# data[].attributes.headline
Stickers that kids can stick on theirselves

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Stickers that kids can stick on theirselves

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Use chart to deduce how sick they are

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Interactive toy

I can design a toy-like equipment for children to show their symptoms of disease.

according to this article, children are "communicate with the doctor what exactly is wrong, what is hurting, and how they are feeling."

Fictional character

Children tend to follow a cartoon character's behaviour, maybe I can design an animation to show on the screen, children will be able to empathise with it.

RPG (Role Playing Games)

I can design a game that starts when children step into the clinic. "immersive" is a good way to explore.

Build like CIS that can easily use in any cilic, as well as can help children to adapt any style of clinic

Source: 1 2

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Eye care clinic of the future launched by UCL and Moorfields

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Eye care clinic of the future launched by UCL and Moorfields

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This flexible clinic reduced the time that patient spend on waiting.

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A new pop-up diagnostic hub has been opened at a London shopping centre in a unique research collaboration between UCL and Moorfields Eye Hospital, aimed at "defining the principles of healthcare in the UK and globally for the next 50 years".

Project lead, Paul Foster, a of Ophthalmic Epidemiology and Glaucoma studies at UCL Institute of Ophthalmology and consultant at Moorfields said: "This important innovative eye clinic, builds on the decade of research that led to the earlier Moorfields' diagnostic hubs.
Patient experience
Image

Photos taken at the pop up outpatient clinic at Brent Cross, credit Moorfields

Media contact

Henry Killworth

Tel: +44 (0) 7881 833274

E: h.killworth [at] ucl.ac.uk

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Eye care clinic of the future launched by UCL and Moorfields

# data[].attributes.attachment_link.description
A new pop-up diagnostic hub has been opened at a London shopping centre in a unique research collaboration between UCL and Moorfields Eye Hospital, aimed at "defining the principles of healthcare in the UK and globally for the next 50 years".

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biped employs self-driving technology to guide blind and partially sighted people. It uses 3D sounds to help users avoid obstacles and navigate safely. The harness is equipped with cameras and a small computer, providing obstacle detection, GPS navigation, and even descriptions of surroundings using AI.

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Instead of biped, this tool is an orientation tool that uses a base and activator model to provide audible information about a location. The base units are installed at key points where a visually impaired person might need assistance, and the activator, held by the user, vibrates to alert them of the base's proximity.

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La Shed Architecture separates eye clinic into light and dark zones

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La Shed Architecture separates eye clinic into light and dark zones

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This case shows how interior design plays a role in a clinic.

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La SHED Architecture separates eye clinic into light and dark zones

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A white spectacles showroom contrasts with black examination areas at this eye clinic near Montreal by Canadian studio La SHED Architecture.

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A new, integrated eye care, research and education facility

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A new, integrated eye care, research and education facility

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Background knowledge

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Stress-related sickness absence, which costs the NHS up to £400 million annually

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Stress-related sickness absence, which costs the NHS up to £400 million annually

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Abstract

The United Kingdom's National Health Service (NHS) has a higher-than-average level of stress-related sickness absence of all job sectors in the country. It is important that this is addressed as work stress is damaging to employees and the organisation, and subsequently impacts patient care. The aim of this study was to gain an in-depth understanding of working conditions and wellbeing in NHS employees from three employing NHS Trusts through a mixed-methods investigation. First, a cross-sectional organisational survey was completed by 1644 respondents. Questions examined working conditions, stress, psychological wellbeing, job satisfaction, and presenteeism. This was followed by 33 individual semistructured interviews with NHS staff from a variety of clinical and nonclinical roles. Quantitative findings revealed that working conditions were generally positive, although most staff groups had high levels of workload. Regression outcomes demonstrated that a number of working conditions influenced mental wellbeing and stress. Three themes were generated from thematic analysis of the interview data: wellbeing at work, relationships, and communication. These highlight areas which may be contributing to workplace stress. Suggestions are made for practical changes which could improve areas of difficulty. Such changes could improve staff wellbeing and job satisfaction and reduce sickness absence.

Keywords: work stress, working condition, communication, peer support, wellbeing, mixed methods

1. Introduction

The United Kingdom's (UK) National Health Service (NHS) is the single biggest employer of over 1.5 million individuals in the country and is funded primarily by taxes. The NHS provides healthcare to UK citizens which is free at the point of delivery. However, employing NHS Trusts are largely running a financial deficit due to the UK government's austerity agenda of recent years, which has meant lower levels of NHS funding [ 1], with these financial deficits subsequently affecting staff and being a distinct barrier toward implementing wellbeing initiatives for NHS staff [ 2], but also care provided to patients [ 3]. Indeed, the health and social care occupational sectors now have the highest levels of stress-related sickness absence in the country, estimated to be 46% higher than the UK average [ 4]. Approximately 40% of all staff sickness absence in the NHS is due to work stress [ 5] and costs the NHS up to £400 million per year [ 6]. This project presents the outcomes of a mixed-methods study looking at stress in the NHS and strategies which can be implemented in order to improve staff experience.

1.1. Stress in the Workplace

Stress in the workplace is defined by the United Kingdom Health and Safety Executive (HSE) as "the adverse reaction people have to excessive pressures or other demands placed on them" [ 7]. The job demands-resources (JDR; [ 8]) model is one of the most widely applied theories of work stress. It proposes that employees encounter job demands, which require physical or psychological effort such as high work pressure or problems related to reorganisation. Conversely, job resources (such as support from peers, feedback, or career opportunities) are aspects which are positive in terms of reducing demands, helping to achieve goals, or may be important for personal development. The model suggests that resources can act as a buffer against job demands, but if job demands outweigh the resources available, this can lead to stress and eventually burnout and absenteeism [ 9, 10].

The HSE reports that over 15.4 million working days were lost due to stress, depression, and anxiety in 2017-2018, accounting for 57% of all days lost at work due to sickness absence [ 11]. Indeed, stress and mental ill health combined are the biggest cause of long-term sickness absence (i.e., that which lasts 4 weeks or more) in the UK, and is second only to colds and flu in terms of short-term absences [ 12]. The Health and Social Care sector has the highest level of sickness absence of all employment sectors in the UK [ 11]. Within the NHS, the five-year forward view argues strongly that mental health and wellbeing should be given equal priority statement as physical health in terms of funding and staffing. Indeed, staff health and wellbeing is such an important topic in the NHS that it is linked to the levels of funding awarded to Trusts through the Health and Wellbeing Commissioning for Quality and Innovation (CQUIN).

