Blog: Supporting Staff to (really) Check-In

By Chloe Kitto

The wellbeing of healthcare staff continues to be a heavily discussed topic within the NHS. And rightly so, given the role we have all played, and continue to play, in responding to the needs of our patients and our hospital organisations. 

As Staff Wellbeing Lead at the Royal National Orthopaedic Hospital (RNOH), one of the National Orthopaedic Alliance’s (NOA) founder member Trusts, I am immersed in the field of health and wellbeing. There is a lot going on and a lot on offer.  Hospital Trusts have a responsibility to ensure staff wellbeing is high on the agenda. We have seen things like signposting to wellbeing offers, development of wellbeing champions and a variety of wellbeing training.  The NOA, specifically, have supported the wellbeing of its member organisations with events such as the recent NOA wellbeing workshop series, which I am told was very well received by participants.

Despite the clear benefit of all these initiatives for hospital staff, they generally take a ‘top-down’ approach.  That is, they target the big picture of staff wellbeing.

The area of wellbeing that may not be addressed with this approach, however, is the exploration of an individual’s engagement with their own wellbeing.  This more ‘bottom-up’ approach focuses on the unique and complex factors that impact wellbeing at the individual level. 

For me, best practice in staff health and wellbeing is the investment in both top-down and bottom-up approaches. 

The aim of the bottom-up approach, or approaches which facilitate individualised exploration of wellbeing, is to usher people closer to being ready, willing and able to say ‘’yes, I need help here” within the context of their own unique lives.

The simple reality of the healthcare culture many of us have grown up with is one of self-sacrifice.  Frequently we make decisions which favour the care of our patients or hospital organisations over those that serve ourselves.  Broadly, many people who dedicate their time to care for others (professionally or personally) can often find it difficult, even counter-intuitive, to hold a mirror up to their own needs.

One reason for this is many of us may not be well-practiced in checking-in with ourselves. We may know all the wellbeing resources out there, but there is still this barrier to accessing them for our own benefit. 

The wellbeing strategy across the NHS needs to support a culture of checking-in with ourselves, regularly and effectively.  Prioritising time and space for staff to hold up that mirror and ask themselves “how am I going this week?”, “where are my stress levels at?”, “how is my self-care practice going?”, “do I need to do something different, or reach out for support?”. 

In practice, these can be really difficult questions to ask ourselves in real and meaningful ways.  Especially during a stressful week.  Definitely during a stressful month.  

The fact is: the activity of checking-in with oneself is a skill. And like any skill, checking-in can feel clunky and ineffective to a novice, but improves with time, consistent practice and social feedback.

If we acknowledge checking-in as a skill, then we need to see it as more than a 2 second quick fix of ‘how am I doing?’ – ‘fine’ – ‘great, on I go’ process. Thankfully, there are frameworks available to support us. 

Like all wellbeing approaches, there is no one-size-fits-all.  Some teams have been using the ‘Going Home’ checklist. Others have embraced the ‘Time To Think’ approach pioneered by author Nancy Kline, based on the concept that people think at their best when they are being listened to.

Another approach, which I have used frequently and in a variety of settings is ‘Pause>Review>Respond’ (see figure 1).  This is a thinking-to-action framework which facilitates real and meaningful check-ins at an individual level leading to a realistic action point for the day/week. Although primarily for the individual, using Pause>Review>Respond in groups or teams acts to normalise self-care and models the practice of checking-in. It can also create a space of seeing that others feel as you do which can counter the impacts of stigma.  

In summary, top-down approaches, which target wellbeing at a general level, have a clear role. However, equal investment in bottom-up approaches, which explore wellbeing at an individual level, is the crucial other half of the story.

A common experience for healthcare staff is the difficulty we can have in seeing our own wellbeing needs and taking actions toward the support that is out there.  Nurturing the skill of checking-in is a bottom-up approach which hospital organisations can take, for the individual at the individual level. 

The ‘Pause>Review>Respond’ framework is a tool that I find useful as a Staff Wellbeing Lead to help model and imbed the skill of checking-in within the culture of the RNOH.