I feel my organisation cares about my health & wellbeing

A discussion paper to help understand what is contributing to the positive NES score on “I feel my organisation cares about my health & wellbeing”

1. Introduction

As for all organisations, the impact of Covid-19 on NES and the individuals, teams and directorates that go to make up our organisation has been unprecedented, and has changed the way we work and live in ways unimaginable 9 months ago.  The impact on our staff; where they work, the way they work, the interaction between work life and personal life has been significant.

NES, as an organisation was well placed to pivot from mainly office-based working to overwhelmingly home-based working as the initial lockdown was initiated. High levels of digital literacy, an advanced degree of remote working capability, a positive approach to smarter working and flexible working allowed for a transition to home working without this being a disabling seismic shock.

However, this positive response, which allowed NES to continue to discharge key responsibilities, does not mean that both the organisation and our staff did not face many significant complex challenges.

2. Understanding the Impact on Staff - Staff Survey

In order to understand the impact on NES staff we carried out a Staff Survey in June 2020, which allowed us to capture, at that point in time, the thoughts, views and concerns of the workforce.  As a first positive indicator we had a 70% response rate.

Partnership engagement from the start enabled a focus on what matters to staff which meant that the question sets we used allowed staff to share their thoughts, feelings, concerns and ideas.

Given the pervasive impact of lockdown and the gradual nature of the move to less restrictive guidance it is unsurprising that 48% of respondents indicated that their sense of wellbeing has worsened to some degree since starting to work from home as a result of the pandemic.

Half of our staff reported feeling ‘burned out’ by their work ‘a few times a month’ or more, and for about 1 in 4 this was once a week or more. Whilst it is not known if this was better or worse before the pandemic, it highlighted an issue which required further investigation and attention.

Some headlines from the survey results which relate to staff health & wellbeing are;

• Support from line managers; of the support available, 88% reported receiving regular support and contact from their line manager, with a similar proportion indicating this was useful. This response may be significant in terms of why staff report positively that they feel NES cares about their health & wellbeing.
• Autonomy; 72% of those who responded felt that they could make up their own mind about things often or all of the time. We know that autonomy is one of the key elements of motivation, and this approach combined with the support from line managers we hope will have had a positive impact.
• Technology; The vast majority (79%) indicated that they could do all the work required of them from home, with only 13% disagreeing; this suggested that the technology available to support the kind of remote working required was meeting workforce needs. NES had already invested in hardware to support smarter working, Office 365 and Teams as our platform, and this investment will have enabled staff to work effectively from home.
• Work / Home life balance; 44% of respondents indicated they found it easy to balance home and work during this time, 22% found it difficult and 29% were neutral. This has emerged as a key feature of the recovery work, and focus groups have been held to further understand and respond to support staff.
• Work stability; 72% reported that the focus of their work had changed, with 65% reporting that they enjoyed their work during this time. This is interesting in that a large number of staff were moved from their normal roles to support Covid-19 related activities such as the Covid Accelerated Recruitment Programme.  Although this contributed to the 72% of staff who had a change of focus, the review of this work highlighted many positives for staff around the empowering approach of the Team Leads, the opportunity for staff to learn new skills and work with new teams, and the sense of contributing to the greater good.

What is working well for staff? We asked staff to tell us what was working well, and the responses are captured in this work cloud.

The top phrases in answer to this question were:

• Being able to carry out all aspects of my job from home
• Using teams to keep in touch with colleagues
• Daily catch ups with my team
• Teams to keep in touch with colleagues
• Keeping in touch and holding meetings
• I have a quiet space to work

What other forms of support? We asked staff to tell us what other forms of support they accessed.

Most common themes coming out of the text were:

• Line manager support
• Catch up with colleagues
• Daily catch ups
• Support from other colleagues
• Regular catch ups
• CEO Video updates

3. What is NES doing that will support and care for staff?

3.1 A focus on Communication

As the impact of the pandemic began to be felt, and critical decisions were made around all staff working from home NES focussed on communication and connection with staff, from all levels and using as many different channels as possible.

