An outbreak of appreciation: A discursive analysis of tweets of gratitude expressed to the National Health Service at the outset of the COVID-19 pandemic

Performance-related pay for NHS consultants: exploring views and perceived impacts in one NHS Trust in England

BACKGROUND/AIM

To investigate senior doctors' (consultants) views about local clinical excellence awards (CEAs; a form of performance-related pay (PRP)) in theory and in practice.

METHODS

Online survey of consultants in one National Health Service Trust in England which had implemented new variations to local CEAs. 31% response rate, comprising 250-500 applicants and non-applicants. Descriptive statistics were conducted with quantitative data and content analysis with qualitative data.

RESULTS

Most consultants (57%) were supportive of CEAs in theory and in practice. A minority was not supportive (21%). This was justified by not applying (due to opposition, limited time to apply or being apathetic about them); 22% were neutral. About one-third (32%) of respondents had not applied for local CEAs in 2022, mainly because they thought they would be unsuccessful (30%). Two-thirds (67%) of respondents felt that CEAs provided recognition for their work, with female respondents and those working less than full-time expressing most recognition. Respondents were not supportive of the idea that CEAs should be paid fully for those working less than full-time (45% disagreed, 35% agreed, 21% neutral).

CONCLUSIONS

The exploratory study found mixed support for CEAs. Engagement with CEAs was complicated by pension and tax issues, claims of limited time to apply, and equity concerns about current and previous applications. However, CEAs offered some consultants some recognition for their work. These findings are more nuanced than existing evidence and elaborate extant theoretical perspectives of PRP in relation to doctors.

From applause to disappointment - appreciation among healthcare providers that provided end-of-life care during the COVID-19 pandemic and its impact on well-being - a longitudinal mixed methods study (the CO-LIVE study)

BACKGROUND

The healthcare sector is facing increasing work pressure, making a healthy workforce essential. Appreciation is a factor influencing well-being, and the COVID-19 pandemic offers valuable insights into this. This study aims to: 1) describe to what extent end-of-life care providers felt appreciated and understood during the first 18 months of the pandemic, 2) examine the impact of appreciation on their well-being, and 3) explore their perceptions of what appreciation should look like.

METHODS

A longitudinal mixed methods study among healthcare providers in the Netherlands delivering end-of-life care during the COVID-19 pandemic. Surveys were conducted at four timepoints (n = 302), and interviews were conducted at three timepoints (n = 17) during the first 18 months of the pandemic. Generalized Estimating Equations analysis was performed on the quantitative data and thematic analysis was conducted on the interview data.

RESULTS

This study shows that feeling of appreciation among healthcare providers peaked in the first wave of the pandemic, but significantly dropped in the second wave, with only about half of the healthcare providers feeling appreciated. This slightly improved afterwards. Furthermore, nearly half of healthcare providers felt misunderstood during the first 18 months of the pandemic. Additionally, this study shows that between September 2020 and September 2021 about 1 in 3 healthcare providers had a score on the Well-Being Index indicating higher risk for burnout. Feeling appreciated and not feeling understood were both significantly associated with worse well-being. Interviews revealed that nurses did not always feel understood and appreciated by society, employers, patients and their families, as well as their own friends and family, leading to feelings of sadness, anger, and frustration. Three major themes emerged: 'recognizing real needs, 'we are not in this together' and 'short-lived appreciation that failed to lead to structural changes'.

CONCLUSIONS

This study shows that during the COVID-19 pandemic, healthcare providers often felt neither appreciated nor understood, which is associated with lower scores of well-being. The expressed appreciation often did meet their needs or expectations, from both employers and society. With healthcare provider well-being still under strain, sustained attention to appreciation and understanding is important for retaining the workforce.

The influence of waiting times and sociopolitical variables on public trust in healthcare: A cross-sectional study of the NHS in England

Objectives

This study aims to assess factors influencing public trust in the National Health Service (NHS) in England, focusing on the impact of waiting times in Accident & Emergency (A&E) departments and for GP-to-specialist cancer referrals.

Study design

A cross-sectional survey-based research design was employed, covering the period from July 2022 to July 2023.

Methods

Data were collected through YouGov surveys, yielding 7415 responses. Our analysis is based on 6952 of these responses which we were able to aggregate to 42 NHS Integrated Care Boards (ICBs) for A&E waiting times and 106 ICB sub-units for cancer referral times. Multiple regression analysis was conducted, with the dependent variable being trust in the NHS.

Results

Waiting times for A&E and cancer referrals did not significantly affect trust in the NHS. However, other sociopolitical factors displayed significant influence. Specifically, being a member of an ethnic minority group, or having voted Conservative in the 2019 general election were associated with lower trust scores. Other variables such as age and local unemployment rate were also significant predictors.

