In December 2019, a previously unknown acute viral respiratory disease was identified in Wuhan, China. This disease, caused by a novel coronavirus (SARS-CoV-2) and now known as COVID-19, quickly began to spread across the world. On January 29 2020 the first two patients were diagnosed and quarantined in the UK (British Foreign Policy Group (BFPG), 2020). At the time of publication (mid-June 2021), UK COVID-19-related death rates sit at 127 926 from 4 589 814 known cases. Worldwide COVID-19-related deaths number 3 834 951 people, from 177 120 609 known global cases (John Hopkins University, 2021).
This emerging international healthcare crisis required the NHS to maximise its frontline workforce fast, allowing very little time for detailed planning due to the speed at which the pandemic was proliferating (Majersik and Reddy, 2020). The National Institute for Health Research (NIHR) responded to the COVID-19 crisis in March 2020. Those NIHR-funded clinical and academic health professionals, who were not already working on COVID-19-focused studies, were released to be redeployed as required within the NHS national pandemic response (NIHR 2020). Staff were thus redeployed to assist with the COVID-19 efforts, in both acute-care COVID-19 environments and COVID-19-focused clinical trials, with the remaining staff left to maintain pre-pandemic non-COVID-19 research. The exact number of NIHR-funded health professionals who were redeployed nationally is not currently available in the public domain; however, the reduction in staffing in existing research teams resulted in a much reduced capacity for non-COVID-19 research (NIHR, 2020). Consequently, research staff had to adapt quickly to new workloads and modified ways of working.
The COVID-19 crisis has necessitated many healthcare staff to be redeployed outside of their areas of expertise (Tavabie et al, 2020). The change to an unfamiliar working environment with new colleagues, and a resultant reduction in collegial communication, has been shown to increase work-related psychological stress and have significant effects on mental health and wellbeing (Maunder et al, 2008). Feelings of stress, anxiety, uncertainty, insecurity, and fears regarding practical issues such as shift patterns, competence, location of the redeployment and length of redeployment all factor highly (Ferres et al, 2005; Woodford et al, 2020; Rimmer, 2020). These feelings can manifest in reduced trust and negative attitudes towards the employer (Ferres et al, 2005). Additionally, staff members can present with worries regarding the potential negative attitude of co-workers surrounding team contribution during redeployment. For those staff members, there is the anxiety of letting both teams down when moving to a different role (Matthewson et al, 2020). Similar feelings of guilt are displayed by staff members who were not redeployed, thus not directly contributing to a COVID-19 team (Maben and Bridges, 2020). These negative feelings within the workplace can have a detrimental effect on staff retention, motivation and job satisfaction (Duffield et al, 2011; Rangachari and Woods, 2020). Likewise, the rapid reorganisation of job roles may lead to job dissatisfaction through the potential underutilisation of staff and limited individual consideration of staff skills (Shevchuk et al, 2019; Hughes et al, 2020; Willan et al, 2020), which was already an area for concern prior to COVID-19 (Boxall et al, 2019).
Previous pandemics have demonstrated that healthcare staff are one of the most vulnerable groups of professionals to develop psychological stress and associated mental health symptoms during outbreaks (Babore et al, 2020). The 2002-2003 severe acute respiratory syndrome (SARS) pandemic in Canada and Asia resulted in increased levels of trauma-related stress, occupational burnout and emotional distress in healthcare workers (Ruiz and Gibson, 2020). Similarly, a study conducted during the 2009 H1N1 influenza pandemic in Australia showed extreme stress and increased workload as contributing factors for absenteeism in the workforce (Considine et al, 2011). Maunder et al (2008) demonstrated that, during a pandemic, reinforcing skills such as resilience, coping strategies and mental health first aid through training helps staff to adapt to the requirements of a pandemic and promotes the ability to work outside their usual area of familiarity. As such, pre-redeployment training and coaching on coping strategies prepares staff for challenges associated with their new role and reduces mental health risks (Greenberg et al, 2020; Woodford et al, 2020). Understanding the implications of redeployment is crucial if the NHS is to maintain the quality of care in healthcare environments, and the motivation and health of the professionals staffing these areas during the pandemic.
