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Huge issues are facing the UK’s medical workforce: angst among staff, battles for training opportunities, a lack of basic amenities, discrimination, shortages of posts, roles with no career progression, and a failure to support workers asking for pay reviews. In this BMJ opinion piece, Partha Kar says we need fresh leadership to lead basic changes with support from the royal colleges and unions, and other external organisations need to step up now.

This article in The Joint Commission Journal on Quality and Patient Safety reports on the findings of a pilot programme to improve healthcare staff wellbeing. Between November 2018 and May 2020, researchers engaged five healthcare sites to take part in a pilot intervention. The pilot used evidence-based approaches to wellbeing including a comprehensive culture assessment, redesigning daily workflow and leadership and team development. The researchers found that healthcare worker wellbeing improved when: an integrated, skills-based approach was taken there was a focus on team culture, interactions and leadership workflows were redesigned to promote positive emotions. This study suggests that combining a number of these approaches at the same time can improve healthcare working environments and reduce levels of staff burnout.

'I am a junior doctor. It is 4 a.m. I have run arrest calls, treated life-threatening bleeding, held the hand of a young woman dying of cancer, scuttled down miles of dim corridors wanting to sob with sheer exhaustion, forgotten to eat, forgotten to drink, drawn on every fibre of strength that I possess to keep my patients safe from harm.' How does it feel to be spat out of medical school into a world of pain, loss and trauma that you feel wholly ill-equipped to handle? To be a medical novice who makes decisions which - if you get them wrong - might forever alter, or end, a person's life? To toughen up the hard way, through repeated exposure to life-and-death situations, until you are finally a match for them? In this heartfelt, deeply personal account of life as a junior doctor in today's health service, former television journalist turned doctor, Rachel Clarke, captures the extraordinary realities of ordinary life on the NHS front line. From the historic junior doctor strikes of 2016 to the 'humanitarian crisis' declared by the Red Cross, the overstretched health service is on the precipice, calling for junior doctors to draw on extraordinary reserves of what compelled them into medicine in the first place - and the value the NHS can least afford to lose - kindness.

At its heart, Appreciative Inquiry (AI) is about the search for the best in people, their organisations, and the strengths-filled world around them. It is the art and practice of asking questions that strengthen a system’s capacity to heighten positive potential, (Stavros et. al (2015) Appreciative Inquiry: Organisation Development and the Strengths Revolution). In this area you will find useful resources relating to the aspect covered below.  The resources on this web page include past webinars on: What is appreciative inquiry? Appreciative conversations The 5D cycle SOAR analysis.

See how incivility affects all of us in the NHS and how that can impact patient safety.  Join the staff of Epsom and St Helier University Hospitals NHS Trust on their journey as they reflect on the real-life effects of both incivility and active kindness.  This video was devised, filmed and produced by the Elena Power Simulation Centre.

In this edition of the Royal College of Anaesthetists bulletin, articles include: psychological consequences of COVID-19 a shift in incident reporting sleep and exhaustion.

This toolkit is available by request to the Department of Defence Patient Safety Programme. The benefits of team events like briefs and huddles are documented. Briefs, or briefings, are planning events that occur before a case (for example, in the operating room), a shift, a procedure, a day in the clinic/office, or before an intervention. The brief allows the team leader to explain what is going to happen, cover pertinent contingencies, get input from each member of the team (including the patient), and ensure that each team member knows his or her roles and responsibilities. Huddles are team events for problem solving and updating the plan. Anyone can call for a huddle to deal with new issues, added complexities, unusual circumstances, or any need to adapt the earlier plan. Huddles occur frequently throughout the health care system and many times throughout the day. Briefs and huddles can be used in virtually any health care venue. The Briefs and huddles toolkit contains everything you need to implement briefs and huddles in your health care organisation. The toolkit includes: Toolkit overview Toolkit user guide Briefs and huddles facilitation guide Briefs and huddles facilitation slides Handout Briefs and huddles quick review Additional resources Action planning guide Toolkit evaluation form.

In Maintaining motivation in uncertain times the King’s Fund advises leaders how they can best support their teams by offering structure and containment, protecting, encouraging, and creating opportunities. 

