Health and wellbeing interventions for staff: report summary

A summary of the Society of Occupational Medicine's report on effective interventions to support staff wellbeing in the NHS.

4 July 2023

The Society of Occupational Medicine (SOM) has published a report looking at the most effective measures to support staff wellbeing in the NHS.

The report was carried out by researchers working across Birkbeck, University of London, University of Nottingham and University of Sheffield, and includes current literature reviews, practitioner interviews and in-depth case studies on this topic.  

Key drivers

A series of key drivers are identified in the report as central to improving staff health and wellbeing. These drivers exist at different levels within an organisation and need to be backed up by evidence-based interventions:

  • autonomy
  • leadership
  • organisational culture
  • good team relationships.

Key characteristics

The findings indicate there is no single intervention that would resolve staff health and wellbeing in the NHS, but they do indicate common characteristics across a range of organisational interventions that can impact change. Interventions found to be most successful were:  

  • organisation-wide 

  • developed with staff involvement  

  • involved visible leadership 

  • had long-term implementation. 

The report also shows that even small health and wellbeing interventions can build confidence among staff and contribute to wider organisational success.  

  • The report aims to: 

    • identify examples of organisational interventions to improve NHS staff wellbeing 

    • map how these interventions attempt to reduce demands on and increase resources for individuals, groups, leaders, organisations and overarching context 

    • identify the barriers and facilitators of success for organisational interventions 

    • summarise key recommendations to encourage more, and better, organisational interventions to support staff wellbeing. 

  • The report identifies two broad models for understanding health and wellbeing related interventions. 

    Job demands resource model

    The job demands resource model focuses on the demands on individual members of staff and how these can be reduced or mitigated. These demands include factors intrinsic to healthcare, such as dealing with illness/death, trauma, physical demands, and hazardous diseases and substances, to those shaped by employer activity, such as high workload. 

    NHS staff understood these intrinsic demands and were generally able to deal with them and maintain a high level of job motivation due to the offsetting impact of a positive job purpose and feeling valued. The study noted that recently the NHS had to deal with unprecedented “natural” demands (the COVID-19 pandemic) and the ongoing issue of mismatch between demand and supply of staff.  

    Where job demands had increased but employee resources had not, this could eventually lead to burnout. The most effective interventions would be those seeking to reduce or at least control job demands, for example by limiting access to services or changing how work was undertaken.  

    Other interventions could seek to increase employee resources to help them to deal with demand, such as resilience training, support from colleagues or mental health support.

    IGLOO model 

    The IGLOO model (Individual; Group Leader; Organisation; Overarching Context) provides a framework for understanding demands on individuals and how to address them. Individual actions can aim to improve personal or group resources, leader actions including manager behaviour and work allocation. Organisation action can address internal issues such as employer policy on flexible working. Overarching context refers to external factors, for example NHS policy on waiting times. 

  • The report also looks at whether interventions should be primarily whole-organisation or system-wide approaches compared with individual intervention such as resilience training. It shows that whole-organisation approaches generally have more long-term impact, however they can be challenging to develop and sustain.  Individual interventions can have an impact but may be on a limited scale with effects lost over time.  

    In both types of intervention, the following were identified as success factors: 

    • understanding staff wellbeing as a systemic issue generated from overall staff experience 

    • tailored interventions around organisational context (not one size fits all)  

    • involving staff in development and delivery of interventions 

    • visible support from leaders, especially boards and clinical leadership 

    • a continual process, with ability to reshape intervention to respond to changing circumstances 

    • a long-term commitment; shifting behaviour takes time and impact may not be immediate.  

  • Staff involvement and participation is a key theme for successful sustainable interventions. It should cover both the process (how an intervention operates) and goal (what it will do and how outcomes will be measured). This will not only deliver better health and wellbeing activity but will also boost staff engagement.  

    The study does not go into detail on how interventions were evaluated but does emphasise the need for measurement of impact. In most cases there are ‘before and after’ measures of impact on staff via surveys. Interventions are complex and context dependant and not all of them were successful. Lessons should be learned even where the intervention did not work out as intended.  

    “Evaluation is not only about whether the intervention worked but evaluating the process of its implementation to understand how and why it worked (or not).” 

  • The study reviewed 13 interventions in a range of trusts and produced 10 detailed case studies. Interventions ranged from traditional health and wellbeing practices to wider initiatives, such as: 

    • fatigue and risk management in a maternity service 

    • changes to investigation of employee harm 

    • annualised hours for doctors 

    • bespoke rostering for doctors  

    • team huddles to create psychological safety 

    • more effective multi-disciplinary team meetings 

    • work restructuring in a clinic 

    • quality improvement huddles  

    • a trust-wide mental health support programme.  

  • The following examples of successful interventions are highlighted in the report: 

    Fatigue risk management strategy in maternity services – Newcastle Hospitals NHS Trust 

    A highly participative process developed a range of solutions working with affected staff with high level support from clinical leaders. 

    Annualised hours in emergency medicine – Brighton and Sussex University Hospitals 

    An annualised hours scheme was introduced through an electronic software tool. Doctors participated in the implementation, which resulted in benefits to work-life balance, reduced burnout and resulted in financial savings due to reduced locum cover.  

    Team huddles to support teaming and psychological safety - North Bristol NHS Trust  

    Working in unfamiliar areas during COVID-19 was creating stress for staff and increased risk of incidents. The trust introduced check in/out processes for staff working in new areas and team huddles to provide opportunities for peer-to-peer briefings. It also provided a ‘space for gratitude’ for colleagues to use and introduced measures aimed at increasing the wellbeing and sense of psychological safety among staff.. 

    Trust-wide mental health support programme for all staff - Wye Valley NHS Trust 

    New leadership at the trust developed new support approaches, focusing on creating a culture of wellbeing through interventions including: 

    • training for managers 

    • mental health first aid programme 

    • self-directed workspaces for staff to discuss concerns 

    • staff-led initiatives 

    • greater support for staff returning to work following ill health.