Looking after our MSK staff establishing orthopaedic servicesin the recovery phase of Covid-19 and beyond

Moral Injury, Staff Well Being and Psychological Challenges in delivering MSK Services ‘with’ Covid-19

Tony Clayson, Consultant Orthopaedic Surgeon Wrightington Specialist Orthopaedic Hospital

Aims

• Why are psychological needs important right now?

• Recap: psychological responses in the active phase

• Psychological responses in the recovery phase

• Responding appropriately in the recovery phase

• Our Wrightington MSK staff challenges

– ‘Moral Injury’

• WWL plans to support staff over the next 12 months and beyond

Why are psychological needs important?

• Covid-19 pandemic has presented challenges

• Long-term benefits of psychologically supporting as early as possible in the pandemic

• Any staff member can be affected• Psychological support is

everyone’s responsibility

Therefore, aim to: Foster resilience, reduce burnout,

reduce likelihood of PTSD

Be Aware of ‘Moral Injury’

Why are psychological needs important?

• Covid-19 pandemic has presented challenges

• Long-term benefits of psychologically supporting as early as possible in the pandemic

• Any staff member can be affected• Psychological support is

everyone’s responsibility

Therefore, aim to: Foster resilience, reduce burnout,

reduce likelihood of PTSD

Be Aware of ‘Moral Injury’

Normal psychological responses in the active phase

Normal psychological responses active phase progression to recovery phase

Normal psychological responses active phase progression to recovery phase

‘Moral Injury’ – what is it ?

‘Moral Injury and MSK staff’

• Military term

• Not PTSD

• Why MSK staff esp at risk ?

• Risks and Impact

• Support

‘Moral Injury’

• Why MSK staff ?

• Redeployment experiences

• Experiences out of comfort zone

• Return ‘home’ not normal

‘Moral Injury’• Not PTSD ! Not Burnout !

• Emotional guilt and shame

• Betrayal of what’s right

• Anger/frustration

• Moral ‘disorientation’

• Sorrow, grief, regret

• Shame, alienation

• Theatre, physio, nursing, admin and medical staff !

‘Moral Injury’• Not mental illness/PTSD

• Responds to group discussion &listening forums

• Be proactive now

• Alert to progression and individual support

It is important to act now to support MSK teams mental health, reduce likelihood of later problems !

Possible psychological responses in the recovery phase and beyond

DIFFICULTY WITH THE

‘HEROES’ NARRATIVE

CONCERN FOR FUTURE

POST-CRISIS

GROWTH

TIME TO

REFLECT

CHANGED FEELINGS

ABOUT YOUR JOB

INTRUSIVE THOUGHTS

SHAME & GUILT

RECOGNITION OF

PERSONAL STRENGTH

WID

ER IMPACTS –

FAMILY, SOCIAL

BURNOUT

PTSD‘Moral Injury’ ?

‘Listening forums’

‘Group discussions’

‘WWL Steps4Wellness Team’

Recovery: Communication and Information

• Opportunities to reflect:- Team huddles / check-ins

• Organise active ‘learning events’– involve all staff at all levels

• Keep everyone informed about what is going on

• Offer Crisis Management Briefings if appropriate

• Schwartz Rounds

Wrightington Response for MSK Staff

• Part of wider WWL NHS Trust response

• Recognise potential for delayed impact

• Leaders, managers and Steps4Wellness team/Leads/Champions collaboration

• Trust Exec team buy in !

Trust Executive Board

WWL Response for MSK Staff – unique structure

HR / Organisational Development Team Workforce Committee

Staff Engagement/Steps4Wellness Team

Nursing AHP’s Non Clinical Non Clinical Non Clinical

Steps4Wellness Champions : 50-60 across Trust –active recruitmentWrightington – 8 to date : Medical (3) ,Physio (3), Admin (2)

Dynamic Long term model !

Steps4Wellness Leads (6 Senior Staff) Walkabouts

Medical

• Training in 3-Step process - supportive conversations.

• Training on Mental health awareness and how to spot the symptoms of Mental health issues.

• Supervision support from Well Being Leads and S4W team.

• In-depth training in critical incident defusing (optional)

• Training on how to develop resilience for stress management.

• CPD and community network engagement quarterly calls/ meetings share practice.

Steps4Wellness Champions:

@Steps4Wellness

• Provide general wellbeing support with necessary training to do so.

• They will know their work area and colleagues, so are best placed to know what will work well.

• Signpost to the wellbeing support available to their colleagues – arrange group forums

Implement Trust’s health and wellbeing strategy across the four key areas Mental Health, Physical Health, Keeping Social and Healthy Choices.

The aim of S4W Champions is to:

• Do not provide any form of treatment for mental or physical

conditions.

• Are not there to provide counselling or medical advice.

• Do not diagnose.

What S4W Champions are not:

@Steps4Wellness

Leaders and managers

• Give staff permission to step back and ensure breaks and rest

• Continue to be visible and available

• Look-listen-link

• Continue to adapt to uncertainty

• Demonstrate ‘compassionate leadership’

Leaders and managers

• Be compassionate towards yourself !

• Continue to create a protective environment for your staff

• Staff need time to recover and “reset” before returning to “normal” duties after a period of exceptionally high-demand working

Leaders and managers

• Continue 3 step process check ins

• Do not mandate direct psychological interventions, but encourage access to broader services

• Liase with Steps4WellnessTeam,Leads & Champions

Recap: Psychological responses active phase progression to recovery phase

Recap: Possible psychological responses in the recovery phase and beyond

DIFFICULTY WITH THE

‘HEROES’ NARRATIVE

CONCERN FOR FUTURE

POST-CRISIS

GROWTH

TIME TO

REFLECT

CHANGED FEELINGS

ABOUT YOUR JOB

INTRUSIVE THOUGHTS

SHAME & GUILT

RECOGNITION OF

PERSONAL STRENGTH

WID

ER IMPACTS –

FAMILY, SOCIAL

BURNOUT

PTSD‘Moral Injury’ ?

‘Listening forums’

‘Group discussions’

‘WWL Steps4Wellness Team’

WWL: Psychological Support for the next 12 months

Level 3:

Signficant distress

Level 2:

Moderate distress

Level 1:

Mild distress

Level 0:

Prevention, meeting basic needs, training and information

Investment in Steps 4 Wellness / OH psychological support services

– Clinical wellbeing leads and wellbeing champions, providing psychological first aid

– More advice/support available for managers

– Continue SOS support

– Clinical psychologists, wellbeing practitioners, psychological support assistants, counsellors and CBT practitioners.

– Set up new services to support the recovery process (Schwartz Rounds)