During the past five years, hospital systems across the nation have made an effort to improve the wellness of hospital and clinic-based healthcare employees.(1,2) The known stresses of the COVID-19 pandemic, in addition to staffing challenges, have increased employee burnout, depression, and, ultimately, staffing resignations.(3)
To mitigate the effects of these challenges on healthcare employees, the medical staff of Allegheny General Hospital formed a physician-led Employee Wellness Committee in 2018 with the charter to improve employee wellness efforts within the hospital, demonstrate concern for the employees’ personal well-being, and express appreciation for their partnership. The committee’s work resulted in an annual wellness expo to highlight and communicate the medical staff’s ongoing commitment to supporting employees.
Although an employee wellness expo is not unique, in this instance, the origin, leadership, and financial support of the medical staff were novel. Here, we report how we implemented this program, its impact, and how our success in 2022 led us to expand the expo to other hospital sites in the health system. We highlight the benefits of our program and provide a template for those who are interested in a similar program generated by medical staff leadership.
The Origins of the Wellness Expo
To promote well-being in a large academic hospital and demonstrate caring and appreciation to the hospital employees, an Employee Wellness Committee was formed in 2018 and staffed with several employee leaders; the hospital’s employee health physician director served as chair.
The committee’s efforts included health education via multimedia billboards in the hospital, expanded onsite fitness facility hours and accessibility, better food choices at all hours of operation, fitness challenges, and enhanced communication about these initiatives.
The committee also created the wellness expo for employees of the hospital, which required leadership and financial support from the medical staff to organize, operate, and fund.
The annual expo was designed to promote wellness and allow employees to participate during short breaks in their workday. Event hours were set around employee lunch times when coverage was already scheduled.
We enlisted hospital divisions that promoted preventive care and education and provided blood pressure measurements, onsite preventive exam scheduling, and promotion of human resources (HR) wellness efforts, behavioral health efforts, dietary advice, addiction medicine education, and diversity, equity, and inclusion activities. Internal programs were supplemented with external community vendors that helped with financial advice and education, healthy food choices, exercise gear, massages, Reiki, music therapy, pet therapy, and food banks.
The medical staff approved and provided modest financial support from medical staff dues for marketing fliers (Figure 1), décor, and raffle prizes, including an exercise bike and grocery gift vouchers to entice staff to attend. Logistical help was provided by the onsite fitness facility manager, director of medical staff services, environmental services staff, maintenance staff, and security and dietary services staff.
Figure 1. This flier advertising the 2022 Wellness Expo held at Allegheny General Hospital was distributed in staff areas and was posted on the hospital’s electronic bulletin board. Similar fliers were used in 2018 and 2019.
After the initial expo in 2018, feedback encouraged additional efforts to improve and continue the expo in 2019; it was an even greater success (Table 1). Unfortunately, the COVID-19 pandemic forced us to cancel the expo in 2020 and 2021.
Reviving the Wellness Expo
While the wellness expo was paused, the committee relied on annual wellness survey results to develop and communicate ongoing wellness initiatives. These annual surveys, which initially targeted patient-facing clinicians (nurses, physicians, residents, and advanced practice providers), were expanded to all 22,000 health system employees over the course of the COVID-19 pandemic.
The survey results revealed room for improvement in addressing the many systemic issues and drivers that exacerbate burnout of healthcare workers.(1,4) These survey results highlighted the significant impact of the COVID-19 pandemic on employees’ well-being, including a perceived lack of appreciation as a driver for burnout (Figure 2).
Figure 2. The percentage of healthcare providers in key roles who report that feeling unappreciated is a notable cause of burnout over time. There was a significant reduction in lack of appreciation as a cause of burnout on annual well-being surveys in 2022 and 2023 for most categories of workers, likely because of many efforts, including the wellness expos. Results were categorized by role. Dashed lines represent overall trends observed for each role. The 2019 APP cohort was too small to be significant and was excluded from the figure.