Consequently, in a bid to support organisations in dealing with stress in the workplace, the HSE released a set of management standards in 2004 [ 13]. The HSE management standards approach argues that should employees work under poor working conditions (or psychosocial hazards) for an extended period of time, this can lead to sickness absence [ 13]. In particular, seven hazards (demands, control, managerial support, peer support, relationships, role, and change) are discussed, with organisational evaluation of these hazards possible by distributing the associated Management Standards Indicator Tool (MSIT) [ 14]. Poor levels of these hazards in the public sector have been shown to be related to organisational outcomes such as sickness presenteeism [ 15], intentions to leave the profession, and job dissatisfaction [ 16].

1.2. Impact of Stress on Health and Patient Care

Both persistent (chronic) and acute stress have been demonstrated to impact employee psychological and physiological health, although various researchers have suggested that it is generally chronic stress which may lead to stress, anxiety, and depression sickness absence, as well as physiological illness [ 13]. For example, the INTERHEART studies [ 17] demonstrated that chronic work stress is as much of a risk factor for the development of cardiovascular disease as well-known problems such as high blood pressure and smoking. Similarly, chronic stress is related to the development of metabolic syndrome, which is a risk factor for the development of Type 2 Diabetes [ 18].

Furthermore, research is continually demonstrating that for those working in patient-facing roles, positive levels of mental health is generally associated with providing better quality care to their patients [ 19]. In social work, for example, high levels of turnover and sickness absence have been linked to poor working conditions, subsequently meaning more inefficient care and higher costs in terms of replacement staff [ 20]. Similarly, West and Dawson [ 21] demonstrated that positive levels of employee engagement in the NHS was linked to better levels of organisational outcomes such as absenteeism and turnover and patient-related outcomes such as satisfaction, mortality, and infection rates.

1.3. The Present Study

Understanding the key stressors, and approaches which can be undertaken in order to reduce stress and thus improve engagement, in NHS employees are key considerations for individual employees, employing Trusts, and the patients they work with. The aim of this research, therefore, is to undertake a mixed-methods study into the working conditions faced by NHS staff in three large employing Trusts, the impact that these hazards have on employee wellbeing, and strategies which can be implemented by the employing healthcare organisation to maintain positive and improve wellbeing for healthcare staff.

2. Materials and Methods

2.1. Methods and Participants

A mixed-methods study, consisting of an employee survey and individual semistructured interviews, was conducted to investigate the influence of working conditions on stress and wellbeing in NHS staff employed in one of three NHS Trusts in the southwest of the UK. A mixed methods approach involving quantitative surveys and qualitative semistructured interviews was undertaken because it can allow in-depth exploratory and confirmatory research in health and social care settings [ 22]. Mixed-methods approaches can also be used with health and social care research in order to develop and understand improvement processes [ 23]. This mixed-methods approach therefore allowed the exploration of working conditions and health and wellbeing through a quantitative survey, and following qualitative interviews allowed an in-depth exploration of these findings in addition to the development of improvement mechanisms with health and social care organisations.

Quantitative survey data was collected using the web-based data collection software Qualtrics ( www.qualtrics.com), with the research team putting together an email containing the survey link which was sent to all staff (both clinical and nonclinical) in the three Trusts by the wellbeing lead in each Trust, on behalf of the research team. Links were sent to staff in February 2018, a reminder sent two weeks later, and the data collector closing one week following. The first page of the online survey was an informed consent form, and the survey completed with a full debrief form.

Individuals were invited to qualitative semistructured interviews via another all-staff email designed by the research team and sent by senior management in each Trust. Interviews were conducted on a first-come first-served basis, with iterative rounds of data collection and analysis continuing through to saturation point in which no new themes emerged [ 24]. Upon contacting the first Author stating interest in an interview, an information sheet and consent form was sent via email at least 48 h prior to the interview taking place, with the consent form returned via email to JR and stored separately from any data collected in order to maintain anonymity. Each interview also started with a reminder of ethical considerations, and verbal consent was gained prior to beginning the interview proper. Immediately upon study completion, a debrief form was emailed to participants. No job roles were excluded, and those interviewed included a variety of clinical and nonclinical roles such as nurses, administrators, managers, occupational therapists, and dentists. Interviews were semistructured with open-ended questions which were iterative in nature, developing through the study and expanded upon during interviews [ 25]. Interviews lasted on average 45 min and took place between February and May 2018. They were conducted over the telephone by JR, AM, and CB, audio-recorded, and professionally transcribed prior to analysis. The researchers were completely separate to all organisations and participants, and thus had no pre-existing relationships with any of the survey or interview respondents. Ethical approval was gained from the Bath Spa University Research Ethics Committee ( JR181217).

2.2. Materials

2.2.1. Quantitative Measures

Working conditions were measured using the 25-item version of the Management Standards Indicator Tool (MSIT) [ 26]. The MSIT assesses seven areas of the workplace (demands, control, managerial support, peer support, relationships, role, and change) that could lead to worsened employee and organisational outcomes if left at unacceptable levels. The 25 items are answered on a 5-point Likert scale. Higher scores equate to better working conditions. Psychological wellbeing was measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) [ 27]. The WEMWBS uses 14 positively phrased items to measure positive affect, psychological functioning, and interpersonal relationships (answered on a 5-point Likert scale). Higher scoring represents better mental wellbeing. Stress was measured by a 4-item version of the Perceived Stress Scale (PSS, Mind Garden, Menlo Park, CA, USA) [ 28]. The PSS asks how often respondents have experienced stressful situations in the past month (answered on a 5-point Likert scale), with higher scoring reflecting higher stress. Demographics (see Table 1 ) were also asked at the end of the survey. Participants were asked if they worked more hours than they were contracted to and to estimate how many.

