1st place - A hard-won battle to 'Fight Fatigue': Setting a standard for night shift rest facilities

Project lead - Amrit Dhadda (Royal Glamorgan Hospital, Wales)

Project team - Laura McClelland (Princess of Wales Hospital, Wales), Tei Sheraton (Royal Gwent Hospital, Wales)

Project aims:

The aims of our campaign were as follows: 

• To ensure overnight and post-shift rest facilities were available to all junior and SAS doctors working on a night shift in the new Grange University Hospital in South Wales. 
• The standard deemed 'acceptable' was individual, private rooms containing a horizontal-lie within them; i.e. within the 'GREEN' category of the Associations' rest facility traffic light system. 
• To establish a ‘rest facility group’ that comprises of junior doctors who could feed back at an executive level issues related to rest and well-being.

Our campaign started almost 24 months ago when the construction of the £350 million Grange University Hospital (GUH) in South Wales was nearing completion. This was the first major hospital to be built in Wales in more than 2 decades.

The university health board serves a population of approximately 600,000, and employs in excess of 300 junior doctors and SAS doctors. In early 2019, we became aware that this new hospital would not have any overnight rest facilities for junior doctors working a nightshift. This was despite the fact that the GUH was to become the health board’s Specialist and Critical Care Centre and designated trauma unit, combining A&E and Critical Care services from the existing 3 acute hospitals. This would mean that the GUH would be where most junior doctors employed by the health board would be doing their night shift on-calls.

Our 2-year campaign started in early 2019 when the health board were insistent that there was no funding or space for the provision of overnight rest facilities to be incorporated into the GUH, construction of which had started in 2017. Further difficulties arose when the Covid-19 pandemic hit, and the hospital needed to open 6 months early in November 2020 to meet the ongoing demands of the pandemic.

Organisations including the RCoA and Association of Anaesthetists have done significant work on fatigue and night time working. A survey of 2,231 trainees, published in Anaesthesia, found that more than half experienced an accident or near-miss when driving home after a night shift. Given all this work and evidence for best practice, we were concerned that the planned provision for rest facilities at GUH would have fallen in the Associations' ‘RED’ category–defined as an ‘unacceptable standard’.

We felt that this new flagship hospital could set a precedent for the future working environment of junior doctors, especially given that this was the first major hospital built in over 2 decades in Wales.

Beneficial effects on wellbeing

After 24 months of incredibly hard campaigning we managed to achieve the following: 

1. The health board commissioned the redevelopment of office spaces into 22 private rooms, each containing a bed, available for junior doctors, specialty-wide, for in-shift and post-shift rest (going from 'RED' to now fulfilling the 'GREEN' standard) 
2. The health board had to open the GUH earlier than anticipated due to the Covid-19 pandemic. This would have been 6-months prior to the rooms being available. We campaigned that suitable facilities should still be made available from early opening, particularly with the demands of Covid working. After many months of further negotiation, the health board acquired 28 temporary pods that were available to use from the day of opening, until the rooms were completed.

We were delighted to view the completed rooms on 12 March 2021. This will no doubt benefit future generations of not just anaesthetists, but junior doctors specialty-wide. This will hopefully significantly reduce the number of near- and actual accidents when driving home from nightshifts. The most recent survey carried out has shown that these facilities are already being utilised by doctors in the health board including for post-shift rest.

2nd place - The Royal Free Wellbeing Team

Project lead - Shivani Pandya (Royal Free Hospital)

Project team - Harriet Pittaway (Royal Free Hospital), Tessa Thompson (Royal Free Hospital), Tamara Banerjee (Royal Free Hospital), Jenny Price (Royal Free Hospital)

Project aims:

The Royal Fee wellbeing team was established with the aim of improving staff wellbeing during and after the first and second covid-19 surges. As a large tertiary hospital and a designated Covid referral centre, the staff in anaesthetics, ICU and within the greater hospital have experienced a significant burnout rate. This multifaceted, multi-disciplinary project aimed to better wellbeing through an improved sense of community. We hoped that by taking a varied approach we would appeal to the range of people and backgrounds working in our hospital-with small, simple projects we achieved a ‘something for everyone’ approach.

