Speaker 1
I’m going to share, I guess, several stories, my own story about, as Carol was saying, what made me interested in well-being at work and how that then took me on to do my PhD and then the stories of the people who’ve been very generous in giving their times as part of my PhD. So I did my masters through the NHS Leadership Academy and any of you who’ve done the Elizabeth Garrett Anderson programme may be familiar with that course, which really introduced me to the idea about qualitative research, was something that traditionally I wasn’t terribly well versed in and had been schooled very much in a quantitative background, particularly as a Physiotherapist, what works for this population? What’s the intervention we’re expecting to see, and what outcome will that provide? So the idea, thinking about more qualitative approaches was a really exciting and novel approach that I, when I finished my masters, I thought I need to find out more about this and the module that we finished on was about compassionate work. I was working as an operational manager at the time and one of the modules, as I say, was talking about if we, if we’re in the business of providing good quality care to our patients, then we need to look after our staff and this was going back to sort of 2014, 2015. So nearly ten years ago now, people weren’t really talking about that and it just occurred to me that we had just sidestepped the most important enabler to being as being able to provide patient care and working as an operational manager I could see some examples of poor behaviours and ways that we weren’t looking after our staff, and I thought there’s lots to do in this in this area and I want to find out more about that, so I became very interested in psychological well-being, and actually what makes us well as a workforce, what makes us well. So I started my PhD back in 2019 so this was pre COVID and I’ve used a method called experience based co design which some of you may be familiar with. Co design principles are much more commonly used now I’ll talk a little bit about what makes it slightly different with experience based co design and my question really was trying to find out well what does well-being mean to people and I don’t know if you want to just maybe as we’re going through this session, just think what does well-being mean to you because back in 2019 when I started my PhD, I found that well-being was very Marmite. Some people really didn’t want to talk about it, some people were all over it. And you may remember we used to have sequins where we used to talk to our Commissioners, and we used to be able to apply for extra money and the well-being sequin was, do you provide nutritious meals in your canteen? Do you offer a flu jab? And do you have a cycle to work scheme? And that was well-being, you’d get your money from your Commissioners if you could tick those boxes and it struck me that well-being was not only wider than that, but was actually incredibly complicated. And when I started my PhD, as most PHD’s do, start with a literature review and I looked at some of the evidence, building very much on the work by Jill Maben, who used to work at Kings College, now at Surrey. And reviewing the evidence in the last 10 /12 years or so, what really struck me was that people talk about well-being as if it’s an already understood concept. So people assume that they know what you’re talking about and over half the articles actually didn’t give a definition of well-being. So I guess when we’re thinking about what, what’s our starting point, do we have an agreed starting point that seems to be lacking. Thing. But also not only was there no agreed definition, there was also the way that it was framed was actually about stress and anxiety and well-being, and the literature was talking about purported to talk about well-being, but was actually talking about the complete opposite. So we talk about well-being by its absence rather than its presence. So this really strikes me that actually we are not only we’re not at a level playing field, but we don’t actually know what well-being is. So when I was looking at my research, I wanted to find out what did well-being mean to my participants, and I’d encourage you to think about what does it mean to you and how might that relate to the people around you and in your organisations? An experience based co design essentially has been used in healthcare specifically by Robert Bates and Glenn Robert, who brought this into healthcare. They used it famously for improving patient experiences through our services, so what would happen is you it’s been used in head and neck cancer, was pioneered, you’d speak to patients and ask them about their experience of going through a cancer, a cancer appointment. You’d filmed the patients, and you would then make a film which was very much the cold light of day, because these were the patients telling you what their experiences were. And then as a group of clinicians and a group of patients, you’d get together and then together you would you view the film, you’d reflect on the film, and then you would think about, OK, what are the parts that that the patients think are the problems? What are the parts that we think are the problems? And then how can we work together through the principles of co design to? Make improvements for service. So as part of my PhD I’m interested to know what could we apply this to the idea about well-being and how we might improve the well-being for, for staff and our organisations. This obviously creates a problem because I’m very clear that this is a sensitive topic. I think people might think about well-being and think about mindfulness and yoga, but we’re actually talking about, can you get up in the morning? What headspace are you in before you’ve even got through the front door? And for some people, these are very, very difficult conversations to have. So how do we handle this really sensitively. So I was very mindful about protecting the anonymity of my participants. So rather than filming, they were very generous with their time. I assured them of their confidentiality and anonymity and I’ll get that in a second. And so I had to think quite creatively about how I might preserve their voices and their stories. So what I’ve done is I’ve created this film that we’re going to play in a second and the words are the words that my participants shared, but they are voiced actually by AI voices. You can make your own assumptions about whether you think it’s effective or not. But what I’d like to do is when we talked, when I talked to my participants and asked them what did they think about what wellbeing at work meant. They then talked about the barriers to well-being and the enablers to well-being, and unsurprisingly, I started my PhD in 2019, I think we all know what happened in 2020 and suddenly COVID, you know, spread like wildfire through everybody and well-being was very much more talked about. But I would argue, not necessarily very better understood, despite the increased profile on it. So, but there is hope. So whilst the whole film is actually 8 minutes and I’ve created an edited version down because of time today. So this is just basically to give you a little flavour and I’d be really interested if you could. We’ll watch the film in a second and then maybe you might want to just spend a minute just reflecting and then we’ll maybe come back together and it would be really useful for me to hear what it then makes you feel because this is what’s called a catalyst film, used to be called a trigger film triggering has, the word trigger has now got other sort of connotations now they’re called catalyst films. But the whole idea is basically to get you thinking, so this is the first time I’ve shared this in public, so thank you, Carol.
