{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T07:40:07Z","timestamp":1756712407364,"version":"3.44.0"},"reference-count":65,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health and Social Care Delivery Research (HSDR) Programme","doi-asserted-by":"publisher","award":["NIHR132931"],"award-info":[{"award-number":["NIHR132931"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Soc Care Deliv Res"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title>\n<jats:p>The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-2\"><jats:title>Aim<\/jats:title>\n<jats:p>To work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors\u2019 workplace well-being and reduce negative impacts on the workforce and patient care.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-3\"><jats:title>Design and method<\/jats:title>\n<jats:p>Three inter-related sequential phases of research activity:<\/jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Phase 1: a typology of interventions and mapping tool to improve hospital doctors\u2019 workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors\u2019 workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers\/practitioners and leaders.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors\u2019 workplace well-being \u2013 drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:sec>\n<jats:sec id=\"abs1-4\"><jats:title>Results<\/jats:title>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or \u2018curative\u2019).<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor\u2019s well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Phase 3: our \u2018Workplace well-being MythBuster\u2019s guide\u2019 provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:sec>\n<jats:sec id=\"abs1-5\"><jats:title>Limitations<\/jats:title>\n<jats:p>Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-6\"><jats:title>Conclusions<\/jats:title>\n<jats:p>Misaligned well-being solutions can cause harm. It is paramount to prioritise improvements in working environments, instead of well-being \u2018add-on\u2019s, and to involve doctors and other relevant staff in identifying problems and in planning how to address these.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-7\"><jats:title>Future work<\/jats:title>\n<jats:p>Further research is required to tailor the findings to primary care, mental health and social care settings. Health economic studies of well-being interventions (ideally, at systems level) are urgently required, since small investments could have far-reaching positive impacts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-8\"><jats:title>Funding<\/jats:title>\n<jats:p>This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132931.<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/pasq1155","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T07:11:03Z","timestamp":1756710663000},"page":"1-35","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Optimising the delivery and impacts of interventions to improve hospital doctors\u2019 workplace wellbeing in the NHS: The Care Under Pressure 3 realist evaluation 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