The challenge growing uptake of Resilience-based Clinical Supervision in Lincolnshire Community Health Services

Ruth Cocks, Clinical Practice Educator, Lincolnshire Community Health Services

Looking back over the last 10 months, it has been a real rollercoaster of success and challenges. As a multidisciplinary team of clinical practice educators, we already had the skills as trained facilitators for RBCS. We were ready and had plans, the trust senior leadership had endorsed the offer and release of staff. We had promoted RBCS using every avenue available to us; internal social media, briefings, team meetings, opportunistic encounters and attending networks such as the BAME support network meetings. We intended to use PRoQoL for our outcome measure to prove our value and, curious about the impact of ethnicity and redeployment, we planned to collect more data around this too.

Rooms were difficult to book because of the COVID restrictions and travel times can be long for a community trust in a rural county, so we trialled RBCS over Microsoft Teams,

quickly identifying maximum numbers to enable inclusion and communication. Some of the delivery team were unsure, preferring the traditional face-to-face methods but we worked through this. We found it worked and the reduction in time away from patients was a bonus. Also, given participants had not experienced other delivery methods, they embraced the opportunity and the reduction in travel time.

RBCS was actively promoted at formal and team meetings, staff networks and in-house social networks. Response was positive, everyone liked the concept and thought it was a great idea, but sadly signup to groups did not happen. We went back to the groups and engaged with staff on the ground and listening to the suggestions, we changed our approach but again we had limited response. Sometimes it felt in meetings or groups everyone would agree it sounded really helpful, but it appeared in the meeting or later individuals were looking for others to blink first because engaging was a sign of weakness. Though this may have been our interpretation because of disappointment with uptake. These groups remain impossible to get engagement from and we are unsure if this is the impact of the COVID pandemic on values or individuals exercising preferences.  Members of staff support networks said they were interested during meetings but when we asked them to confirm with network chairs, they didn’t. In future, we will request direct contacts.

Eventually our persistence paid off and slowly individuals came forward and groups were formed. When there were no others to form a group or the urgency of the individual’s need was high, we used a framework to work with individuals. By the using principles of RBCS we enabled these colleagues to look at their emotional responses and the role of the critical voice with success. The individuals that took part quickly reported that they were finding the benefits and individuals and consequently services regained their resilience and thrived. The impact for these individuals has been significant, they clearly stated in evaluations they would not have done anything if there was only a group offer.

RBCS was used with groups of non clinical staff in the finance and business intelligence team who had been redeployed in COVID to great effect. We had thought that the challenges would be different but we were wrong. They too were concerned about workloads and the impact of mistakes they might make on patients.

But still, engagement from some clinical groups was still low.

In the autumn we had another drive to recruit as the impact of the pandemic on life and services changed, but still staff seem to believe they were too busy with patients to make the time. More disappointment of more failed groups, as even many who had asked to take part didn’t come to the sessions.

In terms of evaluation, one downside to the virtual groups is the difficulty getting PRoQoL questionnaires returned, somehow, it’s not the same as asking people to complete it before they walk out of the room. The response rate was about 1/3, also the scores did not show significant change. Reflection for ourselves suggested that perhaps, we were helping people to stay static (rather than going backwards in terms of their wellbeing), quite an achievement during this prolonged pandemic. For one group who disliked the terminology and could not identify with the questions of PRoQoL, we implemented a simple qualitative evaluation to collect information on the impact of RBCS, all reported significant benefits and we plan to use this in the future.

A new year brought a new approach. As a team we deliver a taster session during our preceptorship programme. The aim is to overcome preconceived ideas about RBCS, the benefits and what commitment is needed to be able to take part. These practitioners in their early clinical career are taking up the offer of groups, based on their current preceptorship groups and we wait to see if this translates to increased engagement.

Word of mouth and personal recommendation, as well evaluation data, are slowly growing and embedding the process. The challenge remains to gain release of staff: whether the barrier is managers releasing or individuals’ perception that there is not sufficient capacity in the team for them to take time for themselves.

We may not have achieved the numbers participating we had hoped for, or the PRoQoL shift to demonstrate quantitively the impact, but we believe the impact of RBCS is still significant. RBCS remains a slow but powerful burn and we remain committed to fanning the flames of engagement.

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