Altruist Enterprises (#2142)

Creation
Draft
Initial
Closed
Idea Description
Overview of Innovation:
Mismanagement of stress is costing UK businesses £30 billion per year with 31% of employees experiencing a mental health problem whilst in employment.

Altruist provide training to help organisations:
- Prevent problems through building resilience
- Identify the early signs of stress and mental health problems
- Support staff and manage situations more effectively

We currently work with over 60 organisations with notable customers including Natwest, Solihull Council and Birmingham Children's Hospital.
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Innovation 'Elevator Pitch':
Nearly 40% of NHS staff have reported feeling unwell as a result of stress (NHS Staff Survey).
Mental Health First Aid is an evidence based programme designed to help individuals to prevent, identify and tackle stress and mental health problems.
Overview of Innovation:
NHS staff are more likely than the rest of the working population to become patients, increasing demands on the system they work in (King's Fund).

Altruist Enterprises are experienced in providing training to help organisations to prevent, identify and tackle stress within organisations.

Since forming in 2013, we have grown from 1 trainer to 3 members of staff and 10 contracted trainers delivering courses nationally with notable customers including Birmingham Children's Hospital, Solihull Council and WMAHSN.

We currently offer the following main courses to the NHS:

Resilience Training - A 3 hour course which helps employees to manage stress and build resilience in an everchanging work environment using proactive approaches.

“I learnt how to recognise situations in my daily working and home life that I can work on to reduce my personal stress and build my resilience. We were taken through a process which allowed us to challenge our negative thoughts and look at things from a different perspective. A very helpful course”. Federica Merella, Consultant Anaesthetist, Birmingham Children’s Hospital

Mental Health First Aid Lite - A 3 hour evidence based mental health awareness course accredited by the Royal Society for Public Health.

“We learnt about some of the main mental health problems, how to support others who may be experiencing issues and also discussed ways to support our own well-being. The course was very thought provoking”. Sophia Nasreisfahany, Solihull Council

Adult Mental Health First Aid - A 2 day evidence based indepth mental health awareness course accredited by the Royal Society for Public Health.

"This 2 day training delivered by Altruist was one of the most fulfilling training courses I have attended.  Having worked in the NHS for 17 years and managing staff for 13 of those I found this course enlightening.  It compounded how mental health affects us all no matter what your background is.  It also really tackled the stigma of using the words “mental health”.  Practical advice, tips and scenarios were used to give us a toolbox of strategies to help staff.  On reflection of my own career I now realise I have been in this position many times and now I feel more empowered and equipped to deal with these sensitive situations". Helen Hunt, WMAHSN

We measure outcomes including increases in knowledge and personal confidence in supporting others. We can also measure reduction in absenteeism and recently helped a local charity reduce absence by 25%.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wellness and prevention of illness / Education, training and future workforce
Benefit to NHS:
Increase in Confidence and Knowledge - Consultant Anaesthetists at Birmingham Children's Hospital saw a 32% increase in personal confidence of managing stress levels following our Resilience course. (Delegates are asked to rate their personal confidence, scale of 1-10 in managing stress levels and knowledge of resiliency building skills before and after the course).
Reduction in sickness absence - Stress affects the health and quality of life of staff. The benefits of tackling work-related stress are the obvious ones of more staff at work more of the time, and the reduction in sickness absence and its associated costs.
Improved Employee and Community Engagement - It also demonstrates the organisation’s commitment to its workforce and to addressing their health needs. This, in turn, affects how the organisation is perceived by both staff and the local community in terms of being a good employer.
Reduction in costs-  employees who are away from work because of stress will have to have their work covered by other staff, frequently bank or agency. Investment in stress management can reduce the need for this expenditure – one NHS trust reported a saving of £500,000 a year in agency cover costs.
Improved patient care - Chronic stress can lead to an increase in accidents and cause safety issues for staff and patients. Investment in resilience and stress management training will help reduce the risk.
NHS seen as innovators - There is a current campaign in government to make Mental Health First Aid a compulsory element of First Aid training in the workplace.
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
Mental Health costs the West Midlands region £12 billion a year & affects around 70,000 people (West Midlands Combined Authority). Poor mental health results in enormous distress for individuals, greater pressure on public services and reduced economic productivity.
Current and planned activity: 
We recently delivered our Resilience course to doctors at Birmingham Children’s Hospital. We also recently delivered a Mental Health First Aid pilot course to NHS staff in partnership with WMAHSN.
 
