Shifting the Narrative: Taking a Systems-First Approach to Support Healthcare Worker Mental Health

Theoretical Background and research questions/hypothesis:

Even before COVID-19, healthcare workers faced challenging work conditions and suffered high rates of poor mental health outcomes, with 79% of physicians reporting burnout starting before the pandemic (NIOSH, 2022). To address this issue head on, the Centers for Disease Control and Prevention (CDC)’s National Institute for Occupational Safety and Health (NIOSH) conducted robust formative research to inform the development of a campaign to improve healthcare worker well-being. Key research questions included: (1) Who has been most affected by healthcare worker burnout?, (2) What communication campaigns and materials already exist on this topic?, (3) What are healthcare workers’ and hospital leaders’ unmet needs related to well-being at work?, and (4) How can hospital leaders support well-being among their healthcare workers?

Methods:

Research was intentionally split into two phases so that findings from prior activities informed the methodology of the next.

Phase 1 of research focused on defining campaign audiences, priorities, and needs. It included (1) holding collaborative briefing sessions with healthcare organizations, labor unions, researchers, and non-profit organizations, and (2) auditing existing communication campaigns and interventions that promote healthcare worker well-being. Phase 2 efforts aimed to better understand key audiences and guide message and concept development, including (3) in-depth interviews (IDIs) with healthcare workers and hospital leaders and (4) two rounds of online bulletin board (OBB) testing to ask about communication preferences, draft messages, and creative concepts.

Results:

Formative research findings underscored the gap in publicly available resources for hospital leaders and the need to develop materials that directly equip this audience with tools to support the well-being of their workforce. Further, Phase 1 findings revealed most existing campaigns focus on individual-level interventions for the healthcare worker, but Phase 2 insights emphasized the lack of and need for systems-change efforts on this issue. In IDIs and OBBs, healthcare workers and hospital leaders alike agreed there was a need to change working conditions, but leaders needed to take action to improve staff well-being at their hospital.

Conclusions:

NIOSH used research findings to define campaign audiences, communication goals/objectives, materials development, and dissemination strategies. For instance, prior to conducting formative research, NIOSH intended to launch two distinct but complementary campaigns for each priority audience. Upon completion of this research, the focus is now on a national-level campaign that equips C-suite level executives with tools and resources to make operational changes at their hospital. This approach also leverages leaders as the primary messengers to reach healthcare workers, removing the need for a national-level campaign for workers. This top-down approach to campaign dissemination reaches both audiences with key campaign materials but uses the most appropriate messenger for each one based on learnings.

Implications for research and/or practice:

This presentation demonstrates the critical role formative research plays in shaping campaign development. Rather than focusing on individual resilience, the campaign’s systems-first approach to improving mental health among healthcare workers may serve as an example for using similar means to address well-being among other high-risk populations.