Moral injury and well-being in essential workers during the COVID-19 pandemic: local survey findings

BackgroundEssential workers have faced many difficult situations working during the pandemic. Staff may feel that they, or other people, have acted wrongly and be distressed by this. This represents moral injury, which has been linked with significant mental ill health.MethodsThis survey asked essential workers in County Durham and Darlington about their experiences during the first wave of the pandemic and anything they felt would help. Well-being and moral injury were rated using sliders.ResultsThere were 566 responses. A majority of respondents reported feeling troubled by other people’s actions they felt were wrong (60% scored over 40, where 0 is ‘not at all troubled’ and 100 ‘very troubled’, median score=52.5). Respondents were generally less troubled by their own actions (median score=3). Well-being and moral injury scores varied by employment sector (eg, National Health Service (NHS) staff were more troubled by the actions of others than non-NHS staff).Staff suggestions included regular supervisor check-ins, ensuring kindness from everyone, fair rules and enforcement and improving communication and processes. Respondents offered simple, practical actions that could be taken by leaders at team, organisation, societal and governmental levels to tackle moral injury and the underlying causes of moral injurious environments.ConclusionUsing these findings to develop a strategy to address moral injury is important, not only for staff well-being, but staff retention and continued delivery of vital services in these challenging times. Working together, we can seek to reduce and mitigate ‘moral injury’ the same way we do for other physical workplace ‘injuries’.

Board affiliate pilot: leadership and innovation—creating new opportunities to deliver better patient care

BackgroundLeadership and management have become a key facet of medical training. However, there remains enormous variation in the quality and effectiveness of medical leadership training. This article describes an innovative pilot programme that aimed to prove a new method of developing clinical leaders.MethodsWe undertook a 12-month pilot integrating a doctor in training onto our trust board in a role called the ‘board affiliate’. We collected qualitative and quantitative data throughout our pilot programme.ResultsQualitative data demonstrated a clear positive impact of this role on senior management and clinical staff. Our staff survey results increased from 47.4% to 50.3%. The pilot programme has had such an impact on our organisation that we have expanded the single pilot role into two positions.ConclusionThis pilot programme has demonstrated a new and effective method of developing clinical leaders.

Medical students’ and junior doctors’ leadership and teamwork skills improved after involvement with Simulation via Instant Messaging-Birmingham Advance (SIMBA)

BackgroundLeadership and teamwork skills are essential components of medical education. Simulation via Instant Messaging-Birmingham Advance (SIMBA) is an innovative simulation-based learning tool mainly delivered by medical students and junior doctors. This study aimed to investigate the effect of SIMBA on leadership and teamwork skills of medical students and junior doctors during COVID-19.MethodsAll medical students and junior doctors involved in the delivery of SIMBA were invited to complete the Leadership Trait Questionnaire (LTQ) and Teamwork Skills Questionnaire (TSQ) assessing their views pre-SIMBA and post-SIMBA involvement. The changes in scores were analysed using the Wilcoxon signed-rank test. Open-ended questions were reviewed in an inductive thematic analysis.ResultsA total of 33 SIMBA team members completed both questionnaires. There was improvement in all traits measured in the LTQ and TSQ, significant in 9/14 LTQ traits, and all 6 TSQ traits (p<0.05). ‘Decision making’ had the highest improvement (p<0.0001). Response to open-ended questions reported positive effects on personal development, medical professionalism, communication skills and medical/clinical knowledge.ConclusionsSIMBA is an effective model to inculcate leadership and teamwork skills among medical students and junior doctors. Prospective studies are underway to assess long-term impact.

Designing the careful and kind clinic: an evidence-based approach

BackgroundThere is evidence that creating a ‘healthy workplace’ can be of profound importance for clinicians, team members and patients. Yet there have been few papers that have proposed mechanisms to take decades of research and translate this into a practical list of options for leaders and managers to take into account when structuring a clinic based on care and kindness to achieve optimal health.EvidenceWe bring together 20 years of scholarship linking care of the caregivers with outcomes for caregivers and patients. The data are used to support both structures and cultures that will result in satisfied and thriving healthcare team members, as well as satisfied and healthy patients.ResultsThe clinic based on care of the caregivers will be structured to address key aspects of worklife that are known to cause either satisfaction or burnout. Aspects of care, such as time pressure, chaotic environments and worker control of their workplace, will be taken into account in clinical design; organisational culture will be supportive and cohesive, emphasising quality, values and communication. Experiences based on gender and race will be measured and continuously improved; and performance will be evaluated in a new, human-centred manner.OutcomesThe careful and kind clinic will be a remarkable place to work; in contrast to industrialised healthcare, this will be an environment where health can indeed be optimised, for both workers and patients.

