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Abstract

Introduction:

Workplace wellbeing programmes are increasingly recognised as essential in managing occupational distress, burnout, and improving staff wellbeing in healthcare. This study examines the implementation of the SEED Champion Initiative, designed to embed sustainable wellbeing practices across diverse hospital and community settings. The study aimed to determine the key components of implementing a workplace wellbeing initiative in an Australian public health service.

Methods:

This study utilised triangulated qualitative methods, including observations of the implementation process and semi-structured interviews with participants trained as SEED champions. Reflexive thematic analysis examined data from participant observations, SEED team reflections, and champion feedback. The analysis focussed on champions’ experiences participating in the initiative and the systemic factors that influenced their capacity to engage.

Results:

The study identified 3 key components for implementing workplace wellbeing initiatives in healthcare: (1) Laying the Groundwork for Wellbeing; (2) Becoming a Wellbeing Champion; and (3) Sustaining the Wellbeing Momentum. Leadership commitment and staff preparation were essential in fostering engagement. Creative, strengths-based approaches, including arts-based activities and in-person interactions enhanced peer support. Regular follow-ups and leadership-driven resource allocation ensured long-term engagement.

Conclusion:

This study demonstrates that champion-led workplace wellbeing initiatives are a feasible approach to enhancing staff wellbeing in healthcare settings. While the strengths-based peer support approach was successful, long-term sustainability requires ongoing leadership commitment and structural integration into organisational practices. Future research should investigate the long-term sustainability and impact of staff-led wellbeing initiatives on absenteeism, presenteeism, and organisational change to inform policy and practice.

Keywords

workplace wellbeing peer support staff-led initiatives strengths-based approaches healthcare wellbeing champion model qualitative research

Introduction

The mental wellbeing of healthcare staff is increasingly acknowledged as critical to the functionality and sustainability of healthcare systems globally.^1-4 High rates of burnout, moral injury, and mental distress in healthcare staff have underscored the urgent need for effective wellbeing initiatives integrated within healthcare workplaces.^4,5 Moral injury, defined as the psychological distress stemming from the inability to provide optimal care due to systemic limitations, has been shown to significantly affect the mental health of healthcare staff, contributing to feelings of guilt, shame, and disillusionment.⁶ Burnout compounds these challenges, characterised by emotional exhaustion, depersonalisation, and diminished professional efficacy, all of which are shown to negatively affect both clinicians’ wellbeing and the quality of patient care.^7,8 This study draws on interviews and observations of training and support sessions with healthcare staff implementing a wellbeing initiative in their Australian work teams. The intent is to inform healthcare providers and planners on strategies and approaches to integrate wellbeing initiatives for staff by understanding the process of uptake and delivery of a champions model.

Literature Review

The psychological distress experienced by healthcare staff directly impacts patient care, leading to reduced empathy, impaired decision-making, and diminished care quality. Studies indicate that distress leads to emotional disengagement, detachment, and communication breakdowns with patients, raising the potential for errors and decreased patient satisfaction.^9-11 Occupational distress contributes to absenteeism—the practice of frequently missing work due to illness, stress, or burnout¹²—and presenteeism, where employees continue to work despite being unwell, leading to reduced efficiency and performance.¹³ Together, they cost the healthcare system billions annually due to loss of productivity.^14,15

Globally, wellbeing initiatives are increasingly viewed as essential for mitigating burnout and supporting the mental health of healthcare staff. Workplace health promotion (WHP) programmes are a common approach, promoting resilience and mental health via organisational changes and individual support measures.^16-19 For instance, the United Kingdom’s (UK) National Health Service (NHS) People Plan emphasises flexible work options and a compassionate workplace culture,²⁰ while the United States (U.S.) Agency for Healthcare Research and Quality (AHRQ) includes programmes to reduce burnout and enhance workplace wellbeing.²¹ Australian initiatives also reflect this, with Safe Work Australia’s new guidelines addressing psychosocial hazards, aiming to protect mental health across sectors, including healthcare.²²

Some workplace programmes include peer support networks such as Schwartz Rounds, which facilitate open group discussions of the emotional challenges faced by staff designed to reduce isolation and promote resilience.²³ The Mayo Clinic’s COMPASS programme, which focuses on resilience and peer support, has equally shown effectiveness in managing staff stress.²⁴ Similarly, the adoption of wellbeing champions has been found to play a significant role in promoting workplace wellbeing programmes by advocating for and supporting colleagues in adopting healthier practices.^25,26 Despite progress, systemic challenges such as high workloads and staffing shortages continue to impede the effectiveness and sustainability of these wellbeing programmes, necessitating ongoing adaptation and leadership support to integrate wellbeing practices into healthcare settings sustainably.^1,5,8,17,27

In Australia, healthcare systems have implemented diverse wellbeing initiatives to support healthcare staff, especially in response to the pandemic’s demands. Initiatives like Victoria’s 24/7 mental health support service offer healthcare staff immediate psychological support, while programmes at New South Wales (NSW) Health provide counselling and targeted self-care workshops.^28,29 Localised initiatives include the South Eastern Sydney Local Health District resilience training, mindfulness sessions, and mental health awareness campaigns to address the specific needs of healthcare staff.³⁰

Emerging evidence highlights the effectiveness of arts-based interventions and peer support models in promoting healthcare staff wellbeing. Creative therapeutic approaches, such as multi-level psychosocial interventions delivered by trained arts therapists significantly reduce emotional exhaustion, work-related stress, and psychosocial distress, while enhancing resilience and alleviating symptoms of anxiety and depression.^31,32 Peer support programmes implemented across hospital settings have also proven both feasible and well-received, fostering trust and emotional safety.³³ These individual-level initiatives are most effective when embedded within supportive organisational environments. Professional development opportunities, psychosocially safe workplaces, and responsive leadership are increasingly recognised as essential enablers of staff wellbeing.^33,34 Recent reviews show that high psychosocial safety climates are linked to improved resilience, reduced job demands, and enhanced performance among healthcare staff.³³ A rapid review of systematic reviews further identified organisational-level interventions, such as workload management and access to wellbeing resources, as critical role to mitigating burnout and supporting mental health.³⁵ These findings align with broader workforce trends, which highlight the urgent need for proactive, multi-level strategies to address declining wellbeing and engagement across the healthcare sector.^{4,17,34,36,37}

