August 2018 - Dr Ahmed Saeed Yahya, higher trainee in psychiatry working in a NHS Trust in East London

This month’s guest blog is a follow-up piece to an article brought to us by Dr Ahmed Saeed Yahya, a Higher Trainee in Psychiatry working in a NHS Trust in East London.

Dear Colleagues,

Many thanks for allowing us to publish on your guest blog. We enclose our final article in a series of three which explore staff burnout and wellbeing in psychiatric services. In this blog we amalgamate previous research and conclude our work in this area. We discuss the importance of a ‘happy workforce’ and how changes can be implemented across the board to accentuate this. We hope you have enjoyed our series of articles in your College division and welcome any feedback.

Dr Ahmed Saeed Yahya, Specialist Registrar in General Psychiatry (North East London)

Addressing Staff Morale and Wellbeing in Psychiatric Services

Dr Ahmed Saeed Yahya (Speciality Trainee in Psychiatry), Dr Nisha Shah (Consultant Perinatal Psychiatrist), Dr Claudius-Adeniyi Olusegun (Acting Consultant Perinatal Psychiatrist), and Dr Jude Chukwuma (Consultant Psychiatrist).

About the authors

Dr Ahmed Saeed Yahya is a Specialist Registrar in Psychiatry who is currently based at East London NHS Foundation Trust. Dr Nisha Shah is a Consultant Perinatal Psychiatrist with the North East London NHS Foundation Trust. Dr Olusegun is an Acting Consultant Perinatal Psychiatrist also with North East London Foundation Trust. Dr Jude Chukwuma is a Consultant Psychiatrist with the Cygnet Hospital Group.

Introduction

Declining staff morale is an ongoing concern amongst senior managers and clinicians who are striving to make improvements to patient care. There is a causal link between staff engagement and the level of care provided to patients. Forty seven percent of NHS Finance directors at the King’s Fund ranked staff morale as one of their top three concerns¹. With mounting pressures the NHS remains reliant on the dedication of staff to provide a continued world class standard of healthcare.

Challenges in psychiatric services include recruiting appropriate numbers of high quality staff and retention. Shortages in the workforce can in turn affect the mental wellbeing of existing employees in a feedback type loop. They may feel pressured to meet the high levels of expectation and make up for shortages created by unfilled posts.

We have researched and written about leadership/management in previous articles. We completed quality improvement projects on staff burnout and bullying within the workplace. Our research investigating workplace stress and time management in administrative staff continued to nurture our interest.

In this short review article we aim to pool together our research and explore the significance of staff wellbeing. We make reference to the Boorman Review² and the findings from the King’s Fund survey.¹ We discuss strategies to boost morale particularly amongst colleagues with lower banding grades but who nonetheless form the lynchpin within respective psychiatric services.

Discussion

Dr Boorman in his 2009 review urged for a ‘sea change in the way in which staff health and wellbeing was perceived.’²One of the highlights was the emphasis on placing the health of staff within the ‘heart of the NHS mission’. The review found clear links between workplace wellbeing and patient satisfaction/trust performance. It suggested that more than £555 million pounds could be saved annually if measures were placed to address this.²

Dr Boorman called for a ‘rebranding’ of the occupational health service and a drive towards staff health and wellbeing. A key recommendation included early intervention for staff with mental health or musculoskeletal health problems. Additionally, senior management were to be held accountable for staff health and wellbeing. Finally the NHS organisation should adopt a prevention focused health and wellbeing strategy for employees.²

Strategies have since been put in place to implement the recommendations from this report. A positive feature is that staff wellbeing remains a primary focus in the agenda of senior management. This can be evidenced from the findings of the King’s Fund survey.¹ It is apparent that there has been a change in the culture of the NHS. There are opportunities for NHS employees to access a gym membership at reduced rates. The change in staff canteens/shops is also visible with the greater availability of healthier meal choices.

Our findings

In July 2017 we aimed to evaluate the use of the Oldenburg Burnout inventory in establishing the signs of burnout in staff working in a London based inpatient PICU. The findings demonstrated signs of emerging burnout in staff on the unit. We concluded that the use of a burnout inventory may be considered in individual psychiatric services. It would assist as a screening measure for staff wellbeing.³

Towards the end of 2017 we investigated the workload demands on administrative staff in a London specialist perinatal service. The demands and pressures they experienced were noticeable. We found from this that three out of the four secretaries reported heightened work stress levels. We noted a possible link between time management and work stress levels but the sample size was very small to reach any definitive conclusion.⁴

We discovered that the health care environment has one of the highest incidences of workplace bullying. The Francis report examined the causes and failings within an NHS trust. Workplace bullying was a likely contributory factor in the failings of this trust.⁵ Bullying at work is known to impact staff morale/wellbeing and in turn precipitating increased feelings of burnout. We accentuated the benefits of ‘good leadership’ and in particular distributed leadership. It was imperative that there should be continued progress in introducing policies and strategies that deterred bullying at all levels and across the board.⁶ There already had been some service change to account for staff wellbeing. A monthly staff support group supervised by a senior psychotherapist was introduced.

Conclusion

In this brief article we have discussed staff wellbeing and the influence of this in delivering effective, quality care to patients. We have brought together our research and written about causal factors which can lead to an ‘unhappy’ workforce. We are drawn to the importance of good leadership and the positive manifestations of this. It is imperative that the progress in circulating the relevance of this is continued, given the key role of positive leadership, in addressing workplace bullying and subsequent burnout in staff.

Good time management can moderate work stress levels and subsequent job strain. This is an area that can be targeted and improved. Monitoring of staff skills within this domain by conducting individual anonymised questionnaires would guide further management. The consideration of delivering a lecture to all new employees in strategies and positive outcomes may be an additional step. These are simple measures which could be effective in improving wellbeing at relatively low cost.

The utilisation of a screening measure for staff burnout within services may quantify the problem and the proportion of staff on the threshold of emerging burnout. It would likely exemplify the importance of continued efforts to address staff wellbeing. Employees remain one of the, if not the most important assets within any NHS organisation.

References

1 www.kingsfund.org.uk: ‘Are we supporting or sacrificing NHS staff’ year 2015.

2 The Boorman Report on the Health and Well-Being of NHS Staff: Practical advice for implementing its recommendations May 2010. Professor Ivan Robertson and Professor Cary Cooper.

3 Yahya AS, Phillips M, Naguib M, Chukwuma J. Assessing the utility of the Oldenburg Burnout Inventory for staff working in a Psychiatric Intensive Care Unit… A Pilot Study, rcpsych.ac.uk 2017:1-7.

4 Yahya AS, Shah N, Chukwuma J. Investigating Workplace stress and Time management in Administrative staff who work in Psychiatric Specialist Services, rcpsych.ac.uk 2018: 14-18.

5 The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC,http://www.health.org.uk/.

6 Yahya AS, Shah N, Chukwuma J. Targeting Workplace Bullying: Emphasis on Good Leadership with Across the Board Approach, RCPsychiS June 2018 Blog.