As one of five successful Digital Solutions Fund (DSF) bids, and to provide support to NHS staff across Wales, DNA Definitive rapidly piloted a digital learning solution for trauma response management. This has demonstrated how an established programme can be quickly adapted to a digital solution, making it more accessible for those who need it. It also has long-term applications for a blended solution far beyond Covid-19.
Overview
Managing wellbeing is vital for employers across healthcare, and never so more than in the past year. According to a recent Deloitte report, an average of £1 spent on supporting mental health sees employers get £5 back from reduced absences and staff turnover.
Staff of all specialisms may often find themselves in demanding and emotionally charged environments – with potential long-term consequences on their mental and physical health. This impacts staff welfare as well as the long-term quality of clinical services.
MedTRiM is a medical trauma and resilience management programme that can help support those exposed to such pressures. Trauma risk management (TRiM) was originally developed for those working in the military but was repurposed in 2011 for those working across healthcare by DNA Definitive in collaboration with Dr Mark Stacey, Associate Dean of New Initiatives at HEIW and Consultant Anaesthetist at Cardiff and Vale University Health Board.
This was a well-established resource for face-to-face learning, creating an atmosphere where healthcare staff could openly learn to support colleagues following a potentially traumatic experience. However, the programme’s face-to-face and classroom delivery was interrupted by the COVID-19 pandemic. This happened at a time when there was a great demand for staff support and training in the face of significant pressure. Rocketing COVID-19 case numbers and unprecedented strain on our healthcare services meant that the need for MedTRiM was greater than ever.
The Welsh Government funded Digital Solutions Fund provided an opportunity to adapt the training to a digital delivery format. Five winning digital health initiatives were offered funding as part of a £150,000 call to rapidly pilot innovative uses of digital technology in response to Covid-19. The Digital Health Ecosystem Wales managed the competition and supported the winning projects.
Objective
This pilot aimed to develop a digital learning solution to make the MedTRiM course accessible not only in response to Covid-19, while also looking at the potential as a long-term blended learning approach. The course was open to anyone working across NHS Wales, providing them with access to a digital framework and credible training for managing adverse psychological consequences of potentially traumatic events.
Collaboration
This DSF project was submitted as a joint application between DNA Definitive, Cardiff and Vale University Health Board, NHS Wales Innovation Group Leads, HEIW, and MiMentor.
MiMentor provided important support due to their experience in developing online learning platforms. They made the MedTRiM digital course interactive, developing ongoing knowledge checks and learning scenarios.
HEIW provided administrative and booking support for prospective and enrolled students.
DNA Definitive drew from NHS Wales Innovation Group Leads, trauma-related governance experts and digital content producers to map out and provide teaching and learning content. This included teaching videos, the transfer of existing MedTRiM course notes, and the development of the MedTRiM Incident LogBook content into iPDF’s and supportive infographics.
Challenges
Initial sign ups from NHS staff in Wales were low. Informal chats with colleagues revealed that this was because many staff did not have the capacity to enrol on a course like this. Many were working exceptionally long hours, some designated roles had been removed, and others were being deployed to new areas of work. We also had feedback that there was a lack of awareness about MedTRiM so undertook proactive engagement with Health Boards and numbers did increase.
There was also initial difficulty with tracking the progress of people enrolled on the course as they were all starting at different times. The programme was amended by creating a monthly intake to ensure similar start and completion dates.
One of the biggest challenges facing participants was being able to get a good internet connection in the workplace. This was a mixture of lack of good WiFi connections in some buildings, or technical issues accessing the course and content online from NHS equipment. This limited their ability to access the course as it required them to stream digital content. This will be a key consideration for courses looking to move to a blended approach.
Outcomes
The project is still ongoing with 322 digital learners accessing the course online between October 2020 and May 2021. This is almost four times the delegates who could access the face-to-face programme during such a time period. There was a wide spread of people enrolling onto the course both in terms of specialism and geography, including nurses, general practitioners, staff working in intensive care and anaesthetists. As part of the pilot, those who accessed it got the training for free.
A Ward Sister working at University Hospital Wales said:
“I just wanted to say thank you for the resources that you have provided over the last year for me and my staff. They have enabled me to get through what has undoubtedly been the worst year of my life and has enabled me to provide extra support to my staff.”
Based on this experience, Cardiff and Vale Health Board is embedding digital MedTRiM as training for all theatre staff (22 theatres in total). And Dr Harsha Reddy, Consultant in Anaesthetics and Critical Care, is now working to support its uptake in Betsi Cadwalladr University Hospital.
There is also interest in using this programme in training beyond Wales, across the UK and internationally.
The support from the Digital Solutions Fund has created an important legacy in how training and engaging healthcare staff can be achieved rapidly through a digital interface. The pilot enabled DNA Definitive to create the necessary digital methodology and platform for online training– making it more accessible and limited the need to travel. This helps contribute to wider environmental targets such as those in the Wellbeing of Future Generations Act.
The digital MedTRiM course will remain available to NHS staff in Wales. DNA Definitive can now provide the training in three ways for healthcare professionals, depending on different requirements: online, face-to-face and blended learning. The feedback provided in this pilot is now helping to inform future iteration of the training course and materials.
In summary, this pilot has made it easier and more accessible for healthcare staff to access training that can support their wellbeing. It has also opened the door for a blending learning approach for trauma management when social distancing is no longer required. The pilot gave DNA Definitive the opportunity to create and test new online learning materials – providing a training resource to support the NHS of the future.
Dr Mark Stacey, Associate Dean of New Initiatives at HEIW and Consultant Anaesthetist at Cardiff and Vale University Hospital Board, said:
“The drive for online learning as a result of the pandemic, and the collaboration meant that we were able to put together an online course of exceptional quality. This almost mirrored the excellent face to face MedTRiM course, we developed to maximise wellbeing in the NHS over the last 10 years.
The availability of the online course means that we can deliver large volumes of appropriate content and follow that learning up with the face to face or face to zoom option of moving from being aware of the training to actually using it in the clinical environment to help colleagues. This peer support model has never been needed more than it is at the moment and the model could easily be implemented across the whole of the Welsh NHS with appropriate funding.”
Professor Andy McCann, a Director of DNA Definitive, said:
"I would like to thank Welsh Government and the partners within the Digital Solutions Initiative. With the grant support, as a collaborative project team, we have successfully developed and piloted a learner-centred and contextually based course and resource to help NHS staff support their colleagues after potentially traumatic experiences."
Minister for Health and Social Services, Eluned Morgan said:
“The wellbeing of our health and care staff has never been more important. This project is an excellent example of how working with the private sector to develop solutions has been successful in providing support for staff to remain well, while continuing to deliver high quality healthcare throughout the most challenging times.”
If you are a healthcare professional based in Wales and would like to book onto the online MedTRiM course, then please visit the HEIW website or email heiw.newinitiatives@wales.nhs.uk.
Check out the full project timeline