Despite the abundance of wellbeing initiatives, studies indicate gaps in design and implementation, with interventions often developed without input from healthcare staff themselves.^37-39 This top-down approach limits the relevance and effectiveness of programmes, as interventions are often one-size-fits-all rather than adaptable to specific healthcare contexts.^39,40 A potentially more effective approach to implementation could involve co-designed wellbeing initiatives that engage healthcare staff as active stakeholders, incorporating their unique needs and experiences to build on existing strengths and tailor interventions across diverse settings.^41,42 This qualitative study is part of a larger PhD project exploring the SEED Programme—an Australian workplace wellbeing intervention designed and led by healthcare staff, and implemented across diverse settings using strengths-based approaches. This paper examines the implementation phase of the SEED Champion Initiative, addressing the following research question: What are the key components to implementing a workplace wellbeing initiative in an Australian public health service? By focussing on the SEED Champion Initiative, this research sought to identify practical strategies for embedding, sustaining, and scaling staff-led workplace wellbeing initiatives in healthcare.

Theoretical Perspective

This study is underpinned by a humanistic framework emphasising growth, self-actualisation, and meaning-making.^43,44 It merges strengths-based practices—nurturing healthcare staff’s capabilities and resilience^45-47—with relational leadership, which fosters co-created meaning, shared responsibility, and collective caring.^48,49 Together, these perspectives frame kindness, agency, and connexion as strategic levers for driving cultural change across acute and community healthcare settings.

Methods

Study Design

An exploratory qualitative study design⁵⁰ was chosen to capture the depth and complexity of participants’ experiences and the contextual factors influencing the implementation of the SEED Champion Initiative. The implementation process involved 3 main stages: preparation and planning, delivery of champion training, and ongoing follow-up support. We employed triangulated qualitative methods, including observations during each implementation stage, semi-structured interviews with participants, and SEED team reflections captured through field notes to deepen our understanding of the implementation process and document experiential insights. Data from observations, interviews and field notes were analysed thematically, with findings from each source compared and integrated to develop a comprehensive understanding of the implementation process. As suggested by Noble and Heale,⁵¹ the use of data triangulation enhances the credibility and validity of the findings by providing a comprehensive view of the phenomena being studied. Ethical approval was granted by the Human Research Ethics Committee of New South Wales (NSW) Health and the University of Wollongong (2023/STE00269). The Consolidated criteria for Reporting Qualitative research (COREQ) checklist⁵² was used to guide the documentation of our study’s methodology and procedures.

Study Setting

This study was conducted in a regional public health service spanning 250 km along the NSW coast, Australia. The health service operates 7 hospital sites and 59 community health services, serving approximately 420 000 people. Five hospital sites and 2 community services participated in the SEED Champion Initiative as part of the SEED Programme.

Description of the SEED Programme

The SEED Programme (Stability, Encompassing, Endurance, and Direction) was launched in response to the 2019 to 2020 Australian bushfires as a place-based, staff-led workplace wellbeing intervention.^53,54 Grounded in strengths-based principles, SEED combines responsive, compassionate leadership and inclusive co-design with practical resources—such as toolkits and reflective prompts—and peer support structures, including co-facilitated debriefings, mentorship and team-building activities.⁵³ These elements empower staff across clinical and non-clinical roles, in both acute hospitals and community services, to design and lead their own wellbeing activities for their work teams, aiming to enhance resilience and reduce burnout.

The SEED Programme operates under 5 key strategies (see Table 1) and is managed by a team of healthcare staff. At the time of implementation, this team included the Director of the Clinical Governance Unit, a senior social worker as the Programme Lead, an administrative Programme Coordinator, and 3 clinical Programme Facilitators (a pharmacist, registered nurse, and occupational therapist). Details of various iterations of the SEED Programme are reported elsewhere.^53-57

Table 1.

The Key Strategies of the SEED Programme.

Five key SEED programme strategies	Description of each key strategy
1. Strengths-Based Workshops	Interactive training sessions tailored to staff needs, including Wellness Warrior and SEED Champion training, team building, and leadership workshops.
2. Staff-Led Wellbeing Initiatives	A bottom-up approach where trained staff collaborate within their teams or sites to design and implement wellness initiatives.
3. Team-Driven Wellbeing Activities	Onsite activities fostering staff connexion and self-care, e.g. quiet rooms, coffee buddies, and Wellness Wednesday sessions.
4. Tangible Wellbeing Tools	Accessible resources e.g. SEED Kindness Trolley, debrief boxes, spiralling kindness books, and SEED Affirmation Cards.

Description of the SEED Champion Initiative

The SEED Champion Initiative was developed as part of the SEED Programme to equip healthcare staff with the skills and knowledge required to implement wellbeing activities in their own teams across hospital sites and community services. Healthcare staff, identified by their leaders as potential wellbeing champions, were nominated based on their interest in wellbeing within the workplace. The initiative ran for 6-months and was structured into 5 phases: (1) engaging the leaders, (2) pre-implementation educational sessions, (3) a 2-day training event, (4) weekly support meetings over an 8-week period, and (5) SEED champions gathering (see Table 2).

Table 2.

Implementation Phases of the SEED Champion Initiative.