Conclusions

Our findings suggest that waiting times for healthcare services have no effect on public trust in the NHS. Instead, trust appears to be largely shaped by sociopolitical factors. Policymakers should therefore look beyond operational efficiency when seeking to bolster trust in the healthcare system.

Finding Silver Linings in the Covid-19 Pandemic: A 2-Wave Study in the UK

The Covid-19 pandemic has resulted in widespread anxiety, fear and depression, yet focussing only on these negative issues may obscure the opportunity to promote positivity and resilience. Traumatic events can often result in positive life changes (adversarial growth) though there is little evidence in the context of pandemics, and no previous studies in Covid-19 with the general public. The present research investigated whether adversarial growth was perceived in Covid-19 and whether this could account for variance in wellbeing, over and above effects of personality traits. Participants recruited from the UK public (N = 183) completed the Big Five Personality Inventory, the WHO-5 Wellbeing Scale and the Silver Lining Questionnaire (SLQ) measure of adversarial growth. Questionnaires were completed online, at two timepoints, nine months apart. At Time 1, wellbeing was negatively associated with trait Neuroticism and positively associated with Openness to experience. Both associations were positively mediated by SLQ score. At Time 2, SLQ score again mediated the effects of Openness on wellbeing, and also the influence of wellbeing at Time 1 on that at Time 2. Reported Silver Linings included strengthened personal relationships at Time 1, and improved ability to handle life events at Time 2. This suggests a shift from an appreciation of relationships to an awareness of personal development once life returned to some semblance of normality. Overall, results suggest that perceived adversarial growth supported wellbeing during the pandemic and highlight a focus for therapeutic intervention.

Reluctant heroes: New doctors negotiating their identities dialogically on social media

BACKGROUND

Ensuring that students transition smoothly into the identity of a doctor is a perpetual challenge for medical curricula. Developing professional identity, according to cultural-historical activity theory, requires negotiation of dialectic tensions between individual agency and the structuring influence of institutions. We posed the research question: How do medical interns, other clinicians and institutions dialogically construct their interacting identities?

METHODS

Our qualitative methodology was rooted in dialogism, Bakhtin's cultural-historical theory that accounts for how language mediates learning and identity. Reasoning that the COVID pandemic would accentuate and expose pre-existing tensions, we monitored feeds into the Twitter microblogging platform during medical students' accelerated entry to practice; identified relevant posts from graduating students, other clinicians and institutional representatives; and kept an audit trail of chains of dialogue. Sullivan's dialogic methodology and Gee's heuristics guided a reflexive, linguistic analysis.

RESULTS

There was a gradient of power and affect. Institutional representatives used metaphors of heroism to celebrate 'their graduates', implicitly according a heroic identity to themselves as well. Interns, meanwhile, identified themselves as incapable, vulnerable and fearful because the institutions from which they had graduated had not taught them to practise. Senior doctors' posts were ambivalent: Some identified with institutions, maintaining hierarchical distance between themselves and interns; others, along with residents, acknowledged interns' distress, expressing empathy, support and encouragement, which constructed an identity of collegial solidarity.

CONCLUSIONS

The dialogue exposed hierarchical distance between institutions and the graduates they educated, which constructed mutually contradictory identities. Powerful institutions strengthened their identities by projecting positive affects onto interns who, by contrast, had fragile identities and sometimes strongly negative affects. We speculate that this polarisation may be contributing to the poor morale of doctors in training and propose that, to maintain the vitality of medical education, institutions should seek to reconcile their projected identities with the lived identities of graduates.

Health service improvement using positive patient feedback: Systematic scoping review

BACKGROUND

Healthcare services regularly receive patient feedback, most of which is positive. Empirical studies suggest that health services can use positive feedback to create patient benefit. Our aim was to map all available empirical evidence for how positive patient feedback creates change in healthcare settings.

METHODS

Empirical studies in English were systematically identified through database searches (ACM Digital Library, AMED, ASSIA, CINAHL, MEDLINE and PsycINFO), forwards and backwards citation, and expert consultation. We summarise the characteristics of included studies and the feedback they consider, present a thematic synthesis of qualitative findings, and provide narrative summaries of quantitative findings.

