{"id":7981,"date":"2022-04-13T10:00:00","date_gmt":"2022-04-13T10:00:00","guid":{"rendered":"https:\/\/leadersinsport.com\/performance-institute\/?post_type=article&p=7981"},"modified":"2025-12-15T05:11:38","modified_gmt":"2025-12-15T05:11:38","slug":"innovation-under-pressure-how-the-nhs-in-wales-has-enabled-its-people-to-thrive-during-the-pandemic-part-i","status":"publish","type":"article","link":"https:\/\/leadersinsport.com\/performance-institute\/articles\/innovation-under-pressure-how-the-nhs-in-wales-has-enabled-its-people-to-thrive-during-the-pandemic-part-i\/","title":{"rendered":"Innovation Under Pressure: How the NHS in Wales Has Enabled its People to Thrive During the Pandemic – Part I"},"content":{"rendered":"\n\n
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\n 13 Apr 2022 <\/p>\n \t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>Articles<\/a>\n\n\t\t\t\t\t\t

Innovation Under Pressure: How the NHS in Wales Has Enabled its People to Thrive During the Pandemic – Part I<\/h1>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n \n\t\t\t<\/div>\n\t\t<\/div>\n\n\t<\/div>\n<\/div>\n
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Category <\/div>\n Leadership & Culture<\/a> <\/div>\n
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https:\/\/leadersinsport.com\/performance-institute\/articles\/innovation-under-pressure-how-the-nhs-in-wales-has-enabled-its-people-to-thrive-during-the-pandemic-part-i\/<\/div>\n <\/div>\n <\/div>\n <\/section>\n\n\n\n\n
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Dr Peter Brown and Dr Adrian Neal<\/h6>\n
When you strip it all back, all the politics, the labels, uniforms and statistics, healthcare has many parallels to performance sport.<\/h6>\n

Within healthcare we have multidisciplinary (MDT) teams working together, problem solving quickly and using various interventions in order to maximise the probability of positive patient outcomes. In sport, we have MDTs working together to problem solve performance and use a variety of interventions in order to maximise the probability of achieving optimal performance in the moments that matter.<\/p>\n

However, there is one significant difference between the two: the gift of the performance plan and periodisation within elite sport. Regardless of the sport and the level of competition, following any major event such as a World Cup, a world championship or the Olympic and Paralympic Games, there is always a full stop, a closing parentheses of the performance plan, a break to rest, recover, decompress biologically, socially and psychologically.<\/p>\n

In healthcare, however, the stark difference is that there is no end, no rest, no full stop and no decompression or recovery. There may well be a period of rest and recovery for the patient but not the clinical support staff. Another significant difference is the variability and visibility around agreed objectives within healthcare; there is rarely a shared line of sight within an objective across an organisation. Objectives can change rapidly leaving little time to recalibrate an MDTs team\u2019s shared sense of purpose or expectation of their work. What’s more, there is rarely a performance plan which factors in milestone events to support performance beyond KPIs. Instead despite delivering world class care to patients daily, the pressure only builds, the demands increase; the treadmill gets faster and the gradient steeper.<\/p>\n

The past two years or so, since Covid officially struck within the UK, have exacerbated these \u2018normal\u2019 pressures and context. Accordingly, this three-part series of articles aims to provide:<\/p>\n

1. A guided tour of the experience of the pandemic for individuals, teams and organisations delivering healthcare within the NHS at the Aneurin Bevan University Health Board (ABUHB) with a provocative comparison to performance sport.<\/p>\n

2. The interdisciplinary innovative response from this health board to overcome some of this context so that we ensure performance of our healthcare staff.<\/p>\n

3. What the future holds for the NHS in Wales and importantly the principles at play which performance sport can learn from within our novel approach to optimising performance of our healthcare workers.<\/p>\n