SEED champion initiative implementation phases	Description of each phase
Engaging the Leaders	• SEED Programme Lead emailed leaders about the initiative.
	• Requested staff nominations as champions.
	• Virtual meetings with interested leaders.
	• Discussed the initiative and the accompanying research.
Pre-Implementation Education Sessions	• Introduction sessions for 33 prospective champions launched in early 2023.
	• 30 to 90-min sessions conducted over 2 wk at five hospital and two community sites.
	• Sessions included an overview of SEED practices, discussion of SEED’s history, and implementation examples.
	• Tailored to staff schedules. Those unable to attend received SEED resources via email.
Two-Day Intensive Training	• A 16-h interactive training was held over 2-d off-site to remove staff from work environment.
	• Included a recap of SEED’s history, workplace wellbeing theories, and practical implementation strategies.
	• Activities focussed on creative self-reflection, companioning, and team building.
	• Facilitated by local artists and the SEED team.
	• Champions developed 3-mo action plans for their teams.
	• Participant tools - interactive workbooks, pens, highlighters, stress balls, SEED Affirmation Cards.
Weekly Support Meetings	• Eight weekly 1-h meetings (in-person or virtual) facilitated by the SEED team.
	• Champions shared progress, challenges, and collaborated on wellbeing activity design.
	• Additional support available outside scheduled meetings if required.
	• Aimed at sustaining engagement over time.
SEED Champions Gathering	• Celebratory event marking the completion of the initiative.
	• Included a meet-and-greet, a video showcase of the 8-wk initiative, storytelling, interactive trivia, and networking opportunities.
	• Champions shared personal reflections, team successes, and strategies for engaging leadership.

Sampling Approach

A purposive sampling approach was used to recruit participants for the study. All staff who attended in the pre-implementation education sessions, 2-day intensive training, weekly support meetings, and champions gathering were invited to join the study, as their insights were crucial for understanding the implementation process.

Participants were eligible if they were healthcare staff or leaders within the health service who had direct involvement in the SEED Champion Initiative. Members of the SEED team and facilitators, including local artists, were also eligible to be observed during implementation and to contribute their field notes for analysis. However, they were not included in the interview process, as the focus was on capturing the experiences of champions rather than facilitators. Healthcare staff who were not involved in the initiative from the outset, including staff present at hospital sites and community services only during the data collection period were excluded.

This approach ensured that SEED champions represented a broad range of roles, including nurses, medical specialists, allied health professionals, facilities management staff, and managers, thereby capturing diverse perspectives across disciplines and settings.

Study Recruitment

On the first day of training, the researcher introduced the study’s purpose and provided a Participation Information Sheet (PIS) to all attendees. Potential participants were advised that their involvement in the research was voluntary, and that a researcher would attend the 2-day training and follow-up support sessions, observing participants who had provided informed consent. After reviewing the PIS and having the opportunity to ask questions, staff and facilitators were asked to sign a consent form if they wished to participate the study. It was explained that participants could withdraw at any time and have their data removed. All participants consented to be part of the study (see Table 3). Five staff from the SEED team and 2 local artists also provided their consent to include their reflections and field notes of discussions that took place during researcher observations.

Table 3.

Demographic and Professional Characteristics of Participants Involved in the SEED Champion Initiative.

Gender identity	Specific department or unit within the health service	Professional role or position within the health service
Female 36	Facilities Management 8	Cleaning Staff 1
		Kitchen Assistant 1
		Administration Officer 1
		Security Officer 5
Male 4	Ambulatory Primary Health Care 3	Administration Officer 1
Male 4	Ambulatory Primary Health Care 3	Management 2
	Rehabilitation 6	Clinical Nurse Educator 1
		Physiotherapy Unit Head 1
		Allied Health Assistant 1
		Registered Nurse 2
		Enrolled Nurse 1
	Medical 1	Clinical Nurse Specialist 1
	Palliative Care 1	Clinical Nurse Educator 1
	Aged Care 2	Enrolled Nurse 1
	Aged Care 2	Registered Nurse 1
	Perioperative 5	Registered Nurse 3
		Clinical Nurse Specialist 1
		Anaesthetist 1
	Renal 3	Registered Nurse 2
	Renal 3	Nurse Unit Manager 1
	Public Health Unit 2	School Information Officer 1
	Public Health Unit 2	Immunisation Coordinator 1
	Maternity 1	Registered Nurse and Midwife 1
	Neurology 1	Clinical Nurse Educator 1
	SEED Team 5	Social Worker 1
		Administration Officer 1
		Occupational Therapist 1
		Clinical Nurse Educator 1
		Pharmacist 1
	Local Artists 2	Artists 2
		Total = 40 participants

Data Collection

Data collection included observations (n = 40), SEED team and facilitator reflections (n = 7) and semi-structured interviews with SEED champions until data saturation was reached (n = 22; see Table 4).

Table 4.

Qualitative Data Collection Methods Used Across Key Phases of the SEED Champion Initiative.

Phases of the SEED champion initiative explored	Type of qualitative data collection method	Explanation of how the method was applied
Two-Day Intensive Training	Observations and facilitator reflections	Conducted during the 2-d training, documenting activity facilitation, and participant engagement in team building. Daily written reflections were provided to the research team by SEED team members and facilitators.
Weekly Support Meetings	Observations and facilitator reflections	Conducted during the 8-wk support period, documenting participant experiences including, perceived barriers and enablers to implementation. SEED team members submitted written reflections to the research team after each meeting.
SEED Champions Gathering	Observations and facilitator reflections	Conducted during the celebratory gathering, capturing discussions of challenges, successes, and the perceived impact of SEED practices on workplace culture and individual self-care. Reflections were documented by SEED team members during and after the event.
Pre-Implementation Education Sessions	Semi-structured interviews (n = 22)	Conducted with participants following the support period, exploring their perceptions of each activity and their personal workplace wellbeing implementation efforts. Interviews took place in-person, online, and via telephone, lasting between 15 and 45 min (average 30 min).
Two-Day Intensive Training
Weekly Support Meetings
SEED Champions Gathering

Observational data collection involved documenting participant interactions and discussions in real time during training sessions, meetings, and the concluding celebration event. Detailed field notes were recorded either in a paper notebook or electronically on a laptop, documenting key events and participant statements. Where feasible, long quotes were transcribed verbatim to preserve the authenticity of participants’ reflections; however, if exact wording could not be recorded, statements were paraphrased without quotation marks. Interviews were audio-recorded, transcribed, and de-identified to ensure participant confidentiality.

