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GROUND truth framework

Recognising the need to review practice within dynamic settings and capture trends as soon as they emerge, it is important for teams to have a framework within which to share experiences and develop a shared understanding of the challenges they face. Drawing on a wide range of areas and best practice we have designed a bespoke debriefing tool.

Staff working in high-stakes and pressure roles experience elevated levels of stress, impacting their welfare and increasing their risk of mental ill health. The societal trauma experienced during the pandemic has led to rising burnout, and higher levels of anxiety, depression, and PTSD in frontline workforces. The move to increased remote working and extended periods of isolation have exasperated these challenges, with more staff working in isolation with fragmented support from their colleagues. Leaders and managers often feel disconnected from their team’s core issues when teams are deployed elsewhere and work remotely. Providing a digital mechanism for staff to connect, reflect and actively monitor stress can support insights into what is helpful, improve team cohesion and morale, whilst boosting coping within teams.

During the pandemic in the intense operational environments of the NHS, Project Ares and Alder Hey Hospital worked together to support staff welfare by deploying the Ground TRUTH tool (see Project Ares, University of Liverpool). The Ground TRUTH tool was developed by Emily Alison, Martin Ferguson, and Prof. Laurence Alison, based on the best available evidence to support staff in adaptive recovery. The tool can be deployed in stressful working environments to support staff to function well and keep going together. The Ground TRUTH tool is based on cognitive and behavioural principles supported by a coaching approach. It offers a structured prompt that supports people to reflect, improve insight and boost coping; whilst simultaneously developing situational awareness and cohesion in teams in a way that supports learning and boosts team morale. The framework focuses on the dual responsibility of individuals and their employing organisations, to actively monitor stressful situations and proactively respond with solutions that promotes resilience.


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Responsive and accessible interventions connected to staff’s work context have the highest chance of success for staff welfare. The tool provides a structured framework focused on cognitive and behavioural aspects of coping to support individuals to keep going together whilst supporting reflection and team learning. The platform also allows staff to develop a more accurate and comprehensive picture of the challenges faced by all, as normalising distress can support coping. Gained insights can also improve shared situational awareness among teams while also feeding directly up to leaders, enabling them to respond more effectively to needs and requirements on the ground. The tool also supports staff to acknowledge and monitor the psychological, emotional, and organisational fatigue that is part of working in these extreme circumstances.


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Original site created as part of Project Ares and original report available for download.

Article written up for CREST, and original overview handout available for download with details on the implementation at a local hospital during the pandemic.


Implementation and support programme at Alder Hey Children’s Hospital.

“The Ground Truth tool has been implemented by Dr Sarah Robertson as part of a range of interventions within Organisational Development at Alder Hey Children’s Hospital which are led by Dr Jo Potier and have received national awards for their impact and contribution to staff welfare"

(HSJ 2020HPMA 2021; IHF 2023)

The framework and the digital tool also formed part of the recent University Innovation Concept programme as part of the Home Office's  Accelerated Capability Environment (ACE) funding call. This resulted in a feasibility report for UK CTP, looking at piloting it with specialist units and potential expansion to individual police forces.


The work carried out at Alder Hey Hospital was also featured in UK Resilience Lessons Digest "Learning to Read Risks", as part of part of a programme of work at the Cabinet Office Emergency Planning College (EPC) to synthesise lessons learned from all major exercises and emergencies.


Finally, below you will also find a short introduction session to the tool and the overall facilitation process.

Facilitator guidance and instructions to carry out the after-action review.

If you would like additional information about the framework or the digital tool, please contact the team directly via email or using the form below.

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