The Staff Mindfulness Service is part of Tees, Esk and Wear Valleys NHS Foundation Trust’s approach to improving the health and wellbeing of our staff. Staff Mindfulness Programmes have been offered in the Trust since 2009.
The Staff Mindfulness Service is part of Tees, Esk and Wear Valleys NHS Foundation Trust’s approach to improving the health and wellbeing of our staff. Staff Mindfulness Programmes have been offered in the Trust since 2009. Due to their success, in April 2013 a 3 year pilot project was launched which aimed to make mindfulness training more widely available to staff with anticipated benefits for individual staff members, for patient care and for the Trust as a whole (including reduced sickness absence). Building on the success, in 2015 a Clinical Mindfulness Team was developed and in April 2016 both Staff and Clinical Mindfulness Services received permanent funding and were integrated as one Mindfulness Team.
Mindfulness is increasingly recognised as an effective intervention for building resilience and alleviating stress and mental health problems. The evidence base for this approach has increased since the Staff Programmes were first launched. Mindfulness is a term used to describe an open and non-judgemental awareness of moment to moment experience. This quality of awareness can be cultivated through relatively simple meditation practices which are most easily learnt by attending an 8 week mindfulness programme.
In advance of 8 week programmes, Introductory Workshops take place to help staff to decide if this form of support would be beneficial to them. Workshops include teaching about the theory and practice of mindfulness, experiential elements (short guided meditation practices) and some time for discussion.
Over the last three years (April 2013-March 2016) approximately 1000 staff attended Introductory Workshops and 450 staff attended the full 8 week programme. The programmes have been highly valued by staff and sometimes described as ‘life-changing’. Demand has continued to grow, with ‘word of mouth’ an important factor. Many of those attending had previously taken time off sick with stress / mental health problems and programme attendance was often associated with statistically significant shifts in a number of measures including psychological distress, perceived stress, mindfulness and wellbeing.
Days of mindfulness practice are offered as part of every Staff Programme. These silent days are open to staff who are currently attending and all graduates of previous 8 week programmes. Attending a day of mindfulness offers an opportunity to deepen and refresh mindfulness practice. In total, 21 days of mindfulness have been run, involving over 500 staff. In addition to days of mindfulness we also continue to support staff who wish to continue using the skills and practices they have learned by signposting them to websites and local activities which will support on-going practice. They are put on the mailing list for future days of mindfulness and given details of how to subscribe to the monthly mindfulness newsletter. Practice groups are also available to participants who have completed an 8 week course and wish to meet with others to help sustain their personal mindfulness practice. They meet monthly (usually in a lunch break) in various parts of the Trust.
Wider Active Support
The Staff Mindfulness Service has the full support of the Trust, staff side representatives and gives updates on progress to the Health and Wellbeing Strategy Group. South Tees Hospitals NHS Foundation Trust and Stockton Local Authority have commissioned 8 week programmes for their staff.
Mindfulness expertise has been built up in the Trust over a number of years by working with service users. The Staff Mindfulness Service has taken these skills and concepts to create an innovative approach to support staff mental wellbeing. The outcomes of the programmes including significantly reducing psychological distress and emotional exhaustion and increasing levels of mindfulness and self-compassion (demonstrated in 1st year evaluation). Some of the staff who participated in the 8 week mindfulness programme are also service users/carers themselves.
Service user and carer representatives are a key part of the Mindfulness Steering Group that oversees the work of the Mindfulness Team. There was extensive service user and carer involvement during the development of the Clinical Mindfulness Team. We are also currently exploring ‘mixed’ service user, carer and staff mindfulness programmes and have consulted widely with both service users and staff regarding this.
Looking Back/Challenges Faced
The Trust is keen that mindfulness is available to all staff irrespective of occupation or work base, some groups have been hard to reach.
In hindsight it would have been helpful if we had undertaken the following earlier: Designed leaflets and promotional material on the Trust intranet; Targeting senior manager meetings in order to promote the benefits of the programme ensuring that staff were supported to attend. Although information was gathered on a participant’s job role, no initial information was requested on job banding. This is now included in the initial data collected at the beginning. This extra information about the demographics of the staff attending the programmes has been compared with the demographics of the Trust as a whole. In year 3, staff from lower bands made up proportionately more of the total numbers of participants than in the previous year (18% in year 2 and 27% in year 3).