Data Analysis

Data analysis was conducted using reflexive thematic analysis, following Braun and Clarke’s⁵⁸ 6-phase process for data engagement, coding, and theme development. Transcripts from interviews, field notes, and observations were uploaded into the QSR NVivo 12 software for systematic analysis.⁵⁹ Initial coding was undertaken by a single investigator; however, coding decisions were iteratively reviewed in supervisory meetings, supported by reflexive dialogue and memo-writing, to ensure transparency and enhance the trustworthiness of the analysis. During the first phase of familiarisation with the data, transcripts and notes were read repeatedly to gain a deep understanding of the content. The materials were reviewed chronologically, starting with observational field notes from the 2-day training, followed by the 8-week support meetings, gathering, and transcripts from the semi-structured interviews.

In the second phase, initial codes were generated, capturing key features of the data relevant to the research question. This phase involved organising initial codes based on the stages of the initiative, for example participant descriptions of the implementation process. Under each of these initial codes the relevant items of interest identified were collective care, building connections, bringing creativity, tangible tools, and leadership support. The coding was conducted in an iterative and reflexive manner, meaning codes were not predefined but developed through active engagement with the data.

The third phase involved the development of themes, during which the coded data were reviewed, identifying patterns and overarching concepts that could be organised into broader themes. Fortnightly discussions took place during this phase between the research team to order the existing codes into themes. Nine key themes for implementing workplace wellbeing initiatives in a healthcare environment were identified.

These themes were refined in the fourth phase, where the research team reviewed and defined them to ensure they accurately reflected the data. At this stage, themes and definitions were discussed regularly by the team resulting in 9 themes merging into 3 key themes, each with 3 subthemes that comprised the core elements of implementation.

In the fifth phase, the themes were confirmed and named, with a focus on capturing the essence of each theme and its relevance to implementation. This phase included reading and rereading the definitions of each theme and subtheme, ensuring that the essence of the data was reflected. Finally, the 3 overarching themes incorporated 2 actionable subthemes that serve as key components for successfully implementing a workplace wellbeing initiative in healthcare settings that were narratively reported in the sixth phase.

Reflexivity

Reflexivity was integral to the study design and analysis. AK, a doctoral researcher and social worker, has engaged with the SEED Programme since its inception, developing deep familiarity with its practices while maintaining an insider-outsider stance that facilitated rapport and participant comfort. Her role was explicitly framed as an observer, with no involvement in group discussions, to preserve analytic distance. Reflexivity was maintained throughout data collection and analysis using a reflexive diary through the NVivo 12 memo tool, enabling critical reflection on positionality and its influence on theme development.⁵⁹ PP, the SEED Programme Lead and AK’s field supervisor, acted as a site facilitator by providing access to hospital sites and services, and facilitating introductions with healthcare leaders and staff. To minimise potential influence on participant accounts, PP was not involved in interviews or early coding and contributed to the analysis only at the final interpretive stage. JA, JC, and KO senior researchers and social workers had no direct contact with participants, but provided fortnightly reflexive supervision, methodological oversight, and critical debriefing to interrogate assumptions and enhance rigour.

Findings

The data analysis constructed 3 overarching themes, each encompassing 2 actionable subthemes that function as essential components for effectively implementing a workplace wellbeing initiative within healthcare settings (see Figure 1). These core themes are: (1) Laying the Groundwork for Wellbeing, focussing on foundational support through steps including securing leadership commitment and preparing the staff before they participate; (2) Becoming a Wellbeing Champion, emphasising creative approaches to de-stress and facilitating in-person interactions; and (3) Sustaining the Wellbeing Momentum, which highlights the importance of regular follow-up, accountability and creating a lasting community. Each theme outlines critical aspects to consider in designing a sustainable wellbeing initiative in healthcare. Quotes from participants are identified by their assigned number, work role and the data collection method.

Figure 1.

The 3 overarching themes and associated subthemes.

Laying the Groundwork for Wellbeing

The first theme, Laying the Groundwork for Wellbeing, encompasses the essential steps for thorough preparation and foundational planning, which are crucial for implementing a workplace wellbeing initiative.

Securing Leadership Commitment

The first subtheme describes the essential role of leadership in promoting staff engagement in the SEED Champion Initiative. The SEED team took deliberate steps to ensure that leaders of the teams who would subsequently be running their own wellbeing activities endorsed and engaged in the initiative, reinforcing its importance across the organisation and creating a foundation for sustained support.

During initial meetings with leaders, leadership perspectives on wellbeing varied. Some leaders were highly supportive, while others expressed hesitation. One senior leader acknowledged her discomfort with wellbeing but had previously identified SEED’s positive impact on her colleagues. Despite her reservations, she was willing to nominate multiple staff members and expressed interest in future initiatives: “Even though I don’t feel comfortable with wellbeing it doesn’t mean I can’t support my staff to do SEED, they have my permission to be the wellbeing advocates in our team” (32 – Manager - Observations).

To reinforce leadership commitment, the SEED team actively involved leaders throughout the initiative. On the second day of training, the SEED Programme Lead announced that the health service’s Chief Executive Officer (CEO) would be joining in via a virtual meeting alongside service and department managers. The CEO voiced her full support for SEED and the champions, while other leaders shared words of encouragement. The SEED Programme Lead acknowledged this support, emphasising that “. . . in the wellness space, we all sit as equals” (26 - Observations). Following the meeting, champions reflected in small groups on their experience. They described the encounter as significant, stating, “It was nice to see all the bosses together; it is a pretty big deal” (6 – Security - Observations) and “Having the leaders turn up showed us that they cared and wanted to support us” (25 – Registered Nurse - Observations).

