In Australia, the 'black summer' bushfires of late 2019 to early 2020 provided stark foreshadowing of what will increasingly happen if we continue failing to hit international emissions targets and prevent further global temperature rise. In New South Wales (NSW) alone, fires destroyed 2,439 homes between July 2019 and February 2020. What's more, 57% of the Australian adult population were physically affected by smoke from the bushfires and the physical and mental health effects are still being felt today.

At the epicenter of NSW's bushfire response was Illawarra Shoalhaven Local Health District (ISLHD), a regional health care system operating 58 sites and providing care for 400,000 people in NSW. As well as treating patients, they also had to ensure their 7,300+ staff were safe and supported throughout the crisis, especially as many employees' homes were destroyed or staff had family that needed to be evacuated. After employees' basic needs such as adequate shelter and physical safety were met, ISLHD leaders knew they needed to focus on employees' emotional and mental distress caused by the crisis.

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But most importantly, leaders recognized that even when the physical damage was over, the emotional damage would continue, and this had to be addressed. They understood that the emotional impact of the bushfires would last for years. And there was no quick fix. ISLHD needed to provide long-term emotional support that could be expanded or adjusted if future crises arose and had to be targeted and multifaceted to meet employees' diverse needs. Thus, they developed the SEED program (Stability, Encompassing, Endurance, Direction).

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Unique staff trauma requires a response that matches their needs

The ISLHD Chief Executive initiated the SEED program when they commissioned a senior social worker (program lead) from within the health system to lead emotional support and recovery across the organization. The social worker's deployment was initially on a short-term basis and the program started at Milton Ulladulla Hospital, one of the systems major rural acute hospitals.

The social worker conducted several focus groups and individual conversations with staff from all areas of the organization to truly understand their needs. She initially thought four to five employees would turn up but in the first session alone, 23 people turned up. Attendees used their experiences to create a list of potential support resources that were brought back to other focus groups for feedback. Co-producing the program with staff meant that the organization was truly meeting staff needs, but it also signaled organizational commitment to staff wellbeing and recovery.

Not everyone processes trauma the same way. And for some people, there was recognition that continuing to work when work was the only stable thing left was the best coping mechanism. Essentially, the program responded to people's needs in a way that allowed people to have autonomy in how they received support.

The SEED program's five initiatives focused on peer support and embedding spaces to recover

By the end of the consultation process, participants settled on five initiatives that could be accessed by anyone at the organization who needed support. These five initiatives were selected because they were long-term solutions that could be used for other crises, relatively easy to implement and engage staff with, resource-light, and, above all else, what staff selected. These five initiatives are described below:

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1. Quiet room: ISLHD designated an easily accessible room in the Milton Uladulla Hospital as the staff's "quiet room:" a space where they could recharge and reflect during their shifts. Staff and patients donated furniture, art, and aromatherapy oils to make the room feel comforting and calm. One employee created a wooden tree to serve as the centerpiece of the room, intended to represent the hospital's growth following the bushfires. Staff wrote reflections on a piece of paper and stuck it to the tree. The tree now has hundreds of reflections posted on it.
2. Coffee buddies: ISLHD partnered with three local cafes to provide an opportunity for staff to informally interact and support each other away from work, with free coffee. Each staff member was matched with someone who they wouldn't normally work closely with (e.g., a doctor paired with a food service worker). These relationships helped staff members see alternative perspectives and allowed them to be helpful to someone else, which gave them a purpose outside of themselves.
3. Wellness warriors: 18 hospital employees attended a two-day peer support training program. Staff learned to become better at listening, empowering others, and sharing leadership responsibilities. These 'wellness warriors' returned to the organization as designated emotional support leaders embedded within teams across the organization. Most importantly, these wellness warriors 'listen to understand', they don't 'listen to fix'. Typically, this is hard to do because it requires a mindset shift away from the typical 'treat-first' mentality often adopted by health care staff.
4. 24/7 wellness sessions: Staff led twice-weekly meetings to discuss wellness and emotional recovery. These meetings were open to any staff member who wished to attend, listen, or speak. Almost nothing was off limits for attendees to talk about and they were encouraged to "take off their professional hats" and just be themselves. This helped many employees share their concerns, vulnerabilities, or pain around their life outside of work and provided peer support. These sessions were so popular in fact, that many employees still attended on days they were not scheduled to work and, during the Covid-19 pandemic, ISLHD had to create a waiting list for these sessions because they filled up so quickly.
5. "See ya 2019": Due to the bushfires preventing most staff members from being able to celebrate New Year's Eve, the executive team coordinated a 'New Year's Eve party' in February 2020 at an employee's house. The party was attended by staff and their families and was nicknamed "See ya 2019". The party brought staff a moment of catharsis at the end of a difficult period and was an important step towards emotional recovery.

The social worker who led the SEED program was only meant to be stationed at Milton Ulladulla Hospital for two weeks, but the Chief Executive realized that longer-term emotional recovery needed longer-term commitment. The Chief Executive supported staff requests to have one stable and trusted social worker for a longer period and, as a result, the social worker ended up staying at the hospital for five months. ISLHD didn't assume that the initiatives were going to solve everyone's problems, but rather they offered space for people to respond and recover how they wanted to, using each other as support mechanisms.

This is non-negotiable for effective emotional recovery, regardless of what traumatic event staff have experienced. ISLHD implemented this in response to a climate disaster, but these initiatives and the way that the organization consulted their staff to create them can be replicated in response to any health system challenge. And they will stay in place to help the organization recover from the bushfires, from Covid-19, and from any other traumatic event that comes their way.