Rapidly formed COVID-19 teams in the NHS: implications for leadership, team-working, career intentions and individual mental health.

Lead Research Organisation: Oxford Brookes University
Department Name: Faculty of Health and Life Sciences

Abstract

A key component of the NHS (and global) response to the COVID-19 pandemic has been to
reinforce acute and critical care capacity, through an unprecedented re-deployment of personnel
from different care pathways into fluid teams consisting of volunteers, student doctors and nurses,
and in some cases military personnel [1-4]. These COVID-teams provide a unique opportunity to
examine the interaction of many of the established factors for successful delivery of medical
teamwork and care. Current evidence suggests that without common teamwork, shared
communication patterns and clear leadership structures, the ad-hoc and fluid nature of these
COVID-teams increases risk to patient outcomes, delivery of care [5-9] and team member
resilience, mental-health and retention [10,11].

This project will examine how non-technical factors for healthcare delivery (leadership, social
support & cohesion, communication, shared mental models, co-ordination) and expected
moderating factors (occupational background, preparedness, work-life balance, home situation,
proximity, workforce allocation models) impact on perceived COVID-teamworking and
performance, individual team member well-being and team member employment retention
intentions. It will be a mixed methods cross-sectional exploratory study of COVID-team members,
clinical directors and senior hospital managers across a wide range of partnered NHS Trusts.
Qualitative interviews will identify key themes and will be followed up by a more widely recruited
confirmatory survey examining longer term individual well-being and retention intentions.
Throughout, there will be a high emphasis on rapid dissemination of results to NHS partners and
wider medical and other stakeholders to inform evidence-based workforce guidance and
accelerate team-working theory, practice and policy.
 
Description Individual Impact
The findings from Phase 1 of the study show that personnel working on Covid wards frequently reported emotional distress caused by the work environment, with many participants discussing not being prepared for the uncertainty, and the hardship of working on Covid wards. This was especially strong in those from non-intensive or acute care environments. Most participants - irrespective of preparedness or prior intensive care experience - highlighted difficulties of dealing with unforeseen levels of patient mortality. Concerns arose around difficulties communicating (due to PPE, social distancing, lack of common break areas), lack of training and instruction prior to working on Covid wards and safety worries about PPE. Younger and less experienced staff worried about losing out on formal opportunities for professional development. A common concern from female participants revolved around the impact on their family (infecting family members or care responsibilities). During the latter half of 2021, many began reporting a lack of public and governmental support, leading to increased anxiety over new waves.

Team Bonding and Teamwork
Despite the above-mentioned individual concerns, 78% of participants in the study reported a high level of identification with their rapidly formed team. Consequently, many participants discussed team bonding (based on the recognition of colleagues as "one of us" and "being there with us") as well as teamwork (e.g., "having our back", "everybody pulling together"). The latter appeared to be often based on valuing professional or occupational skills that individuals brought to the table. Simultaneously, personnel repeatedly discussed that colleagues were one of the biggest providers of social support in making sense of the situation - especially for younger, and less experienced personnel. Nevertheless, many participants reported concerns around inter-personal difficulties while working in teams, which were often couched in occupational differences and medical hierarchies. Participants who were re-deployed to their old position or rotated to a new position discussed feelings of ostracization and isolation upon leaving the Covid team and being unable to discuss events with "those that were there".

Leadership
Leadership, especially during the first wave, was crucial for the establishment of effective teamwork and team cohesion. However, due to social distancing, leadership appeared more localised, with most frontline staff attributing leadership to "those on the shop floor", and often emphasising the emergence of "natural leaders" who took on responsibilities beyond their occupational role. Leaders therefore were claimed to show a presence on the wards, to have experience in direct patient contact and to support staff by checking up on people, listening to staff concerns and solving problems. Many senior leaders (e.g., medical and nursing directors) did choose to be directly involved on covid wards aiding with patient care, family liaison, or supporting healthcare staff.

