Health and social care organisations in Derbyshire have been working closely together for some time, to improve care and services for people and make them as efficient and effective as possible.
As a manager, you may feel concerned about your capacity to support your staff through this unfamiliar and exceptionally demanding situation. You may feel ill-equipped to manage this level of staff distress, lacking in support for yourself, and unsure of the ‘right’ or ‘wrong’ thing to do.
The first thing to emphasise is that you are human - it is reasonable to expect that you might have some emotional and psychological reaction to the circumstances that you are encountering. The resources in this web area are equally applicable to you, they are relevant for everyone.
The resources below are some of the key documents that underpin the support offer at Joined Up Care Derbyshire, and some additional resource hubs that may be useful for you as a leader.
Conversations around new roles with staff can feel difficult. We’ve put together this brief practical guide to assist you with these conversations.
It’s normal for us to struggle with uncertainty and the unknown
Studies have found that uncertainty is often more stressful than circumstances when we know for sure the outcome, no matter how bad that is. We are all hard-wired to find uncertainty stressful. We have a brain that has evolved to predict, and then avoid, negative consequences. So, when uncertainty is high and we don’t know whether or not something difficult may happen, our protective system is fired up. This makes sense for our survival.
However, this in-built way of processing means that conversations about new roles in this situation can often feel challenging.
Key things to remember when you are having conversations about new roles with staff:
Brief tips for having a ‘coaching-style’ conversation with staff around taking on a new role
Some types of communication have ‘push’ energy and some have ‘pull’ energy. Under pressure, we may ‘push’ – this can create immediate resistance or push back and impact the relationship. ‘Pull’ helps us understand concerns and can build relationship and mutual problem-solving. When dealing with anxiety, ‘pull’ and listening to concerns before making suggestions is advisable.
An example conversation might therefore be:
So, we’re going to talk about you undertaking X role, how do you feel about taking it on?
So – my concerns are that I’ve never done it before, I’m not trained in it and it would bring me into closer contact with people who might be covid-19 positive.
What may help your staff to feel able to take on their new roles?
Crucial elements of performing in demanding environments and roles, such as those your staff may be moving into, are control, confidence and an approach focus:
Control: the belief that we have or will have some control over our performance leads to a ‘challenge’ state. Conversely, ‘threat’ states arise from focusing on situations that cannot be controlled. Challenge states lead to better decision-making and performance… Can you support your staff to focus on the control they will have over the way they do their new role rather than the aspects they may have less control over?
Confidence: the belief in our ability to perform well and execute plans correctly. A high level of confidence is important for a challenge state, and the reverse is true for threat… Can you support your staff to have increased confidence in their new role? How are their skills transferable? Have they managed something in the past that may help with this?
Approach focus: this is a focus on what can be achieved, rather than focusing on failure and what can go wrong… Can you support your staff to focus on the value of the role they will be performing, and what they may be contributing as part of this (as opposed to what might go wrong if they do the role)?
In summary: Emphasise the qualities your staff have (confidence), draw attention to what they can control (control) and keep a focus on what can be achieved (approach focus) (adapted from Jones M. Crest Security Review. 2019;10).
Looking after your team and colleagues
The King's Fund has produced a really helpful video on looking after colleagues at this time, that may be of interest.
Principles for responding well in this active phase to sustain staff well-being
You may be wondering about how to best support your team during the active phase of this situation. The principles below are from guidance available from the NHS and professional and specialist trauma bodies including Psychological First Aid.
Most of our own and our colleagues' reactions will be healthy and normal responses to immense stressors. Thus we must be cautious in thinking through our responses at organisational, team and individual levels and be mindful of not stigmatising normal human reactions as ‘lack of resilience’.
Support basic needs - this includes access to food and drinks, breaks, spaces to relax, and adequate equipment and training.
Have a communication strategy and keep information simple.
Communicate regularly with staff using simple messages. May involve passing on trust communications to those not regularly accessing intranet. Be visible, available and supportive. You do not need to have all the solutions all the time!
Normalise responses - it is important that staff know that feelings such as fear, anger, exhaustion, and numbing are common during a crisis situation. ‘Normal human responses to abnormal events’.
Stay connected - providing and encouraging opportunities to connect with peers helps people remember that they are not alone in a crisis. Consider regular 'check-ins' and 'check-outs' at the start and end of each day/shift. Maintain connections with remote workers to replace face-to-face contact.
Provide information on further support - be clear on what support is available and how it can be accessed, so you can provide this information when necessary. See below.
Acknowledge difficulties – and successes. It is important to acknowledge the pressures that people are under, and to appreciate the commitment and care staff are showing during this difficult time.
Take care of yourself and pace yourself. This is a marathon, not a sprint!
Your main task will be to listen well to your staff at this time. Listening may be one of your strengths, or you may be wondering whether you could improve your listening skills. Samaritans have produced a 45-second video on listening well with some simple tips such as using open questions and saying back what you’ve heard. Remember to pause, often staff will fill the gaps.