Table 1

Job Role

Mean Age (SD)

Sex

Average Length in Role

Ethnicity (%)

Disability (%)

Hour Disparity *

Male

Female

White British

Other

Yes

No

%

Length

All Respondents ( n = 1644 ⁺)

46.2

16.4%
n = 263

83.6%
n = 1364

7 Years, 9 Months

90.0%

10.0%

10.%

90.0%

56%

5.5

Two further outcome measures (presenteeism and job satisfaction) were assessed via single-item global measures, which are argued to be as reliable as multi-item measures [ 29]. The job satisfaction measure asked, "taking everything into consideration, how do you feel about your job as a whole?" [ 30], with responses from 1 to 5 (extremely dissatisfied to extremely satisfied). Presenteeism was measured via the question, "as far as you can recall, has it happened over the previous 12 months that you have gone to work despite feeling that you should really have taken sick leave due to your state of health?" [ 30], and responses given on a 4-point Likert scale from 'no, never' to 'yes, more than 5 times'. Lastly, one open-ended question was asked: "in one sentence, what would you do to improve working conditions in your Trust?" [ 16], although these responses were not analysed due to a number (approximately 34% of respondents) of nonrespondents, potentially because this question added significantly to the length of time it would take to respond to the survey. Of all of the measures used, only the PSS has previously been used in healthcare employee populations [ 31, 32]. However, each have been used and demonstrated to be reliable with other occupational groups, such as social workers and teachers [ 16, 33].

2.2.2. Interview Materials

Thirty-three NHS employees from three Trusts in the southwest of the UK were recruited to take part in the study. The interview schedule was not piloted among healthcare professionals, but was peer-reviewed both by members of the research team and senior management in all participating Trusts. The schedule sought to investigate the stressors associated with working in the NHS, as well as approaches which can be taken in order to improve upon such stressors. Participants were therefore asked to outline any particular stressors that they faced at work: for example, "what difficulties do you experience at work that may affect your wellbeing", as well as the resources available to buffer these stressors, such as, "how can we build upon the work that your work does well in order to support your wellbeing". Finally, interviewees were asked for changes or interventions which could be taken in order to improve upon these stressors: for example, "what initiatives would you like to see in your job to support your wellbeing?", while also building on the positivity associated with the resources already available at work.

2.3. Analytical Strategy

Quantitative data were analysed using IBM SPSS 24.0 (IBM, Armonk, NY, USA). Initially, descriptive statistics were presented for each measure (mean, standard deviation, and frequency where available), as well as comparisons to UK-wide benchmarks where possible. Subsequently, a series of regression analyses were undertaken in order to investigate the influence of working conditions on stress and psychological wellbeing.

Qualitative data was analysed by a qualitative researcher (CB) using thematic analysis following steps by Braun and Clark [ 25]. Following immersion into the data by repeatedly listening to the recordings, NVivo software (QSR International, Melbourne, Australia) was used to code the transcripts into themes and subthemes. Themes were created, split into subthemes, and omitted throughout analysis as they were reviewed. Half of the data was then independently coded by JR in order to reach a consensus. Verbatim quotes with labels were used to illustrate each theme.

In order to integrate the findings of the quantitative and qualitative approach into a truly mixed methods study, we utilised a triangulation protocol via the organisation-wide surveys and semistructured interviews [ 34]. As such, we disseminated the organisational survey to all in each of the participating organisations and analysed the results. Following the survey, we invited interested parties to take part in the semistructured interviews, while maintaining an open and exploratory interview schedule. Following analysis, the findings from each of the quantitative and qualitative elements were considered together to discover whether there was agreement or dissonance between the two sets of findings [ 34].

3. Findings

3.1. Survey Results

Invitation emails were sent to all employees in the three Trusts (n = 11,370), with 1644 responses gained (a response rate of 14.5%). Apart from the demographic questions, all questions were forced-response, and thus there was no missing data. The majority of participants identified working excess hours, on average ranging from 3.7 to 7.2 h excess per week. Compared to reference scores [ 35] of over 67,000 public and private sector employees in the UK, working conditions were relatively positive (see Table 2 ). These reference figures have previously been used with UK social workers [ 16] and teachers [ 33], among many other populations. However, workload demands on management, doctors, and physiotherapists and a lack of control and role understanding in physiotherapists scored in the 10th percentile, or worse than 90% of those in reference figures. Similarly, the amount of control over the way in which physiotherapists and healthcare assistants do their jobs scored in the 10th percentile, as did management and physiotherapists' understanding of their role in the organisation. Other than this, all outcomes were in the 25th percentile or greater, with the demands faced by administrators and peer support for physiotherapists scoring in the 95th percentile.

Table 2

Job Role

Demands

Control

Managerial Support

Peer Support

Relationships

Role

Change

PSS

WEMWBS

Apart from management in this sample, scoring was above average on the PSS [ 36], suggesting higher stress, although still within one standard deviation. Mean scoring on the WEMWBS was 49.9 [ 37], higher than all employees irrespective of job role in the presented sample, indicating lower average psychological wellbeing than the UK average. Findings also demonstrate that most (59.1%) were satisfied in their jobs, whilst 42.1% had been to work at least twice in the previous 12 months despite being so ill they should have stayed off work. Interestingly, nurses and healthcare assistants were least satisfied whilst also being in the top three of presenteeism scorers.

Regression analyses ( Table 3 ) were conducted to investigate the influence of working conditions on perceived stress and psychological wellbeing. The stress regression model demonstrated good fit, accounting for 20% of variance for all participants. Six MSIT variables significantly influenced both perceived stress (managerial support was the only one which did not; see Table 3 ) and psychological wellbeing (excluding demands), accounting for 27% of variance.

Table 3

Outcome Measure

Significantly Related Factors

Coefficient Estimates

t

p

R²

Adjusted R²

Perceived Stress Scale

Demands

−0.77

−7.12

<0.001

0.20

0.20

Warwick-Edinburgh Mental Wellbeing Scale

Control

1.37

4.30

<0.001

0.26

0.26

3.2. Interview Findings

Three overarching themes from the interviews were identified from the 33 semistructured interviews undertaken. These were wellbeing at work, relationships, and communication.