Adams and Walls (2020) found that ‘transparent and thoughtful communication could contribute to trust and a sense of control’. Regular, clear, considered and supportive communication from an organisation and line managers is shown to help staff stay focused and assured in their roles, helping to minimise psychological risk, and promoting the health and wellbeing of workers (Newnam and Goode, 2019; Adams and Walls, 2020; Greenberg et al, 2020; Woodford et al, 2020). Communication practices in an organisation have a significant impact on the quality of relationships in the workplace (Newnam and Goode, 2019). Improving workplace communication skills contributes to increased levels of professional contentment, improved working relationships and reduced occupational stress (Lapeña-Moñux et al, 2015). Conversely, poor communication in the workplace is shown to contribute strongly to conflict between staff, reduced emotional engagement in work, lowered productivity, decreased job satisfaction and poor staff retention (Duddle and Boughton, 2009).
This audit aimed to investigate and analyse the experiences of research staff redeployed during the COVID-19 pandemic and the associated perceived negative psychological outcomes. It is hoped that by investigating this topic, areas of concern will be identified to help improve experiences of redeployment in the future and ensure staff wellbeing.
Method
In total, 379 clinical research staff from one NHS Trust were invited to participate; 43 questionnaire responses were received, giving an 11% response rate.
The audit questionnaire was developed by the authors following consultations with colleagues. It was not validated. This method was chosen as the data collection tool for several reasons:
- Ease of use
- The ability for responses to remain anonymous, thus reducing the potential for response bias
- Low time and resource costs
- Ability to participate remotely, therefore maintaining social distancing.
All audit questionnaires were identical and consisted of the following parts:
- Demographics: job title, length of time in current post and whether or not the participant was redeployed
- A closed-ended question for those who were not redeployed, and an open-ended question to allow this demographic to document how they felt they contributed during COVID-19
- A section for those who were redeployed, containing multiple closed-ended questions to gain specific answers on a variety of topics, including areas these staff were redeployed to, negative psychological outcomes, communication and skill utilisation. Two open-ended questions were implemented to allow respondents the opportunity to document how the redeployment process could be improved and the main contributor to negative psychological outcomes as a result of redeployment (if applicable).
The audit questionnaire was distributed to staff via email. Two options were given for returning the questionnaires to the audit coordinators: via email (quickest, but not completely anonymous if sent from a named email address), or via internal post (fully anonymous). Each questionnaire received was allocated a consecutive number for anonymity, no personal details were recorded on the printed questionnaires or database. This was done to minimise bias and give greater assurances to the participants that responses could be honest without adverse consequences.
A thematic analysis was employed to analyse responses from open-ended questions. Specific categories were identified and these were disseminated into overarching themes and subthemes. Each response was allocated into one of the themes/subthemes. Where multiple themes were very similar, they were merged into one. If participants discussed more than one point in their response, coders chose the information that was stated most frequently. Cohen's kappa coefficient (κ) was employed to consider inter-rater reliability with agreement levels based on the Altman (1991) classifications. As such, two markers (FG/KW) independently coded all the responses, thus reducing bias.
Results
Redeployment statistics
In total, 43 employees responded to the questionnaire. Of the 43 respondents, 46% were redeployed (n=20) and 53% remained in their pre-COVID-19 research teams (n=23).
Research nurses (n=7) had the highest redeployment rate (16.3%) followed by data managers (n=3, 7%) and clinical trial associates (n=3, 7%) (Figure 1). The redeployment rate was highest for those who had been in post for 0-5 years (n=13, 30%). This was followed by staff who had been in post for 6-11 years (n=5; 11.6%) (Figure 2). Responses to the audit were highest among research nurses and staff who had been in post for 0-5 years, which reflects the target population.
Figure 1. Numbers of staff members redeployed in each job role 
Figure 2. Numbers of staff who were redeployed, depending on length of time in role
Predominantly, staff were redeployed from a non-clinical role to another non-clinical role (n=9; 45%). Of the staff who responded, no one was redeployed from a non-clinical to a clinical role, but 15% (n=3) moved from clinical to non-clinical. Most staff who responded remained in a research-related role when they were redeployed (n=13 to research, n=6 to different directorates and n=1 to both; 68%). Fifty per cent of the redeployed staff who had returned to their pre-COVID-19 role said they would volunteer to go back.
Staff who were not redeployed
Twenty-three staff who responded were not redeployed. Sixteen (70%) who were not redeployed felt they contributed towards COVID-19 efforts. A thematic analysis considering how these staff members felt they contributed in the pandemic identified four main themes, as follows:
- Staff continued in current role
- Helped other departments and staff
- Could help if they were required
- Contributed outside of work.
‘Staff continuing in their current role’ was split into two subthemes:
- Adapting their role
- The need to continue with their current tasks (Table 1).