From the word clouds and themes above, mention of the CEO weekly video update, regular communication with managers and informal social connections with colleagues featured highly.  The weekly CEO video update, which shares the thoughts of the Executive Team around key issues, plans and challenges was initiated in the very early stages of lockdown.  It has been maintained to this day, has been highly valued by staff and viewed as a positive investment in keeping staff informed. Initially hosted by the CEO, the video is now presented by different members of the Executive Team based on a rota. Webinars have also been held to which all staff are invited.

Key messages are reviewed weekly by the Executive Team and provided on the Intranet Site. Where necessary messages are communicated through all staff emails and in Frequently Asked Questions pages.

3.2 A Focus on Line Manager Support

Line manager support was also viewed extremely positively.  The focus groups indicate that flexibility is a contributor to this, but there is an additional key element which mediates flexibility, which is manager empathy.

When managers have empathy and understanding for their staff and their lives -- when they 'get it', as the staff said, they are more likely to trust, to manage to outcomes, to be flexible in a way that is helpful and to help staff to use the policies that enable flexibility.

Staff told us in the focus groups that managerial flexibility was helpful because it:

• enabled them to balance work and life (e.g. parenting, caring responsibilities), particularly as these were changing on “the journey” through lockdown
• empowered them to stay active and connected with activities and people that mattered to them - whether that was finding new ways to be physically active, gardening, spending time with families. Again, in a context that was challenging, changing and often isolating, this was cited as positive.

It was clear that flexibility was not only about working from home but also about flexible hours and work patterns. Where people experienced stress, it was more likely to be associated with 'digital presenteeism' -- that feeling of being expected to respond immediately ('digital is immediate; people are not') or being tied to the computer.

As the 'journey' progressed, this has become more of a problem, and it's something that we are addressing now through the work of the NES People Recovery Group.

3.3 A Focus on Focus Groups

We recognised that the pandemic has been experienced differently by groups within society, and that will be true for NES staff.  In order to better understand and respond to the experiences of staff in particular groups 3 focus groups were facilitated.  These were:

• Parents & Carers
• Black, Asian and Minority Ethnic Staff
• Disability & Long-Term Conditions

Doctors in Training

As well as providing the training programmes, NES is the single employer for all Doctors in Training (DiTs) in Scotland.  In order to provide support and care for this group of staff, who were, in the main working clinically, the Medical Directorate offered weekly webinars where trainees could connect with a senior member of the Medical Directorate and also with colleagues in the system.  They also provided an e mail “hot line” where trainees could e mail a senior team member with any concerns or questions and this would be answered within 24 hours.  They developed a dedicated Covid support page on the Scotland Deanery website which held key information for DiTs.  

3.4 A Focus on Psychological Wellbeing

NES Psychology developed a range of supports which were for both NES staff, but also for the Health & Care system.  Three podcasts which are based on the e-learning modules developed by NES Psychology:

• Introducing Psychological Wellbeing
• Psychological First Aid
• Resilience for Managers

These were promoted across the organisation, made available via the Intranet and used by individuals and Teams to support psychological wellbeing during this challenging time.

• Resilience and you: This course is open to anyone in NES.  It is an online, safe space where participants talk about what resilience means to them, and where they can see tools and techniques they might apply in their day to day life.  It has proved to be very popular, with very positive feedback.

3.5 A Focus on Technical, Practical and Digital support

NES took a proactive approach to working with staff to make their home working environment as safe, effective and easy to work in as possible.  Most staff had already worked at home at some point, but many infrequently.  Hardware in the form of desktop equipment and office furniture were offered to staff who we recognised would be working from home for some time.

When asked, staff indicated that in terms of what would make a difference to them Digital skills development featured highly with 38% of those who responded to this question indicating that would be useful to them.