3.2.1. Wellbeing at Work

Many contributing factors were mentioned for those experiencing work stress, including high workload and changes at work. Generally, it was felt that there was insufficient support and understanding around mental health issues, emphasizing not only the impact of poor work on individual wellbeing, but also what organizations can do to prevent employees from experiencing negative work stress and wellbeing.

Mental health at work: Participants spoke of mental health problems which resulted in being absent from work for a period, with this being attributed to work stress. Many participants described a lack of support and a lack of understanding about mental health issues from management. They proposed more mental health education for managers to increase understanding and thereby level of support, including more frequent debriefs. As an example: "If somebody has been off with stress or depression or anxiety, when they come back, the same conversations should take place...what can we do to help you get back to work and make things more comfortable for you?" (P15, nurse, female).

Workload: Workload was discussed as the predominant stressor among the majority of participants. Employees spoke of unrealistic deadlines and workloads and consecutive clinic appointments: "Sometimes you're asked to do things at very short notice which sometimes is nigh impossible" (P16, consultant, female). This was spoken about in connection with a high level of stress: "It's very much workload is causing the biggest stress at the moment." (P20, male, administrator). This also led to the majority describing an inability to take any kind of a break while at work: "It seems to be a habit across my team. I see people doing it all the time. I think it's an organisational thing. We do not take half an hour out of our day to get a breath of fresh air or anything like that" (P25, nurse, female).

Improving mental health: Some employees suggested that it would be helpful to have a room where staff could go to get away from their desk to have a break, especially during a difficult time: "I'd like the idea of a quiet room, just to sit down for five minutes. If you've had a difficult call, you can go in and bring yourself back in and remind yourself that you're okay and that person's going to be okay" (P7, administrator, female). Participants were also positive about "extra" wellbeing events which were put on by their employing organisation specifically aimed at improving wellbeing: "Get people to go into departments...and show them different ways of keeping fit or maybe dealing with stress. That sort of thing would be really good." (P3, occupational therapist, female). However, a lack of communication meant that some respondents did not know when and where these events were happening, and many activities were hosted at organisational "hub" organisations, but not associated satellite sites such as hospitals: "There are not many days and things that are really accessible for us." (P28, doctor, male).

3.2.2. Relationships

This theme relates to relationships that employees have within work, with their line managers and peers, and the positive influence that such relationships can have on wellbeing. Peers were a source of support in this group, while there was a mix of positive and negative relationships with managers. Finally, the subtheme of supervision revealed that a number of participants felt that they would benefit from an increase in the frequency and quality of supervision from management.

Relationship with line manager: Participants had polar views when it came to their relationships with their managers. Those who participants saw in a positive light were described as being good communicators and supportive. They were understanding both in terms of managing workload and issues that may be affecting their staff personally: "Whenever I've needed time off personally, my manager's been fantastic. I can't fault her on those things, which I think staff really value, because it makes you feel like you're a human being...you're seen as a valuable member of staff" (P22, manager, female). Those who felt negatively towards their line manager described them as being poor communicators and having weak management skills: "They cannot manage people...they've had no management development" (P11, no job role recorded).

Relationship with colleagues: Employees clearly experienced a great deal of support from their team at work and were markedly positive about their relationships with their peers. They appeared to be a key source of encouragement for many interviewed. Communication was again highlighted as being important: "The communication here is amazing. It's really as if like I'm in a big family. It's the best place" (P24, nurse, female). Listening skills and being helpful and friendly were important: "They're so helpful and friendly. If you've got an issue, they're quite happy just to put their issues aside and listen to you and give you praise when it's needed. They make you feel not just needed but appreciated" (P7, administrator, female). It appeared therefore that being part of a positive team environment impacted on how much they enjoyed their job.

Supervision: Many felt that both clinical and general supervision was lacking, despite being important. In some cases, supervision was missing altogether or not being carried out as frequently as it should be: "We're supposed to do clinical supervision, and I say supposed, because it never seems to properly take off" (P32, nurse, female). Additionally, there was sometimes a reactive instead of proactive practice in providing supervision to clinically focused staff: "Clinical supervision is something that we're supposed to do but it's never really been ingrained in our culture...it tends to only happen when there's been a problem" (P25, nurse, female).

3.2.3. Communication

This theme focuses on both top-down and bottom-up communication. Indeed, each organisation is constantly changing due to the financial pressures currently facing the NHS [ 3], and the way in which these changes are communicated was described as a particular stressor.

Bottom-up communication: Of those interviewed, some felt able and motivated to put constructive suggestions for change forward to managers/senior managers; however, for many, there was negativity surrounding this issue. Some described being far too busy: "it's all about surviving the day" (P17, doctor, male), or did not feel that their views were valued: "the impression you get is if it doesn't come from them, it doesn't count" (P1, nurse, female). Participants also spoke of not receiving any feedback if they did put forward ideas: "I think that when you're constantly feeling that you're not being listened to then that is part of the problem" (P25, nurse, female).

Top-down communication: Many spoke about poor communication from management, particularly regarding changes which were directly relevant to them, and not finding out about changes until they had actually taken place. A lack of communication and consultation about change was described as being something which affected staff wellbeing: "it's just as if the organization at the top doesn't actually care about how that makes people feel" (P15, nurse, female). Relatedly, staff described that information about change was not shared with them and were worried about redundancies and having to reapply for jobs. Employees wanted open and honest communication from the Trust.

4. Discussion

This study examined the influence of working conditions on employee wellbeing and stress in three NHS Trusts using mixed methods. Survey results suggested that working conditions performing well-better than 75% of benchmark scorers [ 35]-are management and peer support, and change communication within the organization. Furthermore, management respondents reported having autonomy and change communication, and the workload of those in administrative roles, at a level better than 90% of benchmark scorers. This is positive given that recent research has shown teachers [ 33] and social workers [ 16] scoring in the bottom 90th to 95th percentiles. More negatively, demands were worse than 90% of benchmark scorers in some staff groups. Similarly, over 40% were not satisfied in their job, and over 40% attended work at least twice in 12 months while ill (presenteeism). Regression outcomes demonstrate perceived stress and psychological wellbeing were influenced by a number of working conditions.

