Jill Maben

Background: Healthcare professionals are 24% more likely to die by suicide than the general population. The impact of such deaths on National Health Service colleagues is unclear. Early post-suicide support (postvention) is beneficial for those affected, yet little is known about how to offer this support within the National Health Service. Objectives: We set out to: (1) review existing research on suicide impact and postvention interventions in workplace settings; (2) explore the impact of colleague suicide on staff well-being; (3) examine staff perceptions of contributing factors to their colleague’s suicide; (4) identify what supports or hinders bereaved colleagues in seeking help, and gather staff preferences for future support; (5) explore how managers currently support workers following a death by suicide; and (6) use the findings to develop evidence-based postvention guidance for National Health Service organisations. Methods: This study had four work packages: (1) an integrative review of primary research to review the impact of suicide in the workplace; (2) a qualitative interview study with National Health Service staff affected by a colleague’s suicide or involved in supporting others ( n = 29 affected staff, n = 22 supporters). Data were analysed using grounded theory and thematic analysis; (3) a co-production workshop with key stakeholders to review research findings and generate recommendations; and (4) a synthesis of all findings and recommendations to develop evidence-based postvention guidance. Results: The integrative review revealed that existing postvention guidance often lacks empirical support and does not address how workplace culture affects staff after a suicide. Those tasked with delivering postvention face stigma and complex challenges, and current support does not fully meet the needs of affected staff. In the interview study, two theories were developed. First, staff affected by a colleague’s suicide faced cultural and behavioural barriers to accessing support. Some devised strategies to overcome these barriers, while others fell through the gaps. Second, those providing postvention support also encountered barriers and required emotional and practical backing to effectively support others. Thematic analysis generated key recommendations for National Health Service trusts: (1) promote staff mental health and encourage open discussions about suicide; (2) establish trained teams to deliver timely support; (3) share information swiftly and compassionately, giving staff space to reflect together; (4) offer ongoing emotional support and staff-led activities like memorials and (5) ensure support teams also receive emotional and practical assistance. All findings and recommendations were discussed during our co-design workshop. Stakeholder attendees supported the recommendations. Findings informed our guidance, which emphasises the need for postvention teams within National Health Service trusts and integrated care boards, and the need to be ready to respond to colleague suicide before it happens. Limitations: The integrative review was limited to English-language papers. Most interviewees were White British women, meaning the findings may not represent the experiences of all National Health Service staff. Furthermore, many ‘supporters’ interviewed were already offering high-quality support, potentially leading to an overly optimistic view of the postvention currently provided. Conclusions: Our guidance recommends the following: that skilled and trained individuals must actively offer immediate and ongoing postvention support to National Health Service staff; that those offering postvention must be supported so they can support others; and National Health Service trusts and integrated care boards must foster a suicide-aware, supportive culture that enables supporters to implement our recommendations. Future work: We recommend that further research be undertaken to explore the impact of colleague suicide on minoritised and global majority health workers. In addition, we suggest a robust evaluation study to report on implementation of the guidance and to ascertain what works in practice. Study registration: This study is registered as IRAS: 291050; HRA 21/HRA/4450. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129341) and is published in full in Health and Social Care Delivery Research ; Vol. 13, No. 40. See the NIHR Funding and Awards website for further award information.