The reality of burnout in healthcare provision<\/strong><\/p>\n

The Aneurin Bevan University Health Board (ABUHB) employs ~15,000 people and is the largest employer in the south east Wales county of Gwent. Approximately two thirds of these staff are patient facing, with ~600+ consultants, over 1,000 hospital and general practice doctors, 6,000 nurses, midwives, allied health professionals, health care scientists, community workers, and estates and facilities workers. All of this functions within a range of primary care provisions, five enhanced local general hospitals and a new acute care hospital. The past two years have been unprecedented within the Health Board, with the entire service provision turned on its head in 24 hours, with mass redeployment of staff to critical administration, control, coordination roles and deployment to mass vaccination clinical hubs across the county of Gwent.<\/p>\n

The reliability of our understanding of the impact of the pandemic on the NHS workforce is rapidly improving. Initially during the first wave (March to June 2020) there was an emphasis on predicting a major mental health crisis especially around PTSD. Data from meta analyses is now rewriting this prediction even though rates of reported anxiety and depression in the workforce have risen. What has become apparent is that the impact is more diffuse and less overtly clinical in nature. Disengagement and burnout is now more of a reality and potentially a threat to performance in the NHS than diagnostic levels of mental illness, though distress is commonplace.<\/p>\n

Burnout is categorised by the World Health Organization as a syndrome resulting from chronic workplace stress that has not been successfully managed. It is identified as having three dimensions: feelings of energy depletion or exhaustion, increased mental distance from one\u2019s job (or feelings of negativism or cynicism related to one\u2019s job) and reduced professional efficacy. Burnout has been linked to workplace performance since it was coined in the 1970s, however is not a new phenomenon in the NHS with pre-pandemic rates within Critical Care estimated to be as high as 20 per cent.<\/p>\n

Measuring psychological wellbeing<\/strong><\/p>\n

Within ABUHB one attempt to measure broad psychological wellbeing has been monitored via a survey carried out five times since April 2020 and has now had over 15,000 individual responses. The survey asks about coping, fatigue, as well as factors considered foundational to psychological workplace wellbeing including one\u2019s sense of fairness, control, effectiveness, belonging and others. Early in the pandemic the survey observed a pattern which suggested a third of the workforce were doing well, a third OK, and the remaining were struggling across all domains. Then, surveys conducted 21 months into the pandemic (July and November 2021) suggest this pattern has progressively worsened. Put simply, we are seeing data to suggest that at least half of our workforce are experiencing psychological difficulties and are also relating to their work and peer groups differently. Many report feeling the work they loved has changed, that they feel like they no longer make a difference, are demotivated as a result and, importantly, that they do not feel connected to or a part of the wider organisation.<\/p>\n

This data and lived experience represents a major threat to the organisation given NHS services often rely excessively on a workforce with high intrinsic motivation, willing to offer extra discretionary effort to function let alone high performance, or any performance unremittingly.<\/p>\n

Comparing performance measures in healthcare and sport<\/strong><\/p>\n

From a human factor perspective, the pandemic inevitably has and will continue to have an impact on NHS performance on an individual, team and organisational level, however an artifact of how performance is commonly framed in the NHS may make it even more challenging and requires closer examination especially when you juxtapose to elite sport.<\/p>\n

When it comes to the performance and performance outcomes of performance support staff and athletes, elite sport have excelled in contrast with healthcare. Within sport there is normally a clear alignment between performance outcomes and capability of the athlete(s) and \/ or the service provision provided by the performance support team due to the investment and robustness of the performance plan and multidisciplinary dissection of performance through a performance backwards approach. In healthcare, it\u2019s a little less clear with a lack of agreed and shared objectives across organisations and teams.<\/p>\n

Table 1 below provides an example of the comparison of definitions and measurements of performance between healthcare and elite sport.<\/p>\n

