Introduction

One of the two most common reasons for sickness absence is stress and anxiety (the other is musculoskeletal problems) (Health & Safety Executive, 2013). The financial cost of stress-related sickness absence has been estimated as £1.4 billion per annum (NHS Employers, 2014). This figure represents only a quantitative estimate of the loss of employee time. There is also a detrimental impact on the quality of care and treatment delivered by the NHS where there are high levels of sickness absence. Poorer outcomes for patients/service users are found where there are high levels of temporary staffing often due to sickness absence (Needleman et al. Reference Needleman, Buerhaus, Pankratz, Leibson, Stevens and Harris2011).

By contrast, organizations where staff members feel valued are more successful (e.g. Foresight Mental Capital and Wellbeing Project, 2008). Mortality in patients in healthcare organizations that have a culture of staff development is lower. Sickness absence is also lower (West & Dawson, Reference West and Dawson2012).

The impact on the individual who is off sick with stress and anxiety is considerable. It is known that individuals who are off on prolonged absence are much more likely not to return to work (Black & Frost, Reference Black and Frost2011). This has a detrimental impact on their well-being over the long-term. Unfortunately, management and occupational health input often only start after the individual is off sick for a specified period of time and while these can be successful in enabling individuals to return to work, they are reactive to a problem rather than proactive and preventative. Health and well-being initiatives promote a more holistic approach – preventative as well as interventionist.

There are a number of key drivers that support the development of well-being in work. The Black report into health and work (Black, Reference Black2008) indicated the need to have holistic approaches to health at work and improving the health of the population to enable them to work. The Boorman report into the NHS (Boorman, Reference Boorman2009) indicated the need for health and well-being interventions for its staff. This was restated by the Department of Health (DoH) in the ‘Health and well-being improvement framework’ (DoH, 2011). Available evidence and guidance (NICE, 2009) suggests that interventions to manage or prevent stress have beneficial effects in improving health and work outcomes (Graveling et al. Reference Graveling, Crawford, Cowie, Amati and Vohra2008).

More recently, the report following the public enquiry into Mid Staffordshire NHS Foundation Trust (Mid Staffordshire NHS Foundation Trust Public Enquiry, 2013), known as ‘the Francis Report’ identified staff behaviours that contributed to the appalling experiences of patients. The development of ‘Compassion in practice’ (DoH, 2012) identifying the six ‘C’s: Care, Compassion, Competence, Communication, Courage, Commitment, has been a response to this in aiming to improve staff behaviour. Similar approaches have been found with person-centred care approaches (e.g. The Health Foundation, 2014), these seek to put the patient at the heart of NHS care. They are important in describing the framework in which care and treatment should be delivered. They do not in themselves provide the skills and competences to enable staff to deliver the expected high quality of care.

Proposals such as Schwartz Rounds (Lown & Manning, Reference Lown and Manning2010) are focused on reflection and the sharing of difficult experiences and emotions. The format of Schwartz Rounds includes a case presentation around a theme that enables a multi-professional group of staff to share and understand the emotional experiences of delivering care. The evidence base in the UK to date has shown that staff members attending the Rounds have felt supported and that relationships between staff and their patients improve (Goodrich, Reference Goodrich2011). They do not focus on the individuals’ own methods of managing their own experiences in difficult situations and therefore may not enable all staff to improve their compassionate care.

Many NHS organizations have also sought to improve the process around care and treatment by the introduction of quality improvement/management systems (e.g. Lean approaches, Jones & Mitchell, Reference Jones and Mitchell2006). These seek to reduce inefficiencies but do not always directly aim to improve care or staff well-being.

One area that is lacking in these approaches is the member of staff themselves in this environment and how they conduct themselves. Their ability to manage themselves within their daily environment is a key component of care. This is illustrated in Figure 1.

Fig. 1.

Link between staff well-being, person-centred care and productivity.

Focusing on staff well-being is a key component in the delivery of high-quality care. This also promotes a preventative approach to staff sickness. Interventions focusing on staff well-being have focused on stress management techniques which can be of benefit in identifying and managing unhelpful coping strategies and behaviours. Given the current context of challenging economic circumstances and the need to deliver public services with constrained finances, there is a need to support staff enabling them to deliver high-quality services under these pressures. Well-being approaches are recognized as having a beneficial effect (Edwards & Burnard, Reference Edwards and Burnard2003).

Mindfulness approaches have also been noted to be of some benefit but are resource-intensive to deliver and require significant commitment to maintain mindfulness practice. An 8-week mindfulness course requires attendance at 2-hour sessions per week with an hour of practice daily to acquire and maintain competence but they do not suit everyone (Perez-De-Albeniz & Holmes, Reference Perez-De-Albeniz and Holmes2000).

Cognitive Behaviour Therapy (CBT) has been used widely and successfully for people with anxiety and/or depression as well as a number of other mental and/or physical health problems. CBT also has demonstrable benefits on mental well-being in the workplace (Graveling et al. Reference Graveling, Crawford, Cowie, Amati and Vohra2008). Approaches have tended to focus on the individual's difficulties and identifying unhelpful patterns of thoughts and behaviours and seeking to modify these.

In relapse prevention work within the therapeutic model, strengths-based approaches have been used in relapse prevention (Tarrier, Reference Tarrier2010). These have sought to identify helpful coping strategies that individuals can use to maintain the improvement in their emotional well-being. These include identifying thoughts and behaviours that promote emotional well-being and have been used successfully therapeutically for depression and anxiety.

The development of the positive psychology literature describes interventions designed to increase ‘wellness’ and ‘happiness’ by focusing on these rather than the ‘disorder’ or ‘deficit’ approach typified within health service provision. Positive psychology principles are used to build strengths and positive experiences to enable individuals to manage their own emotions to enhance their well-being. Guided imagery approaches have been used to enable individuals to utilize previous positive experiences and/or construct positive templates for the future (see Hackman et al. Reference Hackman, Bennett-Levy and Holmes2011). These principles are not restricted to only those who present with mental health problems but can be applied to a variety of situations by a diverse range of populations. There is an opportunity to develop strengths-based approaches for staff members that will enable them to recognize and manage difficulties during their working day. Clearly, these may also generalize to their personal lives.

If staff members are able to improve their emotional self-management and thus their emotional well-being, they will then be able to function more effectively and develop greater resilience to the challenges of the working environment. Therefore, offering these approaches to a staff-based group would potentially enable better staff well-being and better outcomes for patients.

What does a strengths-based CBT approach involve? It would involve: familiarization with the cognitive behavioural model (thoughts, feelings, behaviours, sensations and environmental context), followed by identifying situations where an individual is managing well and seeking to enable translation to more difficult settings. The strengths-based CBT intervention, while focused at promoting better coping strategies at work, is intended to be generalizable to activities outside work. Better management of home tasks and activities will also improve the capacity of staff to manage both difficult work situations and those that are part of their daily workload. Positive psychology principles contribute to this approach by building on strengths and positive experiences enabling individuals to manage their own emotions enhancing their well-being. Guided imagery approaches have been used to enable individuals utilize previous positive experiences and construct positive templates for the future. The Looking After Me Looking After You (LAMLAY) programme was developed to enable staff to acquire these skills within a workplace setting within a comparatively short period of time.

LAMLAY includes the CBT model and positive imagery approaches enabling staff to identify strengths and utilize these to develop self-management strategies in more challenging settings. The LAMLAY programme has been delivered over 18 months within an NHS organization. This evaluation reports on the participants’ ratings of well-being and satisfaction with the course.