We focused on 4 main pillars, these were physical activity, reflection, social wellbeing and positive re-enforcement. It is well known that physical activity improves mental alertness, mood and boosts energy levels, therefore we provided free exercise and yoga classes virtually to all staff members and these were taught by trainees. Regular reflective practice sessions facilitated by a trust psychiatrist were introduced and drop in sessions with a dedicated psychologist provided a safe space for debrief and reflection. We also created a designated wellbeing room (the wobble room) where staff are able to unwind during breaks. Sending out an informal weekly newsletter detailing mental heath and wellbeing resources was another initiative of this project, this included local and home based activities and social virtual events to keep staff members engaged and improve social wellbeing. We addressed the pillar of positive re-enforcement by the organisation of personalised mugs for ICU and anaesthetic staff and the introduction of the Greatix (the opposite of the datix) highlighting individuals or teams who have gone above and beyond at work.

Beneficial effects on wellbeing

The activities demonstrated in this project and the benefits seen are easily reproducible in other trusts. The wellbeing team will continue to operate after the pandemic and there will be an increased emphasis on staff wellness within the anaesthesia and critical care teams. The in house psychologist will now work full time within the department, with a focus on staff mental health. The newsletter has now had 23 editions with 12 different trainee writers and over 170 greatix nominations. Qualitative feedback has included that this has helped ‘build a sense of community’ and has ‘grown a culture of gratitude’ on our unit and in our theatres.

The reflective practice sessions have had overwhelmingly positive feedback (collected via post-session surveys) from trainees with 100% of attendees being ‘very satisfied’ with the sessions and leaving comments that they felt ‘That I’m not alone in my concerns at work’ and that the sessions were ‘very useful and definitely something positive to have come out of the pandemic, would definitely recommend!’

A quality improvement project was conducted after the implementation of regular virtual relaxation yoga classes. A simplified, modified Warwick-Edinburg wellbeing questionnaire using a likert scale was used to determine staff wellbeing before and after yoga sessions. Stress levels, mood and relaxation were the key areas of focus. The data collected showed that 100% of participants felt more relaxed after the session with 94% noticing a reduction in stress levels and 73% feeling better about themselves.

To further understand the impact of our wellbeing initiatives we are currently in the process of putting together a research questionnaire for all ICU and anaesthetic staff – this will help us know more about our work and develop the projects to better meet the needs of our staff.

3rd place - Mersey Anaesthetics Buddy Scheme: Setting up a Novel Buddy and Exam Buddy Scheme - From a Regional to National Approach

Project lead - Andrew Veal (St Helens and Knowsley Hospitals NHS Trust)

Project team - Reeanne Jones (St Helens and Knowsley Hospitals NHS Trust), Adam Sturmey (St Helens and Knowsley Hospitals NHS Trust), Alice Arch (Wirral University Teaching Hospital)

Project aims:

Following the 2017 Royal College of Anaesthetist’s report, which identified that 85% of anaesthetists in training are at a higher risk of burnout, there has been an increased focus on wellbeing and support in training. The Mersey Anaesthetics Buddy Scheme was launched in August 2019, with the aim of providing informal advice and support to new starter core anaesthetic trainees (CTs), through a buddy pairing with a more senior trainee. The scheme is now available to CT1s, CT2s, ACCS and new starter Specialist Trainee (ST) 3 trainees.

The main aims of the Buddy Scheme are: 

• To provide new starter anaesthetic trainees with a more senior buddy trainee, for informal advice and support. 
• To improve general wellbeing and help new trainees to ‘settle in’. 
• To establish support networks and build lasting relationships between trainees of different grades. 
• To develop and nurture trainee support skills for senior trainees. 
• To create a network of support, including local leads, a regional trainee lead and a Consultant lead. 
• To develop guidance documents to support all trainees involved. 
• To support trainees returning to work after a period of absence or rotating from another deanery. 
• To promote the importance of wellbeing and trainee support across the region.

The huge impact of the COVID-19 pandemic resulted in the cancellation of face-to-face opportunities for exam support. In response, we expanded our scheme to launch a new Exam Buddy Scheme to support trainees sitting the FRCA exams.

Additional aims of the Exam Buddy Scheme are: 

• To pair anaesthetic trainees sitting the exam at the same time, providing invaluable support to each other throughout the exam process. 
• To develop ‘buddy bubbles’, where ‘bubbles’ of six-eight trainees are overseen and supported by a post-FRCA trainee. 
• To work closely with the Mersey School of Anaesthesia (MSA) in setting up and running the scheme.

