Patient and public involvement and engagement
The absence of evidence-based postvention guidance for NHS staff and its importance within this context was driven by the experiences, concerns and unmet needs of doctors (two of whom, Gopfert and van Hove, were study co-applicants) impacted by the death by suicide of a doctor who was a colleague and friend.
For the purposes of the study, PPIE members constituted NHS staff with lived experience of suicide bereavement of an NHS colleague who had died by suicide. The established PPIE group, comprising six members, including doctors, nurses and paramedics, were consulted for the duration of the study. We sought their advice on, for example, suggestions for recruitment, topic guides, and the wording and content of participant-facing documents such as publicity material and the participant information leaflet. Their contributions and perspectives ensured that the study processes and participant-facing documentation were sensitive and appropriate to the needs of potential participants. Additionally, their input was sought on the implications of the study findings, the guidance, and relevant changes to policy and practice.
Stakeholder group
The role of the stakeholder group was to provide project oversight, advise on recruitment and application of the study findings, co-produce the guidance, and facilitate dissemination and implementation of the postvention guidance.
A stakeholder group comprising representatives from across the professional groups (e.g. Association of Ambulance Chief Executives and The Health and Care Professions Council), policy-makers (e.g. NHS England and NHS Employers), NHS Employers (well-being leads, Chief People Officers, HR), relevant not-for-profit organisations (e.g. CRUSE and Doctors in Distress™, UK) and academics in the field were consulted three times throughout the study and invited to the stakeholder workshop alongside a range of multilevel constituents and potential beneficiaries of the study within and beyond the NHS (see Chapter 5 for further detail on the stakeholder workshop and methods employed to co-produce the guidance).
Equality, diversity and inclusion
As we have reported in Chapter 3, despite our concerted efforts during our participant recruitment to establish connections with ethnically diverse populations of NHS workers, our sample was 98% White British. Given that Black and minority ethnic people comprise almost a quarter of the NHS workforce 118, our findings are unlikely to represent the experiences of all staff members. We did not gather demographic data with regard to sexual identity, country of origin, or disability, so we are unable to state that our findings are representative of NHS staff who identify as belonging to these cohorts.
We have also reported in Chapter 3 that most of the participants in our second grounded theory study were delivering supportive postvention. Although we proactively sought participants who were delivering less optimal support, we could not recruit these people. Thus, the paper reflects the views and experiences of those providing supportive postvention and may give the impression that NHS workers are more fully supported following the suicide of a colleague than in reality. However, in the first grounded theory study, we do report the experience of NHS staff impacted by a colleague suicide who experience notable gaps in, and barriers to, support. We believe that across both studies, we are able to present as holistic report of NHS staff experiences as was possible, given the experiences of our study participants.
As reported above (PPIE and Stakeholder Group) we were successful in recruiting and including NHS staff members, stakeholders and interested parties to contribute to this work in meaningful and impactful ways. Of particular note is the methods that we employed in the development of the published guidance (see Report Supplementary Material 1), utilising our empirical data, and participant and stakeholder input (via a co-production workshop) to inform the content, presentation and design of the final product. We were considerate of the needs of everyone who contributed to this work in any form, including our participants, transcribers, administrative support staff, stakeholders and co-authors. Given the sensitivity of the topic, we ensured that everyone knew how and where to access additional support, such as de-briefing sessions and therapist support sessions.