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Key findings The survey responses confirm that for the majority of respondents, the pandemic has been a very challenging experience. They indicated that their work and wellbeing has been worse or much worse than at normal times, during the survey period. Having to accept patients from hospitals with unknown COVID-19 status, being told about plans not to resuscitate residents without consulting families, residents or care home staff, lack of guidance on issues like personal protection and issues of poor access to pay if they became ill were some of the major issues the care home workforce faced during March and April 2020. While two thirds of respondents said they ‘always’ had access to appropriate personal protective equipment (PPE) and most others said that it was usually available, a small minority were not provided with PPE and had to improvise, by obtaining it themselves or by making it. The need for appropriate PPE in care homes is of critical importance in staff and resident safety: 21% of respondents said that their home accepted people discharged from hospital who had tested positive for COVID-19. The majority of survey respondents found it easy to access hospital care for their residents when this was required; however, a substantial minority found this difficult or very difficult. Additionally, a substantial number found it difficult to access District Nursing and GP services, which are universal parts of the National Health Service. In addition, many indicated that they were not able to access essential training from other health professionals at this time. Some respondents refocused work to consider how they could improve on their approach to end of life care. Worryingly, some who responded raised serious ethical and professional concerns, for example GPs, Clinical Commissioning Groups and hospital trusts making resuscitation decisions without first speaking to residents, families and care home staff or trying to enact ‘blanket’ ‘do not resuscitate’ decisions for whole groups of people.

In this short video, Dr Donna Prosser discusses these questions below. 1. Healthcare workers are under extreme stress these days as they deal with the COVID-19 pandemic. Can you share some insight about what they are dealing with right now? What are you hearing from the frontline? 2. What are some tips that hospitals can employ to mitigate some of this stress? 3. What are some ways that healthcare workers can better support each other at this time?