The return of the expo in 2022 provided an opportunity to visibly demonstrate how much the medical staff valued all employees. It was also a way to regenerate the trust that had deteriorated during the pandemic and facilitate camaraderie and community, which are vital to maintaining a culture of well-being.(2,5)
The hospital Employee Wellness Committee revived the wellness expo in collaboration with the Employee Health Office and HR to explore ways to make self-care more accessible, highlight opportunities for self-care, and provide multiple access points for emotional or mental health support to address post-pandemic stress.
The revived expo was advertised on the employee website and via internal communications, and feedback from the two previous expos was used to plan the expanded post-pandemic expo.
Measuring Success and Identifying Challenges
It is difficult to scientifically measure the benefit of these programs that included the pandemic years, other than through participation and post-event surveys. We had to pause the event during the initial years of the pandemic, but the pause may have fueled the enthusiasm for in-person gatherings and events when such activities resumed in 2022.
Figure 3. Flier describing the 2022 expo tables for participants. The flier was distributed at the entrance to the expo.
A flier was distributed at the entrance to the 2022 expo that described the activities and vendor displays (Figure 3). The number of vendors and attendees for four of the annual expos are depicted in Table 1. Many employees made medical appointments during the three expos in 2023 (Table 2).
According to the annual wellness surveys, lack of appreciation was less of a factor in causing burnout in 2023 than in 2022 (Figure 2), correlating with the expo’s efforts to demonstrate appreciation for the staff members.
While causation cannot be proven between these survey results and the expo, the results do indicate improvement. We believe the attendance numbers show the leadership’s cooperation and the hospital staff’s enthusiasm to have employees attend. Even more impressive was the attendance increase despite staffing challenges that were made more severe by COVID-19. The number of scheduled appointments demonstrated that the events had useful mechanisms for employees to address their individual health needs while enjoying the event.
Although many efforts may have helped reduce burnout linked to feelings of lack of appreciation comments support that the expo events contributed to the improvement. We also distributed vendor feedback surveys and held employee focus groups at department head meetings and engagement councils after each event, and received some valuable suggestions. The overall feedback was to continue the efforts. In fact, most respondents suggested hosting several events each year rather than one.
The following 2022 expo focus group’s qualitative feedback is from meetings of department heads and the engagement council in one hospital:
Event Time, Location, and Duration
The location was unanimously approved and appreciated.
Daylight staff had time and appreciated efficient processes and space.
Negative comments regarding evening and night staff’s inability to participate.
Quality of Information Provided
All positive remarks.
Appreciation for the ability to make medical and radiology appointments at the event.
Prizes and samples
Unanimous support for healthy food vendors’ samples.
Expressed gratitude for the medical staff supplying the grand prizes of an exercise bike and fitness watches.
Requests
Would like to have the event twice per year.
Request for another event for evening and night staff.
Desire more publicity of event closer to date.
Post-event surveys demonstrated the many ways the wellness expos are successful:
Gratitude and Recognition. The expos provide the physicians a chance to put their staff dues to work in a way that is visible to employees and demonstrates recognition, gratitude, and care for their well-being.
Connection. The communal nature of the event contributes to the feeling of camaraderie, which is a vital component of a healthy team.
Healthy Living. The expos highlight many healthy preventive practices, such as diet, blood pressure monitoring, exercise, quality sleep, and stress relief, such as meditation. The expos also promote numerous internal programs that support health, such as mammography screenings, primary care appointments, women’s health services, behavioral health services, and employee assistance programs.
Community. The expos strengthen our relationships with the various local vendors that collaborate with the local hospital in support of good health and well-being.
While none of these benefits can be quantified scientifically, we believe the expos demonstrate the value that our medical staff place on our employees and the community we serve. We believe the expos have contributed to improved participation in the wellness survey, which the hospital uses to measure burnout and well-being; participation increased by 10% at this hospital between 2021 and 2023. Improved survey participation will allow us to optimize the support provided based on staff feedback.
Finally, the perceived lack of appreciation has decreased based on annual surveys, which this program is likely to have influenced (Figure 2).