Table 1. Staff who were not redeployed: themes and subthemes on how they felt they contributed to the workplace during COVID-19
| Theme (number of staff*) | Subtheme (number of staff*) | Description | ||
|---|---|---|---|---|
| Continued in current role | n=10 | Adapting their role | n=6 | Staff adapted their roles by working from home, taking on more tasks as other staff were redeployed, changing their usual tasks to suit new areas of interest, becoming more clinically based and by managing a larger workload |
| The need to continue with their current tasks | n=4 | Staff remained in their current role completing their normal tasks to ensure the safety of patients and colleagues. These staff members were required to continue with their pre-COVID-19 research | ||
| Helped other departments and staff | n=4 | Staff assisted other departments and colleagues when there was a heavy workload due to COVID-19 | ||
| Could help if they were required | n=1 | Staff felt they contributed because, although they were not redeployed, they could have been had it been necessary | ||
| Contributed outside of work | n=1 | Staff members helped by taking part in COVID-19 research outside of work | ||
Most staff felt they contributed to COVID-19 by continuing in their current role. Inter-rater reliability of this thematic analysis showed a 67% agreement in themes of staff contribution between the two markers, which is a good level of agreement, κ=0.673 (95% CI, 0.3–1.0), P=<0.001.
Redeployment contribution
All the redeployed staff felt they contributed to the COVID-19 efforts. Of the redeployed staff, 55% felt that redeployment adversely affected their regular team causing a proportion of the staff to feel stress or guilt (Figure 3).
Figure 3. Percentage of staff who felt guilt, stress, both or neither, about their redeployment adversely affecting their pre-COVID team (n=11; 55% of the redeployed group of 20)
Negative psychological outcomes in redeployed staff
Eleven redeployed staff (55%) had perceived negative psychological outcomes as a result of redeployment. A thematic analysis considered the main issues that contributed to staff 's negative psychological outcomes; five themes emerged:
- Larger workload
- Lack of communication
- Date of returning to pre-COVID-19 job
- Boredom
- Negative comments on return to pre-COVID-19 team.
An additional three subthemes were identified within the lack of communication group:
- Trust and under-appreciation
- Issues with management and leadership
- General communication (Table 2).
Table 2. Themes and subthemes: what led to redeployed staff's negative psychological outcomes as a consequence of redeployment? (n=11)
| Theme (number of staff) | Subtheme (number of staff) | Description | Examples | ||
|---|---|---|---|---|---|
| Larger workload | n=1 | Managing a larger workload than usual and under time constraints led to stress | ‘Particularly given the urgency of work required’ | ||
| Lack of communication | n=7 | Lack of trust and under-appreciation | n=1 | A lack of communication led to perceived under-appreciation of starting a new job out of the staff's comfort zone. Additionally, there was a perceived lack of trust to complete the new tasks | ‘Didn't seem trusted to do simple tasks’ |
| Issues with management and leadership | n=5 | A lack of communication from staff in a management grade role regarding the logistics of redeployment, the decision to redeploy staff, an explanation and expectations of their new role and a lack of clarity. Insufficient support from leadership | ‘Difficulty asking for support’‘Management—lack of communication’‘Lack of leadership and support’ | ||
| General communication | n=1 | Overall lack of communication, particularly not communicating the changing guidelines well | ‘Difficult to keep up with changes if they are not communicated effectively’ | ||
| Date of returning to pre-COVID-19 job | n=1 | No confirmed date to return to normal job | |||
| Boredom | n=1 | Boredom due to underutilisation of the staff | |||
| Negative comments on return to pre-COVID-19 role | n=1 | Guilt for leaving the original team and negative comments towards staff who were moved to the COVID-19 team | ‘Upset and stress caused by comments’ | ||
Inter-rater reliability of this analysis showed a very good agreement between the two markers, κ=0.823 (95% CI, 0.5-1.2), P=<0.001.
The most common issue that the 11 staff felt contributed to their negative psychological outcomes was communication (n=7, 64%).
Although a small number of redeployed staff indicated boredom due to underutilisation as the main issue leading to negative psychological outcomes, 25% (n=5) stated that they did not feel as though their skills and talents had been utilised during redeployment.
Sixty-four per cent (n=7) of the staff who indicated that they had experienced negative psychological outcomes had been in their job role for 0-5 years (Figure 4). Within this demographic, more than half experienced perceived negative psychological outcomes. Less than half of staff who had been in their post for 6-11 years experienced negative psychological outcomes, equating to 27% (n=3) of that group.