To assess the ongoing impact of the scheme on trainee wellbeing, feedback is regularly sought. This involves anonymous three-month feedback surveys that are sent to trainees involved in the August cohorts. Group emails are sent, inviting responses on a voluntary basis, allowing for open and honest feedback. The feedback gained has been hugely useful in making adaptations and to aid ongoing development. This is something that we plan to continue to run in yearly cycles with the aim of continuously improving the scheme.

Beneficial effects on wellbeing

We believe that the scheme has been useful in not only improving general wellbeing at work but also helping trainees to settle into new placements. Our experience, since starting in August 2019, is that many trainee pairings tend to keep in touch and communicate even after their initial period has ended. One of the initial aims was to establish support networks and lasting relationships between different grades of trainees, which is something that has been achieved.

Many trainees will go on to undertake the role of Educational Supervisor and a further benefit of the scheme has also been in helping senior trainees develop their skills in trainee support. Additionally, the scheme has become increasingly relevant during the COVID-19 pandemic and has provided trainees with increased support and contact with their buddy during this time.

The Exam Buddy Scheme is currently undergoing its first yearly cycle and it is planned to undertake surveys of those involved to assess its impact on trainee wellbeing and support, enabling it to be continually adapted and developed.

1st place COVID-19 category - Coping with Covid-19: a Team Approach to Work-related Wellbeing

Project lead - Julia Blackburn (University Hospitals Birmingham NHS Foundation Trust)

Project team - Jen Warren (Birmingham Women's and Children's NHS Foundation Trust), Rosemary Worrall (University Hospitals Birmingham NHS Foundation Trust), Christina Stamoulis (Birmingham Women's and Children's NHS Foundation Trust), James Rudge (University Hospitals Birmingham NHS Foundation Trust), Amit Sharma (University Hospitals Birmingham NHS Foundation Trust), Emma Plunkett (University Hospitals Birmingham NHS Foundation Trust)

Project aims:

In our tertiary centre, the response to Covid-19 has necessitated fundamental changes to anaesthetist working practices. Emergency rotas, combined with an increased volume of workload, patient acuity and emotional stress were recognised as significant risks to the mental health and wellbeing of our team. Our coordinated campaign enabled key issues to be rapidly identified and addressed.

In July 2020, a trainee-led qualitative research project was undertaken using ‘appreciative inquiry’ methodology to gain feedback from over half of our anaesthetic and ICU junior doctor workforce (n=40). This highlighted the emotional burden of caring, workload and working pattern demands, and identified areas for improvement from those directly affected. Key areas included: 

• Creating teams that work together regularly 
• Improving rest facilities and rest areas 
• Prioritisation of reflection and debrief

Departmental wellbeing initiatives were seen as critical in supporting trainees’ wellbeing.

Beneficial effects on wellbeing

Our multi-faceted project aimed to positively impact on anaesthetist and the wider team’s mental health and wellbeing through: 

