Moral injury and well-being in essential workers during the COVID-19 pandemic: local survey findings

BackgroundEssential workers have faced many difficult situations working during the pandemic. Staff may feel that they, or other people, have acted wrongly and be distressed by this. This represents moral injury, which has been linked with significant mental ill health.MethodsThis survey asked essential workers in County Durham and Darlington about their experiences during the first wave of the pandemic and anything they felt would help. Well-being and moral injury were rated using sliders.ResultsThere were 566 responses. A majority of respondents reported feeling troubled by other people’s actions they felt were wrong (60% scored over 40, where 0 is ‘not at all troubled’ and 100 ‘very troubled’, median score=52.5). Respondents were generally less troubled by their own actions (median score=3). Well-being and moral injury scores varied by employment sector (eg, National Health Service (NHS) staff were more troubled by the actions of others than non-NHS staff).Staff suggestions included regular supervisor check-ins, ensuring kindness from everyone, fair rules and enforcement and improving communication and processes. Respondents offered simple, practical actions that could be taken by leaders at team, organisation, societal and governmental levels to tackle moral injury and the underlying causes of moral injurious environments.ConclusionUsing these findings to develop a strategy to address moral injury is important, not only for staff well-being, but staff retention and continued delivery of vital services in these challenging times. Working together, we can seek to reduce and mitigate ‘moral injury’ the same way we do for other physical workplace ‘injuries’.

Supporting Staff in Southern Family Planning Clinics: Challenges and Opportunities

Objectives The aim of this study was to identify key challenges and opportunities to better support non-clinician clinic staff at family planning centers in Southern US states. Methods We conducted qualitative interviews with 15 individuals in clinic staff and leadership positions at family planning centers in seven Southern states. Results Turnover had negative impacts on both clinic functioning as well as patient care. Participants identified several challenges related to recruitment and retention in family planning health centers in the South, including the conservative contextual landscape, the perceived value of support staff, gaps in communication, and rural locations. In response to these challenges, staff also identified key strategies to better support and retain health center workers. These included prioritizing investment in management, creating career advancement opportunities, prioritizing staff retention, and creating space for self-care. Health center staff and leadership who used these strategies to support and retain staff noted improvements in the effectiveness of staff work as well as increases in patient volume. Conclusions for Practice Study findings provide key areas for intervention including providing development opportunities, commitment from leadership to recognize and invest in staff and supporting self-care. Focusing on ensuring internal organizational justice for staff may also facilitate resilience to external challenging environments. Better supporting clinic staff is likely also important for quality services and ensures the full workforce involved in providing family planning care can work at full capacity.

Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh

Background “Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting. Methodology In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. Results The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. Conclusions An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

Burnout in frontline ambulance staff

Background: Staff retention is a significant issue for ambulance services across the globe. Exploratory research, although minimal, indicates that stress and burnout, in particular, influence attrition within the paramedic profession. These need to be understood if their impact on retention is to be addressed. Aims: To determine the presence of and contributory factors for burnout in the ambulance service to inform recommendations for positive change. Methods: A two-phased survey approach was adopted using an adapted Maslach Burnout Inventory and Copenhagen self-assessment burnout questionnaire, to measure levels of burnout, depersonalisation (cynicism) and personal achievement. Open-ended questions explored factors that influenced these. Demographic and comparative analysis identified trends and thematic analysis was carried out on the qualitative data. Results: Ninety-four per cent of ambulance staff in this study (n=382) reported a sense of personal achievement within their professional role; however, more than 50% were experiencing varying levels of burnout with 87% displaying moderate or high levels of depersonalisation towards their work. Causes of stress were complex: themes attributed were a perceived lack of management support, the public's misuse of the ambulance service, involuntary overtime and a poor work-life balance. Conclusions: Burnout poses a genuine threat to retention in the ambulance service and needs addressing. Proactive screening, better communication between practice staff and management and access to counselling services are recommended. This problem of burnout is beginning to be acknowledged but further evidence is needed to understand it in more depth in order for effective solutions to be developed.