Table 1. Comparison of performance measures in healthcare and sport.<\/em><\/h6>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\nHealthcare[1]<\/a><\/strong><\/td>\nUK Sport[2]<\/a><\/strong><\/td>\nNGB (GB Boxing)[3]<\/a><\/strong><\/td>\n<\/tr>\n
Mission<\/strong><\/td>\nReduce health inequality experienced by our communities by improving population health, this mission will vary significantly between NHS organisation, department and team.<\/td>\nCreate the greatest decade of extraordinary sporting moments; reaching, inspiring and uniting the nation<\/td>\nTo build the world’s best performance system enabling each GB boxer to very best opportunity to reach their full potential.<\/td>\n<\/tr>\n
Paraphrased ambitions \/ Priorities <\/strong><\/td>\nEvery Child has the best start in life<\/td>\nKeep winning and win well<\/td>\nPerformance focused<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nGetting it right for children and young adults<\/td>\nGrow a thriving sporting system<\/td>\nCoach-led<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nAdults in Gwent live healthily and well<\/td>\nInspire positive change<\/td>\nBoxer centered<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nOlder adults are supported to live well and independently<\/td>\n<\/td>\nOpen and competitive<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nDying well as a part of life<\/td>\n<\/td>\nOne team<\/td>\n<\/tr>\n
Typical Key Performance Indicators <\/strong><\/td>\nWaiting times – National and local KPIs vary: e.g.: Emergency Department, Psychological therapies, specific operations, HR processes.<\/td>\nInvesting \u00a3385m in 57 sports for success in Paris and beyond<\/td>\n3 to 5 medals at the Paris Games<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nErrors<\/td>\n10 World championships<\/td>\nAn Olympic champion at Paris 2024<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nFinancial KPIs<\/td>\n30 European and World Series events in more than 25 sports<\/td>\nMale and Female world champion by 2024<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nComplaints \u2013 response times<\/td>\nGenerate \u00a370m of economic impact<\/td>\nElite boxers to lead the medal table at the commonwealth games<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nNumber of Vaccinations delivered for Covid-19<\/td>\nMedal target 45 to 70 medals[4]<\/a><\/td>\nMedals at every major championship throughout the cycle<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Within healthcare, there is the obsession with key performance indicators (KPIs) which, in turn, are politicised performance targets rather than outcome focused measures of success. Performance management in healthcare is failing to measure performance and succeeding in gaming the data to achieve a given (sometimes malevolent) purpose.<\/p>\n

Within all aspects of health and social care, we currently have a perfect storm. Rising waiting lists, greater than ever patient acuity, Covid restrictions, mass redeployment of staff from all corners of the organisation to support vaccination centers, rising staff absence, hundreds of patients clinically ready to be discharged to community but without the necessary support to leave the hospital and the numbers waiting for referrals, diagnostic tests, therapies and treatments on the rise.<\/p>\n

The Welsh government have provided several hundred million pounds of additional funding across Wales to support the recovery from the pandemic, but the pandemic continues with wave after wave of mutated variant which doesn\u2019t align to financial years. At 8pm every Thursday throughout the lockdown of wave one of the pandemic in the UK, the general public stood on their door steps and applauded the NHS workers and the windows of family homes were smudged with the finger prints of children who proudly displayed their paintings of rainbows to support the NHS and key workers. It feels like those days are gone. We now face increasingly high expectations from the public and government alike.<\/p>\n

But it’s not all doom and gloom and our next instalment of this series describes how through a close collaboration of Organisational Development and Organisational Wellbeing \/ Clinical Psychology at the ABUHB, we are truly embracing the complexity of the situation we find ourselves in to address the key performance issues affecting our workforce. At least for us on the ground, moving away from arbitrary performance outcomes, numbers and dashboards to truly defining and understanding where we are today individually as teams and as an origination, the counterfactuals of our situation, and the adjacent possible to move towards a better future.<\/p>\n

Dr Brown is Director of Organisational Development (OD) at the Aneurin Bevan University Health Board (ABUHB) in South Wales and spent 10 years as the Head of Performance Knowledge at the English Institute of Sport.<\/em><\/p>\n

Dr Neal is a Consultant Clinical Psychologist and Head of Wellbeing at the ABUHB and has researched and published widely across organisational health and wellbeing.<\/em><\/p>\n

\"\"<\/p>\n

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<\/a>1]<\/a> Aneurin Bevan University Health Board; see abuhb.nhs.wales<\/p>\n

[2]<\/a> UK Sport; see uksport.gov.uk<\/p>\n

[3]<\/a> Performance to Paris: GB Boxing Strategy 2021 to 2025<\/a>; see gbboxing.org.uk<\/p>\n

[4]<\/a> Olympic medal target for the Tokyo Games<\/p>\n<\/p>\n <\/div>\n \n \n \n <\/div>\n

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