RESULTS

68 papers were included, describing research conducted across six continents, with qualitative (n = 51), quantitative (n = 10), and mixed (n = 7) methods. Only two studies were interventional. The most common settings were hospitals (n = 27) and community healthcare (n = 19). The most common recipients were nurses (n = 29). Most outcomes described were desirable. These were categorised as (a) short-term emotional change for healthcare workers (including feeling motivated and improved psychological wellbeing); (b) work-home interactional change for healthcare workers (such as improved home-life relationships); (c) work-related change for healthcare workers (such as improved performance and staff retention). Some undesirable outcomes were described, including envy when not receiving positive feedback. The impact of feedback may be moderated by characteristics of particular healthcare roles, such as night shift workers having less interaction time with patients. Some factors moderating the change created by feedback are modifiable.

CONCLUSION

Further interventional research is required to assess the effectiveness and cost-effectiveness of receiving positive feedback in creating specific forms of change such as increases in staff retention. Healthcare managers may wish to use positive feedback more regularly, and to address barriers to staff receiving feedback.

Public Officials' Engagement on Social Media During the Rollout of the COVID-19 Vaccine: A Content Analysis of Tweets

BACKGROUND

Social media is an important way for governments to communicate with the public. This is particularly true in times of crisis such as the COVID-19 pandemic, during which time government officials had a strong role in promoting public health measures such as vaccines.

OBJECTIVE

In Canada, provincial COVID-19 vaccine rollout was delivered in three phases aligned with federal government COVID-19 vaccine guidance for priority populations. In this study, we examined how Canadian public officials used Twitter to engage with the public about vaccine rollout and how this engagement has shaped public response to vaccines across jurisdictions.

METHODS

We conducted a content analysis of tweets posted between December 28, 2020, and August 31, 2021. Leveraging social media artificial intelligence (AI) tool Brandwatch Analytics©, we constructed a list of public officials in three jurisdictions (Ontario, Alberta and British Columbia) organized across six public official types, then conducted an English/French keyword search for tweets about vaccine rollout and delivery that mentioned, retweeted, or replied to the public officials. We identified the top 30 tweets with the highest impressions in each jurisdiction in each of the three phases (approximately a 26-day window) of the vaccine rollout. The metrics of engagement (impressions, retweets, likes, and replies) from the top 30 tweets per phase in each jurisdiction were then extracted for additional annotation. We specifically annotated sentiment towards public officials' vaccine response (I.e., positive, negative, neutral) in each tweet, and also annotated the type of social media engagement. A thematic analysis of tweets was then conducted to add nuance to extracted data characterizing sentiment and interaction type.

RESULTS

Of the six categories of public officials, 142 prominent accounts were included from Ontario, Alberta and British Columbia. 270 tweets were included in the content analysis. Public officials mostly used Twitter for information provision (65.6%), followed by horizontal engagement (17.5%), citizen engagement (11.3%), and public service announcements (5.7%). Information provision by government bodies (e.g., provincial government and public health authorities) or municipal leaders are more prominent than tweets by other public official groups. Neutral sentiment accounted for 51.1% of all tweets, while positive sentiment (43.2%) was the second most common sentiment. In Ontario, 60% of the tweets were positive. Negative sentiment (e.g., public officials criticizing vaccine rollout) accounted for 12.6% of all tweets.

CONCLUSIONS

As governments continue to promote the uptake of the COVID-19 "booster" doses, findings from this study are useful in informing how governments can best utilize social media to engage with the public to achieve democratic goals.

CLINICALTRIAL

Working in value-discrepant environments inhibits clinicians' ability to provide compassion and reduces well-being: A cross-sectional study

BACKGROUND

The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals.

METHODS

More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement.

RESULTS

Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f ²  = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f ²  = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f ²  = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f ²  = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f ²  = 0.004).

CONCLUSIONS

Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.

Warmth and competence perceptions of key protagonists are associated with containment measures during the COVID-19 pandemic: Evidence from 35 countries

It is crucial to understand why people comply with measures to contain viruses and their effects during pandemics. We provide evidence from 35 countries (N_total = 12,553) from 6 continents during the COVID-19 pandemic (between 2021 and 2022) obtained via cross-sectional surveys that the social perception of key protagonists on two basic dimensions-warmth and competence-plays a crucial role in shaping pandemic-related behaviors. Firstly, when asked in an open question format, heads of state, physicians, and protest movements were universally identified as key protagonists across countries. Secondly, multiple-group confirmatory factor analyses revealed that warmth and competence perceptions of these and other protagonists differed significantly within and between countries. Thirdly, internal meta-analyses showed that warmth and competence perceptions of heads of state, physicians, and protest movements were associated with support and opposition intentions, containment and prevention behaviors, as well as vaccination uptake. Our results have important implications for designing effective interventions to motivate desirable health outcomes and coping with future health crises and other global challenges.

