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Work together to increase resilience

During the COVID-19 pandemic the resilience of the NHS was extremely tested, as the push to return services towards normal continues, and the inevitable ask to catch up on what wasn’t done during the height of the pandemic intensifies, it is more important than ever to ensure that your team has a resilience buffer. At what point does the team become so overstretched that it cannot maintain a reasonable equilibrium between capacity and demand; and is the answer to work together to avoid crises. This article looks at team resilience and avoiding a downward spiral.

Helen Northall

During the COVID-19 pandemic the resilience of the NHS was extremely tested, as the push to return services towards normal continues, with the additional asks of enhanced vaccination programmes, and the inevitable push to catch up on what wasn’t done during the height of the pandemic it is more important than ever to ensure that your team has a resilience buffer.

Resilience refers to the amount of flexibility in the team. At what point does the team become so overstretched that it cannot maintain a reasonable equilibrium between capacity (this includes funding as well as staff availability) and demand (workload, and importantly quality). If this reasonable equilibrium cannot be maintained then services can spiral towards a crisis. For example:

  • Workload increases
  • Staff work longer hours
  • Pressure on staff increases, their personal resilience and morale decreases
  • Staff sickness increases
  • Quality decreases
  • Use of locums increase
  • Budget becomes overspent
  • Additional pressure on staff to manage
  • Quality decreases
  • And so it could go on

So what can you do to develop a resilience buffer? Team resilience can also refer to the individual levels of ‘bouncebackability’. This needs to be considered, in most cases, across a number of organisations – for example, across all practices in a PCN, between PCNs and other community services, across an integrated care system. What is needed here is transformational change, and a shift in leadership to support more than just the transactional call for additional resources, this is about redesigning services around potential pressure points, and considering how to use all staff across areas to best effect and having open and honest conversations about personal and team resilience. Now is the time to consider this – before winter and the additional pressures that may emerge hits.

How could you tackle this – at PCC we are working with primary care network (PCN) clinical directors across a number of areas, so looking at services from a PCN point of view. PCNs also have a unique opportunity to recruit and use additional workforce using the additional roles recruitment scheme.

  • What challenges are top of the list as concerns – the flu vaccination programme is likely to be one, but there will be many others
  • Who else in the area can support – for example pharmacists, community nursing teams etc
  • How can this programme be managed to enable each practice to maintain capacity for other pressures – setting up the flu clinics in other settings, using a wider range of workforce (including those outside general practice, as well as using new roles recruited in the most effective way) etc
  • Ask patients for their views and ideas
  • Consider even the most innovative solutions

Using another example – that is more system wide, how can services in the community support hospital capacity to enable resilience in hospitals to be maintained. Much has already been done on this – but looking at two streams with the right leaders in the room is crucial:

  • Community capacity to manage discharges
  • Prevention of admissions

This needs to be at place level or ICS level, with the right leaders in the room. Break down the issues to make a manageable discussion and make incremental changes to develop a resilience buffer.

The only way sufficient flexibility can be maintained in teams is to think out of the box, work collaboratively and consider the system and not just individual organisations.

Time for extraordinary leadership
When working far from certainty and far from agreement leaders need to:

  • say yes to the mess
  • build networks
  • focus on a clear purpose or issue
  • challenge assumptions
  • contain and manage anxiety

As Einstein said about work:

1) out of clutter find simplicity
2) from discord make harmony
3) in the middle of difficulty find opportunity

(Albert Einstein 1879 – 1955)

Now is the time for leaders to work together, and we have found this can often be facilitated virtually, to discuss and develop innovative solutions to the pressures every area is about to face.