A total of 28 focus group discussions were conducted over the course of the project with approximately 450 participants from multiple hospital departments. The focus groups were run in two rounds: the first 17 groups were conducted between July 2016 and May 2017 when the Trust had recently introduced the new initiatives; a further 11 groups were conducted between July 2018 and December 2019, when the initiatives had been in place for some time. Focus groups ran for approximately 20–50 minutes. Table 1 provides a breakdown of where participants were drawn from.
1a: Culture of putting others before self
NHS staff prioritise patient health and wellbeing above their own:
“if we have a busy day you can forget it … we always seem to be at the bottom of the pile of our priorities … we’re always thinking about other things … and then we just forget about putting ourselves first” (FG10).
1b: Shift work, break patterns and extra hours
Many felt their work patterns, limited break times and long hours precluded their involvement in health initiatives:
“…so you have like half an hour lunch and then half an hour some place in the afternoon … but you’re never guaranteed that second half an hour … [you] just get swallowed up with stuff you have to do.” (FG04)
1c: Health-related appointments or activities
Some highlighted the difficulty of attending health-related appointments, eg health checks, during the working day, suggesting they must be done during their own time:
“… sometimes it’s obviously quite difficult to access those services whilst you’re at work, so therefore you’d have to come in … when you’re not at work” (FG13).
There was a particular challenge related to mental health appointments as some felt uncomfortable discussing this within the work environment:
“…if you do have any kind of mental health issue … work can impact it quite a lot … on my day off would I want to come back into work to talk to someone who works where I work to talk about work?” (FG13).
1d: Extra pressure as short-staffed or poorly resourced
Many highlighted how stress and pressure were caused by the lack of resources and under-staffing within the NHS:
“… all departments are short-staffed and sometimes you can get somebody in their place, but if not, the others have to pick it up.” (FG25)
Theme 2: Hospital management agenda and relationship with staff
This theme summarises how staff feel about their relationship with hospital management and their motives and ability to address issues raised. It has four sub-themes.
2a: Privacy and confidentiality
Some staff highlighted concerns about confidentiality and privacy in their dealings with their employers, particularly if utilising any mental health initiatives:
“… when you’re speaking about your mental health … I don’t think it would be confidential … back to the manager and then everyone.” (FG13)
2b: Management motives
Some were suspicious of their employer’s reasons for implementing these initiatives, feeling there was a different agenda in play:
“See I'm a cynic. Are the Trust doing it because they actually care about their staff or are they doing it because of the *C-QUIN for this year? … It does feel historically that nobody really cared and now all of a sudden they do” (FG06)
*Footnote: The Commissioning for Quality and Innovation (CQUIN) framework supports improvements in the quality of services and the creation of new, improved patterns of care.
2c: Positive viewpoint
Many did appreciate the hospital management’s efforts in providing health-promoting initiatives:
“I don’t think it is the Trust’s responsibility… but the fact there is stuff in place, we can access free appointments and stuff and you know help with the diet and all that sort of stuff, is great” (FG21).
2d: Recognising and addressing issues
One criticism was that the hospital management had not effectively dealt with previous feedback and that these initiatives have been implemented without accounting for all staffing groups’ needs:
“I think it would be nice to see the Trust support us to do the things that we want to do, that we can accommodate in our lives, so instead of providing things that not everyone can access, why can’t they just support us to access our own things that we want to do?” (FG06)
Theme 3. Working environment
This theme highlights how the practicalities of the workplace environment can act as barriers for involvement with the initiatives. This has four sub-themes:
3a: Hospital work environment
Many felt the working environment itself had a negative impact upon mood which reduces motivation to engage with health initiatives. One example was the lack of natural lighting:
“No natural day light, especially in the winter, you go out to the dark … come in, in the dark … has to have some sort of impact long term” (FG25)
3b: Lack of space
Another barrier was the confined spaces within the hospital, and also the lack of outside green space or designated ‘staff only’ spaces in which to spend their breaks:
“…If we want to go somewhere, we don’t want to go where all the patients are sat, we want to go and sit … outside” (FG11)
Some staff suggested the workplace does not have enough facilities to support some of the well-meaning initiatives:
“…it doesn’t have changing rooms, it doesn’t have showers, and it doesn’t have a space where staff can all get together.” (FG20)
3c: Lack of time
An oft-cited barrier to keeping healthy was the lack of time to read the hospital’s promotional material shared via the staff intranet or emails, or to attend the organised activities:
“I guess time out to exercise, go to the gym … actually getting the time … it’s just the hours. If you're starting early and getting home late, it’s just quite hard to fit it in” (FG19)
3d: Workplace for work only
Some preferred to manage their health and wellbeing outside of work, in effect distinguishing between their work and home lives:
“I want to separate work and life … I don’t want my personal stuff here, in work” (FG27)
Whereas some staff welcomed the idea of having opportunities within the workplace to focus on their health and wellbeing:
“I think it is also a case of making it part of your working day and that does not necessarily mean you’re working” (FG23)
Theme 4. Staff health and wellbeing initiatives
There was great variability in how positive or negative staff felt about the initiatives provided by the hospital.
4a: “It has been really helpful”
Some felt the new initiatives provided motivation to take care of themselves, that they made it easier to do so, and were appropriate for their needs:
“… it has given me the support and the kick up the backside that I needed” (FG21).
“There is a healthy section … it is easier to choose healthy options … the temptation is reduced…” (FG23)
“They can provide you with support, whether that be counselling, telephone support, face-to-face counselling, group support … I think that’s quite good” (FG20)
4b: “It’s not quite gone far enough”
There were also some negative perceptions regarding the logistics behind some initiatives, how they come and go, and the effort needed to gain access:
“you cycle in … that’s like ten people just waiting for a shower. It was also … it was key-coded, so you had to find the right person who knew the code” (FG20)
“I done some of the classes they used to do here … the yoga was cut I think, and the Zumba classes were gone. And there used to be WeightWatchers here but that’s gone as well.” (FG25)
“… to fill in this questionnaire you will need your NHS number … I’d filled in the whole questionnaire and got to that last … arghhh!” (FG27)
4c: Suggestions for improvement
Some staff made suggestions of how the initiatives could be improved such as making them cheaper, and improving marketing strategies to raise awareness:
“Most people I know downstairs are doing Slimming World and would be nice to make them get that cheaper …” (FG08)
“I think more active advertising, might actually help … I don’t know half the stuff that is available … so maybe a bit more of a … launch of what we do as a Trust” (FG19)
4d: What staff want
There were many ideas for what would be useful and welcomed by staff, including the organisation of group activities with a purpose, such as to raise money, or more services with easier-to-use booking systems:
“…if there were a group of staff that, were going to do something and we were gonna raise some money for something in the hospital, I think that would really motivate me to do it” (FG27).
“… in your lunch break … we could book on staffnet or something like that … a service professionally for staff who perhaps don’t have time to do things, to go” (FG08).
These themes highlight the complexity of a large organisation such as a large acute hospital attempting to meet the needs of a diverse population.