Hospitality education in New Zealand prisons

New Zealand has one of the highest imprisonment rates per capita when compared to the rest of the developed world. People who offend in New Zealand have a 43% chance of reoffending within the first 24 months of their release [1]. It is estimated that approximately 60% of people who offend have literacy and numeracy skills lower than the NCEA Level 1 competency, and 66% of adults have no formal qualifications [2, 3]. A focus on literacy and numeracy, support through baseline education, and specific trades like hospitality, can start to refine the options of a person who offends, further enabling them to start developing goals that will support their futures [4]. Since 2014, the Department of Corrections/Ara Poutama Aotearoa has been upgrading the prison-based educational programmes available to people who offend to achieve this. Goals have been set to integrate the in-prison education with the nationally recognised level of education along with practical elements such as kitchen work, housekeeping and other service-based vocations such as hairdressing and customer service. The courses are relatively short, ranging from six to 12 weeks, and provide key skills and the foundations for further study. Evidence from overseas has found that hospitality and, specifically, catering programmes are a tool that positively impacts the way people who offend engage with their rehabilitation; creating an experience through the sharing and giving of food is seen as a way to reintegrate and regain a sense of achievement and being of service through meaningful social connections and employment. Our study carried out a systematic literature review of the effectiveness of hospitality training and education in correctional facilities. Evidence was found of the effectiveness of educational programmes within prisons and their positive impact on recidivism. It was also found that hospitality training initiatives, such as those provided in prison training restaurants open to the public for dining, could offer a unique opportunity that allows people who offend to change the negative public perceptions held about them. In New Zealand, we have unique tikanga-based initiatives that support people who offend to reintegrate back into the public environment and their families, with reduced reoffending [5]. The literature showed, convincingly, that education leads to opportunities for post-release employment and the ability to manage work-life balance, reintegration into society, and gain skills that support long-term prosperity [3]. Czerniawski [6] sees education as a key step in making a positive change in the lives of people who offend, especially if followed by a period of post-release support. Our study also revealed the challenges of providing hospitality education in prisons. Prison security risks, risk of lockdowns, student mental health, lack of educational resources and support services, and lack of set-up and sustainable funding for educational programmes were seen as hindrances to the success of prison education programmes. Lack of post-release support and the negative stigma of people who offend perceived by the public and employers were further noted issues of concern. Likewise, prison culture, staff retention, general misconduct and mistrust were also cited as aspects of concern [7]. Giousmpasoglou and colleagues [8] suggested that people who offend would prefer education programmes that were carried out by external facilitators over in-prison programmes. The importance of networks between educators, support workers and employers are important in this regard. With the hospitality industry facing a skills shortage and with its low barriers to entry, there is potential to build upon the success of existing hospitality education programmes to build skills, pride and a second chance for those who are engaging in rehabilitation. There is also an opportunity to consider tertiary pathways for these hospitality graduates and entrepreneurs. Furthermore, the Department of Corrections/Ara Poutama Aotearoa could consider the success of initiatives such as The Clink Charity training restaurants in the UK in supporting rehabilitation through hospitality training and work. Corresponding author Madz Crouth can be contacted at: [email protected] References (1) Boomen, M. Where New Zealand Stands Internationally: A Comparison of Offence Profiles and Recidivism Rates. Practice: The New Zealand Corrections Journal 2018, 6 (1), 87–96. https://www.corrections.govt.nz/__data/assets/pdf_file/0005/33449/Practice_Journal_Vol6_Iss1_July_2018_WEB.pdf (accessed Dec 1, 2021). (2) Corrections. Prison Facts and statistics – December 2020, 2020. https://www.corrections.govt.nz/resources/statistics/quarterly_prison_statistics/prison_stats_december_2020 (accessed Dec 1, 2021). (3) Corrections. Prison Facts and Statistics – March 2020, 2020. https://www.corrections.govt.nz/resources/statistics/quarterly_prison_statistics/prison_stats_march_2020 (accessed Dec 1, 2021). (4) Harkison, T.; McIntosh, A. Hospitality Training for Prisoners. Hospitality Insights 2019, 3 (1), 5–6. https://doi.org/10.24135/hi.v3i1.52 (5) Hamer, P.; Paul, J.; Hunia, M. Hōkai Rangi: Context and Background to the Development of Ara Poutama Aotearoa Strategy 2019–2024. Practice: The New Zealand Corrections Journal 2021, 8 (1), 18–22. https://www.corrections.govt.nz/__data/assets/pdf_file/0017/43208/Practice_Journal_2021_Final_Web_Version.pdf (accessed Dec 1, 2021). (6) Czerniawski, G. A. Race to the Bottom – Prison Education and the English and Welsh Policy Context. Journal of Education Policy 2016, 31 (2), 198–212. https://doi.org/10.1080/02680939.2015.1062146 (7) Chui, W. H.; Cheng, K. K.-Y. The Mark of an Ex-Prisoner: Perceived Discrimination and Self-Stigma of Young Men after Prison in Hong Kong. Deviant Behavior 2013, 34 (8), 671–684. https://doi.org/10.1080/01639625.2013.766532 (8) Giousmpasoglou, C.; Brown, L.; Marinakou, E. Training Prisoners as Hospitality Workers: The Case of the CLINK Charity; Paper presented at the Travel & Tourism Research Association (TTRA) 2019: European Chapter Conference, 2019. http://eprints.bournemouth.ac.uk/31827/1/Giousmpasoglou-Brown-Marinakou_TTRA19_conference_Final.pdf (accessed Dec 1, 2021).