Figure 4. Percentages of staff, dependent on time in post, who experienced a negative psychological outcome during redeployment (n=11)
Communication
Sixteen staff (80%) felt communication surrounding redeployment was not good. Of the 20% (n=4) who said that communication was good, 75% (n=3) were in a management grade role. Additionally, 75% of people who said communication was good, nonetheless described communication as one aspect of redeployment that could have been improved.
Improvement
A thematic analysis to consider what aspect of redeployment staff felt could be improved showed the following six themes:
- Clearer communication
- More notice
- More resources
- Support
- Staff rotation
- Overstaffing and time wasted due to not being needed.
Clearer communication fell into four subthemes:
- Communication within the team or from leadership
- Communication regarding logistics, roles or workload
- General communication
- Communication about redeployment criteria (Table 3).
Table 3. Themes and subthemes: one aspect of redeployment that redeployed staff felt could have been improved (n=20)
| Theme (number of staff) | Subtheme (number of staff) | Description | Examples | ||
|---|---|---|---|---|---|
| Clearer communication | n=13 | Within the team/from leadership | n=4 | Lack of decision-making, vague information and lack of communication from staff in a management grade role. Information not disseminated to the team. Too many people giving information and not communicating within themselves | Lower ‘stress levels if communication from managers was established from the beginning’‘Never sure exactly what was going on’‘The senior team needed to make a final decision’ |
| Regarding logistics/roles/workload | n=5 | Clearer communication of workload, when staff would return to their normal teams, what the role would entail, expectations of the role, any new training required, changes in work times and locations | ‘A better idea of how long I would be redeployed’‘Describe [staff's] roles’‘Some pre-redeployment information’ | ||
| General | n=3 | Communication in general, particularly regarding government guidelines | |||
| Redeployment criteria | n=1 | Understanding why they were chosen to be redeployed | |||
| More notice | n=1 | More notice before being redeployed | |||
| More resources | n=1 | More resources allocated to previous team as staff were redeployed | ‘Staff there would again be overloaded’ | ||
| Support | n=2 | More support during redeployment and when leaving the teams—staff want to feel valued | ‘I felt undervalued’ | ||
| Staff rotation | n=1 | A rotation of staff between the ‘COVID-19’ and ‘non-COVID-19’ teams | ‘There is/has been some bad feelings towards deployed staff’‘Creating an idea of a COVID-19 and non-COVID-19 team created a “them” and “us”’‘Would have been better to have rotated staff or to have shared the load better’ | ||
| Overstaffing and time wasted | n=2 | Unnecessary training and time wasting as staff were not doing what they were originally expected to do. Overstaffing. Little to do due to being past the COVID-19 peak | ‘A lot of time seems to have been wasted’‘Overestimated staffing requirements’‘Frontline staff knew the urgent staff shortage “was no longer the case but were not being listened to”’ | ||
Inter-rater reliability of this analysis showed a very good agreement in themes between the two markers, κ=0.904 (95% CI, 0.09–1.09), P=<0.001.
More than half of redeployed staff (n=13; 65%) indicated that communication was an aspect of redeployment that could be improved.
Discussion
This audit considered the effects of redeployment on clinical research staff during the first wave of the COVID-19 pandemic. There is currently limited information on redeployment from the staff 's perspective. This audit is important in filling this gap in the literature and therefore adding to more holistic recommendations on the redeployment process before potential redeployment of staff in the future.
Many staff felt that communication was one aspect of redeployment that could have been improved and, in line with findings in previous literature, was the main contributor to perceived negative psychological outcomes as a result of redeployment (Duddle and Boughton, 2009). Communication issues surrounding management was the most frequently reported cause for negative psychological outcomes. Interestingly, support from management is a protective factor for mental health (Greenberg et al, 2020) and has been found to relieve symptoms of emotional exhaustion in situations of increased work intensity (Huo et al, 2019). Although these negative psychological outcomes could have been the consequence of the pandemic itself rather than redeployment (Labrague and Santos, 2020), the current audit's results were based on the question issued to participants: whether staff experienced perceived negative psychological outcomes as a result of redeployment. Delving into the underpinnings and additional risk factors for staff 's mental health was beyond the scope of this audit. However, considering the current vulnerability of NHS staff to work stress and the strain on their mental wellbeing (Babore et al, 2020), it is of the utmost importance to consider how to improve communication from management and within teams.