We appreciate that the NHS are a large employer and that budgets are continuously being squeezed as demand for services increases. That is why we would introduce a Train the Trainer programme which will allow knowledge, skills and best practice to be cascaded throughout the organisation.
 
Trainers will be selected based on their knowledge of mental health, facilitation skills and willingness to be the go-to person for any concerns.
 
We envisage that the Train the Trainer programme will include an initial mental health workshop to give delegates the opportunity to experience the course first hand, presentation skills and facilitated tasks and assessments.
 
Alongside this, Altruist’s expert trainers will also continue to deliver Resilience and Mental Health First Aid courses to selected groups.
What is the intellectual property status of your innovation?:
Altruist Enterprises are licensed providers of the Mental Health First Aid courses.
The Resilience course and its materials were produced and is owned by Altruist Enterprises UK Limited.
​Altruist Enterprises UK Ltd was incorporated in February 2013 and began trading in August 2013. 
www.altruistuk.com and altruist.community and its content is owned by Altruist Enterprises UK Ltd.
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
2
Regional Scalability:
We would introduce a Train the Trainer programme which will allow knowledge, skills and best practice to be cascaded throughout the organisation therefore aiding scalability.
Alongside this, Altruist’s expert trainers will also continue to deliver Resilience and Mental Health First Aid courses to selected groups. Altruist operate nationally and work with 10 regular contracted trainers and have access to a further bank of 35 specialist trainers.

We are currently 1 year into a 2 year training contract with Stoke on Trent City Council, delivering the Mental Health First Aid Lite course to employees. Delegates that have attended these courses have seen between a 30% - 60% increase in personal confidence of supporting others experiencing stress/mental health problems.
Measures:
All delegates that attend our training courses are required to complete an evaluation form to measure the impact that the workshop has had. Delegates are asked to rate their knowledge of resiliency building skills, personal confidence in managing stress and confidence in supporting others on a scale of 1-10 before and after the course. Percentage increases are then calculated. For this particular contract, we would look for between a 35% - 55% increase in knowledge/confidence following courses.

We will aim for a minimum of 80% good/very good feedback from delegates.
Adoption target:
Minimum of 3 x NHS Trusts enagaged
3 x 5 day train the trainer programmes to be delivered within first 12 months
24 x 3 hour courses to be delivered within the first 12 months
12 x 2 day courses to be delivered within the first 12 months
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Innovation 'Elevator Pitch':
Unique evidence-based app that teaches doctors & nurses to manage stress & avoid burnout. Designed specifically for, and with, NHS staff. The efficacy of Working Stress was proved by a Randomised Controlled Trial (RCT) with 227 NHS doctors in 2016.
Overview of Innovation:
Being a doctor or nurse can be extremely challenging and the negative effects of work-related stress are significant. They affect patient safety, sickness absence and job satisfaction. However, staff can learn to manage stress and develop resilience if they are given effective and practical support to acquire these skills.