Throughout the 8-week support sessions, leaders continued to play a vital role in reinforcing the SEED initiative. Some leaders attended sessions on-site to check in on their champions’ progress, offering encouragement and discussing ways to better support their efforts. Their presence validated the champions’ work and helped bridge the gap between frontline staff and management. One champion reflected:

Having my manager there, listening to what we’re doing, made me feel like this is something they actually care about—it’s not just another tick-box thing (22 – Administration Officer - Observations).

Beyond their attendance at sessions, leaders contributed to the initiative’s uptake by providing additional resources. The SEED Programme Lead held meetings with leadership to request support, including funding for wellbeing activities such as coffee vouchers for staff. These small investments signalled leadership’s commitment to staff wellbeing. As one leader noted:

Giving our team something as simple as coffee vouchers, with no strings attached, goes a long way in showing them that their wellbeing matters to us (30 – Manager - Observations).

By embedding leadership engagement throughout the initiative, SEED aimed to establish a culture where wellbeing was not just encouraged but actively supported at all levels.

Preparing the Staff

The second subtheme highlights the SEED team’s preparatory work to equip champions with the understanding of the initiative and give them insight into what they might do to lead wellbeing activities amongst their colleagues. This theme also describes measures taken by the SEED team to prepare themselves and external facilitators for the implementation process.

On the first day of training, champions reflected on how attending the pre-implementation education sessions and viewing the SEED documentary about how SEED had addressed the impact of bushfires influenced their connexion to SEED. While the documentary evoked emotional responses of sadness, hope, and strength, champions appreciated the SEED team’s effort to meet them in their workplaces. As one champion shared in the interview:

Watching the documentary made me experience a feeling of preparedness, whilst also feeling sadness as well as courage. . . . I had a powerful connection to the firefighter’s story of feeling he has failed, as my husband was a firefighter in the bushfires (15 – Allied Health Assistant - Interview).

The pre-implementation sessions also served as an opportunity for the SEED team to build strong connections with champions while developing their own leadership and decision-making skills. Reflecting on the experience, the SEED team expressed feeling engaged with champions before the 2-day training and that it positioned them as better supporters and advisors. During observations of a SEED team debrief that took place after the 2-day training, one facilitator shared:

Getting to know the champions before the training allowed us to understand where each person was at and what was going on for them and their team. With that extra knowledge we were more prepared and could shape our activities around their needs (33 – SEED Facilitator - Observations).

This preparatory phase also encouraged a sense of respect and appreciation for the SEED team’s approach. During the subsequent 8-week support meetings, champions reiterated feelings of connexion and empowerment, emphasising the initiatives’ bottom-up design.

Going to the session with the SEED team before the training made me feel supported, excited, and connected. . . . I left the session feeling keen to be a part of this, being able to support our staff through the changes, especially with our hospital moving (14 – Registered Nurse - Observations).

During their interviews champions expressed sentiments such as, “By SEED saying that they are coming to talk to us and actually following through with it made us feel respected” (9 – Enrolled Nurse - Interview).

To enhance the training experience, the SEED Programme Lead incorporated creative elements from local artists. Preliminary sessions were held with the artists via MS Teams to prepare them for their involvement in the SEED Champion Initiative, ensuring they were well-informed about SEED’s approach and objectives. One of the artists shared her experience of the sessions at the end of the 2-day training:

Attending meetings with the SEED team before the workshop helped us get to know the team and what they stand for. It made us feel more connected to SEED and its focus of being ‘for the staff by the staff’ (21 – Local Artist - Observations).

This theme demonstrates how intentional recruitment practices created an environment where champions felt confident in their roles and aligned with SEED’s core mission of staff-centred wellbeing. By investing in pre-engagement, the SEED team ensured that both facilitators and champions were well-prepared, nurturing a strong foundation for implementing wellbeing initiatives.

Becoming a Wellbeing Champion

The second theme Becoming a Wellbeing Champion encapsulates the active phase of the SEED Champion Initiative, where champions learnt and applied practical skills to implement wellbeing activities.

Promoting Creative Approaches to De-stress

The first subtheme demonstrates how the SEED team integrated creativity and engagement into the 2-day training incorporating art therapy, meditation, and the use of affirmation cards to demonstrate ways to address the high stress demands of healthcare work. Experiential learning encouraged opportunities for reflection, relaxation, and connexion among champions. For example, during the 2-day training, local artists facilitated sessions to demonstrate the role of creativity in enhancing wellbeing.

On the first day, they introduced art as a means of communication, encouraging champions to engage in nonverbal expression through doodling and leaving positive messages for one another. This exercise aligned with the SEED motto “small is all” (SEED Programme Lead - 26 – Reflections) emphasising the power of small actions in creating meaningful change. Some champions felt initially uncomfortable with the creative process: “I know other people really love it, but the art thing for me was like “Ugh” (16 - Clinical Nurse Educator - Observations). During the interviews, one champion shared how she felt about the art component of the training: “. . . then when we finished, I don’t know, I felt pretty positive, like it must be working because I came out with a different tune” (25 - Registered Nurse - Interview).

On the second day, the artists combined relaxation techniques such as deep breathing and muscle relaxation with creative self-expression. Champions were encouraged to create their own versions of art using examples provided in their workbooks. This activity encouraged personal reflection and communal discussion, with some champions noting how the process helped them feel more connected to themselves and their colleagues.

Sitting in silence, hearing others taking deep breaths, and the sounds of pencils was a bit uncomfortable to begin with. I thought, what is the point of this? But towards the end, I felt calmer and more relaxed . . . maybe there is something in this artsy stuff. (23 – Clinical Nurse Educator - Interview)

The SEED team further incorporated creative wellbeing tools, including the SEED Affirmation Cards, to demonstrate practical applications of wellbeing in the workplace. Champions were introduced to this tool through group activities, where they shared reflections inspired by the cards. One notable moment involved a hospital security guard sharing a deeply personal story. A champion commented how the story encouraged empathy and strengthened group bonds:

Listening to [name of champion] talk about his life made me emotional. I never knew what he had been through until now, and I felt so much pain for him. These cards really opened up needed conversations. (7 – Kitchen Staff - Observations)

By using creative approaches, the SEED team demonstrated how wellbeing practices can be applied. These methods cultivated a sense of community and shared purpose in their roles as wellbeing champions.

