Part 3: Olympic Sport meets the NHS: lessons and learning from the different yet similar...

A three part series exploring innovation Under Pressure: How the Aneurin Bevan NHS Health Board in Wales Has Enabled its People to Thrive During and after the Pandemic

Part 3: The future for Innovation in Health Care exiting and beyond a pandemic

So where are we?

This is the third and final instalment of our three-part series exploring the parallels between high performance sport and healthcare, drawing upon our experiences within the Aneurin Bevan University Health Board (ABUHB); the health board which serves southeast Wales, UK. In our first and second editions, we described the context of operational delivery throughout the pandemic and the effect this has had and continues to have upon the workforce. We then provided comparisons between healthcare and performance sport: specifically in relation to performance plans and outcomes. We then moved on to present the opportunity for innovation within a crisis and the role of leadership within this to create the time, space and options for to enable novelty to emerge drawing upon the theoretical frameworks of complexity science and drive theory.

This final instalment wraps up our series by describing the potential route out of the pandemic in healthcare or as is frequently coined the ‘recovery’ from the pandemic. We will describe the new norm and the timescale and context of what recovery looks like for us and importantly the potential learning for and from performance sport.

Recovery: the impossible utopia for healthcare

There are many parallels between healthcare and performance sport, although one major point of difference is the ability for the performer and their support team to recover after training and performance. In the recent Tokyo Olympic games teams were encouraged to decompress, which provides a time and space to adjust to a more relaxed state after the biopsychosocial stress of the event allowing the processing and acceptance of both positive / negative feelings and experiences to minimize maladaptive adjustments. In Healthcare either on an individual level or an organisational level, recovery is not operationalized as an essential component of the performance cycle which might support biopsychosocial adaptation for sustainability. Instead, NHS systems and the individuals within them are faced with a renewal of demands e.g.: political pressure to resume services and meet targets, public pressure to meet needs and address an increased acuity of patients linked to services not being accessible during the pandemic, budgets restrictions and in some cases cuts, the need to continue to provide covid-related services; and increased staff absence and turnover. The demands are relentless, leaving little space for recovery as a concept or as an essential component of sustainability and performance. Recent survey data from our Health Board demonstrate that significant numbers (>50%) of staff are physically and psychologically exhausted from the pandemic and are worried about how they can continue. In the eyes of many this situation represents a dichotomy, both an existential threat to the NHS but also an opportunity to motivate a system to change. Change the system to enable recovery of the people and the organisation which may slow down services or carry on as we are and risk staff leaving the profession creating even more disruption both fiscal and patient facing. What we also know is that offering NHS workers a greater opportunity to have a positive experience of work is now an organisational priority, if we can help them do the work they have trained to do with purpose, reduce avoidable harm created through our processes and at the same time help them feel like they are valued we will have made radicle progress, and that desired ‘performance’ outcomes will increase.

From Healthcare worker to Healthcare performer

When considering the consistent demands placed upon healthcare workers, whether this be the porters and domestic staff preforming up to 30,000 steps per day, the intense cognitive capacity required by surgeons to perform prolonged procedures, or the emotional demands faced by staff regularly exposed to distressed patients and demanding concerned relatives maybe it's time to reframe how we conceptualized this work.

Perhaps we should reframe healthcare staff as ‘performers’ not workers?

When considering the athlete approach to performance in any given discipline it considers the performance plan (see article one) and the outcome ambitions which create focus, we consider the multi-disciplinary performance science teams which surround the athlete planning and adjusting the environment for optimal training including coaching, nutrition, sleep, mental preparedness and much more. Critically this process revolves around optimizing the athlete's ability to be available to perform, to exert the appropriate effort in context and to recover, ready to go again when it matters and ultimately to achieve the agreed and often very clear goals (I.e.: medals or improvements on previous performance). There is little of this process present in healthcare. We have staff who regularly work 12+ hour shifts (in spite of evidence stating this is detrimental to their health), surrounded by poor quality nutrition, sometimes limited managerial and leadership support, often with insufficient staffing levels. Paradoxically this combination of factors almost guarantees high or sustained performance is not possible.  If we consider the healthcare performer, we will need to re-engineer huge parts of the healthcare system, but perhaps now is the moment to do so. 

A possible way forward might be to, rather than focusing on arbitrary goals or key performance indicators which are externally generated and often inherently political and perversely promote gamification and minimize intrinsic motivation/discretional effort, we focus on clear mutually agreed objectives in the present, and use this to shape how we optimize performance today, this week, this month. We support this by co-creating meaningful performance measures which reflect the work being done by the people doing the work, and have a strong link to their sense of purpose and moral justice. If we focus on these factors within healthcare; as in the educational sector for example, to be intrinsically motivated, their work has to give them meaning to be validating thus rewarding and intern motivating.  

An irony within health care is that we know through research that many of the stressors faced by the workforce are not necessarily due to the work itself (primary stressors) but rather factors classed as secondary stressors (e.g.: bureaucracy without overt meaning, formal processes, management / leadership capability, psychological safety, inadequate job descriptions or role clarity) left unchecked many of these secondary stressors will have a negative impact on wellbeing and performance and have the added potential of creating unintentional harm to both individuals, teams and the organization itself. Changing both the narrative (workers as performers) as well as re-engineering the structures that are in place that maintains the identified performance inhibiting dysfunction is easier said than done clearly in the public funded healthcare sector, especially our Health Board which has nearly 15,000 employees. Notwithstanding this there remains a pandemic generated window of opportunity where we might be able use ‘Recovery’ as a platform to initiate some of the changes we have highlighted and examine the way we support and develop our people, because we very much need to do it differently to enable the people of the NHS to thrive. This message also serves as a call to arms for Performance leaders in sport: are you providing an environment which enables your athletes to thrive, providing co-created measures of performance markers, with a strong focus on their internal sense of purpose, their sense of meaning gained from being an athlete and moral justice and not just the quantifiable performance per se (being mindful that the opposite of these psychological components being burnout).

In summary...

To bring together our thoughts over this series of papers bringing together Organizational Development and Clinical and Organizational Psychology in a novel way, we are determined at the Aneurin Bevan University Health Bored to be different, to disrupt for a better future. Whats more, together between sport and healthcare there is much we can learn together in order to create something which is compelling and will move the future of sport and healthcare to the next level.

Dr Peter Brown and Dr Adrian Neal

Dr Brown is Director of Organisational Development (OD) at the Aneurin Bevan University Health Board (ABUHB) in South Wales, spent 10 years as the Head of Performance Knowledge working within British Olympic and Paralympic Sport and consulted for the International Olympic Committee.

Dr Neal is a Consultant Clinical Psychologist and Head of Wellbeing and Employee Experience at the ABUHB and has researched and published widely across organisational health and wellbeing.