An evaluation of REACTMH mental health training for healthcare supervisors

Abstract

Background

Healthcare workers (HCWs) are vulnerable to developing mental ill-health. Prior research has shown those in managerial or supervisory positions have pivotal roles in creating a healthy work environment, as well as recognizing and supporting HCWs with mental health symptoms to improve occupational outcomes and reduce sickness absence.

Aims

To evaluate the effectiveness of active listening skills training (REACTMH) for UK healthcare managers.

Methods

Managers of HCWs were voluntarily enrolled on a REACTMH active listening skills training package. Attendees anonymously completed questionnaires before and immediately after attending the 1-h remote training session and again 1 month later. The questionnaire asked about confidence in recognizing, conversing with and supporting distressed colleagues as well as perceived usefulness and importance of the training and how often they had used the taught active listening skills.

Results

Fifty-eight healthcare managers enrolled onto the REACTMH programme in July 2020 and 32 (55%) completed the 1-month follow-up. Just less than half reported feeling confident in being able to identify, speak to and support potentially distressed staff before the training; significantly more (>80%) reported feeling confident 1 month afterwards (P < 0.001). Around three-quarters of attendees reported the REACTMH programme as highly useful, highly important and said they had frequently used the learned skills.

Conclusions

A brief active listening skills training package was associated with significant improvements healthcare manager’s confidence in recognizing, speaking with and supporting HCWs with suspected mental health conditions. Further research is needed to investigate the longer term effectiveness and acceptability of REACTMH training.

Active listening, healthcare workers, managerial support, mental health, NHS, supervisors

Key learning points

What is already known about this subject:

• Many healthcare workers work in volatile, uncertain, complex and highly pressured environments which increases the risk of developing a mental health condition.

• Previous evidence has shown that managers who feel confident in recognizing, speaking with and supporting distressed staff, have positive impacts on staff’s mental health which is associated with a reduction in sickness absence.

What this study adds:

• REACTMH is an online active listening skills programme for managers of healthcare workers.

• After 1 month, attendees reported significant improvement in their confidence in interacting with staff with probable mental health symptoms.

• Three-quarters of managers found REACTMH useful, frequently practiced the skills learned and thought REACTMH was important for managers.

What impact this may have on practice or policy:

• REACTMH improved the confidence of healthcare managers to support healthcare workers.

• Given managers’ confidence in supporting the mental health of staff is linked to improved productivity, REACTMH should be considered an essential skill for those in supervisory roles.

• Active listening skills training for healthcare worker supervisors may decrease poor mental health for staff and improve quality of care.

Introduction

The National Health Service (NHS) is one of the world’s largest employers of healthcare workers (HCWs) [1]. HCWs have frequent exposure to work-related stressors [2] increasing their likelihood of developing poor mental health potentially contributing to the NHS 4.7% rate of sickness absence [2,3]. It is likely that many psychologically unwell HCWs continue to work potentially affecting the quality of care delivered [2].

Published evidence shows behaviours and attitudes of colleagues, especially supervisors, can substantially impact staff’s mental health [4]. Supportive managers who encourage early treatment and create healthy work environments [2,5] are likely to increase staff productivity and reduce sickness absence.

A well-constructed randomized controlled trial of a 4-h mental health training programme educated team leader Australian Firefighters on mental health symptoms, their role in supporting staff with poor mental health and the importance of regular contact, early action and communication. The study concluded the training increased managers’ confidence to engage staff about their mental health leading to substantially reduced work-related sickness absence [6].

This study evaluated whether a brief active listening skills training, provided for time-poor UK managers of HCWs affected their confidence to recognize, speak with and support staff with potential mental health difficulties.

Methods

Managerial staff enrolled onto an active listening skills training programme called REACTMH (Recognize, Engage, Actively listen, Check risk and Talk about a specific supportive plan) advertised through the NHS People website. The course was provided by an independent provider (www.marchonstress.com).

Training sessions were delivered online, by Zoom, for 1 h, to groups of up to 10 managers, in July 2020. REACTMH consisted of a 15-min didactic presentation, a 5-min video demonstration, remote practice in pairs remotely overseen by the trainer and questions. Attendees anonymously completed questionnaires before, immediately after and 1 month after using Qualtrics XM. Before the training, attendees provided demographic information (including age, gender and years of supervisory experience) and rated their confidence in three domains: (i) recognizing poor mental health in others; (ii) speaking with colleagues about their mental health; and (iii) supporting colleagues with mental health difficulties. Immediately after, attendees rated the usefulness and 1 month later attendees again rated their confidence and the frequency of utilizing the skills and perceived importance of REACTMH for healthcare managers. Confidence was measured on a five-point scale with fairly or extremely responses being classed as confident. We defined confident supporters as being confident in at least two of the three domains with underconfident supporters defined as not being confident in at least two domains.

Data were analysed using SPSS (version 26). Descriptive statistics summarized demographics. Chi-squared tests analysed changes in confidence over time. Usefulness, perceived importance and frequency of skill utilization were summarized using frequencies. One month after, associations between perceived importance, frequency of skill utilization and confidence were analysed using Fisher’s exact test.

