Case study summary
A perception of increasing workloads and feeling stretched prompted staff at Talking Therapies Service Brent to take stock of how systems were working and focus on how things could be done differently to bring about positive changes in employees’ wellbeing.
The Central and North West London (CNWL) Talking Therapies Service Brent is a large and well-established Improving Access to Psychological Therapies (IAPT) service run by CNWL NHS Foundation Trust. The team receives a high volume of referrals with a broad range of clinical presentations and consistently meets clinical commissioning group targets. Good relationships have been established with community organisations and the physical health care sector for joint work and service promotion.
Alongside high and low intensity cognitive behavioural therapy (CBT) interventions, the service provides brief counselling as part of step 3 treatments. Services are provided across the main hubs, health centres, voluntary sector organisations and some GP practices across the borough of Brent. Regular case management and clinical skills supervision are provided to all staff and there is a good system for peer support. Overall, the service’s retention rates are good; this year, for example, the service retained all its High Intensity trainees in qualified positions that were offered.
There was a general perception amongst staff of feeling stretched, that workloads were increasing and that it was time to take stock of how systems within the service were working.
A staff wellbeing survey was carried out in June and July 2016 and sent anonymously to all staff by the team’s Wellbeing Lead. Results were collated and feedback at a team meeting in November 2016. Broad themes that emerged were (a) staff feeling pressured to meet targets and a sense of the ‘relentlessness of IAPT’, (b) improvements needing to be made in communication and provision of feedback, particularly around performance, and (c) frustrations caused by the physical environment such as IT and lack of space for clinical and administrative work.
A half-day was set aside to discuss these themes in December 2016. This was done ‘in house’ with a ‘bring a dish’ team lunch facilitated by the team’s lead counsellor. It included exercises and small group discussions and a coming together at the end of the day to feedback on actions and plans. The group acknowledged positives such as openness, respect for each other, presence of clear systems and procedures, consistent and good quality supervision, the cultural and linguistic diversity within the staff team and an overall helpful atmosphere.
The focus was very much around looking at what we could all do differently as a team and as individuals to contribute to positive changes.
Specific suggestions were made such as (a) changing the structure of team meetings to make them more inclusive and the sharing of a positive experience (for example positive feedback from a service user, an outreach presentation that had gone well), (b) reflective practice groups for staff, (c) more focus on clinical skills for step 2 staff, and (d) doing things as individuals to manage wellbeing in the workplace such as lunchtime walks, breaks, and taking lunch breaks instead of eating at one’s desk. The plan was to repeat the wellbeing survey in a year’s time.
All the recommendations made above were implemented and the staff wellbeing survey was repeated in June 2017. The wellbeing survey questions were changed slightly to incorporate questions from the CNWL NHS Trust’s own Staff Wellbeing Survey which were felt to be relevant. For both surveys, there were four broad areas which included work satisfaction, intrusion of work into personal life, employer care and organisational respect for the employee and subthemes under each area. Completion rates for both surveys were high with over 80% of staff completing it fully.
The 2017 survey results were fed back at a team meeting in August 2017 and indicated that staff ratings were in the very high to moderately high range for all areas. Good supervision, taking breaks, being boundaried with time; peer support and self-care were identified as factors contributing to wellbeing. Frustrations mainly were work systems, relationships with other teams and a sense of reduced control over workloads.
With regard to next steps, the team has a Wellbeing Lead who is collating ideas to put a bid together for a staff wellbeing bursary which is offered through CNWL NHS Trust to support an activity or initiative to help staff wellbeing. A number of these have already been granted to other staff teams to use at break times or after office hours such as Zumba fitness, Pilates, power walks and yoga.