The Forum

How to create effective staff 'feedback loops' amid Covid-19

by Miles Cottier and Rachel Zuckerman

Health care leaders often strive to create a strong team culture where staff feel heard and empowered to do their best work—but this is easier said than done.

Webinar Thursday: Establish ongoing feedback and support channels for staff

Our colleague Bec Richmond recently ran two virtual sessions with health care leaders to discuss how to establish ongoing feedback and support channels for staff—made all the more relevant during the Covid-19 pandemic. Below, we share some key strategies we learned from the sessions to embed long-term support channels to help prevent burnout and inspire our teams.

1. Develop a continuous feedback process

The biggest takeaway from the sessions is the importance of establishing a dynamic and meaningful feedback process in which we move away from periodic feedback discussions and toward continuous feedback. This is all the more important in a time where "the normal" may feel like a distant prospect.

A great place to start is proactively assessing compassion fatigue risk. Compassion fatigue occurs when caregivers are overwhelmed by stresses stemming from either the clinical or interpersonal components of their role—and it can be detrimental to the overall mental and physical health of staff. This compassion fatigue assessment is an easy-to-use tool to spot the visible and invisible signs of compassion fatigue, investigate the root causes, and seek additional help if necessary.

While this tool is a great resource for your immediate team, it's also crucial for organisations to open wider feedback loops with all staff long-term.

2. Use real-time feedback to drive change

Developed in the pre-Covid-19 world, the Pulssi (Finnish for "pulse") nurse assessment tool from Coxa Hospital in Finland is a great way to gather real-time feedback. Pulssi is designed to routinely solicit and analyse real-time feedback on staff's emotional state on a continuous basis. Not only does it provide an honest and real-time pulse check on how staff are feeling, but it also provides an opportunity to learn and potentially fix the root causes.

Through Pulssi, frontline nurses take a few minutes at the end of each shift to reflect on their day and record the result with a colour-coded response. Unit managers and the Director of Nursing (DON) review the combined real-time data regularly and meet with staff to discuss and address areas of concern.

Processes like this can help facilitate an open and continuous dialogue between frontline staff and managers, instead of the status quo of withholding emotions or feeling resentment. These conversations can also help staff feel empowered to help make changes themselves.

Whether you choose to use a computer-based system, like Coxa Hospital, or simply different coloured counters being put into jars at the end of a shift, the key is to provide staff with an opportunity to deliver ongoing feedback that can help drive change.

3. Provide an outlet to share concerns—and inform next steps

Bec's virtual sessions also highlighted the importance of talking through feelings with staff, even if we can't necessarily fix the problems that are causing distress.

Children's Health, based in Texas, U.S., developed a moral distress consult service to enable staff to share concerns and, just as importantly, participate in facilitated group discussions. Here's how it works. If a nurse is feeling moral distress, they can call a hotline to share their concern. Trained facilitators then lead a session—either one-on-one or with a group—to discuss the concern that prompted the call. The power of these sessions is in convening multiple perspectives, identifying the root causes of the distress, and outlining next steps.

The moral distress consult system has the potential to lead to changes that address distress-causing problems, but at the very least, it provides another outlet for open communication.

Really the most important thing to think about is: How do we successfully open an ongoing dialogue with our teams to address how they are feeling and make sure they are supported?

Thursday: Establish ongoing feedback and support channels for staff

Our teams have been through huge change in the last few weeks and dealt with enormous challenges as they look to provide the best care possible in the current climate.

As we ask them to continue to care for COVID-19 patients and the anticipated wave of non-covid complex patients that we need to renter the system, we must ensure that there are simple ways to get regular pulse checks on staff’s mental and physical well-being, as well as understanding what processes and infrastructure we need to change to allow them to operate safely—for themselves and our patients—in the new normal.

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