In the qualitative data, three themes emerged. The first was "wellbeing at work", in which participants described a too-high workload, inability to take breaks during work, and changes at work contributing to a high level of stress in them and their colleagues. There was not enough support around mental health issues, but employees did welcome wellbeing events provided by the Trust and wanted easier access to these. The second theme was "relationships", in which participants described receiving a lot of support from peers and around half also felt well-supported by managers who were emotionally supportive and easy to communicate with. It was also revealed that supervision could be improved. Finally, in "communication", participants did not feel they had time to feed up their views to senior staff or felt their views were not valued or they would not receive feedback.

There were both agreements and dissonance between the quantitative and qualitative findings. Peer support was positive in both, potentially buffering against the negative influence of other conditions on wellbeing. Additionally, demands (which can include workload, work environment, and work patterns) was a difficulty in both the survey and interviews, with almost all describing a volume of work which was too high and a culture of consistently missing lunch breaks. However, while the survey suggested managerial support was good in those who took part, the qualitative data revealed that while half felt very supported by their manager, half did not. This finding could imply that those with problematic relationships with their manager may have been more likely to take part in the interview stage. Furthermore, while the management of and communication about change scored well in the quantitative data, communication about change appeared to be an issue which was causing a lot of stress and was described as being done poorly in the qualitative data. Finally, an understanding of one's role in the organisation scored poorly (worse than 90% of benchmark scorers), while this did not emerge as a major issue through analysis of the qualitative data.

Together, the findings suggest that there are a number of areas which could be contributing to lower levels of mental wellbeing in NHS employees. Poor working conditions and high levels of stress at work have been demonstrated to influence organisational outcomes such as dissatisfaction at work, absenteeism, and presenteeism [ 16], and subsequently impact on patient care [ 19]. Indeed, research with domiciliary care workers [ 38, 39] has similarly demonstrated the impact that role understanding and occupational autonomy has on individual psychological health and wellbeing. In accordance with the job demands-resources [ 8] model, a number of the issues discussed could be adding to the demands experienced while working in the NHS. For example, the high workload described by many, such as high caseload, high numbers of patients to be seen, or large quantity of requests for reports often in an impossible time frame, is an obvious example of this. Workload could be reduced by increasing levels of recruitment, though we recognise economic constraints are currently in place. Changes taking place which affect, or threaten to affect, employees' work and environment directly and are a cause for concern about redundancy can also add to demands experienced, especially if the changes are not communicated well or in a timely manner. Strategies to improve communication about change are warranted. In terms of information flowing the opposite way, the data suggested that some workers felt they either did not have the time to put their ideas forward or felt their ideas were not valued. It may be useful to give members of staff more opportunities to put forward suggestions and give feedback about any changes so that staff feel their input is valued. Feeling that there is a lack of opportunity to put forward ideas and feeling undervalued as a member of staff could also act as an additional demand.

The JDR [ 8] model suggests that there are factors which can act as buffers to stress at work and these resources may reduce the effect of the demands placed on the individual. One such likely buffer found in both the quantitative and qualitative results was the support of colleagues. Support from peers can help by spreading workload and providing emotional support. It has been widely suggested to be a significant buffer toward the experience of stress at work [ 40]. On the whole, it was found to be positive in this group especially if colleagues had good communication and listening skills and were helpful and personable. In order to increase this buffering effect, it may be useful to encourage regular, formalised communication and peer support groups between team members through meetings and possibly training around good communication. Managerial support scored well in the survey, with more complex findings in the interviews. Those with a good relationship with their supervisor could benefit from this as a buffer to stress at work. Those who felt positive about this relationship emphasised supervisor who were understanding and made them feel valued. Supervisors can provide individualised support such as supervision and one-to-one meetings and can play a part in greater job role understanding (which scored poorly in the survey). In the supervision subtheme, some employees described not having enough supervision. Regular sessions for all staff could nurture relationships, promote better communication, increase feelings of being supported, and could improve wellbeing. There were other factors which could also act as buffers with some changes implemented. For example, the results suggested that there was a culture of not taking lunch breaks. A break from work, with possibly fresh air and exercise or time to talk to colleagues in a relaxed manner, could provide a buffer to daily stress. This could be encouraged by providing lunchtime walking clubs, providing suitable areas to eat away from the desk inside and out, and encouraging managers to lead by example in terms of break-taking. Staff may perform better after a break [ 41].

Wellbeing activities provided within the Trust could also be regarded as resources to balance out the demands employees are confronted with. The results presented here suggest that wellbeing-related activities should be made available to individuals in a variety of times and locations (in order to take into account shift patterns and the diverse geographical nature of many NHS Trusts), and possible cover for staff may be important so that they have the opportunity to attend. Also, it should be clearer what events are available to staff and ensure that this information is made available in plenty of time prior to the events. Additionally, it was suggested that a room for staff to go when they are having a difficult time for a short break would be helpful to allow individuals some space from work. Finally, more mental health awareness and promotion of counselling services available may increase uptake, which could provide a buffer to demands placed on the employees.

4.1. Strengths and Limitations

Exploring the issue of NHS workforce wellbeing using both quantitative and qualitative methodology is a strength of this study. This resulted in both a large data set which could be used to compare NHS employee working conditions to mean UK scores and to other public sector employees, and a richly detailed dataset in which to examine the topic of staff mental wellbeing. NHS employees from a wide range of roles from three large Trusts participated in both aspects of the research. Furthermore, the data suggested a number of practical suggestions which could be implemented with health services organisations in order to support their staff.

In terms of limitations, for the survey, there was a low and imprecise response rate. While these are often described as issues for internet-mediated studies, the approach also allows the collection and analysis of a large sample size while maintaining anonymity and confidentiality. Furthermore, the self-report and cross-sectional nature means causality cannot be ascertained. There may also be errors in self-reporting of contracted/actual hours. For the interviews, since participants were self-selecting, there may have been a degree of bias in the sample in terms of employees who were particularly stressed or who had experienced negative relationships at work. However, the sample provided an opportunity to explore potential areas for improvement.