• Creation of two trainee wellbeing leadership (TWL) roles: improving accessibility to wellbeing support and advocacy for anaesthetic junior doctor wellbeing issues. 
• Expansion of wellbeing team: trainee anaesthetists coordinating activities to promote the above goals and aiming to create a positive, appreciative culture. 
• New activities: twice-weekly online ‘Check-In’ meetings and a ‘Rapid Reflection’ feedback project for all medical staff working across ICM and anaesthesia. These provided real-time information about staff wellbeing and encouraged feedback, reflective practice and debriefing. 
• Improving rest facilities and culture for anaesthetic and ICU staff. 
• Rota coordination by senior trainees, aiming to keep junior teams as consistent as possible. 
• Communication of clinical progress on ICU with twice weekly infographics. 
• Monthly wellbeing newsletters to foster a sense of community, and regular signposting to sources of internal and external support (including a recently established peer support service), wellbeing activities and departmental social information. 
• The Rapid Reflection project created a new focus on reflection and debrief. Anaesthesia and ICU clinicians completed anonymous shift reflections on a voluntary basis. In January to February 2021 (n=32), 72% of respondents scored 4 or 5 to the question: ‘How was my shift today?’ (1-5, worst-best). To the question: ‘How do I feel?’, 53% responded ‘supported’ and 50% ‘valued’. Positive feedback and responses to ‘what helped me today?’ included: ‘great team-working’, ‘frequent breaks’ and ‘excellent rest facilities’. Areas for improvement were quickly actioned, and this ongoing project will continue to monitor and improve wellbeing. 
• Multiple individual private rest rooms close to ICU were clearly signposted and furnished with beds or lie-flat recliners. This improved rest culture and compliance with the AoA Standards for Rest Facilities from ‘Amber/Red’ (September 2020) to ‘Green’ for rest facilities during a shift, potentially improving fatigue and safety. 
• A departmental wellbeing survey was regularly distributed, including the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWS). In May 2020 (n=51): 32% of respondents scored less than 21 (of maximum 35), consistent with possible or probable depression or anxiety. This was followed by 20% in September 2020 (n=60), and 27% in March 2021 (n=41). For trainees, these proportions were 39%, 44% and 16% respectively, showing overall improvement since our initiatives had been instigated. We acknowledge these scores are multifactorial, overall response rates were approximately 20-30%, and many trainees rotated in August 2020. 
• We also found those who reported feeling more supported had higher SWEMWS scores. Responses to ‘What helped your wellbeing recently?’ included: ‘rest facilities, communication, camaraderie, rapid shift reflection, rest breaks, coffee machine’, correlating with our project’s aims and objectives. Survey summaries were communicated via wellbeing newsletters. We will continue to monitor wellbeing and feedback by repeating the survey in 3 months.

2nd place COVID-19 category - A Psychologist-supported multimodal Wellbeing Strategy during the COVID-19 pandemic for Anaesthetic, Intensive Care and Theatre Staff

Project lead - Francesca Millinchamp (Royal United Hospital NHS Trust)

Project team - Kathryn Herneman (Royal United Hospital NHS Trust), Fiona Kelly (Royal United Hospital NHS Trust), Sarah Gouldson (Royal United Hospital NHS Trust)

Project aims:

The arrival of the COVID-19 pandemic presented significant psychological challenges to healthcare workers, with evidence of increased risk of both short- and long-term mental health deterioration. Our multimodal wellbeing strategy aimed to: 

• Provide immediate and longer-term support to all our Theatre and Intensive Care Unit (ICU) colleagues 
• Create a team who could represent the interests of key stakeholders 
• Improve awareness of, and engagement with, wellbeing initiatives 
• Evaluate the impact of these initiatives 
• Proactively respond to feedback, and to the evolving psychological challenges arising from the pandemic

Interventions included: 

• ‘Team Immediate Meet’ (TIM)- we designed this debriefing tool alongside our Psychologist colleagues as a cognitive aid for use immediately following a potentially traumatic incident.2 The bullet point structure facilitates a fast but effective staff debrief and ensures access to Trauma Risk Management (TRiM) follow-up for all involved. TIM also features psychological first-aid information to promote healthy recovery strategies. TIM checklists were displayed throughout Theatres and Intensive Care, and their use promoted by a trainee-led education programme. 
• ‘Care-ona Corners’- implemented across our departments, these areas included notice boards displaying details of wellbeing resources and how to access these. 
• ‘Weekly Wellbeing Wonders’ (WWW)- weekly staff newsletter tackling different wellbeing themes each week, e.g., sleep hygiene, stress management. 
• Dedicated welfare email address for staff to access support and suggest wellbeing ideas. 
• Creation of a departmental Welfare Directory of useful contacts 
• ‘Care boxes’- supported by our hospital charity we created and re-stocked boxes containing food and toiletries which were placed in coffee rooms and changing rooms for all staff. 
• Dedicated quiet room for Intensive Care staff, featuring soft furnishings, care boxes and mindfulness resources to provide a sanctuary away from clinical pressures. 
• Rest facilities, colleague support and shared learning (described further below).

Beneficial effects on wellbeing

In July 2020 we invited anaesthetic, ICU and theatre staff to complete a survey evaluating their wellbeing during the COVID-19 first wave, and the impact of our well-being strategy. There were 59 respondents (return rate 37%) with replies from all staff groups and across a variety of anaesthetic grades.

Staff reported improved awareness of how to access wellbeing support, from 40.7% pre-pandemic to 66.1% post intervention. ‘Care-ona Corners’ and care boxes proved particularly popular. Trainees found M&Ms and ‘Corona Comrades’ especially useful. Using a five-point Likert Scale, 59% of staff reported that wellbeing initiatives were valuable or extremely valuable.