Facilitating In-person Interactions

The second subtheme explores the SEED team’s intentional prioritisation of in-person interactions as a foundation of the SEED Champion Initiative. Recognising the need for inclusivity in wellbeing initiatives, the SEED team designed their approach to connect healthcare staff across diverse roles, shifts, and disciplines. In-person engagement was viewed as critical to facilitating trust and collaboration.

The process began with the pre-implementation educational sessions conducted on-site at various hospital and community service locations. These visits allowed the SEED team to connect directly with champions in their environments, showcasing a commitment to understanding the unique challenges faced by frontline staff. Champions reported feeling valued by the SEED team’s efforts to travel to their sites, with observations capturing one champions reflection on the first day of the training:

Thank you [names of SEED facilitators] for your conversation with us. You are both genuine people who serve your hospital communities with care and sincerity. I feel honoured to be invited to observe SEED is doing and hope to approach this relationship with you all. (18 – Clinical Nurse Specialist - Observations)

These initial face-to-face interactions created a foundation of familiarity and trust that carried through to the 2-day training programme. Champions entered the training with a sense of connexion to the SEED team, which eased the transition into the new environment. During the second day of the training, one champion shared: “This experience has been so inclusive, supportive, and positive” (8 – Immunisation Coordinator - Observations). The emphasis on personal connexion extended beyond interactions with the SEED team to relationships among the champions themselves. The in-person setting facilitated discussions, shared experiences, and the development of a sense of camaraderie. Another champion reflected on this at the end of the 2-day training: “It has been a place of connection to other like-minded people all wanting to make a positive change” (19 – Physiotherapy Head - Observations).

This collaborative dynamic was further highlighted in discussions about the broader implications of SEED’s work. Champions noted how the in-person format helped instil hope and solidarity in a healthcare environment often marked by high stress and disconnection:

I felt a sense of togetherness and kindness where I could see hope for our service, something that has felt out of reach for a long time. It was like we all came together as one from the moment we walked into that hall, even if we didn’t know each other before. Meeting new people and connecting on such a deep level was unlike anything I experienced before. (11 – Nurse Unit Manager - Interview)

This focus on face-to-face engagement exemplifies the SEED team’s belief that sustainable workplace wellbeing requires intentional efforts to connect individuals not only to resources but also to each other.

Sustaining the Wellbeing Momentum

The final theme, Sustaining the Wellbeing Momentum, highlights the SEED team’s commitment to ongoing support for healthcare staff, ensuring that the positive effects of the SEED Champion Initiative are long-lasting.

Providing Regular Follow Up Support

The first subtheme explores how SEED’s 8-week follow-up support sessions presented champions with an ongoing network of people in the same role with the aim of encouragement and keeping people accountable to their plans. For example, during the interviews one champion described this experience as:

I found – they [eight-week support sessions] were great, they kept me in check. They kept me accountable, and it was just that motivation that I needed to keep trying. Without regular check-ins I probably would have given up on SEED . . . (20 – Registered Nurse - Interview).

During the weekly sessions, champions shared updates on the wellbeing activities they had introduced within their teams. These ranged from creative activities like the SEED Kindness Trolley (dubbed the Beverage Trolley in some workplaces) and whiteboard kindness messages to practical wellbeing strategies such as 2-minute stretches during ward huddles. The SEED team used the follow-up sessions to provide positive feedback, affirm champions’ efforts, and inspire further creativity.

Beyond wellbeing activity updates, the sessions created a safe and supportive environment for champions to explore personal and professional challenges. Observations on the last day of the support sessions captured one of the champions reflections: “It was a really comfortable space. We could talk about anything. When I opened up about issues with my manager, I felt listened to and supported” (12 – Clinical Nurse Educator - Observations). The SEED team prioritised the wellbeing of champions, encouraging open conversations about their roles, relationships, and the impact of SEED on their lives at work and home. Another champion expressed gratitude for this safe space: “It’s nice to be comfortable talking about personal life challenges and not feeling judged” (1 – Enrolled Nurse - Observations).

A recurring discussion throughout the 8-weeks was the importance of individual self-care. Champions were encouraged to set achievable goals from their action plans and regularly reflect on their progress. While some opted for smaller, more manageable steps, such as “basic goals . . . like reading an affirmation card each morning” (14 – Registered Nurse - Observations), others initially aimed too high with hopes of “giving out coffee vouchers to the whole hospital” (12 – Clinical Nurse Educator - Observations), requiring adjustments to ensure feasibility. These moments of recalibration allowed champions to refocus on their strengths and develop strategies like prioritising or simplifying activities. As one champion noted during the support sessions: “I’m making sure I’m looking after my own wellbeing as well. I’m getting better at it with the support from the SEED team in these sessions” (13 – Administration Officer - Observations).

By the end of the 8-weeks, a culture of mutual support had emerged among champions. One champion described how this dynamic motivated her:

My goal was to walk 15-minutes at work, I think it was twice a week. So, I’ve increased that to 20-minutes now. It’s my morning tea break . . . What helps me keep going is that my team are so supportive, we’ve even become competitive and monitor our walk on our smart watches, which makes it more fun (17 – Registered Nurse - Interview).

The consistent follow-up approach provided not only a dependable source of encouragement but also accountability, demonstrating the value of sustained effort in implementing wellbeing activities.

Creating a Lasting Community

This second subtheme emphasises the importance of creating a lasting community among SEED champions to sustain their work. Recognising the isolation and disconnection exacerbated by the COVID-19 pandemic, SEED prioritised building connections and cultivating camaraderie among champions. By nurturing a network of mutual support, the initiative encouraged champions to draw strength and inspiration from one another as they navigated the challenges of workplace wellbeing.

