as quickly as we could to the demand we were hearing from our community of Schwartz facilitators and participants. Thanks to development funding from the Health Foundation, we were able to rapidly develop an online forum called Team Time, which follows the principles of Schwartz Rounds, but adapted for a COVID-19 environment.


Ensuring psychological safety

Whilst wanting to preserve the benefits of Rounds for staff, we were careful to do everything we could to ensure that there were no new risks to worker safety that were created by using an online virtual forum. We focused on teams, rather than whole organisations, to increase the likelihood of there being a pre-existing level of safety within the group, and because it is easier for there to be mutual support and the recognition of distress among colleagues. We included additional training material for Team Time facilitators about grounding techniques as a way of managing distress. And we put in place greater safeguards for those sharing their stories within Team Time sessions, to ensure they are ready to tell their stories, and they are not sharing raw, unprocessed emotion that might cause them even greater distress.

It has been the greatest privilege to listen to the stories of healthcare workers during COVID. As well as the difficult and distressing stories it is important for us to remember the inspiring and uplifting stories of care and compassion both for colleagues and for patients. I get goosebumps just recalling them now.

As we hopefully begin to recover from COVID, I know many of us are thinking about what has changed, what to discard and what to keep. I for one want to keep in my mind the power in the simple sharing of experiences and stories, and the hugely beneficial impact of not feeling alone with sometimes distressing feelings. It isn't just during COVID that staff safety matters to patient safety, but always.

About the author

Bev Fitzsimons profile picture

Bev Fitzsimons
Director

Bev is the director of the Foundation, as well as being responsible for the development, design and oversight of patient-centred quality improvement initiatives.

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