Speaker 2
What affects psychological well-being at work?
Speaker 3
The barriers misaligned NHS culture. I suppose I was just trying to advocate for my patient. Cause safety first. Really, and that kind of wasn’t being like listened to. And being kind of like patronised as well. So that kind of just makes you feel like ugh, really rubbish pressurised system.
Speaker 2
You know, get them out. Get them out. Get them out as quickly as possible. Get them out. Get them out. Discharge, discharge. It’s like, well, we haven’t got the resources, we haven’t got this. We haven’t got that knowing some of the patients, I can predict they’ll be back in soon, you know, and that is really heartbreaking.
Speaker 4
Staff struggled to survive.
Speaker 5
I was on shift and found out a member of my family had died, but I couldn’t leave because there just wasn’t enough staff. And there was nothing I could do anyway. But I would never show it like I was tearful with the girls. But you just go back out. Don’t. You.
Speaker 2
Patients suffer.
Speaker 6
Well, I thought I was well cared for all the time.
Speaker 4
But you wouldn’t ask, would you? They said.
Speaker 6
I wouldn’t ask.
Speaker 4
You must ring the bell. That’s what the bells for.
Speaker 6
Ring the bell, ring the bell.
Speaker 4
You wouldn’t, would you?
Speaker 6
Well, I did a time or two when it was necessary.
Speaker 4
Because you had that bed sore, didn’t you?
Speaker 6
Ohh yeah, I’ve still got a bit of a bed sore.
Speaker 4
Because I’d had it all cleared up before you went in. And.
Speaker 6
Yeah.
Speaker 4
It’s back again.
Speaker 3
Enablers, nurturing culture.
Speaker 7
When I came back off sick, one of the staff nurses sat me down and said, you know, how are things going? So I appreciated that. I mean, that’s a long time ago and I still remember, you know, just a simple conversation like that from her.
Speaker 3
Shared vision.
Speaker 8
Some team members you can just work with and not feel like you’re communicating, but you obviously are, but you just work well together and you just kind of know what the other. One’s up to you can kind of trust that they’ve done their bit while you do your bit, and that’s not even like if they’re above you or below you in banding. That’s kind of just as a teammate.
Speaker 3
Staff thrive.
Speaker 9
So when it’s successful and you have those lovely human moments, that’s when it feels like the job is an utter privilege. It’s an utter privilege.
Speaker 3
Patients benefit.
Speaker 10
Because they’re so positive, it made it easier for me to be there and to discuss difficult things with them, especially about having problems, you know. I didn’t feel embarrassed by that at all.
Speaker 1
Thank you, Carol. So I guess the other thing to say though is I also interviewed patients as well to get their perceptions about how staff were feeling, and I was really struck by the way that patients clearly will clearly see what’s happening, clearly see staff under pressure and then modify their behaviour in response to that. That exchange between the patient and his wife about failing to alert that actually they were developing a pressure sore and that particular story really resonated very strongly with me and I thought we build these systems where we’re all rushing around, rushing around, but we’re suddenly our patients become really invisible, and what’s behind that? Curious to understand what’s behind that. But what’s really encouraging, I think, is that despite all of the hard work and we know it is a hard slog out there, people do want to do the best they can and you can see that the way that you talk to people, the way that you listen to people, the talk I was in earlier on today was talking about restorative approaches to safety and asking people how they’re feeling and taking that time to really listen and think about what they need. When we do give people that time and that space, actually, what opportunities and possibilities that opens up and have the patience at the end they’re saying because they were so positive, it actually meant that I could share this embarrassing problem, whatever it was with them and the impact that then has on patients being able to disclose their embarrassing problems. They then get seen quicker, they then heal quicker, they then don’t come back round again and so you can break that cycle. So, what happened next essentially is that I showed this to my participants and we’re in the process now of identifying what they want to take forwards from the wider 8 minute film. We’ve identified 5 priorities or touch points about well-being, about supporting patients to get clear information about their discharge, about escalating problems that staff have getting to work, we’re living in a very rural area, around training for agency staff and the challenges that that gives our staff for their well-being when they have to feel they’ve got to be responsible for the wider ward. And the more social thing, and so one of the things that the ward absolutely celebrated was the fact that they have they look at Christmas, this all happened at Christmas. So they have Christmas celebrations, they have one and cheese they have a lot of social events which actually keeps them together to have those conversations outside of process, task related interactions and find out more about them as human beings and those connections. Well, that’s my story, so I’d be really interested to hear your reflections on my film and any observations that you might have. As well, thank you.