Meeting with Health and Safety Adviser (LE)
Cheshire and Wirral Partnership NHS Trust is four years old. Lyn Ellis joined in March 2004 from Conwy and Denbighshire NHS Trust which already had a stress policy and management arrangements in place which seemed to be having some impact.
When Lyn arrived at the Trust she asked what was happening in the light of improvement notices being issued by the health and Safety Executive (HSE) at other trusts. At the time there were specific initiatives to tackle stress but the Trust had a well established Challenging Stigma campaign and was developing a Mental Health Workplace Charter. Lyn spoke with the director of human resources, who had attended a human resources conference at which ‘Willing 100’ was mooted, about the matter. Following this, Lyn spoke to the Trust Health and Safety Committee about the possibility of taking part in the project and HSE were happy go ahead. The Trust was running a Challenging Stigma Campaign and also supporting a Mental Health in Employment Charter.
Lyn said: “The whole experience has been very exciting for me”.
The Trust has approximately 2700 employees on 75 sites throughout Cheshire and Wirral. This includes large hospital sites, wards, resource centres, supported housing and out-reach teams. The Trust provides mental health, learning disability and drug and alcohol services to Cheshire and Wirral.
HSE Stress Partner- July 2005
The director of nursing, therapies and patient partnership, who had just taken over the risk management role for the Trust, offered to take the executive lead on the project as she was also leading the Challenging Stigma Campaign and the Mental Health Workplace Charter.
Used HSE methodology. The Steering group was worried about survey fatigue i.e. the NHS staff survey was distributed shortly before the stress management survey).
Unsure if IT system would be able to deliver an electronic version of the questionnaire. Additionally, quite a lot of people didn’t have access to individual e-mail and those who did expressed worries about confidentiality issues.
Trust had lots of data on sickness absence - stress, anxiety and depression accounts for 18% of total with uncertified short spells of sickness accounting for 18.5%.
The launch of the revised Managing Attendance policy was already underway to include more detailed sickness notification and introduction of return to work interviews – allowed identification of ‘hot-spots’.
The NHS National staff survey had just been sent out to a random sample of 782 staff, 477 staff responded (61% response of total sampled). The response to HSE survey 785/2685 = 30%. Further publication and briefings sent to managers via the PN Brief each Friday to encourage and remind staff to complete. The closing date was extended due to IT difficulties and staff having to complete a paper copy.
Input and analysis represented a resource issue. Responses from different areas were grouped and counted, areas with low response rate were encouraged to access the questionnaire and complete it. This pushed up response rate - data sent to Health and Safety Laboratories for input.
Director of nursing, therapies and patient partnership presented the findings from the questionnaire to the Consultation and Negotiation Partnership Group, Nursing Strategy Group, Therapies Strategy Group, Acute Care Forum, Human Resources and Organisational Development Committee and the Clinical Management Board. This outlined progress of the project and explained what was happening next. This was in order to publicise the project, give feedback to the divisions and muster interest in the focus groups.
The analysis of the results identified hotspots and this information was used to develop the plan for the focus groups. In total, 33 focus groups were held.
Two Acas Advisers had been part of the process from the outset. Their main role was as trainers for facilitators for the focus groups. Some staff in the Trust already had experience and skills in this area.
LE asked for volunteers to take part in the facilitation training – 38 signed up. Training was carried out in four locations over a four day period. This approach worked very well.
A problem arose because it was assumed that facilitators would organise logistics and do other preparatory ground work – this became an extra burden. Also facilitators needed to know where and when training from Acas was taking place - so need to give plenty of warning.
Participants in focus groups: there were some problems getting sufficient numbers to sign up for groups but in some cases staff were not happy that they had not been invited. This was a communications issue and staff hadn’t seen posters advertising the groups. In some groups, there were three participants, while in others there were 10.
Contingency plans were needed if facilitators were unable to make the groups e.g due to illness. It was thought that the note-taker could facilitate or groups could be merged or run concurrently.
Groups were expected to meet twice. The first meeting was to discuss a particular stressor in their area and the second meeting was to discuss possible solutions. Staff were expected to consult with colleagues before the groups and in the interim period between the first and second group meeting.
Some groups were particularly difficult to run because of geographic spread/workload – some groups met once only due to this and discussed problems and identified possible solutions at the same time. Acas members of staff acted as facilitators for the medical staff groups. Some groups met at the end of staff meetings.
Feeling is that despite some difficulties, the focus group approach has worked well and feedback from staff has been very good. Lots of comments and good ideas were generated and the quality of information was superb.
The approach has been to have an initial meeting where the facilitator is given a brief and a copy of the indicator tool data analysis. Then, for each stressor (DCSRRC) the facilitators are given some background: some data with colour coding and individual STBA including a prompt question for each stressor ‘this is what control is about’ (in training pack for facilitators). Then groups talk about problems and best practice.
After first meeting Lyn contacted facilitators to ask how the groups had gone.
At the second meeting groups were asked to discuss what to do about problems and issues raised.
All of this data was collated and presented to an action planning sub-group. This group comprised of leads from each area of the Trust to determine whether it was realistic to do this. The group of 18 divided into six groups. Each sub group was to look at one of the stressors: demands, control, role, relationships, support and change. Each group had access to the information generated from the focus groups relating to that stressor and the states to be achieved. Despite there being many issues identified, three issues from each stressor were prioritised.
Action plan developed in July 2006 after Action Planning Sub Group- This identified leads for implementation of actions.
Monitored by the steering group and progress against action plan updated regularly.
Questionnaire to be distributed in June 2007 with approval from HSE (due to extension of project time frame)
Clearly there are resource issues that the Trust did not realise at the outset. The Trust could have done with two or three people who could be dedicated to the project – not just admin support. Project support was added after the outset. An executive lead who is willing to put time, support and interest into the project is required.
At one point the project nearly ended - the organisation was experiencing significant change in the management structure and financial issues were prevalent within the area. Staff were wary of getting involved in focus groups and it needed senior management to endorse the project and encourage staff to take part.
Communication is vital. People need to know what is happening and what will be happening.
Benefits – especially focus groups because staff appreciated the opportunity to voice their opinions – good to get things off their chest.
Using question-by-question approach is useful but not sure yet how to present best.
Updated by LE 9.11.06