Fostering tEAmwork for ResiLiEnt Staff and Safe care: driving post-pandemic recovery and renewal in Intensive Care Units (FEARLESS ICU)

The problem Intensive care units (ICUs) post-pandemic are facing a staffing crisis. ICUs have always been scary environments in which to receive/deliver healthcare, but COVID19 introduced added anxiety among overworked staff, and concerned patients/family members. Stretching ICU capacity over a prolonged period, to manage increased demand, meant changes in usual ways of working with staff taking on additional roles and responsibilities in newly-formed teams alongside redeployed or inexperienced staff. Many patients sadly did not recover, new care routines and therapies were introduced rapidly, while visiting restrictions limited staff access to patients' health histories and care preferences. Research interviews I completed with staff and families throughout the pandemic revealed staff to be under enormous pressure, which increases the risk of errors and omissions. Prolonged exposure to such working conditions place staff at high risk of ill health, leading many to consider resigning. Family members have also felt excluded from the care decisions, lacking contact with their loved ones' care providers. These changes are not reverting but gradually becoming the norm. The opportunity ICU staff have shown remarkable resilience in responding to the increased physical and psychological demands placed on them, enabled through unprecedented levels of camaraderie and teamwork. High levels of teamwork have long been shown to have a protective effect, with ICU research linking these to better outcomes for patients, including reduced mortality; higher family satisfaction; and improved staff wellbeing. However, with ICUs remaining busy due to the inevitable backlog and ongoing viral outbursts there are increasing signs, such as from the NHS staff survey, that these high levels of teamwork are waning. This is worrying given the UK Intensive Care Society reports an unprecedented shortage of ICU staff and expects demand for ICU beds to remain high as a recurring feature of COVID19 becoming endemic, with increased/stretched capacity each time to be sustained for months. Fostering high levels of teamwork could drive staff resilience while engendering patient safety; but, more evidence is needed about the changing nature of teamwork in ICU to inform interventions that can improve recovery and renewal. Method This research will complete a detailed analysis of current teamwork practice in ICUs across the UK, identify examples of strong and challenged teamwork practice, and understand the factors that influence team working in the post-pandemic context. This will be achieved by analysing new and historical NHS staff survey data to identify high-level trends on organisational, professional group, and staff profile related factors that influence teamwork. These trends will inform and complement in-depth work with staff on the ICU frontline, involving observations of actual ICU working and interviews with a range of staff of different seniority and from different professions, experienced or new in ICU. I will then use different examples from practice in reflective workshops with ICU teams and guide them to identify ways teamwork can be developed and sustained. As a result, I will develop a blueprint, a logic model and toolkit (including a website, videos, diagnostic tools, training material and exercises) for improving ICU teamwork practice; which I will implement and evaluate in successive research. Impact Project outputs will be disseminated widely through videos, blogs, a project website and newsletter; as well as policy briefs, news pieces, conference presentations and academic publications; and, a final project multi-stakeholder symposium bringing together clinicians, service users and policy makers. By generating an in-depth, evidence-based understanding of teamwork in ICU, and offering a toolkit to ICU teams across the NHS, the project can have a direct impact on the teamwork practice of ICU staff, improvement of which has long been linked with better patient, staff and organisational outcomes.