Ever have one of those days when you feel you are constantly walking up the down escalator, when it just feels tougher than it should? It is hardly surprising that we feel like this during COVID-19. Our previous routines for our work, leisure, friends, family have all been thrown up in the air and are continuing to change. I do not have a miracle cure (if only). However, taking a moment to think about the way you are naturally wired, and how others may be wired differently, can be helpful. It can take away the irritation and frustration and help us develop a few coping strategies. Or, to put it in the words of Swiss psychiatrist, Carl Jung, ‘everything that irritates us about others can lead to an understanding of ourselves’. We all have a ‘type’… The theory of psychological type comes from Jung who said that what appears to be random behaviour is actually the result of differences in the way people prefer to use their mental capacities. In 1921 he published Psychological Types, introducing the idea that each person has a psychological type. However, the academic language of the book made it hard to read and few people could understand and use the ideas for practical purposes. Isabel Briggs Myers and her mother Katharine Cook Briggs set out to find an easier way for people to use Jung's ideas in everyday life. The Myers-Briggs Type Indicator (MBTI) personality inventory makes the theory of psychological types described by Jung understandable and useful. I have used this both with individuals and teams over the years and, more recently, as people get used to different routines. To do an MBTI assessment properly you do need to complete a questionnaire and have a follow up conversation with an MBTI practitioner – all practitioners are trained to administer the tool properly. However, in these tricky COVID times when some of those resources may be less readily available, this blog is to help you reflect on your preferences and how these play out in practice. The four ‘dimensions’ of MBTI 1 How you gain your energy and re-charge your batteries Some of us gain energy through interaction with others, others through quiet reflection. Our work settings are often designed for extroverts, the noise and the constant interaction, not great for introverts who do their best work in a quieter setting. People with an extroverted preference will ‘speak think speak’, whereas those with an introverted preference will ‘think speak think’. Just recently you may have noticed natural extroverts on Zoom calls – the people doing a lot of the talking. The downside of course is that others cannot get a word in edge-ways. If you don’t know what an extrovert is thinking, you have not listened. If you don’t know what an introvert is thinking, you have not asked. And, crucially, you may be missing out on some key information. 2 What type of information you prefer to take in, trust and offer to others When I talk to people about dimension, I often show them a Salvador Dali picture. People who have a strong preference for factual concrete information will give me a list of the painting contents – an apple a knife a bird etc. Others will be reading between the lines and creating possibilities, ‘something has happened here, it’s unsettling’. If I prefer the big picture, any presentation of my ideas with a compelling vision but no detail to back it up is going to raise more questions than it answers from those who prefer realistic and concrete information. It is normally best to think through how to balance the more abstract and the specifics, maybe asking yourself, ‘what’s missing here?' 3 How you prefer to make important decisions Some of us prefer a logical lens. We look at the pros and the cons, we want to help people to solve their problem. Others are concerned about how what is about to happen will impact on others, their values. If you have ever tried to have a pros and cons conversation with someone who appears (as far as you can tell) to be taking this all a little too personally then it’s this dimension that’s rearing its head. There is a difference in your preferences. In MBTI this is the ‘thinking or feeling’ preference. This does not mean that ‘thinking’ people cannot feel and that ‘feeling’ people do not think. It is just about where you start your decision making. People with a thinking preference take a big step back, start with a detached view and then step in. People with a feeling preference do this in reverse. Both are important. 4 How you prefer to live your life Some of us are natural planners, others spontaneous, sometimes VERY last minute. I learnt many years ago that asking for things at the last minute was a great way to hack off your colleagues. We don’t live in a perfect planful world, but a little consideration goes along way… If you like structure, if the word ‘finished’ inspires you, spare a thought for others who may lob something in at the last minute. Your last minute contributor may have come up with the best idea since sliced bread. If you shut them down they may not bother you again with their great ideas. Your loss. And if you love the words ’just finishing’, try where you can to minimise how often you let things run on until the last possible moment and apologise when you do – it can very stressful for colleagues, friends and family who like to plan. In MBTI all these four dimensions come together for us into 16 different types. MBTI then paves the way for us to better understand our responses to conflict, stress, our contributions within our team and how we can be even better. And, particularly relevant now, it can also help us understand why some are really wired to deal with change and others less so. Final thoughts And finally, I wanted to add a few more things that are useful to bear in mind: This is simply about understanding your natural preferences and sometimes adjusting them. People sometimes say ‘I do both of these’. We learn that adjustments to our natural preferences can be helpful. For example I am very planful in work settings, but for me at home it’s all a bit last minute.com unless I try hard! Which leads into my last point. Expect to be more tired on occasions. If you are required to deal with a lot of detail when you prefer the big picture, be aware it may feel surprisingly tiring. It takes your full concentration, just like folding your arms the other way, also surprisingly tricky for most people I know. Try it! In the meantime I hope my blog helps you to get your head around why you may find some of the super people around you not so super at times and how you can adjust your approach to accept and value their differences. If you are interested to learn more, go to your local NHS Leadership Academy to find your local MBTI practitioners and take a look at the Myers Briggs website. Previous blogs by Sally Leading for improvement Immunity to change How a single piece of paper could help solve complex patient safety issues The art of wobbling: Part 1 The art of wobbling: Part 2 Looking after each other in times of change

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Panelists include: Dr Keita Franklin, LCSW, Chief Clinical Officer, PsychHub, Tennessee, United States Bernadette Wilson, MBA, Certified Neurocoach & Mindfulness Coach, Founding Partner, BrainFit Institute, CEO, Cognitive Performance, California, United States Dr Ariele Noble, Research Psychologist & Clinical Supervisor, Mental Health Innovations, United Kingdom Anca M. Sarbu, MSPH, Head of Quality Management and Organisational Development at Klinik Meissenberg AG - Psychiatric and psychotherapeutic hospital for women, Switzerland, Founder and Project Lead at The Digital Aid Project, PSMF Ambassador Switzerland and Austria, Healthcare Innovation Mentor at EIT Health, MIT COVID-19 Challenge, EUvsVirus - EU Commission