Results

Before the training, 58 managers provided data with 33 (57%) after and 32 (55%) 1 month after. Most attendees were 45–54 years old (40%) and female (>80%) with a mean of 10 years (SD ± 1.2) experience working in healthcare supervisory roles (Table 1a).

Table 1.

(a) Demographics of managers of HCWs at baseline and (b) REACTMH evaluation outcomes

(a)
			Frequency (%), mean (SD)
Age
18–24			2 (4)
25–34			6 (10)
35–44			15 (26)
45–54			23 (40)
55–64			9 (15)
Prefer not to say			3 (5)
Gender
Males			9 (16)
Females			46 (81)
Prefer not to say			2 (4)
Healthcare organization
NHS—Primary care			4 (7)
NHS—Acute care or mental health			30 (58)
NHS—Other			20 (35)
Other			4 (7)
Years in healthcare organization
All			10 (1.2)
NHS—Primary care			6.5 (3)
NHS—Acute care or mental health			10.7 (1.4)
NHS—Other			8.5 (2.5)
Other			15 (10.4)
(b)
Reported frequency (%) of high:	Baseline (n = 58)	Post-training (n = 33)	One month (n = 32)	χ 2	P-value
Proportion of confident supporters	26 (45)	–	27 (84)	13.3	<0.001*
Confident domains
Confidence in recognizing symptoms	24 (41)	–	26 (81)	13.2	<0.001*
Confidence in speaking to a colleague	27 (47)	–	26 (81)	10.3	<0.001*
Confidence in supporting a colleague	25 (43)	–	26 (81)	12.2	<0.001*
Programme usefulness	–	25 (76)	–	–	–
Frequency of techniques used	–	–	24 (75)	–	–
Importance of training	–	–	25 (78)	–	–

Confident supporters = participants who reported feeling confident in at least two of the three domains.

*P = 0.05.

The training led to a significant increase in the proportion of confident supporters (44.8% before and 84% at 1 month, χ ²(1) = 13.2, P < 0.001) (Figure 1). Further analysis showed significant improvements in all confidence domains from baseline to 1-month follow-up: confidence in recognizing symptoms of poor mental health increased from 41 to 81% (χ ²(1) = 13.2, P < 0.001); conversing with a colleague from 46 to 81% (χ ²(1) = 10.3, P < 0.001) and confidence in supporting a colleague from 43 to 81% (χ ²(1) = 12.2, P < 0.001) (Table 1b).

Figure 1.

Proportion of confident and underconfident supporters. The bars indicate the frequency and percentage of managers who were confident and underconfident supporters at baseline and 1-month follow-up. Confident supporters were defined as being confident in at least two of the three domains (i.e. recognition, conversation and support) with underconfident supporters defined as not being confident in at least two domains.

Over 75% (n = 24) rated the programme as highly useful (Table 1b) after. Although at follow-up, attendees reported frequently having used the learned skills (75%, n = 24) and considering that the skills were important for managers (78.1%, n = 25); these factors were not related to changes in any of the three domains of confidence (Fisher’s exact test, n = 32, NS).

Discussion

This was a service evaluation of remote active listening skills training for healthcare managers. One month after REACTMH training, attendees reported significantly improved confidence to support distressed colleagues; the proportion of managers who were confident supporters almost doubled from 45 to 84%. Three-quarters of managers perceived the programme as useful, important and had frequently used the learned skills although increased confidence was not associated with these factors.

A previous study of healthcare managers found self-perceived competency in supporting staff well-being was likely to impact on care delivery [7]. A randomized controlled study of a 4-h face-to-face staff support training package led to an improvement in Firefighter’s managers confidence in supporting staff’s mental health and significant reductions in sickness absence [6]. Similar improvements in confidence were also evident after 3 h of similar training delivered remotely. Overall, these studies suggest that managers who feel confident to interact with, and support, potentially distressed staff can create a healthy work environment, improve job satisfaction, job retention and positively influence staff mental health [6–8].

Given the above evidence, finding a remote 1-h active listening skills training was associated with substantial, significant improvement in HCW managers confidence to support staffs mental health is potentially encouraging. We postulate that REACTMH training has potential to improve the quality of patient care, staff well-being and productivity. Positive links between supportive supervisors and employee mental health have also been found in the military [4] and for new graduate nurses [9].

This study has key strengths and limitations. Online delivery made the training easily accessible. However, voluntary attendance may have led to selection bias. Also, the sample size was small with a control group. Furthermore, the use of cross-sectional data sets meant we could not adjust for potentially important covariates (e.g. age) or account for attrition bias. Additionally, we did not measure important outcomes such as sickness absence levels and retention of staff.

Overall, this study suggests a brief, remotely delivered active listening skills package could improve the confidence of HCW managers to support staff with potential mental health difficulties. Further research to explore the effectiveness, confidence and usefulness of REACTMH is warranted.

Funding

This study was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between Public Health England, King’s College London and the University of East Anglia. The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England or the Department of Health and Social Care.

Acknowledgements

We thank all participants of the REACTMH training programme.

Competing interests

S.W. worked for NHS England and NHS Improvement and now works for DHSC. N.G. runs March on Stress Ltd which is the company that provided the active listening skills training.