Working Stress is a unique evidence-based App that offers this vital support, it teaches individuals to manage stress, grief and avoid burnout. Working Stress was developed specifically for NHS staff by leading psychologists in consultation with practicing doctors. Efficacy of the underlying interventions was proved by a Randomised Controlled Trial (RCT) with 227 NHS doctors in 2016:

Reduces:
  • Psychological symptoms such as anxiety, psychiatric morbidity and emotional exhaustion
  • Physical symptoms such as insomnia and changed eating habits
  • Maladaptive coping mechanisms such as alcohol and drug use
Increases:
  • Positive ways of coping with stress such as emotional support and humour
Working Stress offers clinicians 2 modules
  1. Managing Stress & Burnout – relevant to all clinical staff
  2. Dealing with Patients’ Death – for those particularly affected by the death of patients
A single 15-minute interaction with the App is effective. No other commitment is required. If Effectiveness = Adherence x Efficacy Working Stress is perfect for busy professionals and their employers.

The App works on any mobile device or PC. When offered to all clinical staff in a Trust, it can reduce the incidence of workplace stress across the organisation. Deploying Working Stress in a Trust is fast and efficient and the benefits are realised rapidly. Working Stress is a cost-effective way for the NHS to reduce workplace stress and its consequences. 

The benefits for individual clinicians are clear, the benefits for employers are potentially significant; healthy employees are more productive and provide a better and safer quality of care. Doctors who completed Working Stress in the RCT evaluated their organisation more favourably, saying that they receive the respect they deserve and that salary and work prospects are adequate.

Working Stress is an immediate intervention that teaches individuals to recognise and manage their own stress more effectively. No customisation is required and Working Stress is easy to deploy, easy-to-use, anonymous and cost-effective. It can be used during formal induction programmes for new employees and with existing staff at any time
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Work related stress accounted for 43% of all lost working days in 2014/2015 (Buckley, 2015; Beheshtifar & Nazarian, 2013). 37% of National Health Service (NHS) staff reported feeling unwell due to stress and pressure at work (The Picker Institute & National Health Service, 2015). Moreover, Goodwin et al. (2013) meta-analysis revealed a much higher percentage of health care professionals and NHS staff were suffering from a common mental disorder (psychiatric morbidity; 32%) compared with general population (19.1%).

Poor occupational health in the NHS is costly and puts patient safety at risk. For example, Boorman (2009) calculated that better staff health might be associated with up to a million extra working days a year and could save approximately £13.7 million a year to NHS as a whole. The cost of sickness absence alone has been estimated at £2.4 billion a year.

80% of NHS staff admit that their state of health has an impact on a patient’s care (Boorman, 2009). A number of systematic reviews and meta-analyses showed that occupational health is negatively linked to a patient’s care, satisfaction and safety outcomes (Boorman, 2009; Edwards, Burnard, Park, MPhil, & Edwards, 2003; Hall, Johnson, Watt, Tsipa, & O’Connor, 2016; Nahrgang, Morgeson, & Hofmann, 2011), leads to lower job satisfaction, poorer performance, work-life imbalance (Edwards et al., 2003), intention to leave an organisation and earlier retirement (Buckley, 2015; Taylor et al., 2007).

Our academic partners, Dr Caroline Kamau and Asta Medisauskaite, published Prevalence of oncologists in distress: Systematic review and meta‐analysis assessing occupational distress among oncologists. Their analyses showed that:
  • Up to 69% feel stressed at work
  • Up to 51% positive for depression
  • Up to 44% have sleep problems
  • 32% have a high level of burnout
  • 27% have psychiatric morbidity
In response to their own research Kamau & Medisauskaite designed 3 simple online interventions to help reduce levels of occupational distress and burnout. These interventions were tested with a Randomised Control Trial (RCT) Occupational Distress in Doctors: The Effect of an Induction Programme. The participating doctors (n=227) came from a range of specialities and seniority, including consultants. The Working Stress app has been built around these 3 interventions. The potential benefits are clear.
 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
The impact of occupational health for the wider NHS and its patients have been investigated and documented. The potential benefits of improving occupational health for the wider NHS are clear. It can be assumed that the WM would derive identical benefits if Working Stress were offered to NHS clinical staff in the WM.