You may have heard of a person-centred approach, the key principles of this may be useful to consider in your interactions with staff at this time:
Empathy and sympathy are very different, and understanding this difference may help you support your staff effectively at this time. A short video by RSA (three minutes) provides a great illustration of the difference – empathy is described as ‘getting alongside’, sympathy can be experienced as pity by some.
You may be concerned about how to support a staff member when they are upset. There are a few things to consider that we know to be helpful:
It may be helpful for you to have an awareness of the three main phases of staff support during Covid 19. This may help you to anticipate, recognise and respond to the common emotional health needs of your staff throughout this period.
You and your teams may be at different stages (depending on setting, role, task, and locality). Some of you may feel you are in the preparation stage – some may feel they are in the active stage. You may also feel that you are cycling between these stages.
Summary of the three stages of staff support (opens new document)
Increasing the psychological safety of your team
We recognise that at present it is normal for staff not to feel fully safe, this is a time of significant uncertainty for many colleagues. It is therefore important as a leader to think about what you can do to increase your team’s sense of psychological safety.
Here are some key tips to consider at this time:
Model care and compassion
Start with yourself, and your self-care and self-compassion (we are often better at giving this advice to others, than applying it to ourselves). Then, think about ways you can show care and compassion to your team. Checking in with staff, making time to talk (in whichever medium this may be), if you are in work together supporting staff to take a break and get access to food/drink and anything else that may make them more comfortable. Thank staff for their hard work, adaptability, care and compassion. Perhaps there may be a role for you to advocate for your staff to have the things/spaces/set-up they need to look after themselves (it may help to work with your wellbeing lead on this).
In advance, discuss with teams that distress, worry, anxiety and fear is an understandable and human response to threatening events such as this.
These emotions can be scary for staff to experience, particularly if they usually feel quite calm in other very demanding situations that they face. It can be helpful to normalise their reaction to this situation, reminding staff that they are not ‘failing’ or ‘being negative’. It’s okay not to be okay at this time – and also to move between being okay and not okay. It is also doesn’t mean staff can’t do their jobs, or that they are ‘not good enough’; which may be a concern for some staff.
Ensure your team feel supported in being able to talk about worries and concerns
With whom can they speak and when? Where can they speak, is there a supportive space? Is it possible to set up a physical space for staff, or a virtual space if staff are remote working? How can they speak with you? How and when do they find it helpful to communicate with you? Can you make space for this? Consider the following three questions to generate supportive conversations - What went well today? What was difficult? Are you ok?
Ensure colleagues who may be experiencing difficulty balancing commitments to service against responsibilities at home (for example, childcare, fear for vulnerable family) have opportunity to discuss these concerns and, ideally, resolve them with you or your colleagues.
Managing a remote team – perhaps for the first time
If you have suddenly found yourself managing a remote team you may be wondering whether you are ‘doing it right’, or if you are doing what you can to support your team. Ethos Consulting have produced this helpful summary of tips to consider as a leader, if you are leading a team where some or all of your staff are remote working.
Top tips include providing clear direction, supporting your staff to know ‘what’ to do (not necessarily telling them ‘how’ to do it), and minimising emails (using calls to build trust and relationships).
Advice from other leaders
MindEd have developed great information and advice for managers and leaders at this time, including advice from other leaders from their experiences of this pandemic – their key tips being:
Meeting the psychological needs of your team at this time
We know there is a lot of advice out there about meeting the psychological needs of staff at this time. It can get quite overwhelming and confusing.
This brief document - system-wide support offer - developed by clinical psychologists within the Derbyshire network, is intended to offer some clear guidance and tips as to how leaders and managers of all clinical and non-clinical staff may best meet the psychological needs of their teams at this time.
This guidance document has been written for leaders of staff at this time by a consultant psychologist working within Joined up Care Derbyshire. There is information on common psychological responses and things that may be helpful for staff.
The gov.uk website provides adult social care employers with guidance, tools and advice on how to take care of the wellbeing of staff at work.
Psychological first aid, as opposed to psychological debriefing, is the evidenced-based approach after recent exposure to trauma (World Health Organization recommendation, 2009).
Psychological first aid is not professional counselling or something only professionals can do.
The main themes of psychological first aid are:
Psychological First Aid for Field Workers (opens document)
MIND has produced guidance on supporting employees with mental health difficulties. This includes advice on opening up the conversation, and tips for supporting staff.
How to support staff who are experiencing a mental health problem - Mind (opens document)
General mental wellbeing – NHS Employers has a webpage focused on mental wellbeing with a few key tips for supporting staff and linking to other sources of support such as the Mental Health Foundation.
The Intensive Care Society has produced a range of resources, and tips for improving workplace wellbeing.