The BMA sent out its first survey at the beginning of April. The most recent survey closed on 13 August and nearly 4,000 doctors took part.  The 13 August 2020 results found: 60% of doctors said they were not very, or not at all, confident in their local health economy managing demand as normal NHS services resume. Half of doctors said they were not very, or not at all, confident in being able to manage a second wave of COVID-19. 26% of doctors said that in the last two weeks non-Covid demand had increased to pre-pandemic levels, with 17% saying that demand is now even higher than it was before. Previous survey results BMA COVID-19 survey results - 9 July 2020 BMA COVID-19 survey results - 18 June 2020 BMA COVID-19 survey results - 28 May 2020 BMA COVID-19 survey results - 14 May 2020 BMA COVID-19 survey results - 30 April 2020 BMA COVID-19 survey results - 16 April 2020 BMA COVID-19 survey results - 6 April 2020

This guide, published by the Advancing Quality Alliance, has been developed to help managers support their staff and themselves with managing stress.  It also highlights the potential issue of secondary trauma and is an introduction to this subject and part of a phased package that will cover both the crisis and recovery phase in meeting wellbeing needs of the workforce.

Access to wide range of perspectives can bring creativity to solutions and the actions that implement them. This website presents materials that cover topics such as leading in critical times, building and supporting resilience, Leading to Innovate, change and adapt, teaming and working remotely, coaching peers and developing as a leader.

Psychotherapist, Donna Butler from Brighton and Sussex University Hospitals NHS Trust, talks through the mental and emotional challenges during and post-COVID-19. Recommended viewing for staff and managers.

I have been honest in my blogs during the pandemic. I have been apprehensive, scared and, at times, excited to work in the pandemic. So why do I feel so low at this moment? I am experiencing feelings that I have not had before. I have thoughts of leaving nursing. Surely, I can’t be the only one? Why now? Why am I feeling like this? This blog is to explore why this might be. It has now been over 70 days since lockdown. Yes, the restrictions are easing – and this is great news for people who have been isolated for so long, it is great for the economy – but we are waiting for the second wave. My last blog spoke about how we are going to get back to ‘normal work’ and my anxieties about how we were going to do this. Slowly, we have been trying to get back to some kind of normal, but it feels confusing, slow and uncertain. None of us can see the ‘end’. None of us knows what the ‘end’ will look like, when it will happen or will even know when it happens. Remembering the early days of lockdown, the streets were empty, the roads were quiet, there were huge queues for food, and everyone seemed scared. It was a little like the post-apocalyptic film '28 Days Later'. We have all had our highs and lows: the NHS clap every Thursday, rainbows in windows, connecting with family, being furloughed, has meant some people have enjoyed lockdown. The flip side is that for some it has been a living nightmare: money worries, domestic violence, child abuse, operations cancelled and bereavements. Unlike the film that lasts 113 minutes, has a set plot that it follows and ends up with them being rescued, we are still stuck 70 days plus in and there seems no hope of a rescue. Real life does not offer us closure, does not always have a happy ending and, unlike dramas on the BBC, life is not always fair. I’m not even sure we are in the middle, which makes me feel even more helpless. I have been nursing for over 20 years. I have loved working with patients; I have even loved working in the institution that is the NHS. The politics, the hierarchy, the culture, yes, it's difficult work trying to negotiate around obstacles and blockers, but we do it and, weirdly enough, enjoy it. But this pandemic is different. In all honesty, I can’t do this anymore. Work was hard enough, but now it’s even harder. Knowing how to care for patients safely in the right area, wearing PPE all day, not being able to communicate properly through the masks, and having procedure and policy changing weekly, sometimes daily, is wearing. I feel like a new starter every day, especially after days off. I’m tired of it and can’t see an end. Due to this lack of enthusiasm, I feel I am failing at giving the care I want to, failing to give patients the care they deserve. This feeling is horrible. What kind of a nurse are you if you have ‘run out of care’? I know this is burnout. I didn’t want it to be. But it is. In January, I didn’t feel like this. This burnout has been because of the pandemic. I am interested to find out why now? I can’t be burnt out from a few months of difficult working conditions, can I? While looking into this and trying to make sense of my feeling, I came across Kanter’s Law. Rosabeth Kanter is a Harvard Business School Professor and according to her “in the middle, everything looks like a failure". Everyone feels motivated by the beginnings and obviously we love happy endings, but it is in the middle where the hard work happens. She states that in the middle, we all have doubts. This feeling is principally produced because important changes are not developed the way we would like it to, lineal and smooth. The changes that remain usually involve two steps forward and one step back. This is evident when we are trying to get back to ‘business as usual’ but new cases of the virus are detected and we can’t proceed as we thought. In addition, it’s easy to feel that when we are in the middle we are very far away from the expectations we had made. Unexpected events take place as well as deviations. What it had been estimated in regard to the need of resources appear to not be enough. It is then when despondency appears. We can’t plan, we can’t mitigate risks effectively, which often leads us into failure. This is why it’s important to fully understand that failure is a necessary part of change, because there will be periods of confusion in which the temptation to abandon will be great. I’m at the abandon bit! This work is difficult. I am not in the position where I can make big changes in my Trust. I must trust that others are making good decisions and they will support us if things don’t go as expected. Call to action I can’t be the only person feeling this now. What are Trusts doing to guide staff through uncertainty, prevent burnout and inform staff of plans for the future?

