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Winning in winter with marginal gains: enhancing welfare on the frontline

02 May 2021
Volume 13 · Issue 5


Winter pressures on the NHS challenge every one of us. Patients may experience delays waiting for emergency ambulances and face extended waiting times at hospital emergency departments (ED). During this season, GPs, hospitals, NHS organisations and staff will face increased demand for services; yet are still required to deliver on agreed performance targets with only a finite availability of resources. Add Brexit and the second wave of COVID-19 wave into the mix and it might appear difficult to make improvements in any of these areas. During the winter of 2019–2020, a large ambulance service in England introduced a ‘welfare van’ to support busy emergency ambulance crews in one of its busy urban areas. It was tasked to see if it could make a positive difference to staff welfare and uphold or improve on ambulance service performance during a period of expected increased demand.

In sport and business, education and healthcare, the concept of ‘marginal gains’ is being used to find creative ways to be better. Marginal gains is where a goal is broken down into smaller constituent elements, each improved on, with the net result being an overall enhancement of the original goal. The potential cumulative benefits of this type of thinking and action may be significant.

This has proven true for individuals, as well as for complex healthcare organisations such as a large NHS ambulance service pledged to making improvements and delivering high-quality and compassionate care (NHS, 2015a).

The marginal gains concept was to be tested on busy 999 crews attending two large urban emergency departments (ED) over a 3-month period, beginning in December 2019.

The aim was two-fold: to enhance staff welfare by providing refreshments and uphold ambulance performance in terms of the job cycle when data for previous winter periods indicate extended waiting times at hospitals (NHS, 2015b).

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