The SEED Champion Initiative concluded by getting the champions together for a celebratory event at the end of their 3-month journey. The gathering allowed champions to share their experiences and reflect on their accomplishments. During the celebration one champion reflected on this opportunity: “Hearing everyone’s stories reminded me that I wasn’t alone. It’s inspiring to see how others overcame challenges and made wellbeing a priority” (5 – School Information Officer - Observations). Interactive activities like trivia games, storytelling, and a panel discussion further strengthened these bonds. Another champion shared how the event deepened their sense of belonging: “It was great to connect with other champions in-person. Talking face-to-face made me feel part of something bigger” (9 – Enrolled Nurse - Observations).

The connections built during training and support sessions extended into the champions’ daily work. As part of the interview, one champion described: “We check in on each other now, not just about SEED but life in general. It’s comforting to know there’s someone who understands” (10 – Registered Nurse - Interview). Another champion noted in their interview: “We started working on our goals as a group and discovered so much about each other. It wasn’t just about wellness—it felt like building a community” (12 – Clinical Nurse Educator - Interview). This sense of camaraderie also proved to be a source of motivation. One champion shared how he experienced support from another champion at one of the support sessions: “When I was feeling stuck, [name of another champion] reminded me of why I started. That encouragement kept me going” (4 – Security - Interview).

During their interviews, other champions reflected on the friendships and deeper connections they formed through the initiative, which allowed them to navigate the challenges of healthcare more effectively. By working collaboratively on their goals, they built relationships with colleagues they had previously only interacted with superficially:

We were lucky to have a few champions from our hospital. Starting off, many of us didn’t really know one another—I knew some of the nurses and would sometimes bump into [names of two security guards], but we had never really spoken. Leaving the training and then working on our goals together really bonded us, and I feel like we formed a friendship (3 – Registered Nurse - Interview).

The camaraderie formed through the SEED Champion Initiative created a supportive community that extended beyond the initial programme. By promoting collaboration and shared experiences, the initiative empowered champions to sustain the principles of workplace wellbeing over the long term, ensuring the ongoing impact of SEED in their organisations.

Discussion

This study contributes to the growing literature on workplace wellbeing in healthcare by advancing our understanding of existing approaches through a context-specific, champion-led implementation initiative. Drawing on strengths-based and relational approaches, the study findings identify 3 interrelated components: (1) Laying the Groundwork for Wellbeing; (2) Becoming a Wellbeing Champion, and (3) Sustaining the Wellbeing Momentum. Each component comprises of 2 actionable steps, documented in detail throughout the study, and may be applied in other contexts seeking to implement similar staff-led initiatives. This study documented how these steps were applied and how each step impacted the take-up of the champion role.

Improving staff wellbeing has been linked to reduced absenteeism and presenteeism, greater job satisfaction, and improved patient care.^8,12,13 While this study did not directly measure these outcomes, the qualitative findings suggest that interventions such as SEED, which prioritise relational engagement, creative practices, and staff ownership, hold potential to influence these metrics over time. The observed associations between staff-led wellbeing initiatives and perceived improvements in workplace culture can be understood through several interrelated mechanisms. Relational engagement provided a sense of psychological safety by creating spaces for open dialogue, emotional expression, and mutual support. Creative practices helped staff reconnect with meaning and purpose, offering a counterbalance to clinical pressures. Staff ownership enhanced agency and collective efficacy, reinforcing the belief that change is possible from within the system. Together, these mechanisms contribute to a cultural shift that prioritises connexion, compassion, and shared responsibility, laying the groundwork for sustained wellbeing outcomes and broader organisational impact.

Importantly, the cultural and socioeconomic context of the study sites, characterised by workforce diversity, varying resource availability, and localised understandings of wellbeing, played a significant role in shaping both the implementation and perceived impact of the initiative. These contextual factors should be considered when assessing the generalisability of the findings, as they may influence how similar initiatives are adapted and sustained in other healthcare environments.

The first component, laying the groundwork for wellbeing, highlights how the SEED Champion Initiative encouraged connexion and psychological safety through pre-implementation engagement. These early relational foundations proved valuable during the implementation phase, as champions were able to draw on informal peer networks for support, advice, and encouragement. Peer support has been widely recognised as a protective factor in workplace wellbeing,^23-26 but the role of structured pre-engagement in nurturing these peer networks remains underexplored. Importantly, leaders who endorsed the initiative—rather than directed it—helped reinforce a shared responsibility for wellbeing, allowing staff to feel both supported and autonomous. This approach reflects the conditions associated with transformational leadership, which has been shown to promote staff wellbeing and engagement,^19,55,57 while also offering a fresh perspective on how indirect leadership support can empower grassroots change.

The second component, becoming a wellbeing champion, underscores the value of a bottom-up, staff-led initiative in driving cultural change. This participatory approach aligns with literature on co-designed interventions, which emphasises the importance of embedding change through collaboration rather than top-down mandates.^7,25,26,41 Creative and arts-based activities formed a key part of this strengths-based framework. Facilitated by artists and inspired by external wellbeing practices, these activities gave champions alternative, often non-verbal, ways to reflect on workplace stress, and develop solutions. Research on arts-based workplace interventions is still emerging, but there is growing evidence to suggest that such practices can reduce stress, improve communication, and build emotional resilience.^{16,18,31,32,42} However, future research is needed to explore how creative strategies can be meaningfully integrated into broader organisational wellbeing efforts, particularly in high-pressure healthcare environments.

The third component, sustaining the wellbeing momentum, illustrates how continued support mechanisms helped prevent SEED from becoming a one-off event. Champions reported feeling connected to a shared purpose, which reinforced their sense of responsibility for embedding wellbeing activities within their teams. This was a deliberate strategy to integrate wellbeing into the daily practices of the participating healthcare workplaces, addressing a common challenge in organisational change, the risk of enthusiasm fading once initial interventions conclude.⁴² Peer support remained important during this phase, with champions continuing to draw on one another’s experiences and values. While literature on sustaining workplace wellbeing initiatives is still developing^1,3,24,25 the SEED Champion Initiative offers practical insights into how layered relational and structural supports can enhance longevity, ownership, and relevance.