Some text in this abstract and article has been reproduced from Taylor et al. (Taylor C, Ollis L, Lyon RM, Williams J, Skene SS, Bennett K, et al.; SEE-IT Trial Group. The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: a feasibility randomised controlled trial. Scand J Trauma Resusc Emerg Med 2024;32:7). This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text. Background: The use of bystander video livestreaming from scene in emergency medical services is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial of its use in major trauma incidents. Objectives: To obtain data required to design a subsequent randomised controlled trial. To test trial processes. To embed a process evaluation. Design: A feasibility randomised controlled trial with embedded process and economic evaluations where working shifts (n = 62) in 6 trial weeks were randomised 1 : 1 to video livestreaming or standard care only; and two observational substudies: (1) assessment of acceptability in a diverse inner-city emergency medical service that routinely uses video livestreaming; and (2) assessment of staff well-being in an emergency medical service that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff (n = 25) and bystander callers (n = 2). Setting: A pre-hospital emergency medical service in South-East England, with follow-up in associated major trauma centres and trauma units; substudies in (1) London and (2) East of England emergency medical services. Participants: (1) Patients involved in trauma incidents (n = 269); (2) bystander callers (n = 11); and (3) ambulance service staff (n = 67). Intervention: Video livestreaming using GoodSAM’s Instant-On-Scene. Main outcome measures: Progression to a definitive randomised controlled trial based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥ 50% requests to activate livestreaming resulting in footage being viewed; (3) helicopter emergency medical services stand-down rate reducing by ≥ 10% due to livestreaming; and (4) no evidence of psychological harm to bystanders or staff caused by livestreaming. Results: Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts, we randomised by individual call, which contributed four eligible incidents (two control; two intervention), thereby totalling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch) and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in viewed footage; and two were indeterminate due to insufficient data: (3) 2/6 (33%) stand-down due to livestreaming; and (4) no evidence of psychological harm from survey, observations or interviews. In substudy (i), dispatch staff reported that non/limited English language and older age may present barriers to video livestreaming. Limitations: Poor recruitment of patients and bystanders limited assessment of appropriateness of dispatch decisions and potential psychological harm. Conclusions: Video livestreaming is feasible to implement, acceptable to both bystanders and dispatchers, and may aid dispatch decision-making, but further assessment of benefits and harm is required. Future work: Findings support the design and conduct of a future multicentre study taking account of different triage systems and dispatch personnel, potentially using an alternative to a randomised controlled trial due to rapid uptake of video livestreaming in this setting. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130811.

Background: Behavioral and implementation science frameworks should be employed in the design of interventions to change behavior, including those delivered in organizational settings, to enhance their effectiveness, replicability, and transparency. However, this is often not done well in health services research. This deficiency also impacts interventions to address unprofessional behaviors (UBs) among healthcare staff. UBs include rudeness and bullying, which harm patient safety and staff wellbeing. This study builds on an earlier realist review of these UB interventions to retroactively identify their active components. Methods: A systematic search was updated to July 2024 using MEDLINE, Embase, CINAHL, and Google Scholar. Intervention descriptions were extracted from study reports and independently coded using directed content analysis against the May 2024 version of the behavior change technique (BCT) Ontology, which contained 284 BCTs. Results: The search identified 262 titles and abstracts, yielding five new reports. Combined with 42 papers from the prior review, 47 reports of 44 interventions were included. Interventions were categorized as single-session (n = 15), multisession (n = 12), combined session (n = 6), professional accountability (n = 7), and structured culture change (n = 4). Complex interventions used more BCTs: session-based interventions focused on awareness-raising and roleplay, professional accountability on consequences, and structured culture change on goal-oriented techniques. Few interventions reported negative outcomes, limiting the understanding of which BCTs drive effectiveness. Conclusions: The BCT ontology is broadly applicable to organizational behavior change in healthcare. Complex interventions employ consequence-based and goal-oriented BCTs, but the effectiveness of specific BCTs remains unclear due to poor evaluations. Future interventions should use the BCT Ontology to improve intervention reporting and effectiveness.