A number of systematic reviews and meta-analyses showed that occupational health is negatively linked to a patient’s care, satisfaction and safety outcomes (Boorman, 2009; Edwards, Burnard, Park, MPhil, & Edwards, 2003; Hall, Johnson, Watt, Tsipa, & O’Connor, 2016; Nahrgang, Morgeson, & Hofmann, 2011), leads to lower job satisfaction, poorer performance, work-life imbalance (Edwards et al., 2003), intention to leave an organisation and earlier retirement (Buckley, 2015; Taylor et al., 2007).

Poor occupational health in the NHS is costly. For example, Boorman (2009) calculated that better staff health might be associated with up to a million extra working days a year and could save approximately £13.7 million a year to NHS as a whole. The cost of sickness absence alone has been estimated at £2.4 billion a year.
Current and planned activity: 
Discussions about the Working Stress app are ongoing with NHS England, NHS Innovation, NHS Employers, NHS Resolution, MIND and a growing number of individual NHS trusts.

Working Stress is being offered to the clinical, occupational health and finance leadership within targetted NHS trusts. The intention is to create ongoing commercial relationships with NHS trusts whereby Working Stress is offered to all frontline doctors and nurses in a single programme to address immediate issues. Working Stress would then be added to formal inductions for all new staff members and also for existing staff who are facing a significant change their professional personal circumstances. Long-term sustained cultural change is the objective. 

NHS Practitioner Health Programme has confirmed a formal partnership and is working with Focus Games Ltd to develop a face-to-face group intervention to complement the Working Stress app. This is a board game.
What is the intellectual property status of your innovation?:
Intellectual property is wholly owned by Focus Games Ltd, the developers of Working Stress.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Regional Scalability:
The app is very scalable. It can be easily deployed anywhere in the world.
Measures:
For individual clinicians the proven benefits of using Working Stress are:

Reduce:
  • Psychological symptoms; anxiety, psychiatric morbidity and emotional exhaustion
  • Physical symptoms; insomnia and changed eating habits
  • Negative coping mechanisms; alcohol and drug use
  • Root causes of Chronic Embitterment
Increase:
  • Positive coping mechanisms; emotional support and humour
  • Improved perception of employer and working conditions
The benefits for NHS employers, and wider society, are reasonably well-documented regarding reduced staff absenteeism, staff turnover and patient safety risks.
 
Adoption target:
Ideally all employers will recognise the benefits but this will take time. In year 1 we would aim to have 4 medium sized West Midlands Trusts contracted.
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Innovation 'Elevator Pitch':
Evidence-based intervention enabling clinical staff to manage stress and avoid negative effects. Unique 'serious' tool developed for healthcare professionals with ‘gold standard’ RCT trial evidence with 227 NHS doctors to prove efficacy. 
Overview of Innovation:
Clinical practice is stressful, and the negative effects of stress can be harmful and expensive. Working Stress is an evidence-based intervention that enables clinical staff to cope with stress and avoid its negative effects. It is the only occupational health tool developed specifically for healthcare professionals with ‘gold standard’ evidence to prove that it is effective within the NHS. 

It develops valuable lifelong personal skills that have a positive effect on patient safety, sickness absence, staff turnover and organisational culture.

Evidence and effectiveness
The Working Stress is based on widely recognised academic research and cognitive frameworks. It helps users to view stress more constructively and cope with it more effectively. A randomised controlled trial (RCT) with 227 NHS doctors tested the effectiveness of Working Stress. In the trial Working Stress reduced the number of doctors suffering:
  • Severe anxiety by 33%
  • High burnout by 9.5%
  • Severe insomnia by 60% 
  • Hazardous drinking by 50%
It reduced fatigue and improved doctors’ perceptions of their employer and working conditions. It also increased use of coping strategies, such as humour, seeking emotional support and self-reflective practice.

