Wellbeing is having a moment.
Mental health, resilience, and burnout alleviation are among today’s top healthcare HR focuses, according to sweeping research that professional services firm AON released in December, which pulses benefits trends across 160 U.S. health systems and more than 3.3 million employees.
But it’s no small feat to cultivate a shared sense of wellness and engagement in the hundreds to thousands to hundreds of thousands of people who make up a modern workforce. In fact, a new study out of the U.K. has cast some doubt—and kicked up a LinkedIn debate—on whether individual-level interventions even work.
Complexity aside, investing in wellbeing is essential to attracting and keeping talent, HR executives tell HealthLeaders. To do it, get crystal clear on which offerings actually resonate and bake those into a broader culture that honors employees as whole people.
“What we’re trying to do is to create a culture where everybody feels that they belong,” says Ian Lee Brown, vice president and chief employee experience officer at Duke Health, which has more than 26,000 full-time employees across its three hospitals and 110 clinics in North Carolina. “It makes me feel better, and I become a better contributor, and I stay with the organization for a longer period of time because I feel that the organization cares about me.”
Individual Interventions Might Not Cut It…
Published last month in the Industrial Relations Journal, “Employee well-being outcomes from individual-level mental health interventions: Cross-sectional evidence from the United Kingdom,” synthesizes survey data from 46,336 workers in 233 organizations. The study, while focused on the U.K., sheds light on benefits that are just as popular in U.S. workplaces.
Its author, William J. Flemming, PhD, of the Wellbeing Research Centre at University of Oxford, found that use of organizational offerings targeting individual-level mental health, such as mindfulness and sleep apps, resilience training, stress and time management, and relaxation classes, left participants “no better off” in terms of wellbeing.
“I’m not surprised,” says Qualenta Kivett, JD, executive vice president and chief people and talent officer at Tampa General Hospital (TGH), which, since it acquired the Bravera Health Network in December, encompasses six hospitals, more than 150 care locations, and nearly 14,000 team members.
Popular initiatives centering on a narrow aspect of individual health, such as step-counting competitions, haven’t always borne out the desired outcomes, tending to reward those with readier means of participating “as opposed to really focusing on the needs of individuals that maybe didn’t have that same privilege,” Kivett explains.
Programs can also fall short when they fail to account for the myriad dimensions of wellbeing, from the physical and emotional to the social and material. Instead, people leaders should “look holistically at the individual and also holistically at the organization,” Brown says, to create “intentional opportunity for the employee to feel they’re connected to a system that’s going to support their overall health and wellbeing.”
The U.K. study supports this systems-level view. While Fleming acknowledges limitations in his research, including selection bias, the evaluation of interventions in isolation, and methodological challenges stemming from cross-sectional data analysis, he concludes that “more emphasis must be placed on the greater benefits of organisational rather than individual change, as well as on the importance of high-quality intervention implementation.”
…Unless You Get to the Root
To ensure wellbeing offerings, including the individual ones, resonate, take an employee-first stance, Kivett advises. “If you take care of your team members, they are going to take care of your clients, your patients, your visitors, and really be an extension of our mission and our shared purpose.”
It starts with asking employees what they need to feel well cared for—and bracing for surprise answers.
Two years ago, TGH learned through their annual engagement survey that they were “missing the mark” when it came to mental health, despite offering what they considered a robust set of services, including a 24/7 help line, Kivett says.
So her team dug deeper. In partnership with their third-party administrator, Gallagher, they launched a biennial research initiative: a dedicated benefits survey followed by focus groups where benefits team members and leaders could observe but not speak. Around 60% of employees took part in the first cycle.
The results were humbling.
“What we heard was not only that our mental health support wasn’t good enough—it’s that we didn’t have any,” Kivett recalls. “You can imagine the shock.”
It’s why she says it’s important to test assumptions. “A lot of people assumed what would rise to the top, and nobody had it on their list that it would be mental health because we had all of these programs.”
So her team took a step back to acknowledge that the current offerings, however good on paper, weren’t having the intended impact. Then they got to work.
Make Individual Supports Scale
Based on their research, Kivett’s team scrapped their existing offerings and, in October 2022, debuted Tava Health, a third-party, out-of-the-box platform that connects team members and their dependents to a wide array of mental health resources, including a licensed therapist within 72 hours of request. It also addresses other aspects of wellbeing such as financial health.
It’s been a hit. In 2023—the first full year of implementation—TGH racked up close to 5,000 visits from nearly 1,000 team members and their dependents, representing more than 12% of their pre-acquisition workforce.
Beyond the quick and enthusiastic uptake, Kivett’s team is seeing success across several metrics.
Anecdotally, employees often cite the program as a reason they’re excited to come to work in “What Fills Your Cup” conversations with executive leaders and through other feedback avenues, such as emails featuring “amazing stories from our team members,” Kivett says.
Same goes for their loved ones. “The dependent piece of this is very important, especially when we think about adolescents,” Kivett explains. Employees have shared that their children are especially keen on the quick and confidential process for connecting with “a live person.”
