What hit the NHS?
The NHS has never experienced such a crisis since its creation in 1948.
Healthcare workers need comprehensive support as delivery of every aspect of care by all clinical and non-clinical departments in the UK’s NHS has been reassessed and fundamentally reorganised to cope with the surge of Covid-19 patients. Modelling assumed an infection fatality ratio of 0.9% and hospital admission rate of 4.4% with 30% of those admitted requiring critical care. The increased demand on healthcare services has been compounded by staff infection risk and 20% absence because of illness or self-isolation. Where administrative/managerial departments have been affected, it has placed increased burdens on frontline workers.
Workforce responses included thousands of medical students beginning work as junior doctors and recently retired doctors being asked to return to work. Those working in education, research, or inspection have been urged to return to clinical duties. Clinical staff have been redeployed to the areas of greatest need, with additional training provided rapidly. The government has also called on military logistical and medical expertise. Doctors in training have lost training and rotation opportunities and the cancellation of exams impacting longer term career progression.
In responding to unprecedented demand, clinicians found it necessary to deviate from the established standards for the management of most conditions. Some patients may be harmed because of undetected deterioration of a longstanding condition or cancellation of planned surgery and treatments. Many doctors have been asked to practise outside their areas of expertise or to exceed their contracted hours. Some groups of doctors may lack confidence in their clinical skills because they have moved into a very different role, graduated early, or not worked for some years.
Infrastructure challenges are vast. Medical beds and critical care capacity required substantial expansion enabled by cancelling elective work, repurposing operating theatres, and commissioning use of private facilities. Increased support for discharging existing patients to the community has been underway. Routine outpatient work has been scaled down to reduce the burden on the hospital and the infection risk to the patients from contact with more people. Some hospitals provided off-site clinics and medications have been delivered by courier. In hospitals and Primary Care Networks, appointments moved to telephone or video calls and services pooled.
The UK government declared the country is now on a war footing. In the new normal, every healthcare worker is under huge strain with the mental, emotional, and physical risks involved in the crisis response. NHS staff are its most valuable asset and react with energy and flexibility. Their health and wellbeing for the greater purpose and benefit of all needs ongoing support.
What showed up locally?
In working with a relatively small yet varied sample of clinicians in the South West of England, it became apparent that in addition to dealing with extreme work-related stress, adjusting to social distancing and worrying about personal health, as well as that of loved ones, doctors initially felt psychologically and physically unsafe to varying degrees. Standard Business Continuity Planning was insufficient. However, there was much to build from and confidence was given a boost that they were not starting from scratch.
NHS England predictions proved to be overly conservative and staff sickness levels reached twice the predicted level in some areas while reorganising resources and scaling at a pace kicked in like never before. To thrive in this unprecedented environment and maintain clinical performance, the doctors needed to access their full resilience, collaborate effectively, nurture relationships and adopt new technologies at speed. Those in both clinical and leadership roles have additional pressures and responsibilities.
It can be hard to balance all these vital elements in a complex and constantly shifting system. Sometimes insecurities or inconsistencies creep in and pressure behaviours show up. Coaching a provided an outlet to put everything under the spotlight and create a new way of being from the off.
What themes emerged?
Whilst preserving the confidentiality of the coaching conversations, themes can be grouped by phases of the crisis. The four phases have been defined by The British Psychological Society, the bullet points emerged and were defined by the medics in using coaching to think through and deal with these challenges:
- Preparation
- Managing preparation for the Covid-19 response and ramping up an over-stretched service
- Recognising that it is a marathon and not a sprint and setting an achievable pace
- Raising awareness of clinician needs and establishing self-care regimes and rituals
- Showing leadership and/or compassion to other clinicians who were lagging on the change curve
- Influencing other people in the system for the greater good/purpose?
- Making sense of a complex unpredictable situation with very little/no data or modelling and multiple unknowns
- Action
- Recognising frustration, fear and role confusion as clinicians rapidly adapt in the current situation
- Managing self and fear of making errors because responding differently or on instinct
- Holding uncertain boundaries e.g. working hours, different location or work/life tensions as family life unsettles
- Dealing with shifting social norms and slipping behaviours as tensions rise ‘Behavioural Slip’.