Making sure mindfulness is available for all staff. This is being addressed by targeted promotion of ‘hard to reach’ groups especially those with limited access to electronic communication. Internal Trust premises have been used to undertake the mindfulness training. Some venues have needed to be sourced outside the Trust when internal premises do not have large enough rooms. This unexpected cost was able to be offset against income from other organisations.
As discussed earlier, building on the success of the Staff Mindfulness Programmes, in May 2015 a new Clinical Mindfulness Team commenced within the Trust. The remit includes:
Clinical provision of Mindfulness-Based Cognitive Therapy
Training of TEWV staff
Work with external organisations
Evaluation and research As discussed previously, due to both Clinical Team and Staff Mindfulness Programmes receiving permanent funding they were integrated in April 2016 and became the TEWV Mindfulness Team. If the Staff Lead left the post there may be a gap in the service. However, integration means there is now much less reliance on one person to run the staff programmes. The Mindfulness Clinical Lead and Team Manager provide leadership, support and supervision to the Programme Lead as well as delivering some of the elements of the project. Discussions would need to take place to determine if more support could be given to the Staff Programmes whilst a replacement was being recruited. The Trust has an excellent reputation for innovation and sustainability of proven initiatives for staff such as staff retreats, pre-retirement programmes and the Employee Support Officer role. In terms of safeguarding the future of mindfulness in the Trust eight graduates of staff mindfulness programmes are now training to become Mindfulness teachers on a new in-house Mindfulness teacher training course.
The programmes have been continuously evaluated and each year an annual report has been produced and shared with the Executive Management Team and the Trust Health and Wellbeing Strategy Group.
In summary the annual reports have demonstrated that:
Approximately 150 participants per year attended 8-week programmes. •Many of those attending had previously taken time off sick with stress / mental health problems (38 % in the most recent evaluation). •During the first two years certain staff groups proved to be harder to reach – including those in lower bands and in-patient staff. Efforts to engage staff from lower bands and staff from inpatient settings has had some success. •Demand has continued to grow. Advertised programmes are recruited to very easily. •Attendance was generally good – in the most recent evaluation only 7 percent of sessions were missed by those who completed programmes. •Participants are asked to rate how important the programme has been to them on a scale of 1-10 and give written comments. Ratings are very high, for example in the most recent evaluation, 94% of participants gave a rating of between 8 and 10.
Validated research questionnaires were given to participants before and after the 8-week programmes and the results were presented in the annual reports. Over the last 3 years the following questionnaires have been used:
Mindful Attention and Awareness Scale (Brown & Ryan, 2003) – attention and awareness. General Health Questionnaire (Goldberg & Williams, 2000) – psychological distress. The Maslach Burnout Inventory (Maslach & Jackson, 1981) – risk of burnout. The Self-Compassion Scale (Neff, 2003) – compasssion to self.
The Compassion scale (Pommier, 2010) – compassion to others. The Penn State Worry Questionnaire (Meyer et al, 1990) – worry severity.
The General Anxiety Disorder 7-item scale (Spitzer et al, 2006) – generalised anxiety *Perceived stress scale (Cohen et al, 1983) – perception of stress.
Short Warwick-Edinburgh Mental Well-being Scale (NHS Health Scotland, 2011) – wellbeing
*The WHO-5 Wellbeing Index (WHO, 1998) – wellbeing.
The first two annual reports noted that measures of psychological distress, risk of burnout, self-compassion, anxiety, worry, mental wellbeing, compassion (to others) and mindfulness all showed significant positive changes. The third annual report demonstrated that all the measures (general health, perceived stress and wellbeing) showed significant changes in the desired directions. Some of the changes were of considerable magnitude.
At longer term follow up (completed during year 2 of the pilot project), programme graduates reported ongoing mindfulness practice and long term benefits. Most believed that stress-related sickness absence had been reduced. There was near universal support for the project being made permanent.
A local authority that has commissioned staff programmes is hoping to commission a further 4 programmes a year for their staff on a pilot basis.
The Trust was invited to contribute to the Mindfulness All Party Parliamentary Group (APPG). The report of the APPG was launched in October 2015 and includes discussion of the TEWV Staff Mindfulness Project as an example of good practice. Internal Trust groups are also aware of the service developments such as the Executive Management team, Trust Joint Consultative Committee and the Health and Wellbeing Strategy Group.