Practical Implications

These findings provide practical guidance for designing and implementing wellbeing initiatives in healthcare. Embedding relational practices, such as peer support, storytelling, and reflective spaces, can help reduce emotional exhaustion and strengthen staff connections. Creative engagement activities, like art-based reflection and shared practices, offer accessible ways to manage stress and reconnect with purpose. Staff-led wellbeing interventions, as demonstrated by the SEED Champion Initiative, promote local ownership, improve uptake, and boost sustainability. These adaptable approaches, requiring minimal external resources, are especially valuable in contexts facing workforce shortages and systemic strain. By centring staff agency and relational care, such interventions can help reduce burnout and build organisational resilience.

Strengths and Limitations

This study has several strengths that enhance its contribution to workplace wellbeing research. It advances understanding of staff-led, bottom-up approaches by demonstrating how participatory and co-designed initiatives foster ownership and engagement among healthcare staff. It also integrates a strengths-based perspective, showing how existing staff values, skills, and relationships can drive change – an important addition to organisational change literature. Methodologically, the study benefits from the use of Braun and Clarke’s⁵⁸ reflexive thematic analysis, which allowed for a nuanced and contextually grounded interpretation of participants experiences. The inclusion of both interview and observational data further enriched the depth of analysis, while the real-world healthcare setting enhanced ecological validity. By documenting the role of leadership endorsement, the study also contributes to literature on sustaining staff-led initiatives, highlighting how supportive and engaged leadership can create conditions for grassroots innovation.

Despite these strengths, the study has acknowledged limitations. As a context-specific study conducted within a particular Australian healthcare service, its findings may not be directly transferable to other settings with different cultures, structures, or resources. The potential for self-selection bias is also recognised, given that champions were either nominated or volunteered may have resulted in the overrepresentation of staff already engaged with wellbeing. Additionally, participants nominated by leaders may have experienced subtle pressure to present the initiative in a favourable light, introducing the possibility of social desirability bias. This influence may have affected their willingness to share critical feedback or dissenting views. Also, while the study provides rich insights into early implementation, it does not investigate long-term outcomes or cultural change over time. The absence of quantitative measures also limits conclusions about broader organisational impacts such as reduced burnout, presenteeism, or absenteeism.

Implications for Future Research

Future research could build on these findings by employing mixed methods approaches that integrate qualitative insights with quantitative outcome measures. For example, longitudinal studies could examine whether participation in SEED activities correlates with reductions in staff absenteeism, turnover, or improvements in validated wellbeing metrics. Linking narrative accounts of kindness, connexion, and support with organisational data would offer a more comprehensive understanding of SEED’s impact and inform scalable models for wellbeing initiatives in healthcare settings.

Conclusion

The findings from this study suggest that successful workplace wellbeing initiatives require a multi-faceted approach, with peer support, staff-led initiatives, and strengths-based frameworks playing key roles in their implementation. The SEED Champion Initiative demonstrated that when staff are given the opportunity to lead wellbeing initiatives, supported by both peers and leaders, they are more likely to be successful. By incorporating creative and arts-based activities, SEED was able to provide champions with tools that cultivated connexion and resilience within participants. Future initiatives seeking to implement similar models should consider how these key components can be adapted to their own organisational contexts to maximise impact and longevity.

Footnotes

Acknowledgements

The authors wish to thank the SEED champions, their leaders, and all staff who participated in the study for their openness and contribution. The authors extend their acknowledgement to the managers who supported the implementation of SEED by enabling staff to engage in wellbeing activities during work hours. Appreciation is also extended to the SEED team and local artists, whose facilitation and creative contributions were integral to the success of the study.

ORCID iD

Andrea Knezevic

Jacqui Cameron

Katarzyna Olcoń

Author Contributions

AK: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Writing – original draft; Writing – review and editing; Visualization; Project administration. JA: Conceptualization; Supervision; Formal analysis; Methodology; Writing – review and editing; Project administration. JC: Supervision; Formal analysis; Writing – review and editing; Project administration. KO: Conceptualization; Writing original draft; Supervision; Methodology; Project administration. PP: Conceptualization; Writing – review and editing; Supervision; Project administration; Visualization; Resources.

Ethical Considerations

This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Human Research Ethics Committee of New South Wales (NSW) Health and the University of Wollongong (2023/STE00269).

Consent for Publication

All participants provided written informed consent prior to participation. Participants were informed of their right to withdraw at any time without consequence, and confidentiality was maintained throughout the study.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by the Research Training Programme Scholarship awarded by the Australian Government.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analysed during the current study are not publicly available due to ethics committee requirements regarding confidentiality and the potential risks of participant identification. Given the nature of the data collected in a specific health service, full anonymisation is challenging, and sharing raw data could compromise the privacy of healthcare staff and leaders involved. However, the data are available from the corresponding author on reasonable request.

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Workplace Wellbeing in Action: A Qualitative Exploration of a Champion-Led Approach in Healthcare

Abstract

Introduction:

Methods:

Results:

Conclusion:

Keywords

Introduction

Literature Review

Theoretical Perspective

Methods

Study Design

Study Setting

Description of the SEED Programme

Description of the SEED Champion Initiative

Sampling Approach

Study Recruitment

Data Collection

Data Analysis

Reflexivity

Findings

Laying the Groundwork for Wellbeing

Securing Leadership Commitment

Preparing the Staff

Becoming a Wellbeing Champion

Promoting Creative Approaches to De-stress

Facilitating In-person Interactions

Sustaining the Wellbeing Momentum

Providing Regular Follow Up Support

Creating a Lasting Community

Discussion

Practical Implications

Strengths and Limitations

Implications for Future Research

Conclusion

Footnotes

Acknowledgements

ORCID iD

Author Contributions

Ethical Considerations

Consent for Publication

Funding

Declaration of Conflicting Interests

Data Availability Statement

References