County Durham and Darlington NHS Foundation Trust

Background

Approximately 6000 employees situated across Durham and Darlington, with 4 main hospital sites. In January 2005 their former Occupational Health Physician had advanced warning of SIP1 and signed up the Trust so they were on the list from the beginning.

Before this they realised they had to do something, and H&S and the Staff Counselling Service were in the process of putting something together.

They had already arranged a steering group and done some preliminary work which was “crucial” – without this starting from scratch would have been very difficult.

Steering group

In a sense, senior management commitment was provided by the steering group - chaired by the Director of Estates and Facilities. Unions were a key player in this but in practice found it very difficult to get release of staff – so a major struggle to get meetings fully attended (but this is a general problem – not just stress work – reflects general pressures). Key aspects:

• Buy-in from staff side after various presentations given to unions (RCN, UNISON) – they then signed an agreement to participate and to get employee involvement – they were keen to do this and very happy to support.
• Input from communications manager (a former journalist) whose expertise was very valuable but at a premium because the Trust was going for foundation status. The size and fragmentation of the Trust made communications strategy difficult. Various media were used (flyer/leaflet/night shifts contacted/e-mail/bulletins/staff newspaper and the branch meeting and consultative committee were also involved).

Data gathering

Used the HSE methodology. Questionnaire made up of demographic information and a question set was attached to employee pay slips, as a lot of things are. The response rate reduced as a consequence – approximately 1800/6000.

Some sickness absence data was gathered, as was data from the Occupational Health Department and Counselling Service.

All of this data was sent back to the steering group for consideration. A major problem was that there was not enough reflection time – things were very rushed – "should we use focus groups?", " who should be in them?", "what are the key groups?".

Focus groups

These have been most successful

• At first struggled to get attendees – "favours" were called in to fill early groups. This generated momentum so later sessions were attended by many willing and interested staff.
• Had 120 attendees so experimented to get make-up right – split junior/middle/senior; some mixed; some site specific.
• Peer group ones best – common experience and similar problems.
• Comment – this is the first time in the Trust where we feel we have a “voice”. The opportunity to speak out and say “radical things” was very much appreciated because it was done in a way “not done before”.
• Difficulty to get clinical staff because of workload.
• Facilitator recruitment (originally 12) was done via the steering group who were asked to recommend good listeners. Recruitment of facilitators and participants may have been best achieved through a “global” e-mail but there were restrictions against these.
• ACAS did a two-day training for facilitators, which went down very well. Most people learnt a great deal. The facilitators were taken from a huge range of backgrounds. This required the line manager’s co-operation.
• Approach – one person facilitates one focus group and acts as a scribe for another but must have time to prepare and then to write up notes (the latter may take several days).
• PLANNING is absolutely critical in such a large organisation. Booking rooms, sending out invitations etc dictated when the focus groups could run.
• Format – every group had the same lead off question “what is it like to work in this Trust” then split according to six HSE risk areas – different issues for different groups – one per group – results varied.
• Data from flip charts transcribed onto proformas to aid action planning – done by scribes then e-mailed to steering group – could be a bit of a struggle to capture everything in focus groups – this depended upon facilitator expertise and composition of groups – some just wanted to “whinge” and were not as useful.
• Twenty-four (24) sets of notes fed back to steering group based on questions and notes.

Action plan

The output from the focus groups has lead to action plans for trust-wide adoption for common themes and plans for sub-groups. A huge range and array of actions some devolved down to named individuals to take forward asking them “What do you think, what might be the timescale, can it be done?”. Some extra work has been done with specific departments where difficult issues have arisen. Focus groups have been held in 4 Directorates, and 2 Directorates used the ACAS “FAST” system (Facilitated Analysis and Solution Tool) – an electronic “chat room” run like a focus group. This was highly successful in 1 Directorate.

Learning points

• HSE/ACAS support was excellent – “prompt support and encouragement”
• SIP1 activity taking place against a background of 700 redundancies (ca 10%)

Key points

• Prepare and resource properly – the original Occupational Health Physician who started the process left and was not replaced – so it can be quite daunting if on your own – you need a team who can be mutually supportive and who understand the project – otherwise things can grind to a halt.
• We encourage others to do it – it is an excellent scheme.