4.2. Implications and Future Research

The survey results emphasised a low scoring for understanding how one's role fits within the organization, with this contributing to both wellbeing and perceived stress scores. This deficiency could be increased through targeted information sharing and discussion during one-to-one meetings. There were some differences in roles, with management, doctors, and physiotherapists scoring particularly poorly for demands, while physiotherapists and healthcare assistants scored poorly for control. Targeted aims to reduce demands and increase the level of control in these roles may be valuable. Future research should also investigate these role differences in more depth, such as whether differing interventions would be more amenable and have greater efficacy in differing job roles.

It is clear that peer support is potentially a significant resource for employees [ 40]. We suggest that formal peer support groups and networks such as Schwartz Rounds be set up across NHS Trusts. Additionally, an increase in managerial support, for example by providing regular one-to-one meetings to staff, may reduce stress. Also, in the results, change communication was highlighted as lacking, and with it, an absence of consultation over change. This could be addressed by providing opportunities for employee input and regular and timely information about upcoming changes. Future research could also focus on differences in experience between managers and employees. We have demonstrated some differences between management and employees in working conditions (as per the MSIT), and thus potential differences could be investigated in more depth.

Previous researchers focusing on predominantly health behaviours have found workplace wellbeing interventions in the NHS to successfully improve physical activity and job satisfaction and lower sickness absence [ 42]. A focus on interventions to increase mental wellbeing in this staff group may be beneficial. An emphasis on the areas discussed, such as improving top-down (such as Chief Executive blogs and more dedicated and targeted use of newsletters), bottom-up (such as communication training and anonymous feed-up communication systems), and wellbeing-related (for example, mental health awareness training) communication; making the best use of support by scheduling regular supervision and team meetings; improving access to wellbeing activities; and promoting break-taking would be a suitable next step in research in this field. Quirk et al. [ 2] demonstrate some wellbeing-related approaches which can be undertaken within the NHS despite financial and workload pressures, such as having a senior management team who will support wellbeing initiatives and a supportive organisational culture, a strategic and creative approach to implementing wellbeing initiatives, and allowing key wellbeing champions within organisations to be innovative in their approach to developing and supporting wellbeing, such as working closely with external providers. A feeling of being undervalued was mentioned by a number of participants, and indeed, in an NHS staff survey, only 41% said they felt valued [ 43]. This may be linked with self-esteem and employee engagement [ 22], and therefore it may be important to focus on changing this perception. Future research should focus on longitudinal studies to determine whether findings are consistent across time, and interventional projects which seek to reduce demands should be sought.

5. Conclusions

To conclude, it is clear that chronic workplace stress has the potential to negatively impact both the health of employees and the wider organisation, and in the context of healthcare, also negatively impacts patient health outcomes. This study showed that while the experience of stress may be different across different roles in the healthcare sector, across the whole workforce, various working conditions negatively influenced the experience of stress. Qualitative interviews supported this, demonstrating that working relationships, communication, and perhaps most importantly, workload, were distinct influencers of stress. As such, by supporting employees and implementing interventions within the healthcare sector which seek to improve upon these working conditions, it will not only improve health outcomes for employees, but subsequently improve things for the patients that they work with.

Acknowledgments

This is to acknowledge that no financial interest or benefit has arisen from the direct applications of this research.

Author Contributions

Conceptualization, J.M.R.; Data curation, J.M.R. and C.B.; Formal analysis, J.M.R. and C.B.; Funding acquisition, J.M.R. and A.M..; Investigation, J.M.R., A.M. and C.B.; Methodology, J.M.R.; Project administration, J.M.R. and A.M.; Resources, J.M.R.; Validation, J.M.R.; Writing-original draft, J.M.R., A.M. and C.B.; Writing-review and editing, A.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Economic and Social Research Council, grant number ES/R002983/1. No funding was received for the APC.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

References

16. Ravalier J.M., McFadden P., Boichat C., Clabburn O., Moriarty J. Social worker well-being: A large mixed-methods study. Br. J. Soc. 2020 doi: 10.1093/bjsw/bcaa078. [[ CrossRef] Google Scholar]

Articles from International Journal of Environmental Research and Public Health are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Work Stress in NHS Employees: A Mixed-Methods Study

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The United Kingdom's National Health Service (NHS) has a higher-than-average level of stress-related sickness absence of all job sectors in the country. It is important that this is addressed as work stress is damaging to employees and the organisation, ...

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Reducing workload and increasing patient safety through work and workspace design

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Reducing workload and increasing patient safety through work and workspace design

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Labyrinths Or Mazes As Visual Exercises To Work On In Vision Therapy

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Labyrinths Or Mazes As Visual Exercises To Work On In Vision Therapy

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The children's unit offers a wide range of facilities to care for children of different age groups.

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Inspiring confidence, encouraging playfulness and offering hope. (hdrinc, 2019)

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Multicare Health System’s Mary Bridge Children’s Hospital

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Multicare Health System’s Mary Bridge Children’s Hospital

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Theme is important, this hospital follows the maritime theme.

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This children's wand consider about parents not only need to take care of their children but also need to balance their work.

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Awareness of something out of 'Sickness'

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Awareness of something out of 'Sickness'

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According to a Taiwanese report, a doctor said paediatricians have to sense about some wounds might caused by domestic abuse

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Paediatricians have to manage the emotion of children's parents.

"Learning how to communicate effectively and calmly with families is a skill many pediatricians need to learn. "

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Pediatric Associates Of Plainview L.L.P.

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Pediatric Associates of Plainview is dedicated to ensuring that your children live a happy and healthy life. The Pediatrician in Plainview offers a wide variety of services ranging from hearing and vision screenings, immunizations, depression and anxiety screenings, and much more. Our doctors want only the best care and treatment for your children, so we make sure our office feels like your home away from home.

What is a pediatrician?

There is a big difference between a regular doctor and a pediatrician. A pediatrician specializes in children and teenagers. They focus on the physical, mental, and behavioral health of children from the time they are born until they are 18 years old. A pediatrician helps diagnose children with all different types of illnesses and diseases ranging from mild to severe.

To become a pediatrician, you have to go to medical school and complete a 3-year residency specializing in pediatrics. Before becoming an official pediatrician, you also have to take several exams and then, every year, complete continuing education requirements as well.

What do pediatricians do?