Her team has also seen a decrease in FMLA cases, a trend they plan to further evaluate in year two, plus less benefits “leakage” from mental health services.
To get the program up and running, Kivett tapped TGH’s total rewards leaders to helm the vendor selection process, which involved evaluating candidates to ensure alignment with the health system’s purpose and a “frictionless” experience for team members, who had voiced frustration with the “clunkiness” of their EAP program.
When it comes to communicating about Tava, “the platform makes it really easy,” Kivett says. TGH shares a feed of employee names and email addresses, and the vendor takes outreach and reminders from there.
Kivett’s team then finds organic opportunities to reinforce. “It always comes up every orientation,” she says. Leaders also reference it in written benefits overviews and ensure it’s presented as an option in moments of need, such as when someone reaches out to share that they’re considering FMLA or struggling with a team member interaction.
The biggest challenge to implementation? Cost. TGH found the money by reallocating funds from the mental health programs they disbanded to make way for Tava, plus gained significant funding from their foundation. For organizations without such resources, Kivett says to “look at grants,” which proliferate in the mental health space.
Also work with prospective vendors. TGH’s total rewards VP negotiated an extended trial period with Tava, garnering the hospital four full months to roll out and pressure test the platform. The move was not only cost effective, but also revelatory in terms of vendor fit. “That’s probably what stood out to us the most—to say, if they’re willing to offer us this platform for free to see if it works for us, then why wouldn’t we take that opportunity?” Kivett says.
If a new platform isn’t in the cards, consider lower-cost opportunities to improve wellbeing. For example, by investigating benefits leakage, Kivett’s team noticed that employees were having trouble getting timely appointments to confirm they were pregnant. Now, thanks to a joint effort by the physician medical group and hospital benefits team, TGH reserves Wednesdays for their own employees’ confirmations, and prioritizes appointments when members call into their experience center.
Kivett’s team is getting ready to launch their second cycle of benefits research this month to ensure program enhancements are “still working” and “that we can present a package that really does support our team members as a whole,” Kivett says. “That’s why we want to keep doing that survey—because it gives us real-time information that we can act on.”
Be Better Together
When it comes to creating the right container for wellbeing, make things official. Duke Health enshrines their initiatives in cultural commitments—such as an anti-racism pledge enacted following George Floyd’s murder in 2020 and an update to the university’s anti-discrimination policy in 2022 to “prohibit discrimination or harassment based on hair texture or hairstyles commonly associated with a particular race.” They also create measures to support and evaluate safety—”not just physical safety but psychological safety as well,” Brown says.
As part of their overarching Better Together strategy, his team fosters cohesion around measures such as ease of discussing errors in the work unit. This empowers team members to share their perspective, shape strategy, and speak up when things go awry. “In healthcare, that’s really important because we want to make sure that people feel that when something happens, they can actually raise their hand and say, ‘oh gee, here, I made a mistake. Let’s figure out how we solve this issue that created the opportunity for me to make this mistake, so, ultimately down the road, it may not happen again.'”
Another focus, professional accountability, ensures disrespectful behaviors are handled in such a way that “they won’t happen again, and that people feel that when they see something that’s contrary to our values, and contrary to our commitments, contrary to our culture, that they can call it out and feel that, as an organization, we’re going to work really hard to solve them.”
Take It from the Top
For these messages to stick, they need to come from the top. “A lot of this culture transformation efforts start with our leaders,” Brown says. “We need our leaders to own and commit to behaviors and then cascade them down throughout the organization.”
To help people internalize and spread this skill in their spheres of influence, Duke recently launched inclusive leadership training that centers self-awareness. The rationale? “The more I know about myself, the more vulnerable I can become,” Brown explains. “As I become more vulnerable, it allows for me to be more empathetic with the folks who are around me, to be more compassionate, and also to invite different, diverse perspectives to the table.”
It’s working. In its initial run with nearly 300 leaders, the program received high praise, with participants reporting they’re better equipped to “listen more intently, to be more empathetic in their approach to folks who may have made a mistake, to understand more in terms of what may be going on in someone’s life outside of work,” Brown explains. Based on this reception, his team is expanding the experience to about 3,000 additional leaders across the organization.
This intentional care for team members as whole people has created the trust and space for open, honest dialogue, even around deeply personal subjects, such as loss, and fraught ones, such as the Israel-Hamas War. Such discussions are facilitated by people from within the organization, and sometimes outside it, to provide a more objective vantage point.
“What we see around us can have a devastating impact on our wellbeing,” Brown says. “Conversations with colleagues have been really impactful in getting folks to come to the table and share perspectives on what’s going on across the world.”
It all translates to better, and more rewarding, work.
“That’s how we thrive, and that’s how we create joy in work, when we feel that we can have these deeper conversations among teams to build a deeper sense of trust,” Brown says. “At the heart of what we do is creating deeper teamwork that ultimately leads to the experience of the patient, when they come in, leaving feeling that, no matter what challenges this team faces, they’re going to make sure that they deliver ultimate care.”
Delaney Rebernik is an editor at HealthLeaders.