What do people write about COVID-19 and teaching, publicly? Insulators and threats to newly habituated and institutionalized practices for instruction

Covid represents major changes in teaching across the world. This study examined some of those changes through tweets that contained threats and insulators to habitualization of newer teaching practices. The investigator harvested tweets to determine sentiment differences between teaching and schools and teaching and online. Topic modeling explored the topics in two separate corpora. Omnibus Yuen’s robust bootstrapped t-tests tested for sentiment differences between the two corpora based on emotions such as fear, anger, disgust, etc. Qualitative responses voiced ideas of insulation and threats to teaching modalities institutionalized during the pandemic. The investigator found that ‘teaching and school’ was associated with higher anger, distrust, and negative emotions than ‘teaching and online’ corpus sets. Qualitative responses indicated support for online instruction, albeit complicated by topic modeling concerns with the modality. Some twitter responses criticized government actions as restrictive. The investigator concluded that insulation and threats towards habitualization and institutionalization of newer teaching modalities during covid are rich and sometimes at odds with each other, showing tension at times.

A content analysis on the perceptions of LGBTQ+ (centred) health care on Twitter

BACKGROUND

LGBTQ+ individuals have experienced many barriers to receiving quality health care, but the worldwide implementation of person-centred care should make a positive change. However, as forthright disclosures are difficult to find using traditional methods, novel approaches should be utilized to uncover opinions and experiences on LGBTQ+ health care. Twitter could be a place where people post on this topic.

AIM

This study aimed to explore tweets mentioning LGBTQ+ (centred) health care.

METHODS

The methods consisted of an explorative qualitative content analysis of tweets. The tweets were collected between 26 February and 30 March 2021, resulting in 2524 tweets of which 659 were relevant for content analysis.

RESULTS

The results showed an excess of political tweets involving LGBTQ+ health care. Many tweets included general statements on the need for LGBTQ+ health care. The few tweets on personal experiences in LGBTQ+ health care showed the overwhelming need for quality care that has been made difficult by political developments.

CONCLUSION

Most tweets were made to inform others of the necessity of quality health care for LGBTQ+ individuals, but the utilization of person-centred care is hardly noticeable.

PUBLIC CONTRIBUTION

This study was conducted with the involvement of a public partner (second author) who contributed to the design, data analyses and writing of the paper. Moreover, this study involves the analysis of data provided by the public and published on social media.

Evaluating a Psychological First Aid Training Intervention (Preparing Me) to Support the Mental Health and Wellbeing of Chinese Healthcare Workers During Healthcare Emergencies: Protocol for a Randomized Controlled Feasibility Trial

AIMS/BACKGROUND

The mental health challenges faced by frontline healthcare workers responding to emergencies have become a prominent public concern. Despite the consensus that Psychological First Aid (PFA) training can effectively support public mental health during emergencies through reducing acute distress and improving self-efficacy, yet it is concerning that previous flexible delivery and neglect for evaluating PFA training has resulted in unintended potential harms which may prevent further proactive uptake of this mental health prevention strategies. Establishing the feasibility of the PFA training through adapting to the local culture, tailoring to frontline healthcare context, and evaluating systematically may be helpful to inform a large trial, or ensure effective and sustained training delivery. This study aims to present a protocol for evaluating the feasibility and acceptability of a well-adapted PFA training intervention (Preparing Me) to address the implementation gap in this mental health promotion approach.

METHOD

This is a two-armed feasibility randomized controlled trial (RCT) to be conducted among 80 Chinese frontline healthcare workers without prior related mental health training. Participants from the intervention group will receive an adapted PFA training program tailored to the Chinese frontline context to improve their knowledge and skills to support people in crisis. The primary objectives are to evaluate the training intervention's feasibility and the target population's acceptance of this educational intervention. The secondary objective is to obtain preliminary estimates of variability in participants' outcomes over a 3-months period. Measurements are taken pre-intervention (T0), post-intervention (T1), and at 1- and 3-months follow-up (T2-T3). A process evaluation using qualitative research with a subgroup of trainees, their clinical managers as well as trainers will be conducted to gain a comprehensive understanding of the intervention's acceptability and feasibility.

DISCUSSION

This present study protocol will help to establish whether this adapted PFA training intervention is feasible and accepted by the frontline healthcare workers, in preparation for a later effectiveness trial. It is anticipated that the resulted information would be an impetus to maximize usability and acceptance of this low-intensity PFA skillset by a wider population, thus supporting the mental health of frontline healthcare workers in dealing with crises for future emergencies.

TRIAL REGISTRATION

This trial has been approved by the Institution Review Board from Central South University (LYG2020029) and by the Psychiatry, Nursing and Midwifery Research Ethics Committee at King's College London, England (LRS/DP-21/22-23161). It also has been processing registration at the Chinese Clinical Trial Registry.