Innovations and means to increase teamwork
Participants routinely discussed a range of innovations, which aided teamwork during their Covid work. Regular information exchange and co-location on the same ward would benefit teamwork and a feeling of inclusion. For example, physiotherapists reported higher identification with their inter-professional colleagues, and were more likely to aid in patient care responsibilities, if they were incorporated into the bedside rounds and located in the same area as nurses. Simultaneously, considering the noise and need for PPE, personnel often valued visible signifiers of professional competence, such as stickers or different coloured hats, which provided quick cues as to who had experience and expertise. Simultaneously, participants valued dedicated positions for family liaison, who took over virtual end of life video-chats with family members.
Exploitation Route The large-scale reinforcement of NHS acute and intensive care capacity during Covid has provided the opportunity to examine how rapidly formed inter-professional teams of varied experience and training best work together and implications for NHS policy and practice have been identified.
Recommendations for NHS policy and Practice
• The NHS needs to learn from and promote more inter-professional working as routine;
• The NHS needs to learn from and educate staff on how to lead rapidly formed inter-professional teams;
• The NHS needs to standardise inter-professional team procedures, working environments and processes for a crisis;
• NHS Trusts would benefit from NHS workforce guidance for Inter-professional Leadership and Teamwork during crisis;
• Health Education should encompass psychosocial training and Inter Professional team training in real world situations.
Recommendations for individual NHS Trusts
• NHS trusts should optimise communal space for interprofessional teamwork and collaboration;
• NHS trusts are advised to routinely review occupational and mental health support services.
Recommendations for Inter professional Teams and Wards
• Invest in regular team-wide debriefs during a crisis;
• Challenge pre-existing hierarchies and power-dynamics, while emphasising the occupational value of individuals;
• During a crisis, Inter Professional teams require leaders to be physically present if at all possible, directly support the team, and model good mental health awareness.
Sectors Healthcare
 
Description Presentation and dissemination of the findings have been used by NHS professionals and managers to influence the lessons learned from COVID-19 for future pandemic planning and inter-professional team work. This impact is currently only at regional levels as it has been very difficult to secure engagement from NHS Trusts during the last year due to their ongoing workloads and the long running impact of the pandemic on time to engage. It is hoped more will be achieved over the next year with further events and publications in the pipeline.
First Year Of Impact 2022
 
Description Internal extension funds
Amount £20,000 (GBP)
Organisation Oxford Brookes University 
Sector Academic/University
Country United Kingdom
Start 10/2022 
End 12/2022
 
Title Interview transcripts of COVID-19 frontline staff in rapidly formed COVID-19 teams in the NHS: implications for leadership, team-working, career intentions and individual mental health 
Description Interview transcripts of COVID-19 frontline staff in rapidly formed COVID-19 teams in the NHS: implications for leadership, team-working, career intentions and individual mental health. The data set supporting the conclusions of this article have been uploaded to the UK Data Service ReShare collection (https://reshare.ukdataservice.ac.uk/).The data set is currently being reviewed by the UK Data Service before being made available to others. 
Type Of Material Database/Collection of data 
Year Produced 2023 
Provided To Others? No  
Impact This data has been to key to the publications and presentations allied with this grant from the researchers. It has also been used to collaborate with other researchers for an output with on the resistire project https://resistire-project.eu/ 
URL https://reshare.ukdataservice.ac.uk
 
Description collaboration with the EU Horizon2020 funded RESISTIRE project 
Organisation Örebro University
Country Sweden 
Sector Academic/University 
PI Contribution We collaborated with the RESISTIRÉ project to modify some and include new questions in our survey to ensure that gender+ implications - in relation to social support, gender-based violence and care were considered and analysed in the future. Collaboration led to shared outputs paper on the gender+ dynamics of our collected data.
Collaborator Contribution The partners made suggestions about items to be included in our survey. Collaboration led to shared outputs on the gender+ dynamics of our collected data.
Impact A joint paper was produced with the results of the collaborative items demonstrating that when controlling for other factors, women experience more burnout than men, but other variables such as ethnicity, grade or age are not statistically significant. ? Violence from patients and relatives has a stronger effect on increasing burnout than violence from colleagues and managers, though both are statistically significant. ? Sex does not moderate the relationship between experiences of violence and burnout. ? Perceived impact of care responsibilities is positively associated with burnout, and this effect increases with age.
Start Year 2022
 
Description Invited talk on Results and Recommendations for NHS Leicestershire Partnership Trust Research Day by Stefan Schilling 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact NHS Medical professionals and NHS managers who have influence on ICU and other emergency NHS Trust planning attended a presentation on the results and recommendations. This garnered a lot of interest and the feedback was that the research recommendations would feed into future Trust planning for pandemics and other major crises.
Year(s) Of Engagement Activity 2022
 
Description Nursing Standard news article 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact NHS teamwork in the pandemic: how is it for you? Nursing Standard news article.
Year(s) Of Engagement Activity 2021
URL https://rcni.com/nursing-standard/newsroom/news/nhs-teamwork-pandemic-how-it-you-172321
 
Description Press release about research on rapidly formed COVID-19 teams in the NHS 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact Press release about research on rapidly formed COVID-19 teams in the NHS picked up by regional news outlets and social media.
Year(s) Of Engagement Activity 2021
URL https://www.brookes.ac.uk/about-brookes/news/covid-19--investigating-the-team-working-experiences-of...
 
Description ReWAGE Covid-19 Grants workshop 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A talk on the research at the ReWAGE Covid-19 Grants workshop -ReWAGE - Renewing Work Advisory Group of Experts
Year(s) Of Engagement Activity 2022
URL https://warwick.ac.uk/fac/soc/ier/rewage/