This article consists of a citation of a published article describing research funded by the Health and Social Care Delivery Research programme under project number NIHR130811, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1186/s13049-024-01179-0 Background: Use of bystander video livestreaming from scene to Emergency Medical Services (EMS) is becoming increasingly common to aid decision making about the resources required. Possible benefits include earlier, more appropriate dispatch and clinical and financial gains, but evidence is sparse. Methods: A feasibility randomised controlled trial with an embedded process evaluation and exploratory economic evaluation where working shifts during six trial weeks were randomised 1:1 to use video livestreaming during eligible trauma incidents (using GoodSAM Instant-On-Scene) or standard care only. Pre-defined progression criteria were: (1) ≥ 70% callers (bystanders) with smartphones agreeing and able to activate live stream; (2) ≥ 50% requests to activate resulting in footage being viewed; (3) Helicopter Emergency Medical Services (HEMS) stand-down rate reducing by ≥ 10% as a result of live footage; (4) no evidence of psychological harm in callers or staff/dispatchers. Observational sub-studies included (i) an inner-city EMS who routinely use video livestreaming to explore acceptability in a diverse population; and (ii) staff wellbeing in an EMS not using video livestreaming for comparison to the trial site. Results: Sixty-two shifts were randomised, including 240 incidents (132 control; 108 intervention). Livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to determine appropriateness of dispatch), and caller recruitment (to measure potential harm) were low (58/269, 22% of patients; 4/244, 2% of callers). Two progression criteria were met: (1) 86% of callers with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in footage being obtained; and two were indeterminate due to insufficient data: (3) 2/6 (33%) HEMS stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations or interviews, but insufficient survey data from callers or comparison EMS site to be confident. Language barriers and older age were reported in interviews as potential challenges to video livestreaming by dispatchers in the inner-city EMS. Conclusions: Progression to a definitive RCT is supported by these findings. Bystander video livestreaming from scene is feasible to implement, acceptable to both 999 callers and dispatchers, and may aid dispatch decisionmaking. Further assessment of unintended consequences, benefits and harm is required. Trial registration: ISRCTN 11449333 (22 March 2022). https://www.isrctn.com/ISRCTN11449333 Funding: This publication was funded by the Health and Social Care Delivery Research programme as a part of award number NIHR130811. This article reports on one component of the research award Emergency medical services Streaming Enabled Evaluation In Trauma: The SEE-IT trial. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/NIHR130811] DOI: https://doi.org/10.1186/s13049-024-01179-0

This article consists of a citation of a published article describing research funded by the Health and Social Care Delivery Research programme under project number NIHR130811, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1186/s12873-024-01015-9 Background: Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as ‘callers’ in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers’ smartphones to emergency medical dispatch centres. Methods: A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews. Results: Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers’ (referred to as ‘dispatcher/s’ in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols. Conclusion: Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers. Keywords: EMERGENCY MEDICAL DISPATCH, EMERGENCY MEDICAL SERVICES, VIDEO LIVESTREAMING, CALLERS, SMARTPHONE, REVIEW Funding: This publication was funded by the Health and Social Care Delivery Research programme as a part of award number NIHR130811. This article reports on one component of the research award Emergency medical services Streaming Enabled Evaluation In Trauma: The SEE-IT trial. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/NIHR130811] DOI: https://doi.org/10.1186/s12873-024-01015-9

Support for NHS staff was vital during the COVID-19 pandemic and Team Time was developed as an adaptation of Schwartz Rounds™ – a well-evidenced, facilitated group intervention. Building on the existing evidence base for Schwartz Rounds implementation, this study aims to understand the key factors associated with Team Time implementation and sustainability in this context. Twenty semi-structured interviews were conducted within 10 NHS acute, community and mental health organisations that ran Team Time during the pandemic: six with no prior experience of Schwartz Rounds and four that ran Schwartz Rounds prior to the pandemic. Additionally, three Team Time mentors who provided support to these organisations were also interviewed. Data analysis was underpinned by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically, and key implementation factors were mapped onto CFIR constructs using the Framework method to explore patterns. Implementation of Team Time was challenging in organisations that did not run Schwartz Rounds previously. Facilitating factors included having incentives in the outer setting (wider context of the organisation), the adaptability of the intervention, and wide ownership across the organisation. However, barriers to implementation were the perception that the intervention was complex and resource intensive and an unsupportive organisational culture and communication difficulties which hindered engagement. In those organisations which already ran Schwartz Rounds the burden of setting up the organisational infrastructure for Team Time was smaller and the implementation climate more supportive. Similar to Schwartz Rounds, Team Time needed broad and sustained organisational support for implementation to become embedded in organisations and deliver benefits. Implementing it as an entirely new and stand-alone online intervention during the pandemic was challenging. Team Time should therefore be considered as an addition to Schwartz Rounds and as part of a long-term organisational investment in staff psychological wellbeing, not as a short-term intervention in a period of crisis.