We received the following comments:

"Trainee M&M very important to disseminate up to date information of challenges of working in DICU. Nice forum to share ideas"

"Tips on self-care and mindfulness were great in times of increased anticipation and perceived stress, found in the WWW email and on the noticeboards"

"The care boxes have been great for the boost you need on your shift and getting clean before going home to see your family"

"Corona comrades kept lines of communication open and allowed both an opportunity to offer help and support when colleagues were unwell and isolating, but also time for a bit of a joke to lighten the mood"

"I think that the most important aspect was the buy in from the department from the start- we started from a really good place- and the team have worked tirelessly, liaising with EAP and the psychologists for our benefit. THANK YOU!"

Our interventions are reviewed in response to the evolving challenges of the pandemic and can be adapted to ensure ongoing benefit beyond COVID-19. Our survey demonstrates an appetite for wellbeing measures, and ongoing emotional investment from stakeholders ensures that these projects continue to benefit our workforce into the future.

3rd place COVID-19 category - 'KeepWellNHS': Supporting NHS workers and their local communities - a response to COVID-19

Project lead - Eleanor Powell (University Hospital of Wales)

Project team - Kathleen Shelley (University Hospital of Wales)

Project aims:

The ‘KeepWellNHS’ initiative launched just as the COVID-19 pandemic swept across Europe towards the UK. We braced ourselves for the storm as the shocking headlines and uncertainty of what we were seeing and hearing intensified. We recognised the immensity of the forthcoming challenges associated with an imminent pandemic and the resilience that would be required of a workforce to withstand this challenge.

We felt strongly that a resilient workforce requires both mentally and physically healthy individuals. Much of the local and national efforts in preparation for COVID-19 dealt with strategy, logistics and physical resources but very little was being done in preparation for the mental and emotional strain that would inevitably be felt by the service providers themselves.

The aim of KeepWellNHS was to create a virtual shelter – a peaceful and positive online space and community that boosted morale and provides mentally, as well as physically nourishing resources for individuals and thus, strengthens the overall organisational (NHS) staff wellbeing.

The objectives were multi-fold. Firstly, to showcase the good work, good will and good news from NHS departments and other organisations across the UK in response to pandemic-wellbeing. Secondly, to collate a wide range of mental- and physical wellbeing resources. And finally, to support the local independent businesses in South Wales that looked after our workforce during the pandemic and make our community what it is.

The resources are all located on an easy to access mobile-friendly website (https://keepwellNHS.com) and are linked to the widely accessible social media platforms Twitter, Instagram and Facebook (@keepwellnhs), which are regularly updated. It is open access to all multidisciplinary healthcare providers in the NHS as we were certain that the impact of this pandemic would not only be wide-reaching, but long lasting.

Given the sudden and unprecedented nature of the pandemic, no baseline measurements or surveys took place. The best method of assessing effect and impact in this setting, therefore, is that of online engagement.

Beneficial effects on wellbeing

The initiative launched March 2020 to the following reception:

Website

• To date, the KeepWellNHS website has received 16,458 all-time views. 
• The highest period of engagement was seen from April-May 2020 during the peak of the pandemic (~11,000 views). 
• A recent increase in activity was seen in January 2021, reflecting perhaps the delayed effect of those now seeking support in the wake of the pandemic. 
• The website also has 225 current subscribers who have opted in for notifications of new articles.

Social Media

To date, KeepWellNHS has 1217 followers on social media. In addition to links with other anaesthetists nationally, we have also successfully reached out and made links with a number of other Royal Colleges and national bodies, e.g., Royal College of Midwives, the Royal College of Nursing, the Royal Pharmacological Society and The Royal College of Physicians.

Feedback

We have received formal feedback in the form of comments and messages on the website and social media platforms. Examples include:

‘This resource is fantastic. I am currently a shielding GP trainee and have really benefited from the meditation resources and feel linked in with other HCWs’

‘I think what you guys are doing is ace – just what is needed right now. Please keep it going once this is all over’

‘Going to massively promote this. So important and such a professional website’

‘Fantastic resource and a huge amount of work. We would love to get involved…’

KeepWellNHS intends to continue to the wellbeing of our colleagues by furthering our reach through further social media campaigns and collaborations (detailed later).