Is it another mindfulness app?
No. Working Stress is not a mindfulness, meditation or yoga app. It is based on widely recognised academic research and frameworks. The Working Stress app contains 3 modules:
  1. Understanding Stress & Burnout
  2. Managing Stress & Burnout
  3. Dealing with Patients’ Death
It targets an individual’s cognitive appraisal of stressors and improves their ability to cope with them. It provides information about stress, grief and burnout and explores their psychological and physical effects. It then presents a range of evidence-based coping strategies that clinicians can apply immediately. Quizzes and self-reflection reinforce and consolidate learning.
 
It is an HTML5 web app that works on any mobile device or PC. When offered to all clinical staff in an organisation, it can reduce the incidence of workplace stress across the organisation. Deploying Working Stress is fast and efficient and the benefits are realised rapidly. Working Stress is a cost-effective way for the NHS to reduce workplace stress and its consequences. 

The benefits for individual clinicians are clear, the benefits for employers and local health economies are potentially significant; healthy employees are more productive and provide a better and safer quality of care. 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Education, training and future workforce / Digital health / Innovation and adoption
Benefit to NHS:
Work related stress accounted for 43% of all lost working days in 2014/2015 (Buckley, 2015; Beheshtifar & Nazarian, 2013). 37% of National Health Service (NHS) staff reported feeling unwell due to stress and pressure at work (The Picker Institute & National Health Service, 2015). Moreover, Goodwin et al. (2013) meta-analysis revealed a much higher percentage of health care professionals and NHS staff were suffering from a common mental disorder (psychiatric morbidity; 32%) compared with general population (19.1%).

Poor occupational health in the NHS is costly and puts patient safety at risk. For example, Boorman (2009) calculated that better staff health might be associated with up to a million extra working days a year and could save approximately £13.7 million a year to NHS as a whole. The cost of sickness absence alone has been estimated at £2.4 billion a year.

80% of NHS staff admit that their state of health has an impact on a patient’s care (Boorman, 2009). A number of systematic reviews and meta-analyses showed that occupational health is negatively linked to a patient’s care, satisfaction and safety outcomes (Boorman, 2009; Edwards, Burnard, Park, MPhil, & Edwards, 2003; Hall, Johnson, Watt, Tsipa, & O’Connor, 2016; Nahrgang, Morgeson, & Hofmann, 2011), leads to lower job satisfaction, poorer performance, work-life imbalance (Edwards et al., 2003), intention to leave an organisation and earlier retirement (Buckley, 2015; Taylor et al., 2007).

Our academic partners, Dr Caroline Kamau and Asta Medisauskaite, published Prevalence of oncologists in distress: Systematic review and meta‐analysis assessing occupational distress among oncologists. Their analyses showed that:
  • Up to 69% feel stressed at work
  • Up to 51% positive for depression
  • Up to 44% have sleep problems
  • 32% have a high level of burnout
  • 27% have psychiatric morbidity
In response to their own research Kamau & Medisauskaite designed 3 simple online interventions to help reduce levels of occupational distress and burnout. These interventions were tested with a Randomised Control Trial (RCT) Occupational Distress in Doctors: The Effect of an Induction Programme. The participating doctors (n=227) came from a range of specialities and seniority, including consultants. The Working Stress app has been built around these 3 interventions. The potential benefits are clear.
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
The impact of occupational health for the wider NHS and its patients have been investigated and documented. The potential benefits of improving occupational health for the wider NHS are clear. It can be assumed that the WM would derive identical benefits if Working Stress were offered to NHS clinical staff in the WM.

A number of systematic reviews and meta-analyses showed that occupational health is negatively linked to a patient’s care, satisfaction and safety outcomes (Boorman, 2009; Edwards, Burnard, Park, MPhil, & Edwards, 2003; Hall, Johnson, Watt, Tsipa, & O’Connor, 2016; Nahrgang, Morgeson, & Hofmann, 2011), leads to lower job satisfaction, poorer performance, work-life imbalance (Edwards et al., 2003), intention to leave an organisation and earlier retirement (Buckley, 2015; Taylor et al., 2007).