The COVID-19 pandemic has resulted in an overall surge in new cases of depression and anxiety and an exacerbation of existing mental health issues, with a particular emotional and physical toll on health care workers. Limited resources, longer shifts, disruptions to sleep and to work-life balance and occupational hazards associated with exposure to COVID-19 have contributed to physical and mental fatigue, stress and anxiety and burnout. In this article, published by Wolters Kluwer, the Houston Methodist Hospital share the lessons learned collectively by an interdisciplinary team of Intensive Care Unit (ICU) leadership and collaborating scientists about the experience of occupational fatigue and burnout of intensive care personnel as a result of responding to the COVID-19 pandemic. They propose specific policy recommendations and guidelines for organisational readiness, resilience and disaster mitigation.

Several factors can compromise patient safety, such as ineffective teamwork, failed organisational processes and the physical and psychological overload of health professionals. Studies about associations between burnout and patient safety have shown different outcomes. In this paper, published by Medicina (Kaunas), a team in Brazil analysed twenty-one studies, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses and it is associated with external factors such as: high workload, long journeys and ineffective interpersonal relationships.

The Human Connection is a comprehensive set of clear and resonant stories that illustrate the impact of ergonomics and human factors, produced by the Chartered Institute of Ergonomics and Human Factors (CIEHF). The 60-page document is intended to be of value to a wide range of audiences, including government, policy makers, industry, third sector groups, educators, research funders, regulatory bodies and collaborators. The case studies, available here as the complete set or individually, have been written to increase understanding of the complexity, range and value of the discipline of ergonomics and human factors. The full case studies document is free to download. Request a copy by completing the request form, after which you will receive a link to the document on screen and by email.

This infographic by the College of Emergency Nursing Australasia gives practical advice on how to speak up if patient safety is compromised.

This patient information leaflet produced by Guys and St Thomas' NHS Foundation Trust gives 8 simple steps to keep yourself safe during your stay in hospital. These include; Preventing falls Preventing blood clots Preventing infection Your medicines Pressure ulcers Identification Your concerns Leaving hospital.