When your child is a newborn, your pediatrician will see your child almost every month for checkups. However, as your child grows and gets older, the pediatrician will only see your child every couple of months and then only once a year unless they need to come in for other reasons. A pediatrician does a variety of things for your child, such as:

Checkups or physical exams

Immunizations

Diagnosis of child's illness or diseases

Advice about a child's health, safety, nutrition, and activity.

Answer any questions you may have about your child

Refer you to another specialist if the questions or illness is out of their expertise.

If you need to see a pediatrician in Plainview, the pediatric associates of Plainview are here to help and answer any questions you may have.

What are the challenges of a pediatrician?

Being a doctor can be a very challenging and rewarding job. However, there are many challenges that pediatricians can face daily. The first challenge they often face is managing the family unit. Many times when families come to see the pediatrician for a sick child, they can often be sleep-deprived, tired, and extremely stressed.

This can lead to extremely intense and emotional conversations. Oftentimes, the family can be angry, and the pediatrician has to realize they are acting that way because they are anxious and stressed about their child's health. Learning how to communicate effectively and calmly with families is a skill many pediatricians need to learn.

Another challenge that pediatricians face is solving medical mysteries in children. When children are extremely young, it can be hard for them to communicate with the doctor what exactly is wrong, what is hurting, and how they are feeling. This can be a challenge for the pediatrician to figure out exactly what is wrong with them and how they can treat them correctly. The parents know their children best, so the most effective thing a pediatrician can do is to ask the parents for help or what the child's symptoms are.

Finally, the most common and difficult challenge that many pediatricians face is seeing young children sick and suffering, especially if they lose a child. It is very difficult and upsetting to see a family and a child suffer. Nothing can prepare these pediatricians for this challenge.

Pediatrician in Plainview

Pediatric Associates of Plainview are here to help your child and support your family. This Pediatrician in Plainview has the best doctors and care to ensure your child is happy and healthy.

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What are the Challenges of a Pediatrician in Plainview?

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Our team at Pediatric Associates of Plainview care about your child's well being. To speak with a Pediatrician in Plainview click here.

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Designing for young patients means inspiring confidence, encouraging playfulness and offering hope. To accomplish this, hospitals and practices need high-performing and flexible environments that can do it all: enable excellent medical care, integrate technology, encourage interaction and patient engagement, and instill a sense of comfort for all ages.

These nine fundamental ideas can help create intentionally designed experiences throughout the continuum of pediatric care, culled from the more than 20 years we have been studying best practices in providing care for kids.

1. Design for Engagement at all Levels

Positive distractions can engage families and patients at all levels. Provide space for patients and visitors, including age-appropriate diversion activities such as interactive multi-touch walls, playrooms for young patients and high-tech gathering spaces for teenagers. Craft an architectural language that children and adults intuitively understand. Use form, materials, color and texture to develop places in which patients and their families feel a sense of belonging and a more home-like atmosphere.

At Multicare Health System's Mary Bridge Children's Hospital in Tacoma, Washington, the goal was to create a familiar environment that supported the psychological and physiological well-being of the children. The interiors followed a maritime theme focused on the landmarks and life found in and around Washington's Puget Sound. This theme is reflected in all areas of the expansion, from patient footwalls adorned with illustrations of coastal life to the play area, an aquarium and photographs of sea animals living in Tacoma's Point Defiance Zoo.

2. Keep Families in Mind

It's critical to think of family members' role as caregivers. Emphasize space for families including family sleep rooms, kitchens, laundry facilities, extra storage and other spaces that allow families to continue familiar and comforting routines for a child.

Provide technology so families can connect with work, home, school and classroom spaces that give children the opportunity to continue their education throughout the treatment process. For children who may feel more comfortable in the same bed with their parents, provide beds large enough for sharing.

In Omaha, Nebraska, Children's Hospital & Medical Center brought high-quality medical care for children in a comfortable, adaptable place for family. Each clinic is designed as a module, including office space for one manager, an agile workspace for physicians and nurses and areas for clean and soiled supplies and storage.

3. Create Neighborhoods

Pediatric patients have different social and privacy needs than adults and the organization of a unit should respond accordingly. The linear "hotel" layout of adult inpatient units lacks the environmental stimulation so important to a developing child.

Pediatric inpatient units that are organized around neighborhoods with their own identity and emotionally accessible parameters help to break down the scale of the unit - this reduces stress in patients, families and caregivers as they focus their energies on "living" in a more appropriately sized space.

Vidant Health's James and Connie Maynard Children's Hospital in Greenville, North Carolina, was designed as a sophisticated, yet playful healing environment using the latest medical technologies and best practices. With a theme of "through the eyes of a child," the building flows in a nautical design that creates positive distractions meant to be calming, playful, educational, interactive and inspirational.

4. Integrate Flexible Spaces

Provide added convenience for families by incorporating interactive play areas for siblings and flexible exam rooms that accommodate families. Design patient rooms to be acuity adaptable to minimize the need for moving patients and causing disruption to families. Module clinics can be designed to be expanded as changes to the delivery of healthcare arrive, including new technologies and advancements.

5. Consider Efficiency, Safety and Security

Enhance process through design. Minimize risk and streamline processes to improve efficiency, productivity and the experience. Lean Six Sigma and other process tools can enhance the delivery of care.

Using proven, evidence-based design strategies can help develop a healing environment that will inform best practices into the future. Design procedure rooms and patient care rooms to be same handed whenever possible for a predictable and standardized environment, which can lead to reduced medical errors. Identify numerous scenarios to ensure safety and security is woven into the design from the beginning, including well-thought out and separated paths of on-stage and off-stage circulation, and appropriate precautions for infection prevention and control. Data-driven design and parametric modeling can ensure that departments are planned with maximum efficiency and minimize staff travel distances.

6. Promote Healing Environments

Understand the human impact of design. Consider daylighting, noise control and acoustics, air quality, privacy, social support and positive distractions in designing a healing environment. If possible, separate treatment areas from patient spaces to keep the patient room a safe haven. Consider patients with special needs, including children with autism, and provide low-stimulation healing environments.

Take healing outside. Children need access to outdoor therapy spaces that are playful and healing, calming and rejuvenating. Outdoor healing environments such as healing gardens and activity spaces create opportunities for improved indoor/outdoor connections that minimize stress for children and families - let kids be kids, even in a healthcare setting.