Mental Health at Work toolkit – a resource site for a range of tools that may be suitable for helping you to support your staff at this time (including the 'how are you feeling NHS tool', the Every Mind Matters Hub, and Head First - a set of resources designed for ambulance staff).
The Inter-Agency Standing Committee (IASC) has produced a 20-page briefing document on addressing the mental health and psychosocial aspects of the current situation. The document outlines common responses, overarching principles for the response and globally recommended activities.
Briefing note on addressing mental health and psychosocial aspects of Covid-19 outbreak (opens document)
Recovery and restoration phase: advice for managers and service planners
We are now in the “Restoration and Recovery” phase of service planning connected to the Coronavirus pandemic and so there are different challenges coming our way
In terms of staff support and wellbeing there will be new issues to face in the coming months. While in the early phase of the pandemic, staff were “in the eye of the storm”; feeling overwhelmed, anxious or in “coping mode”. Some were perhaps feeling inspired, supported and bolstered by the public recognition of the hard work taking place in the NHS and social care too
Now there has been a shift with lockdown measures easing and the public moving forwards; the number of patients coming into services with the virus may have lessened and there could be a lull in some areas of patient care. Some staff could be feeling exhausted having given up their own family and social lives for the sake of their work. Others may feel disillusioned with society “returning to normal as though nothing has happened”. Though there is a positive side to this phase in that certain normal activity and services can now plan to resume, it is fair to acknowledge that all of the changes experienced over the past months have been considerable for many staff to bear
Staff may be feeling as though their energy levels are low and they are anxious about planning discussions about “a second wave” of Coronavirus in the winter months. There may be a sense of “do we have enough energy and resources to go through this again?”
On the flip side there may be some really great positives that have come from this pandemic; some services have streamlined their activities and many staff may feel more inspired and motivated than before
The following is some information to help you think about how to work closely with your staff team to check in with how people are feeling on all levels so that they can be as well prepared as possible for the next phase of working.
The concept of “emotional PPE”
The concept of emotional PPE is a helpful analogy and in service terms is made up of the following ingredients. First; good education, resources for wellbeing along with strong teamwork and leadership. Second; having a useful peer support framework for staff and third; having access to strong psychological and professional care where needed (this can come in the form of supervision or external therapeutic contact).
There are various ways of safeguarding staff in an emotional way so that they feel they can do their jobs safely. The following ideas can help to foster resilience in your team and encourage healthy wellbeing.
1. Permission: giving staff the message that it is OK not to be OK at any stage of the virus and service developments. Developing strong supervision systems but also having the concept of a “go to” peer for staff; someone they identify as being supportive that they can share with if necessary.
2. Pacing: encourage good basic routines which are the foundations of good health: breaks; know when to step away; pace self in a graded way if returning to work after shielding or redeployment. Encouraging the idea that it’s not a sprint or even a marathon - this time it’s more like a triathlon!
3. Processing - allow time for sense-making and storytelling. Encourage use of CPD time for webinars and supervision for this. Also encourage making use of Schwartz rounds, reflective time and team meetings (even remotely) to allow space and time to talk through how everyone feels.
4. Perspective and checking-in - make time to ensure feedback loops and supervision time is in place. Asking the team “are we doing the best that we can under the circumstances?” Giving the message that people need to aim for “good enough” rather than placing pressure doing too much or withdrawing and doing too little (due to burning out).
5. Encourage non-verbal activities which will allow people to “process” any difficult experiences or emotions; walking, gardening or running can be helpful. Physical activity is a good way of mentally processing without having to discuss emotions. A special note here for watching out for “quiet staff”; they might need some extra processing time but don’t always want to “talk”.
Key reading for managers
Depending on your staff group, and their experiences, some of the information booklets below may be relevant, and provide you some helpful tips to consider when offering support to your staff.
General advice on providing emotional support at this time
Interested to know more about what to say, or not to say, to support staff in distress? Wondering how to best approach things to support and reassure your team?
Take a look at this Leaders support pack from Northumbria Healthcare for some great tips (page 5).
Anxiety and fear
Do you staff seem to be struggling with anxiety about return to workplace? Return to certain roles? Daily life? See ‘anxiety and fear’.
Are you wondering about how to keep motivation levels up as the situation progresses and continues? See ‘motivation’.
Would you like to know how to boost resilience within your staff team? See ‘resilience’.
Would you like to know what might help staff feel safer in work, and in their roles? See ‘psychological safety’.
Are you noticing or hearing about staff feeling uncomfortable about things that have happened or didn’t happen? See ‘moral injury’.
Wondering how to support your staff to practise self-compassion?
Take a look at these guides for some great tips – the 10-minute version and the five-minute version.
Please see our Someone to speak to and self-care support website section.
NHS England are running leadership support circles that are free and open to everyone. Take a look and get booked on (they are popular, so worth getting your name down fast).
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