Leading wellness in healthcare: A qualitative study of leadership practices for wellness in hospital settings

PLOS ONE RESEARCH ARTICLE Leading wellness in healthcare: A qualitative study of leadership practices for wellness in hospital settings Julaine Allan ID1☯*, Katarzyna Olcon ID2☯, Ruth Everingham2,3, Mim Fox2, Padmini Pai3, Maria Mackay4, Lynne Keevers2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia, 2 School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia, 3 Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia, 4 Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia ☯ These authors contributed equally to this work. * Abstract OPEN ACCESS Citation: Allan J, Olcon K, Everingham R, Fox M, Pai P, Mackay M, et al. (2023) Leading wellness in healthcare: A qualitative study of leadership practices for wellness in hospital settings. PLoS ONE 18(7): e0285103. https://doi.org/10.1371/ journal.pone.0285103 Editor: Elizabeth McGill, LSHTM: London School of Hygiene & Tropical Medicine, UNITED KINGDOM Received: January 11, 2023 Accepted: April 14, 2023 Published: July 19, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0285103 Copyright: © 2023 Allan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Ways of dealing with workplace stress and enhancing healthcare workers wellness are sought globally. The aim of this study was to explore healthcare leaders’ practice in relation to the implementation of a workplace wellness program called SEED in the context of multiple crises (bushfires and COVID-19) affecting a local health district in New South Wales, Australia. Practice theory informed interviews (n = 23), focus groups (n = 2) and co-analysis reflexive discussions (n = 2) that were conducted with thirteen leaders and twenty healthcare workers. A pragmatic approach to program implementation for healthcare workers’ wellness explored the process and actions that resulted from leadership practice in an inductive thematic analysis. Preliminary themes were presented in the co-analysis sessions to ensure the lived experiences of the SEED program were reflected and co-interpretation of the data was included in the analysis. Three key themes were identified. 1) Leading change —implementing a wellness program required leaders to try something new and be determined to make change happen. 2) Permission for wellness—implicit and explicit permission from leaders to engage in wellness activities during worktime was required. 3) Role-modelling wellness—leaders viewed SEED as a way to demonstrate leadership in supporting and caring for healthcare workers. SEED provided a platform for leaders who participated to demonstrate their leadership practices in supporting wellness activities. Leadership practices are critical to the implementation of healthcare wellness programs. The implementation of SEED at a time of unprecedented crisis gave leaders and healthcare workers opportunities to experience something new including leadership that was courageous, responsive and authentic. The study highlighted the need for workplace wellness programs to intentionally include leaders rather than only expect them to implement them. The practices documented in this study provide guidance to others developing, implementing and researching workplace wellness programs. Data Availability Statement: The underlying data (interview and focus group transcripts) from the study cannot be shared because of requirements of the approving Human Research Ethics Committee. PLOS ONE | https://doi.org/10.1371/journal.pone.0285103 July 19, 2023 1 / 16 PLOS ONE The participant information sheets guaranteed participants confidentiality and that no identifying information would be shared. The qualitative data was collected from a small group of participants in a specific identifiable location. Transcripts are unable to be completely anonymized/deidentified to remove information about the interviewees or the people they refer to in their discussions. Data requests may be sent to the University of Wollongong & ISLHD Health and Medical Human Research Ethics Committee (no. 2021/ETH00110) by contacting the university Human Research Ethics Team on T: +61 2 4221 3773 or E: . Funding: JA, KO, PP, MF, MM and LK all received funding for this study from the Australian National Health and Medical Research Council Medical Research Future Fund - COVID-19 mental health research. Grant number APP2005659. https:// www.health.gov.au/summary-of-mrff-grantrecipients The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: PP and RE worked for the Illawarra Shoalhaven Local Health District where this research was conducted. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Leading wellness in healthcare Introduction Healthcare staff work in stressful environments. They primarily deal with people who are ill or suffering and have the responsibility of ameliorating the symptoms or disease in some way. These challenging work circumstances and high workloads can interrupt healthcare workers personal lives and work capacity with physical and mental health consequences, for example burnout [1–5]. Ways of dealing with workplace stress and enhancing healthcare workers wellness are sought globally. Workforce health in large organisations is typically the responsibility of human resources departments and addressed through health promotion campaigns that aim to change employees lifestyle risk factors outside of the workplace [6]. Most programs hope to reduce healthrelated costs and improve productivity[7,8]. Wellness programs conducted during work time are less common and few have been evaluated [9]. However, they primarily focus on an individual’s diet, exercise and stress levels [e.g.6,8,9]. In this study workplace wellness programs are conceptualised eudemonically as activities conducted at work, designed for groups or teams, aiming to enhance belonging and purpose, and develop trusting and supportive relationships with colleagues [10]. The COVID-19 pandemic has exacerbated workplace stress in health settings. Since the pandemic was declared in March 2020 by the World Health Organization [11], it has had a profound impact on the healthcare system i (...truncated)