Reset - the First Step in the Clinical Wellbeing Pathway

Background The COVID-19 pandemic has highlighted the importance of wellbeing support for frontline clinical staff. The newly introduced Great Ormond Street Hospital (GOSH) Clinical Wellbeing Pathway aims to provide consistent support to clinical teams following challenging or distressing events at work. RESET is the initial step in this pathway. It is a brief, facilitated conversation between clinical team members, taking place during the shift in which the clinical event has occurred. 'RESET' is an acronym that encompasses five key themes: Recognise, Evaluate, Stuff still to do, Elevate staff, Taking things forward. Method We used an action research methodology, where the design and clinical outcomes were co-created with the relevant staff groups. This comprised of an e-survey on existing clinical practices, expert consultation, facilitator training and pilot with ongoing qualitative feedback from staff on two pilot wards. Results Limited responses from our E-survey on existing hot debrief practices at GOSH highlighted that debriefs did not occur consistently but when they did, they were beneficial. Respondents indicated that training on facilitating debriefs would be well received. Feedback from the expert consultation (n= 14) highlighted the impact of terminology on clinical staff. Therefore, the language of the acronym was adapted accordingly. Feedback also highlighted the important role of the RESET facilitator, being able to respond flexibly and organically to the uncertain and potentially emotive conversations. Preliminary feedback from two facilitator training sessions with senior clinical staff (n= 11) identified the RESET tool and facilitator training is beneficial. Conclusion This phased introduction of the RESET tool has demonstrated that the proforma and accompanying training is viable to assist in the structure of post-event conversations. Clinical impact has yet to be assessed and we continue to pro-actively gather feedback on the utility and barriers to RESET conversations throughout our ongoing pilot study.

Co-designed strategies for delivery of positive newborn bloodspot screening results to parents: the ReSPoND mixed-methods study

BACKGROUND: Newborn bloodspot screening identifies presymptomatic babies who are affected by genetic or congenital conditions. Each year, around 10,000 parents of babies born in England are given a positive newborn bloodspot screening result for one of nine conditions that are currently screened for. Despite national guidance, variation exists regarding the approaches used to communicate these results to families;poor communication practices can lead to various negative sequelae. OBJECTIVES: Identify and quantify approaches that are currently used to deliver positive newborn bloodspot screening results to parents (phase 1). Develop (phase 2), implement and evaluate (phase 3) co-designed interventions for improving the delivery of positive newborn bloodspot screening results. Quantify the resources required to deliver the co-designed interventions in selected case-study sites and compare these with costs associated with current practice (phase 3). DESIGN: This was a mixed-methods study using four phases, with defined outputs underpinned by Family Systems Theory. SETTING: All newborn bloodspot screening laboratories in England (n = 13). PARTICIPANTS: Laboratory staff and clinicians involved in processing or communicating positive newborn bloodspot screening results, and parents of infants who had received a positive or negative newborn bloodspot screening result. INTERVENTIONS: Three co-designed interventions that were developed during phase 2 and implemented during phase 3 of the study. MAIN OUTCOME MEASURE: Acceptability of the co-designed interventions for the communication of positive newborn bloodspot screening results. RESULTS: Staff were acutely aware of the significance of a positive newborn bloodspot screening result and the impact that this could have on families. Challenges existed when communicating results from laboratories to relevant clinicians, particularly in the case of congenital hypothyroidism. Clinicians who were involved in the communication of positive newborn bloodspot screening results were committed to making sure that the message, although distressing for parents, was communicated well. Despite this, variation in communication practices existed. This was influenced by many factors, including the available resources and lack of clear guidance. Although generally well received, implementation of the co-designed interventions in practice served to illuminate barriers to acceptability and feasibility. The interventions would not influence NHS expenditure and could be cost neutral when delivered by teleconsultations. LIMITATIONS: Participants with a pre-existing interest in this topic may have been more likely to self-select into the study. The researchers are experienced in this field, which may have biased data collection and analysis. COVID-19 hindered implementation and related data collection of the co-designed interventions. CONCLUSIONS: There was variation in the processes used to report positive newborn bloodspot screening results from newborn bloodspot screening laboratories to clinical teams and then to families. The various practices identified may reflect local needs, but more often reflected local resource. A more consistent 'best practice' approach is required, not just in the UK but perhaps globally. The co-designed interventions represent a starting point for achieving this. FUTURE WORK: Future work should include a national evaluation study with predefined outcomes, accompanied by an economic evaluation, to assess the acceptability, feasibility and usability of the co-designed interventions in practice nationally. TRIAL REGISTRATION: This trial is registered as ISRCTN15330120. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research;Vol. 10, No. 19. See the NIHR Journals Library website for further project information.

Inverting the wellbeing pyramid: The GOSH approach to looking after staff wellbeing

At the start of the COVID-19 pandemic experts in trauma and psychology advised about the importance of ensuring the mental and emotional well-being of staff was being considered and supported. Most of the literature and experts advocated a layered, hierarchical intervention approach. At Great Ormond Street Hospital (GOSH) we elected to 'invert the pyramid', mobilising the 'specialists/experts' to create a virtual well-being hub and that overtime layering and blending other interventions as suggested in this classical model. One of the key successes of the COVID crisis at GOSH has been our ability to raise the profile and importance of staff wellbeing across the organisation and this has been well received. The hub continues to remain the centre of our work and has been active identifying, triaging and providing psychological first aid or referring staff for external mental health treatment. In the recovery phase we have extended the 'expertise' to Peer Support Workers, TRiM Practitioners and Well-being Coaches that have collectively formed a pan-trust well-being network to meet the needs of the COVID-19 but also the smaller, repeated and significant traumas that we face when working in healthcare.