Context This case series aims to assess the organisational strategies utilised by two NHS trusts (trust A and B) in North West England in order to improve the well-being of their Healthcare workers (HW) during the time period from December 2019 to March 2021. In the context of existing clinical leadership theory, we investigated what organisational strategies leaders and managers in English hospitals can use to improve the well-being of HWs in response to the COVID-19 pandemic.

1. Establish what strategies are being used by trusts to improve the mental well–being of healthcare workers

2. Ascertain which risk factors are associated with poor mental health during the COVID–19 pandemic in NHS healthcare workers

3. Examine whether strategies can be designed using limited resources to meet the challenging mental health

Issue/Challenge A higher prevalence of mental health issues (MHI) such as depression, burnout, post-traumatic stress disorder (PTSD) and anxiety is observed during epidemics and pandemics. In May 2020, during the COVID-19 Pandemic, Mental health Illnesses (MHI) accounted for 28.3% of all sickness leave in the UK NHS. The highest sickness absence rate (SAR) in the United Kingdom (UK) was reported in the North West England (NWE) at 4.9%; with MHI being consistently responsible for sickness absence, accounting for 31.8% of all sickness leave in June 2020, placing a huge strain on limited resources and patient safety and care.

Assessment of issue and analysis of its causes

Following written, informed consent, semi-structured, 60 minute interviews were conducted via video-conferencing with six participants (clinical managers or directors) of two NHS Trusts in NWE. Interviews were recorded and transcribed verbatim. The transcripts were then read, and Coding was done using NVivo software in an iterative process which used a leadership framework oriented around the interview questions.

We also conducted a retrospective data collection on the average monthly percentage of Full Time Equivalent (FTE) days lost to mental health issues from the trusts’ databases between 1st December 2019 and 1st March 2021 in order to triangulate strategies impact on sickness absence rate.

Impact To date, there is no case study research on the strategies implemented in NHS trusts that address the consequences of the COVID-19 pandemic on HW’s mental health and wellbeing which utilise absence data.

Intervention Trust A had a higher Sickness absence rate versus Trust B, despite the greater funding and larger wellbeing team utilised in Trust A. Understanding early on, via surveys, the needs of HW in Trust B, contributed to their effective response and target of resources. The practical support offered by Trust B may have acted as preventative and proactive measure for poor mental health. Trusts psychological support approach may have only benefitted HW in later stages of MHI, such as PTSD. Nevertheless, Trust B is a significantly smaller trust, with fewer replacements, consequently, HW may feel less comfortable or less able to take sickness absence.

The least engagement in wellbeing strategies was seen in both Trusts amongst Black And Minority Ethnic (BAME) groups. Raising concerns in Trust A and Trust B was aided with BAME ‘listening events’ and a ‘BAME network’ forum respectively. The latter formed part of the ‘governance structure’ of Trust B, ensuring that official reports were acted upon. Trust A also introduced ‘outreach calls’ for nursing staff off sick due to MHI to check in on them with referrals to the Greater Manchester resilience hub and did regular health checks for early prevention of unhealthy behavioural patterns.

Both Trusts highlighted the importance of measuring the efficacy of strategies implemented. However, Trust B reported that due to the ‘fast-paced nature of the start of the pandemic, evaluation was not as important then. Contrarily, Trust A submits quarterly reports on engagement with services, outcomes and feedback as part of their service delivery which they are constantly amending.

Key Messages Both NHS trusts in NWE identified similar risk factors for developing mental health issues and reported similar challenges in implementing wellbeing initiatives. Organisational strategies were dependent on each trust’s needs and outcomes. Our study suggests that practical support may be more effective for stress and fatigue management during the peaks of pandemics in contrast to psychological support which may be more suitable during recovery phases. Screening for psychological issues may highlight areas of support and may enhance engagement with services, particularly in vulnerable population groups (BAME). Ultimately, a whole-systems leadership approach involving the aforementioned systemic change to organisational culture is needed in order to meet the well-being needs of healthcare workers.

Lessons learnt An organisational, rather than individual, approach to re-building team cohesion should be preferred. Furthermore, the focus of interventions in both trusts was individual psychotherapy, with minimal exploration of organisational cultural factors. Even though practical support was seen as superior to psychological interventions in Trust B, both wellbeing strategies may help improve overworked occupational culture.

Self-care coping mechanisms were emphasised more during the peaks of the pandemic. Similarly, according to Avero et.al. 2003 wellbeing initiatives during the peaks of pandemics should help HW cope with stress and trauma, whereas during recovery phases of pandemics they should help with processing psychological trauma.

Identifying common manifestations such as unhealthy eating, smoking and alcohol consumption may be more effective than relying on HW self-reporting. Nevertheless, this system relies on open and honest conversations with HW.