Association of women leaders in the C-suite with hospital performance

BackgroundWomen comprise 50% of the healthcare workforce, but only about 25% of senior leadership positions in the USA. No studies to our knowledge have investigated the performance of hospitals led by women versus those led by men to evaluate the potential explanation that the inequity reflects appropriate selection due to skill or performance differences.MethodsWe conducted a descriptive analysis of the gender composition of hospital senior leadership (C-suite) teams and cross-sectional, regression-based analyses of the relationship between gender composition, hospital characteristics (eg, location, size, ownership), and financial, clinical, safety, patient experience and innovation performance metrics using 2018 data for US adult medical/surgical hospitals with >200 beds. C-suite positions examined included chief executive officer (CEO), chief financial officer (CFO) and chief operating officer (COO). Gender was obtained from hospital web pages and LinkedIn. Hospital characteristics and performance were obtained from American Hospital Directory, American Hospital Association Annual Hospital Survey, Healthcare Cost Report Information System and Hospital Consumer Assessment of Healthcare Providers and Systems surveys.ResultsOf the 526 hospitals studied, 22% had a woman CEO, 26% a woman CFO and 36% a woman COO. While 55% had at least one woman in the C-suite, only 15.6% had more than one. Of the 1362 individuals who held one of the three C-suite positions, 378 were women (27%). Hospital performance on 27 of 28 measures (p>0.05) was similar between women and men-led hospitals. Hospitals with a woman CEO performed significantly better than men-led hospitals on one financial metric, days in accounts receivable (p=0.04).ConclusionHospitals with women in the C-suite have comparable performance to those without, yet inequity in the gender distribution of leaders remains. Barriers to women’s advancement should be recognised and efforts made to rectify this inequity, rather than underusing an equally skilled pool of potential women leaders.

Case for mandatory COVID-19 vaccinations for workers in health and aged care settings: a guide for leaders

BackgroundThis brief paper provides an overview of the analysis in support of mandating COVID-19 vaccinations for all workers in health and aged care settings in Australia. Leaders of health and aged care organisations have a duty of care under work health and safety legislation to eliminate and/or control the risk of transmission of vaccine-preventable disease in their facilities, including COVID-19.MethodsKey issues that should be considered by healthcare leaders when mandating that all health and aged care workers be vaccinated against COVID-19 were analysed by executives from a large Australian national health and aged care provider and discussed in this paper.ResultsThis paper summarises the medical/scientific, ethical, legal, work health and safety, workers’ compensation and industrial relations considerations when mandating COVID-19 vaccination for healthcare workers.ConclusionLeaders of health and aged care organisations must provide a safe environment and workplace for all those who work for them, as well as for those who receive care or treatment at one of their facilities. It is hoped that this paper will assist leaders of healthcare organisations in making their own decisions during this time.

Deliberate practices of speaking up and responding skills: the Speak-PREP e-learning module for healthcare professionals

PurposeSpeaking up and responding to others’ concerns promotes patient safety. We describe health professionals’ utilisation of these important skills.MethodWe developed an interactive e-learning module, Speak-PREP, to train healthcare professionals in speaking up and responding strategies. Participants completed interactive video-based exercises that engaged them with entering speaking up and responding statements, augmenting strategies from a list of prompting phrases and responding to a pushback. We report strategy utilisation.ResultsA total of 101 health professionals completed Speak-PREP training. Most frequently used speaking up strategies were: brainstorming to explore solutions (50%), showing consideration of others (45%) and encouraging others’ opinions through invitations (43%). Responding strategies included reflecting the concern expressed by colleagues, discussing next steps and expressing gratitude (70%, 67% and 50%, respectively). When prompted, participants augmented their statements with reframing concerns, asking questions to deepen understanding, using how or what to start questions and expressing curiosity (p<0.00001, p=0.003, p=0.0002 and p<0.0001, respectively). Pushbacks lead to increased use of reflecting the concern and decreasing consideration, curiosity, empathy, expressing gratitude and encouraging others’ opinions (p<0.05 for all).ConclusionsThe Speak-PREP module targeted deliberate practice in speaking up and responding skills. Future work should examine the application of these strategies in the clinical environment.

Intersectional effects of gender and ethnicity? A quantitative analysis of bonus pay gap data for Shelford Hospital consultants

BackgroundMale hospital consultants earn 13% more than their female counterparts. The intersectional effects of ethnicity and gender are not known.ObjectiveTo describe and analyse the mean bonus pay gap in terms of gender and ethnicity for consultants across the Shelford Group.DesignCross-sectional study.SettingHospitals in the Shelford Group.ParticipantsShelford Group hospitals.Main outcome measuresMean bonus pay gap for male vs female and White vs Black, Asian, Minority Ethnic (BAME) consultants.ResultsSeven of the 10 Shelford Group hospitals provided data for financial year 2018/2019. The average mean bonus gender pay gap was in favour of male consultants (30%; range 12%–48%), and also favoured White consultants compared with BAME consultants (17%; range 7%–31%). The average mean bonus pay gap between White male and BAME male consultants was 20% (range 7%–34%) in favour of White male consultants, while that for White male and BAME female consultants was 46% (range 26%–60%) in favour of White male consultants.ConclusionsOur data show for the first time that there may be an intersectional effect of gender and ethnicity associated with mean bonus pay for consultants. Action is needed to address this imbalance.

Building leadership capabilities in maternity

BackgroundOver recent years, there has been increasing recognition that effective leadership is critical to establishing positive organisational culture and improving patient outcomes. In maternity, there is a unique interplay between different specialties and disciplines in providing high-quality services.MethodsReview of literature pertaining to leadership and maternity.ResultsGood leadership is the key determinant in ensuring that our multi-professional teams function effectively. The relational aspects of teamworking, linked to safer delivery of services, have been explored in great detail in maternity services. However, there has been less focus on the application of leadership theory in this environment and the impact of interventions used in developing leadership skills within maternity teams.ConclusionsIn this paper, we discuss how leadership theory can be used to understand high profile maternity service failures and how effective team culture, clinical team building and individual leadership skill-development are strong contributors to this thinking. Specific examples are used to describe ongoing work in our drive for improvement and to highlight the current lack of evidence in this area.