How leadership styles influence organizational outcomes: an empirical study in Vietnamese SMEs

PurposeThe purpose of this paper is to investigate the impact of leadership styles on different organizational outcomes and value structure such as: overall business performance, working style, motivation and trust of employees, management efficiency and corporate culture in the context of Vietnamese small and medium enterprises (SMEs).Design/methodology/approachThe authors perform a qualitative analysis and gather data by conducting conversational semi-structured interviews with 51 SME managers from different industries. Data were analyzed using a step-by-step approach following Creswell.FindingsThe study explores the effects of leadership styles on various organizational outcomes. Given the features of SMEs, it sheds light on the significance of leadership styles in changing work environment, increasing staff retention, and promoting the viability of SMEs. It also discusses the selection of leadership styles in accordance with Vietnamese culture.Practical implicationsThis study has practical implications on human resource management in the context of SMEs. SME managers, training providers and support agencies may utilize the research outcomes to raise the awareness of SMEs leaders. Based on the research findings, appropriate training programs should be developed to assist managers in tackling major problems.Originality/valueAlthough several previous studies have tried to investigate the influence of leadership styles on organizational outcomes, this is the first research to explore the topic in the context of SMEs and in conjunction with the Vietnamese culture.

The psychological effects of working in the NHS during a pandemic on final-year students: part 1

Resilience in nursing and midwifery involves being able to manage ethically adverse situations without suffering moral distress and is key to mental wellbeing, staff retention and patient safety. The aim of this research was to ask what the psychological effects were for nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. This study looked at the incidence of burnout in a small cohort of nursing and midwifery students who were employed as band 4 aspirant nurses and midwives in acute NHS trusts in the south of England. The findings suggested that student midwives reported higher levels of emotional exhaustion and depersonalisation than student nurses but overall, both cohorts of students reported moderate levels of burnout. Part 2 will present the lived experience of deployment as described by students.

Laying Down the Groundwork for an International Measurement Infrastructure

The COVID-19 epidemic has brought to light the significant problems in the long-term care (LTC) sector, specifically the lack of an infrastructure to collect and aggregate data between LTC sectors in different countries. This talk will briefly describe goals of the WE-THRIVE initiative, and focus on exploring the development of “workforce and staffing” common data elements for LTC. We will describe how the subgroup is “laying down the groundwork” within this domain with various methodologies to develop CDEs related to workforce and staffing. The CDEs aim to measure staff retention and turnover, evaluating nursing supervisor effectiveness, and staff training in LTC. Anticipated challenges of this international work will also be highlighted. International research on LTC can valuably inform LTC policy and practice, and the proposed CDEs can facilitate data sharing and aggregation internationally, including low-, middle-, and high-income countries.

An Assessment of Transformational Leadership Theory against a University EAP Pre-sessional Course

The evolution of leadership theory since the Industrial Revolution has been characterised by a shifting of focus from leaders’ qualities to the construction of effective leadership systems and methods. Transformational leadership, as one such theory, has gained traction in educational settings thanks both to its democratic principles and the applicability offered by its value profile modelling. A set of capacities are provided by the theory, with the intention of providing a toolkit for effective leadership which can be adopted by a range of leaders, thus avoiding the need for inherent leadership qualities. The theory continues to face charges of promoting despotism, however, and most importantly of lacking relevance to real-world settings. Through the reflective analysis of a university-based English for Academic Purposes pre-sessional course – a fixed-term, high-stress setting – a grounded assessment of the real-world applicability of transformational leadership theory can be conducted. It is proposed that such courses within the higher education sector pose specific challenges to leadership, due to time constraints, staff retention and pressures on student achievement. The scope for meaningfully engaging staff in structural processes is thus restricted and there is a clear need for an accessible theory which supports a democratic, pluralistic approach to leadership, such as transformational leadership. However, reflective analysis of the leadership methods employed on the course, and an assessment of their correlation to the principles of transformational leadership, reveals a deficit in real-world applicability of the theory and a failure to convincingly avoid the pitfalls of the cult of the leader.

Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review

Objective To review the impact of clinical supervision of post-registration/qualification healthcare professionals on healthcare organisational outcomes. Background Clinical supervision is a professional support mechanism that benefits patients, healthcare professionals and healthcare organisations. Whilst evidence is growing on the impact of clinical supervision on patient and healthcare professional outcomes, the evidence base for the impact of clinical supervision on organisational outcomes remains weak. Methods This review used a convergent segregated approach to synthesise and integrate quantitative and qualitative research findings, as per the Joanna Briggs Institute’s recommendations for mixed methods systematic reviews. Databases searched included CINAHL, Embase, PubMed, PschINFO, and Scopus. Whilst a narrative synthesis was performed to present the findings of the quantitative and qualitative studies, the evidence from both quantitative and qualitative studies was subsequently integrated for a combined presentation. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results Thirty-two studies including 27 quantitative, two qualitative and three mixed methods studies, were included in the review. The results of the quantitative analysis showed that effective clinical supervision was associated with lower burnout and greater staff retention, and effective supervisor was associated with lower burnout and greater job satisfaction. Qualitative findings showed that healthcare professionals believed that adequate clinical supervision could mitigate the risk of burnout, facilitate staff retention, and improve the work environment, while inadequate clinical supervision can lead to stress and burnout. The evidence from quantitative and qualitative studies were complementary of each other. Conclusion Clinical supervision can have a variable effect on healthcare organisational outcomes. The direction of this effect appears to be influenced by the effectiveness of both the clinical supervision provided and that of the clinical supervisor. This highlights the need for organisations to invest in high quality supervision practices if maximal gains from clinical supervision are to be attained.