This month’s Letter from America highlights approaches to addressing persistent patient safety challenges, such as overprescribing of opioids and staff burnout, through working with clinicians, staff and patients to enhance service delivery and care and opportunities to effectively engage communities. Letter from America is the latest in a Patient Safety Learning blog series highlighting fresh accomplishments in patient safety from the United States. The US observance of ’Groundhog Day‘ is more than just the annual emergence of Punxsutawney Phil – the rodent soothsayer who ceremoniously predicts the timing of the arrival of Spring. It is the name of a popular film that represents how the repetition of unwanted experiences can contribute to scepticism, callousness and burnout for the primary character – weatherman Phil. However, he emerges from the darkness by applying what he learns over time to arrive at a new brighter day. Patient safety leaders are apt to feel like weatherman Phil. Repetitiveness – the feeling that something been done over and over again without change – can decrease engagement but it can also lead to experiential knowledge that can be applied to future efforts. Community engagement is paramount to patient safety success but it can be challenging if people feel like they wake to the same problem every day despite efforts to make a difference. The Boston-based Betsy Lehman Center has developed Including the Patient Voice: A Guide to Engaging the Public in Programmes and Policy Development. The Guide shares a six-element approach to involving members of the public as partners to reduce reoccurrence of poor care. Strategies focus on enabling community members to succeed as partners and contribute as experts to designing health services that are evidence based and accessible to all. This includes leadership-led mini-workshops for staff to inform their engagement programmes and patient correspondence reviews to identify the right consumers to invite as participants. Similarly lessons have been shared by MedStar Health, a large regional healthcare system that sought to engage patients and design strategies that engage patients and families in safety improvement. Organisational structures such as Patient and Family Advisory Councils (PFAC) served as the focal point of the shared learning effort. The system developed a network of courses that shared best practices to foster innovation and sustain realised improvements in event reporting, disclosure (the CANDOR Toolkit), after-incident support and sepsis reduction. The tactics used include board and leadership activation activities, a mentorship programme for new community leaders and public awareness campaigns. For example, the system launched a collaborative to share information to improve early detection of sepsis. Patients who had contracted sepsis along with PFAC members and in-house quality experts were brought together to design an educational video to reduce sepsis that highlighted symptom identification and response. The programme contributed to marked sepsis treatment improvement. The City of Philadelphia recently launched a prescription monitoring strategy to curtail the overprescribing of opioids in their region. Because this programme identifies by name the 10% of physician that overprescribe, these individuals can be offered targeted training and, if necessary, legal interventions to address their behaviour. Home-grown programmes can also be proactive to prevent overprescribing. One Boston-based family medicine clinic described their five-year change management effort to reduce opioid overuse. The authors reported their focus on developing “shared general principles”; communication mechanisms to connect clinicians with in-house addiction experts, patient registries, targeted training, certification opportunities and centralised leadership were all instrumental in embedding improved prescribing practices throughout the organisation. Consistent unremitting workload pressure perpetuates stress and fatigue. Its presence degrades staff relations, performance and the safety of care delivery. It’s a common problem that medical residents are burnt out: no news there. What conveys great promise are programmes like what the Virginia Mason Medical Center in Kirkland Washington has done to address burnout by implementing workflow changes and fostering a culture of “collegiality, respect and innovation”. The Center changed workflow by standardising clinical tasks, defining staff roles and carving out protected time for staff to recharge, self-educate and participate in improvement efforts. The Center has enhanced its culture and improved staff morale through leadership efforts to lower hierarchy, welcome and respond to feedback, and address inefficiencies that can discourage staff and derail efforts. Ninety percent of staff at Kirkland reported in a 2018 internal survey feeling content and engaged about their work. Medical residents can also find support through programmes like the ACGME Aware initiative. This set of tools targets strategies that junior doctors can use to build resilience and embrace their professional community through a mobile phone app to find support as they need it. Personal tactics to protect against burnout for more experienced healthcare professionals are also in demand. A news story in Medical Economics highlights what doctors and hospital administrators can do to minimise burnout, such as making time to socialise with peers and using the opportunity to share stories, rethinking their roles to bring joy back to medicine, and to listen. For 2020, Phil has told us that Spring is due to arrive early. Will the application of the successes reviewed in this month’s Letter reduce the recurrence of opioid overprescribing and staff burntout? We need more than a rodent to speculate on that for us. But given efforts by patient safety champions in the US and UK, improvements optimism is in the air.

Following the traumatic death of an anaesthetic trainee who was returning home after a night shift, the Fatigue Group supported by the Association of Anaesthetists and RCoA have surveyed UK trainees about shift working and fatigue. With a 60% response rate, the survey highlights a wide variation in access to rest facilities, commuting distances and concerning effects of fatigue on trainees. Fatigue self-assessment and fatigue risk management are not familiar steps in routine daily practice. This is due in part to a lack of awareness about the causes and effects of fatigue and limited education opportunities. It is also due to working culture where openness about fatigue and tiredness is not encouraged and collective responsibility for staff wellbeing is poorly developed. Using the results from the survey, the Fatigue Group have developed resources designed to enhance individuals’ knowledge and understanding and to support the culture change required within departments and organisations. To reduce variation in practice and to better manage expectations, standards have been defined for rest facilities and rest culture at work and individual responsibilities both within and outside of the workplace. These provide a platform to support local audit and quality improvement activity. This webpage has posters, guidelines and standards for you to download and use in your Trust.

Engaging for success: enhancing performance through employee engagement sets out the evidence that only organisations that truly engage and inspire their employees produce world class levels of innovation, productivity and performance. The lessons that flow from that evidence can and should shape the way leaders and managers in both the private and public sectors think about the people who work for them. They should also shape the way employees approach their jobs and careers.