Resuming Face-to-Face Groups Post-Covid
Throughout August and September we are holding a number of Resuming Face-to-Face workshops please find below the top tips and good practice discussed and shared throughout these - please keep popping back for updates as more workshops are ran. If you have anything you would like to add to this - a top tip, a document you have prepared etc - then please send these over to alison.northern@uhl-tr.nhs.uk
Please make sure to read the Guidance we already shared on Socially Distanced Groups
As this ‘new world’ unfolds, and with the restrictions still faced within the healthcare setting, there are still many unanswered questions so we are all learning how to make this work together.
Speak with your Infection Prevention/Quality teams as early as possible - they will be expecting new risk assessments to be carried out on venues you wish to use, so the sooner you can start working on these the better - Here is an example from Greater Manchester team
Every area/Trust/commissioner is different in their expectations around resuming face-to-face with some areas not entertaining the idea until 2022 at the earliest
So much of the change is about doing everything possible to eliminate people touching surfaces and coming into close contact with you or each other
Educator top tip
Participants don’t know any different so don’t worry if it feels different to how it did before, they never experienced it so they don’t know how it was!
When your groups do resume please be aware that social distancing and face covering will still be required in England - you can find out more here particularly in 4.4.2 Other areas may have different regulations
Face coverings - Where masks are mandatory in healthcare settings the above link/guidance can be shown as justification for anyone questioning this. From those that have delivered face-to-face groups already, they reported that making the group feel as relaxed as possible upfront helped to relieve any tension and after a while became the norm. Make sure this is mentioned during any booking calls or emails, as well as in confirmation letters
Educator Top Tip
Consider investing in see-through masks or visors so participants can see you expressions
Venues - many people are reporting that rooms they used previously aren’t big enough to accommodate large groups especially when adding social distancing into this. Recommendations for larger rooms have been:
churches,
sport / leisure centres
Community halls
Look for rooms that have direct access/door, have their own toilets
Others have found moving everything else from the room except the required chairs and table helps to reduce the risk of touching or things being moved breaking distancing guidance
Consider implementing a one-way system to reduce changes of close contact
It is fine balance as a venue that can only hold small numbers means cannot offer many groups/places which will also have an impact on the waiting list, but it does mean you can begin delivering and build confidence whilst larger more suitable venues are sourced. Be aware you may need to scope our new venues which can take time.
Consider ventilation - a key part of the governance guidance is to maintain good ventilation
Group size - Depending on the room available will depend on the size of the group you can run - our recommendation as always is a minimum of 5 participants for group dynamics, but we are conscious that this might not always be possible (for example management have stated a maximum number of people that can be together), therefore we ask you to exercise caution as group dynamics may be lost. We wouldn’t be able to QD any groups smaller than 5. Many teams are reporting that they only have rooms with max 6 at any time so can only allow for 4 participants and 2 Educators.
Accompanying person - This would mainly be dictated by the size of the room available and also the size of waiting list; it is recommended that participants are given the choice to bring someone but ultimately the decision lies with each team and the restrictions that are in place.
Cleaning/sanitising - you will need to follow your employees guidance on this. It is felt that this could add time so think about how you can clean as you go through the session but also who you may need to speak with to allow you more time for this. One suggestion is to have sanitiser wipes available and ask participants to wipe anything they touch including their chair at the end of the session. Clinell are the recommended brand for wipes.
Participant materials - much like with virtuals some Trusts have reduced the use of sharing documentation and opting for sending electronically where possible. Therefore you may need to seek clarity as to if it is acceptable to give out and if so how. Also ask them to bring their own pen along! Some teams get packs set up with name on and put on table separately for participants to pick up, others place on chair in advance of arrivals. Some have even sent out to them in advance and said please bring to group
Refreshments - its been tradition that tea and coffee are provided at breaktimes however you may need to think about how this can be offered safely
Bringing own reusable cups
Bring own flask and water
Additionally, a number of teams are not providing any and opting for participants to bring their own.
Waiting lists/Backlogs - Many teams are reporting large waiting lists. Try to perform a cleaning exercise of this by sending opt-in letters to all on the waiting list include details of what is available to them and add to this a ‘call to action’ to call/email with their chosen delivery choice (e.g. face-to-face; virtual; MyDESMOND etc) . Stating that if no response within X weeks then they will be discharged back to GP as no longer interested.
DNAs - as always DNAs do happen; some areas are reporting a stricter protocol for groups whereby if the participant does not attend they are not offered another date and are discharged, otherwise this is adding the burden on administration to rebook.
Administration and organisation is key - many people advice is to not underestimate the amount of extra admin time is now required; many teams have introduced additional telephone calls, reminders (text/email) and when calling to book the participant on a group they need to cover much more than normal inc. covid regulations, covid screening, advising of alternative options to attempt to draw them more towards a digital option if appropriate. These phones often help to alleviate anxiety as you can provide a description of how it going to work on the day. The sooner contact can be made with the person referred the better as teams find this increases attendance.