After the 2022 expo, we expanded this program to 10 other hospitals. By the end of 2023, more than 3,600 employees attended the expos held across the health system. The post-event focus groups and our experiences planning the 2023 events highlighted some of the ongoing challenges we must address and overcome to provide optimal outreach to all our staff:
Ambulatory Sites Exclusion. It is difficult to provide the same opportunities at the multitude of outpatient facilities, as their varied size and geographic locations prohibit similar events of the same scale. We are considering virtual events, but the in-person camaraderie would be missed.
Employee Exclusion. The timing and location of each of the events are selected to allow the greatest number of employees to participate, but around-the-clock patient care makes it impossible to ensure every event is accessible to every employee. Unfortunately, this excludes some employees who wish to participate. We hope to address this by having additional events at varying hours of the day.
Volunteer Staffing. Overall operations of the expos depend on having a sufficient number of volunteers to operate the expo while continuing other work duties, including high-quality patient care. We have begun to collaborate with auxiliaries, volunteer services, and other hospital committees to help with volunteer work.
Inadequate Advertising. We currently advertise with fliers posted in common areas, email communications, reminders distributed by team leaders, and verbal communication at hospital team meetings. Given the barrage of communications that healthcare workers receive in their daily work, we must find a balance between adequate and overwhelming communication so that staff can set aside time to attend. We recently had success with “old school” bulletin boards, social media, and elevator and shuttle service information boards.
Next Steps for the Wellness Effort
Wellness efforts are essential to creating an engaged and healthy workforce. A culture of caring for employees enables us to reduce burnout and provide excellent medical care, minimizes mistakes, and creates a satisfying patient experience.(6,7) This effort should focus on all healthcare workers and must be a collaboration between multiple departments, such as HR; diversity, equity, and inclusion; safety; quality; patient experience; employee engagement; and education offices. This manuscript shares a novel approach because the medical staff led the effort and financed it, rather than the hospital administration or HR.
Many studies have shown that some of the drivers of burnout and role dissatisfaction can be reduced by showing appreciation and recognition, assisting employees with self-care, and providing opportunities for collegial events to offer a caring culture of well-being.(1,4,7-9)
Maslach and Leiter’s study of burnout revealed that appreciation from medical colleagues can be as powerful as that from management.(4) They also found that the prevalence of appreciation helps form workplace culture and enhances community.(4)
Shanafelt and Noseworthy emphasized nine organizational strategies to promote well-being.(7) One of those strategies was the need to create community at work.(7,10) This is especially important today, as many health systems have multiple sites of care spreading out the staff, along with video visits, virtual meetings, and a new work-from-home culture, creating a need to build community. The expo is an effective tool in a multifaceted solution to creating a culture that values employee welfare, shows appreciation, and creates an opportunity for socialization at work.
The annual expo is one of many efforts to address the well-being and reduce burnout of our employees, and we recognize that an annual event is only one of many avenues needed to address employee well-being. The Wellness Committee will expand this program based on feedback from each event and continue with leadership from the medical staff at each hospital. In partnership with the Wellness Committee, the Wellness Office of the Health System will focus on efforts to improve the efficiency of employee work, advance the culture of well-being, and provide support for individual employees.
Future expos will highlight these initiatives, and the committee will add additional programs to build civility and teamwork and focus on areas of need revealed in the annual surveys. The wellness expo model is a unique opportunity to promote those efforts within a hospital while building a collaborative and caring culture.
In conclusion, our wellness expo serves as a template for other hospital systems seeking effective and collaborative ways to promote employee well-being. These expos have proven to be a unique opportunity for the medical staff to demonstrate their appreciation for the multitude of employees who collaborate to provide outstanding healthcare to the public. Communicating this appreciation to all staff is vital as we continue to recover from the staffing shortages exacerbated by the COVID-19 pandemic.
Acknowledgments: The author thanks Sarah Carey, MS, Jade Chang, and Jacalyn Newman, PhD, of Allegheny Health Network’s Health System Publication Support Office (HSPSO) for their assistance in editing and formatting the manuscript. The HSPSO is funded by Highmark Health (Pittsburgh, Pennsylvania) and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3 ). Special thanks to the Chartis Center for Burnout Solutions for their assistance in generating Figure 2 from the employee survey data.
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