Results demonstrated that support from managers was perceived to be limited despite its necessity in the present climate (Carnevale et al, 2020). Staff reported that the main aspect of redeployment that could have been improved was communication regarding the logistics, roles and workloads of their new position. Veshne (2017) outlined the importance of managerial information dissemination and explanation of decision-making, particularly when employees are directly affected by the result. Thus, communicating this information may have prevented the reported negative psychological outcomes and, in turn, reduced any potential uncertainty and feelings of being under-appreciated among staff (Bordia et al, 2004). However, the challenging healthcare situation at the time of these redeployments must be considered. The unprecedented nature of the COVID-19 healthcare crisis, and the speed at which it developed in early 2020, had a direct impact on healthcare managers' ability to plan and disseminate information (Willan et al, 2020). The NHS was in unfamiliar territory. Time restraints, staffing shortages in specialist areas, and the fast-changing situation could all impact managers' and leaders' ability to co-ordinate communications to staff in a timely manner (Habib and Zinn, 2020). These extenuating circumstances put pressure on all grades of healthcare staff, in all roles. Further audits looking at the challenges and difficulties NHS managers encountered with staffing management and dissemination of information would be beneficial for a well-rounded understanding of the challenges encountered.
Regardless of negative impacts discussed, all redeployed staff felt they contributed to their COVID-19 team; more than 50% of non-redeployed staff felt they contributed to the COVID-19 efforts and half of staff said they would go back to their redeployed role. However, as suggested by one participant, there may be a potential divide between staff who were redeployed and those who remained in their pre-COVID-19 roles. A large proportion of staff felt that redeployment adversely affected their pre-COVID-19 team. This led to some staff members feeling guilt and stress regarding redeployment, which is supported by previous research (Matthewson et al, 2020). Potentially, staff who remained in their usual role might have resented those who were redeployed because it led to an increased workload. This could mean that those who were redeployed felt guilt at being absent from their usual team. These themes were also explored by Hesselius et al (2009). Reducing the stress and pressure felt by colleagues who remained in their pre-COVID-19 role may lead to a decreased belief that redeployment was adversely affecting the team (Dawson et al, 2016). Although considering the effects of redeployment on non-redeployed staff was out of the scope of this audit, it is important for future research to explore this demographic.
Limitations
This audit, however, is not without limitations, all of which must be considered when interpreting the findings. Our cohort was relatively small in size, and the response rate was lower than expected at 11.35%. This could be due to a number of factors. The questionnaire was sent out to research staff in the short time between the first and second waves of the COVID-19 pandemic in the UK (summer 2020) and staff were given a 2-week time limit in which to return their completed questionnaires. This time limit, together with the time of year, when many staff would have been on annual leave, may have contributed to the limited response rate. Despite our attempts to minimise response bias, some staff may have been nervous to respond due to fear of adverse consequences as a result of their responses (Kish-Gephart et al, 2009). Consequently, some findings of the thematic analysis should be interpreted with caution. However some responses, such as the suggestion that negative comments as staff returned to their pre-COVID-19 role affecting negative psychological outcomes, do warrant further investigation. It would therefore be beneficial to repeat this audit after the second wave of the COVID-19 pandemic. Inviting staff from multiple clinical directorates, allowing a larger time frame for returning responses and implementing a more robust method of returning completed questionnaires would all improve the reliability of the results.
Conclusion
This audit demonstrated the effects of redeployment during a high-stress situation, the first wave of the COVID-19 pandemic. It suggests that communication is a key variable; one which has the potential to prompt negative psychological outcomes, particularly when managerial communication is perceived to be lacking. Interestingly, it has been suggested that transitioning back to a non-COVID-19 role caused additional anxiety due to feelings of guilt. This would be worth examining further, including more input from non-redeployed staff, so that future potential redeployments can be streamlined to minimise negative feelings within existing teams.
KEY POINTS
- Effects of COVID-19 on the redeployed healthcare workforce are similar to those seen during previous pandemics
- Most respondents felt that communication was one aspect of redeployment that could have been improved, and was the main contributor to perceived negative psychological outcomes as a result of redeployment
- Transitioning back to a non-COVID-19 role post redeployment was found to cause additional anxiety due to feelings of guilt and negative comments from team members who remained in pre-COVID-19 roles
- Further investigation is warranted, including more input from non-redeployed staff, to determine the effects on the non-redeployed workforce and investigate further potential negative reactions to those who were redeployed
CPD reflective questions
- Thinking back to your experiences during the first wave of the COVID-19 pandemic, would you consider your experiences to be similar to those of the staff who responded to this audit?
- How do you think communication affects your team during high-stress periods? How could it be improved?
- What changes do you think would improve the transitional periods into and out of a redeployment?