Background: Unprofessional behaviour in healthcare systems can negatively impact staff well-being, patient safety and organisational costs. Unprofessional behaviour encompasses a range of behaviours, including incivility, microaggressions, harassment and bullying. Despite efforts to combat unprofessional behaviour in healthcare settings, it remains prevalent. Interventions to reduce unprofessional behaviour in health care have been conducted – but how and why they may work is unclear. Given the complexity of the issue, a realist review methodology is an ideal approach to examining unprofessional behaviour in healthcare systems. Aim: To improve context-specific understanding of how, why and in what circumstances unprofessional behaviours between staff in acute healthcare settings occur and evidence of strategies implemented to mitigate, manage and prevent them. Methods: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards reporting guidelines. Data sources: Literature sources for building initial theories were identified from the original proposal and from informal searches of various websites. For theory refinement, we conducted systematic and purposive searches for peer-reviewed literature on databases such as EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases as well as for grey literature. Searches were conducted iteratively from November 2021 to December 2022. Results: Initial theory-building drew on 38 sources. Searches resulted in 2878 titles and abstracts. In total, 148 sources were included in the review. Terminology and definitions used for unprofessional behaviours were inconsistent. This may present issues for policy and practice when trying to identify and address unprofessional behaviour. Contributors of unprofessional behaviour can be categorised into four areas: (1) workplace disempowerment, (2) organisational uncertainty, confusion and stress, (3) (lack of) social cohesion and (4) enablement of harmful cultures that tolerate unprofessional behaviours. Those at most risk of experiencing unprofessional behaviour are staff from a minoritised background. We identified 42 interventions in the literature to address unprofessional behaviour. These spanned five types: (1) single session (i.e. one-off), (2) multiple sessions, (3) single or multiple sessions combined with other actions (e.g. training session plus a code of conduct), (4) professional accountability and reporting interventions and (5) structured culture-change interventions. We identified 42 reports of interventions, with none conducted in the United Kingdom. Of these, 29 interventions were evaluated, with the majority (n = 23) reporting some measure of effectiveness. Interventions drew on 13 types of behaviour-change strategy designed to, for example: change social norms, improve awareness of unprofessional behaviour, or redesign the workplace. Interventions were impacted by 12 key dynamics, including focusing on individuals, lack of trust in management and non-existent logic models. Conclusions: Workplace disempowerment and organisational barriers are primary contributors to unprofessional behaviour. However, interventions predominantly focus on individual education or training without addressing systemic, organisational issues. Effectiveness of interventions to improve staff well-being or patient safety is uncertain. We provide 12 key dynamics and 15 implementation principles to guide organisations. Future work: Interventions need to: (1) be tested in a United Kingdom context, (2) draw on behavioural science principles and (3) target systemic, organisational issues. Limitations: This review focuses on interpersonal staff-to-staff unprofessional behaviour, in acute healthcare settings only and does not include non-intervention literature outside the United Kingdom or outside of health care. Study registration: This study was prospectively registered on PROSPERO CRD42021255490. The record is available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131606) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 25. See the NIHR Funding and Awards website for further award information.

Suicide is a leading cause of death globally, with more than 700,000 people dying by suicide every year (World Health Organization, 2021). UK healthcare professionals are at risk of suicide, with f...

Background Nurses, midwives and paramedics comprise over half of the clinical workforce in the UK National Health Service and have some of the highest prevalence of psychological ill health. This study explored why psychological ill health is a growing problem and how we might change this. Methods A realist synthesis involved iterative searches within MEDLINE, CINAHL and HMIC, and supplementary handsearching and expert solicitation. We used reverse chronological quota screening and appraisal journalling to analyse each source and refine our initial programme theory. A stakeholder group comprising nurses, midwives, paramedics, patient and public representatives, educators, managers and policy makers contributed throughout. Results Following initial theory development from 8 key reports, 159 sources were included. We identified 26 context–mechanism–outcome configurations, with 16 explaining the causes of psychological ill health and 10 explaining why interventions have not worked to mitigate psychological ill health. These were synthesised to five key findings: (1) it is difficult to promote staff psychological wellness where there is a blame culture; (2) the needs of the system often over-ride staff psychological well-being at work; (3) there are unintended personal costs of upholding and implementing values at work; (4) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; and (5) it is challenging to design, identify and implement interventions. Conclusions Our final programme theory argues the need for healthcare organisations to rebalance the working environment to enable healthcare professionals to recover and thrive. This requires high standards for patient care to be balanced with high standards for staff psychological well-being; professional accountability to be balanced with having a listening, learning culture; reactive responsive interventions to be balanced by having proactive preventative interventions; and the individual focus balanced by an organisational focus. PROSPERO registration number CRD42020172420.