UCSF Benioff Children's Hospital Oakland in Walnut Creek, California, is a satellite clinic facility that provides specialty services. One of the major challenges was to capture the essence of a children's healthcare facility - beginning the moment the patient steps into the lobby. Each clinic occupies a major portion of the building and is renovated as a functional space, while creating a light-filled, playful and healing atmosphere for the young patients cared for in the facility.

7. Support Caregivers

Recognize the demands we place on caregivers, acknowledge the emotional investment they make every day and provide areas for respite and recharge with natural light and consideration of circadian rhythms. Design the unit to allow nurses more time at the bedside, greater visibility throughout the unit, and quick and easy access to medication and supplies. Create highly collaborative environments to provide opportunities to enhance the knowledge transfer process among clinicians and patients, and, if appropriate, scientists.

8. Connect to Social Networks

Our children approach and interact with their social networks in ways never before possible, which means we need to create a world where being in the hospital does not mean children are separated from their circle of friends. Incorporate technology so that schools and social networks are brought into the room in full living color, allowing participation and fostering social identity. Here, a child's life is not "interrupted" by a clinical episode.

Footwalls play an important role in this new environment. Consider one with a screen that can switch from developing an app one minute to a dashboard of the patient's health the next. But connectivity will be more than virtual. These networks will demand a physical presence as the hospital becomes social space, transforming a once clinical area into a community center. Areas on the unit should be able to host birthday parties, play dates, study sessions and the myriad of group activities that are part of everyday life.

9. Consider Population Health Impacts

Multidisciplinary space is also needed to support programs that draw in community organizations, religious leaders, educators, police and safety groups. Activities for these groups can include personal or group religious services, classes on the dangers of alcohol and substance abuse among adolescents and teens, educational sessions on mental and behavioral health services to raise awareness. College admissions counselors can host interviews with prospective applicants and emergency response personnel can expand their educational reach through dialogues on public safety.

Health organizations that create space and opportunities for these types of activities will find greater success in their population health initiatives and reinforce the integration of health into "normal" life for their patients and families.

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Designing for young patients means inspiring confidence, encouraging playfulness and offering hope. To accomplish this, hospitals and practices need high-performing and flexible environments that can do it all: enable excellent medical care, integrate technology, encourage interaction and patient engagement, and instill a sense of comfort for all ages.

# data[].attributes.body
caregiver (n) staff who take care with patients in the hospital

paediatric (n) department of children in the hospital

clinician (n) doctors who are directly involved in patient care.

chronic (adj) long-term disease.

chronically (adv)

arthritis (n) e.g: ankle ache

neurologist (n) research about disorders of the brain and nervous system

holistic (adj) treating the whole of something not just a part.

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When I was 7, my mom took me to the hospital at 1 am, that was an emergency clinic. Although I never afraid of seeing dentist, I still don't like the environment -- extremly bright, light, and cold. However the dentist warm word helps me relax.

My nephew is a 1 year old infant, one day his aunt take care with him, he can't stop crying, then my another sister show him his mother's picture and mock her sound, my nephew become gradually peaceful.

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According to Taiwanese Ministry of Health and Welfare, the target group of this service is people who cannot take care by theirselves over 6 months.

The government offers: 1. general healthcare service 2. transportation service 3. Improvement of accessibility at home 4. healthcare centre

The called it "long-term healthcare 2.0"

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什麼是長期照顧服務

（長照服務）

長期照顧服務是指針對預期或已達六個月以上無法生活自理的民眾，由長照服務人員及單位，提供各種照顧及專業服務(包含居家服務、日間照顧、家庭托顧、小規模多機能服務、專業服務)、輔具租借、購買及居家無障礙環境改善、交通接送及喘息服務等。

長期照顧服務對於被照顧者本人或是家屬而言，都可能承受極大的經濟與心理壓力。若您打算在家親自照顧家人，或是聘僱外籍看護工，都可以使用「長照2.0」，經評估符合資格者，有政府提供的長照服務資源與補助，減輕長照的負擔！

可以！
上述的服務可申請專業服務(使用照顧及專業服務額度的30%)、交通接送、輔具與無障礙環境評估，還有當外籍看護工請假休息時也可以申請喘息服務

恭喜你！表示家人生活還能自理，除了長照服務外，現在政府補助設置許多長照的社區服務據點(包括社區照顧關懷據點、巷弄長照站、文化健康站等)，提供長輩健康促進、共餐、預防及延緩失能/失智服務方案，鼓勵社區長輩就近參與據點活動，遠離失能/失智，詳細可洽當地照管中心唷！查詢附近長照服務據點 (長照地理資訊地圖連結)

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衛福部長照專區(1966專線)

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（長照服務） 長期照顧服務是指針對預期或已達六個月以上無法生活自理的民眾，由長照服務人員及單位，提供各種照顧及專業服務(包含居家服務、日間照顧、家庭托顧、小規模多機能服務、專業服務)、輔具租借、購買及居家無障礙環境改善、交通接送及喘息服務等。 ...

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The “Seek and Find” concept is designed to be a sort of scavenger hunt where the PEDS patients are given a card with 6 items for them to “find” hidden in the artwork or the lexan display boxes.

website

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Olee Creative provided wayfinding graphics, area identification, and inspirational door messages for patient exam rooms with contour cut self-adhesive vinyl. Contour cut graphics are a cost-effective way to create custom messaging to mark spaces, create wayfinding, share quotes and more.

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the sense that informs us about the position of our body parts and their relation to each other and to external objects.

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the sense that helps us understand and respond to internal signals from our body, such as hunger, thirst, and the need to use the bathroom.

websites: 1 2

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Body Check Activity for Kids – Identifying Emotions

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Body Check Activity for Kids – Identifying Emotions

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1. Roll out a large piece of paper on the floor.

2. Tape down the corners, so it doesn’t roll up or move.

3. Have your child lay on their back on the paper and trace their body. You’ll probably have to touch up the outline to smooth it out a little.

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Patient Handout: Making a ‘Body Check Chart’

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Patient Handout: Making a ‘Body Check Chart’

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To help doctor know if the wound is due to the domestic violence.

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Design a stuff to help children express theirselves better