In response NES designed, developed and delivered a series of Office 365 Teams development sessions which were aimed at increasing both the confidence and capability of staff in working in this digital way.  These sessions were well attended and evaluated and formed part of an offering to the rest of the Health & Care system as O365 was quickly rolled out across Health & Care.

• A Focus on Coaching: Coaching for Wellbeing

NHS Education for Scotland, in partnership with ‘Know You More’, a digital coaching organisation, offer short coaching sessions to health and social services colleagues in Scotland during the Covid-19 pandemic. The service is aimed at those who:

• want to be more active in caring for their health and wellbeing during Covid-19, but are not sure what to focus on;
• want to make the most of their strengths and preserve their energy as much as possible;
• want to support other colleagues or team members.

This free coaching offer is delivered by qualified and experienced coaches all of whom have experience of working with and coaching health and social services staff. 

The post coaching data consistently shows that coaching has made a strong, positive difference to the overall resilience, wellbeing and morale of those who took up the opportunity.  Improvements in areas of wellbeing, leadership and confidence were shown across all professional areas and role levels in the participant group.   

Participants were asked to provide feedback post-coaching. Some quotes are highlighted below, to help illustrate the perceived value of this service and its impact on them: 

“I have already shared the coaching for self-care opportunity with several colleagues.  I say it put me back in control when I felt life was getting out of control.” 

“I would tell them it has been a transformational experience, which saved me professionally during the most difficult time of my career.” 

“Nothing could have improved my coaching experience. It was a thought-provoking experience and my coach helped me greatly in a very relaxed space. Would be great if this service was available all the time.”  

4. Summary: What has impacted on the positive NES score on “I feel my organisation cares about my health & wellbeing”

• Existing culture & Values: NES as an organisation has a positive, supportive culture which is articulated in “Our Way”, a values and culture model which supports collaborative, compassionate leadership.
• Communication: Frequent, consistent, compassionate and sustained with key messages around self-care and care for colleagues. Communication from, and at, all levels from the Chief Executive, through Directorate Teams to Line Managers and Staff
• Listening: The staff survey indicated to staff that the organisation cared about what was happening to them, and wanted to hear what mattered to them, and importantly what NES could do to help. This started with the staff survey and this has continued with focus groups.
• Positive Line Management: The 88% frequent contact with line manager, and the fact that a similar 88% found it helpful was a significant factor.  The relationships at a Team level both with line managers and colleagues is critical to how staff feel about their work.  The fact that engagement was high, and that NES encouraged and supported the social elements of work with virtual tea breaks, lunches and quizzes appeared to have a positive impact.
• Emotional & Psychological Support: Recognition that the pandemic was having a significant impact on the mental health of at least 50% of our staff meant that resources were developed to offer support.  The on-line sessions, supported by written resources and guidance offered a place for staff to go to help manage the natural stress of living and working through this time
• Practical Support: Staff told us that they needed hardware, software and furniture in order to work safely and effectively from home.  Many staff have been supported with equipment, but we need to do more to support specific groups.
• A Leadership & Management approach: Enabling staff to feel in control of the work they are doing, and to have a reasonable level of autonomy builds the trust and connection between our staff and the organisation.  When allied to training and development to ensure competence, and encouraging the human relationships at work through both work and social connections we create the conditions where staff can perform well, feel supported and trust that the organisation care about their health and wellbeing.

 NES has had to move at speed to deal with Covid related issues and national projects e.g. CARP,

deployment of student nurses and doctors to Boards, employment of student nurses in care homes.  This has required new ways of working, under pressure, for many staff. The measures above have kept the organisation focused and together. There is obviously a way to go and like many, indications are that staff in NES are feeling the strain of the pandemic on their lives at home and work. A Recovery and Renewal governance structure is in place which is overseeing risk assurance processes in relation to use of offices and ensuring scenario planning. Learning exercises have been carried out in relation to several aspects of Covid-19 related work to ensure that those parties involved both within and outside NES e.g. Boards, HEIs etc. feel better prepared to respond to further Covid-related pressures.