Much like most of what has happened since the beginning of the pandemic we want to remain flexible to changing needs and ideas and where possible we say ‘give it a try and see how/if it works’. Collect feedback/evaluation from attendees, continue to reflect on yours and your peer educators delivery to see what may be good to adapt in the future, there is no right or wrong - this is a learning curve for everyone! But don’t forget whatever you do you need to maintain those core educator behaviours; open questions, being non-judgemental
Pre-course arrangements - some areas are asking the following in advance of people being allowed to attend a face-to-face groups, you will need to source advice on this from your employer as each organisation may have a different stance on this:
Carry out a lateral flow test - patients can order their own from here . This seems to be advised but is based on trust and not checked
Asking to see Covid passport on the NHS app - it seems for some they will be insistent on being double vaccinated and in other areas this is seen as discriminatory therefore it is best to check with your managers/Infection Prevention to discuss this whilst carrying out your risk assessment
Checking temperature on arrival
Carry out a Covid Screening questionnaire - this can be carried out in advance and then repeated nearer the time/on the day of the course - click here to download an example from Fife
In letter advise that they will be expected to wear masks and to maintain 2 metre distancing - see notes above re face covering - plus add if become symptomatic on the day that they should not attend including who they should call
Whatever you additional requirements you put in place you really need to consider the impact on admin time - admin has always been essential to the success of embedding diabetes education but it has now become doubly important and necessary
On the day
some teams have mentioned that their Administrator also attends the beginning of the groups in order to sign the participants in, check temperatures and that they also have a waiting room (with social distancing in place) from where they can then be brought to the main room when it is set-up.
If possible, set up a one-way system through your venue
For anyone worried about ‘getting pinged’ and having to isolate the general Gov guidance is that those double vaccinated won’t have to isolate, however please be aware that your own employing organisation may have different guidance
How to maintain interactivity?/Using resources - This is going to feel different and possibly difficult to start with as many of you will be used to delivering previously. Ideas that have been shared are:
Only Educator touches resources - holds them up and patients shout out where item needs to be moved to etc - use lots of open questions to draw out key points
Have one Educator deliver the food models and the other delivers the two professional stories to reduce chances of cross contamination
Having a nominated participant stand up and handle the resources and take the lead for a specific game
Create individual sets of resources that could be given out to each participant and then cleaned down at the end
Have a table at the front, get everyone to stand in front or behind their chair (still maintaining distance)
Encourage people to join in and speak up
Limit the amount of resources you use - feel free to show examples but select just a few - e.g. in Carbohydrate activity - hold up and discuss orange v. orange juice and may be another, but then have an open discussion and highlight in the handbook where they can find more info on this
Laminates - some teams have taken some images from virtual such as the Green, Amber, Red from food continuum and blown them up and had them laminated so they can hold up/walk round room to show.
Swap sugar cubes for lego blocks or laminated cards
Don’t be scared to try things out - if it doesn’t work as well as before don’t worry as the participants attending won’t know
Educator top tip
each Educator should have their own set of flipchart pens - named and separate to reduce cross-contamination
Consider the length of the sessions you are running - the content of the curriculum can not be reduced but if you feel shorter sessions may be more beneficial at the moment to meet need then the new format of 3 x 2-hour sessions that has been introduced for virtual could be adopted for face-to-face groups. Although feedback has been that 6-hour course still works and takes approximately the same time to deliver regardless of the changes to accommodate distancing and are still enjoyed and interactive despite having to wear masks throughout (in England).
Using the virtual slides in face-to-face groups as a means to reduce risk - if you want to consider this then you would need to consider the additional equipment you need to enable this such as projector and screen. Please be cognisant that only one slide can be shown at once and therefore would affect how you can deliver some of the key messages. Please have a go and we would love to hear how it went.
You may want to consider a blended delivery i.e. some in the room and others on virtual simultaneously. Remember the Educator core behaviours; are you still using open questions? Is there consensus in the group on the key points? Has there been a meaningful discussion? Has everyone had a chance to input? Again we would be interested in seeing this in action so please get in touch if you are going to be offering a hybrid/blended style. However please be aware of the challenges that this may bring e.g. knowing who is talking, how to ensure those virtual can see resources if using hands-on resources, do those virtual still feel part of the group?, would it make the session longer?
Team meetings - An important part of what make DESMOND a success is the local teams that are passionate about delivering a superb diabetes education service to their patients. Look to get everyone together to discuss everything within this article and any other challenges/ides that come up. This will help to build up the drive and passion again, and provide a safe-space to discuss any anxieties, to try things out etc.
It was noted that some Educators have not yet had chance to look at Version 6 of the Newly Diagnosed and Foundation curriculum released in November 2019, and others as it has been so long since they delivered that they are feeling ‘rusty’. To increase confidence and the following was suggested:
Sit down with your fellow educators and revisit the main changes
Put time aside to go through the curriculum yourself
Write new cue cards
Shadow other areas that are delivering already
Work as a team of 3 Educators to build confidence
Start off with smaller number of participants and gradually build up size of the group
Academy workshop to be developed to cover a walk through of NDF version 6 - WATCH THIS SPACE AND YOUR EMAILS FOR MORE INFO!
Take a look at the guidance document in the front of the new NDF v6.0 curriculum and you will see that really there is very little that has changes.
Quality Development/Accreditation - Educators will now have the choice as to how they are accredited either when they are delivering virtually or face-to-face - there have been reports that virtual feels ‘easier’ as you forget that anyone is there as Assessors have mics and camera off after initial introduction. Please get in touch with any questions or visit this page for the latest documentation We are here to support you in getting back to delivering in which ever mode this will be and we are flexible to changing needs.
Networking and sharing ideas - we would recommend coming back to this page to see if there are any new ideas being shared. Also join the DESMOND Educator and Provider Network on Facebook. This is a closed group where you can ask questions to other Educators and share ideas.
As and when you start delivering we would love to continue to add to this article with more ideas, documents etc so please do get in touch with anything that you feel may help others.
Many thanks and don’t forget to enjoy it!