Poor occupational health in the NHS is costly. For example, Boorman (2009) calculated that better staff health might be associated with up to a million extra working days a year and could save approximately £13.7 million a year to NHS as a whole. The cost of sickness absence alone has been estimated at £2.4 billion a year.
Current and planned activity: 
Discussions about the Working Stress app are ongoing with NHS England, NHS Innovation, NHS Employers, NHS Resolution, MIND and a growing number of individual NHS trusts.

Working Stress is being offered to the clinical, occupational health and finance leadership within targeted NHS trusts. The intention is to create ongoing commercial relationships with NHS trusts whereby Working Stress is offered to all frontline doctors and nurses in a single programme to address immediate issues. Working Stress would then be added to formal inductions for all new staff members and also for existing staff who are facing a significant change their professional personal circumstances. Long-term sustained cultural change is the objective.

NHS Practitioner Health Programme has confirmed a formal partnership and is working with Focus Games Ltd to develop a face-to-face group intervention to complement the Working Stress app. This is a board game.
What is the intellectual property status of your innovation?:
Intellectual property is wholly owned by Focus Games Ltd, Dr Caroline Kamau and Asta Medisauskaite.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Regional Scalability:
The app is very easy for an NHS organisation to deploy. The process for offering Working Stress to all clinical staff is simple:
  1. Purchase an access package based on the number of clinicians in your organisation
  2. Focus Games Ltd customises Working Stress with your trust logo and welcome messages
  3. We load your ‘edition’ of the app onto our secure server
  4. You invite clinical staff to use the Working Stress app via a secure website where they create individual user accounts
  5. Staff complete Working Stress whenever is convenient. It only takes 15-30 minutes of their valuable time
  6. Users can give anonymous feedback about their experience which we share with clients
  7. We also give you regular reports about the number of registrations and completions.
The app is also available to individual clinicians at a cost of £15 (inc VAT).
Measures:
'Although the overall cost of sickness absence is estimated at £2.4bn even small reductions in sickness absence can have a large impact across the NHS. If we reduced sickness absence by 1 day per person per year then the NHS would save around £150m, equivalent to around 6,000 full time staff. These financial savings do not even take into account the reduced use of agency staff or the costs of recruitment to tackle staff retention issues and so are most likely to understate the overall impact on NHS finances.' (NHS England NHS staff health & wellbeing: CQUIN Supplementary guidance, 2016)

The benefits to the wider NHS, and to individual Trusts, of a healthier workforce are clear:

 
  • improved patient safety and experience
  • improved staff retention and experience
  • reinforced public health promotion and prevention initiatives
  • reduced costs of sickness absence and staff turnover to the NHS

National CQUIN 1a
In addition to the savings resulting from reducing the negative effects of work-related stress NHS trusts also have a direct financial incentive to improve the health and wellbeing of staff via the National CQUIN 1a (Improvement of health and wellbeing of NHS staff). The NHS Staff Survey is used as the measure of a trust's success that triggers staged payments. CQUIN 1a represents a small but significant additional income for NHS trusts.

How, or if, trusts will measure this is not yet known to us. We are including a questionnaire for users to complete when they have completed Working Stress and this will provide limited qualitative feedback. We are not including more formal pre and post intervention questionnaires because they would make the intervention unwieldy for users. Working Stress already has reliable and credible evidence from a 2017 Randomised Controlled Trial with 227 NHS doctors that proves it is effective with NHS clinical staff.
Adoption target:
There are 28 NHS trusts in the WM employing 68,500 professionally qualified clinical staff (HEE March 2017). 

10% adoption in WM NHS generates £68,500 of nett revenue.

A 10% adoption rate in the WM is achievable and viable. Working Stress is being promoted to all NHS trusts in the UK and overseas. 
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