- Focusing on getting things done causing poor communications and silo working
- Disillusionment and exhaustion
- Coping with the highest psychological peak, high adrenaline, physical and emotional exhaustion
- Facing moral distress and injury to self, co-workers, patients and relatives
- Neglecting physical and emotional self-care
- Wondering how to motivate self and others
- Accessing positivity – personal resilience, strength from relationships/connections, global purpose
- Recovery
- Catching and reframing ‘Intrusive Thinking’ e.g. ‘what should I have done differently?’
- Resenting job, NHS, society etc
- Processing the wider impact on family, society etc
- Referring psychological difficulties e.g. burnout, PTSD etc to qualified professionals
- Changing in a positive way and realising personal and professional growth
Working with a coach is to the mind like working with a personal trainer is to the body. You get better results quicker! A coach walking alongside the doctors on their journeys enabled them to:
- Feel safe, held and established the psychological support they needed at the outset
- Take responsibility for and protect their emotional well-being
- Feel some control over their situation and find a sense of ease that ‘this too shall pass’
- Take time out to process, let it out, make sense and prepare for the challenges ahead
- Appreciate themselves, their learning, growth and be proud of their achievements
- Hold themselves accountable for priorities that had to happen in specific timescales
They tracked their own progress throughout and set the agenda for each session to consider what next, where next and what do I need in this new world?
What we discovered?
There was much to be positive about and even celebrate. The clinicians also thrived in and grew through the adverse and challenging crisis.
As patient demand increased and clinical staff supply decreased, they seemed at their most powerful, effective and compassionate selves. The doctors were able to feel in control of and set their own way of being, behaviours and responses recognising that everyone is doing their best. But more than that – they really got into their ‘flow’ or “mental state of operation in which a person performing an activity is fully immersed in the feeling of energised focus, full involvement and enjoyment in the process of activity”*
The challenge was high and they recognised they had trained long and hard to respond, there was total focus on the task, high professional satisfaction and while at work, a feeling like the outside world had fallen away. The doctors (and the traditional system they operate in) were able to be creative, innovate, productive, adopt new technologies and achieve a paradigm shift at speed. They were able to experience ‘test and learn’ and discover they can enable extra capacity in the system e.g. refocusing routine work to the crisis. Risk management and process protocol built into BAU made this previously restrictive for good reason until the boundaries changed.
Being conscious of the pitfalls and learning from those ahead of our area helped to avoid or minimise them e.g. ‘Behavioural Slip’ and ‘Intrusive Thinking’. While planning for the worst and hoping for the best meant that expectations were realistic yet successes could be easily recognised which was vital for morale, self-worth and human spirit.
What was the impact?
Each coaching partnership provided support, time and space to think, generated learning and actions with commitment to clear measurable outcomes.
- Smoother transition into the crisis and able to hit the ground running
- Self-confidence and self-trust to face challenges and meet unprecedented demands
- Positivity and resilience
- Visible difference in soft skills and reduction in ‘Behavioural Slip’
- Space to process that the world understands them, their value and the greater purpose they have dedicated their lives to
- Enhanced professional satisfaction, learning and growth towards ‘mastery’
- Increased productivity and operational effectiveness
- Reputation and respect
What next?
How can the learning, growth and new ways of doing things be captured and retained in the NHS going forward including but not exclusively:
- Speed of response?
- Collaboration?
- Innovation?
- Clinical developments?
- Scientific knowledge?
- Enrolment of the national support and harnessing society to practically support and volunteer?
In continuing coaching partnerships, the doctors have significant appetite for exploring and thinking through this future to be better prepared, resourced and able to recover from crisis.
Curious to find out more?
I coach modern leaders and teams in dynamic growing organisations – clever people who need to accelerate their leadership maturity, impact and performance to achieve great purpose. In this case, the collective leadership of clinicians in time of systemic crisis.
If you know an organisation, team or a modern leader who would be curious to learn how coaching could benefit them, let’s connect:
victoria@coxenconsultandcoach.com
07812 037728
Interested in supporting the NHS?
https://www.aim-you.com/nhsstaff
https://www.england.nhs.uk/coronavirus/returning-clinicians/
https://www.england.nhs.uk/participation/get-involved/volunteering/
*Mihaly Csikszentmihalyi
