Well-being in the Workplace: A Book Club Among Health Care Workers During the COVID-19 Pandemic

Abstract

Introduction/Objectives:

A culture of joy in the workplace supports well-being, but less is known about the effect of a shared experience on well-being and burnout in a health care setting. This pilot study investigated personal well-being and occupational burnout among primary care staff who participated in a 3-month virtual book club.

Methods:

In December 2021, health care workers from a primary care practice were invited to participate in a 3-month virtual book club. Participants were emailed a preintervention survey with questions regarding well-being and burnout, the pandemic’s influence on emotional health, and demographic information. The book club met virtually every month from January 2022 through March 2022. After the March 2022 book club meeting, a paired postintervention survey was sent to participants with additional questions regarding their participation in the book club. Well-being and burnout were measured with the 11-point Well-Being Index, and the pandemic’s influence on emotional health was assessed with the 64-point Pandemic Emotional Impact Scale.

Results:

Of 12 book club participants, 9 participants (6 physicians and 3 nurses) completed surveys before and after the intervention. Postintervention improvement in the median score of the Pandemic Emotional Impact Scale was significant (7 points, P = .04). Although Well-Being Index results uniformly favored improved well-being after book club participation, the median improvement of 1 point was not significant (P = .69).

Conclusions:

Social connection through a virtual workplace activity such as a book club may contribute to well-being and may decrease occupational burnout.

Keywords

burnout COVID-19 health care worker social connectedness well-being

Introduction

Well-being, a positive state involving physical, mental, and social dimensions of a person’s life, has shifted for many people during the COVID-19 pandemic.¹ In particular, social connectedness has evolved into different models in both personal and professional settings. Some authors have suggested that using the term physical distancing over social distancing from the start of the pandemic would have been preferable to encourage social connection in these adapting models for socialization.² The detrimental effects of loneliness and isolation to health and well-being throughout the pandemic are concerning.³ Socialization, a form of community at the foundation of relationships, can promote health and healing. As a pillar of lifestyle medicine, relationships in all aspects of life have an important role in overall health.⁴

Endeavors to promote joy in the workplace have been reported to mitigate the risk of burnout and promote well-being among health care workers.^5,6 Joy is defined as the emotion evoked by well-being. Limited intervention research data exist to support joy in the workplace. However, some studies have reported that shared experiences among health care workers contribute to joy and decrease the risk of burnout.^7,8 During the pandemic, creative ways to socialize through virtual platforms became even more important during a time of isolation. We sought to explore whether a virtual book club during the COVID-19 pandemic would contribute to socialization and well-being in the workplace in an interdisciplinary primary care internal medicine practice.

Methods

This study was reviewed and determined to be exempt by the institutional review board.

Study Design and Sample

In December 2021, health care workers (N = 205) employed in the Division of Community Internal Medicine, Geriatrics, and Palliative Care at Mayo Clinic in Rochester, Minnesota, received a “save the date” email to participate in a 3-month virtual book club along with a preintervention survey (“presurvey”) and postintervention survey (“postsurvey”) regarding the activity. Health care staff invited to participate were physicians, nurse practitioners, physician assistants, nurses, medical administrative assistants, desk operation specialists, and patient access support services.

In January 2022, all potential participants were contacted by email to inform them of the general purpose of the study, confidentiality, and contact information for questions or feedback, and that participation was voluntary. A link was also provided at the end of the email for those who wished to participate in the book club. The link led directly to the presurvey questions captured via REDCap (Research Electronic Data Capture).⁹ All nonresponders received up to 3 email reminders before correspondence with them ceased. In March 2022, a paired postsurvey was sent to all book club participants after the last meeting.

The book club met virtually once a month outside work hours in January, February, and March 2022. The organizers intentionally sought to keep the tone and dialog of the sessions informal to promote participation and social connection. The study organizing team selected Being Mortal: Medicine and What Matters in the End by Gawande¹⁰ for discussion and provided a free copy of the book to participants.

Survey Instruments

The survey focused on understanding participants’ experiences of the shared book club activity, personal well-being, and occupational burnout. Well-being and burnout were evaluated with the Well-Being Index (WBI).¹¹ This 9-item validated questionnaire addresses multiple dimensions of well-being: burnout, fatigue, poor quality of life, depressive symptoms, and stress. Each WBI item has a score; the total score for the WBI ranges from −2 (lowest risk) to 9 (highest risk) points. This total score can be analyzed as a continuous variable or dichotomized into high risk or not high risk of burnout, with the at-risk score threshold identified by the individual health care role (physicians, nurse practitioners and physician assistants, nurses, or other workers).¹¹

Attitudes and beliefs regarding how the pandemic affected a person’s health were assessed with the Pandemic Emotional Impact Scale (PEIS).¹² The PEIS asks about anxiety, worry, and depression as well as about sleep disturbances, decreased productivity, and loneliness. The overall PEIS score is a sum of all 16 items, ranging from 0 to 64 points, with higher scores indicating greater emotional effects of the pandemic. If a question on either instrument was not answered, we imputed the missing response by using the mean of all questions (WBI) or the mean of questions on the scale in which the missed question occurred (PEIS). Participants’ demographic characteristics assessed were current health care role, years of institutional employment, years in the division, highest level of education, self-reported gender, race and ethnicity, and employment status.

Data Analysis

Survey responses were evaluated first with descriptive statistics. Comparisons were made between presurvey and postsurvey scores for all participants who completed both surveys. Paired results for presurvey and postsurvey scores for participants who completed both surveys were analyzed with a Wilcoxon signed rank test. SAS software (version 9.4, SAS Institute Inc) was used for all analyses. P values less than .05 were considered significant.

Results

In total, 34 health care workers expressed interest in study participation and completed the presurvey. Of the 12 persons who attended the virtual book club, 10 completed the postsurvey, but 1 of those had not completed a presurvey, leaving 9 participants who responded to both the presurvey and postsurvey. Three of 25 survey respondents had a missing item on a survey instrument. Only 1 of those persons was in the most relevant sample of 9 participants who completed both the presurvey and postsurvey, and this person had 1 missing value for the WBI presurvey.

Demographic characteristics of survey respondents are summarized in Table 1. The 9 book club participants with full survey data were either physicians (67%) or nurses (33%). Most participants had a graduate or professional degree (67%); those with some college or a bachelor’s degree comprised 11% and 22%, respectively. Most participants worked full time (78%), whereas part-time and retired staff comprised 11% each. More than half of participants identified as female (56%). Participants’ ages ranged from 30 to 70 years or older. Most participants were White (67%) and not Hispanic or Latino (78%).

Table 1.

Demographic Characteristics of Survey Respondents Before and After a Book Club.^a

Survey question	Presurvey only (n = 25)	Postsurvey only (n = 1)	Both presurvey and postsurvey (n = 9)
Current health professional role
Physician (MD/DO/MBBS)	6 (24)	0 (0)	6 (67)
Nurse practitioner	2 (8)	0 (0)	0 (0)
Physician assistant	4 (16)	0 (0)	0 (0)
Nurse (RN, LPN)	8 (32)	1 (100)	3 (33)
Medical administrative assistant	1 (4)	0 (0)	0 (0)
Desk operation specialist	2 (8)	0 (0)	0 (0)
Patient access support service	1 (4)	0 (0)	0 (0)
Other	1 (4)	0 (0)	0 (0)
Time employed at Mayo Clinic, median (range), years	11 (1-40)	9 (NA)	7 (2-49)
Length of primary assignment in division, median (range), years	8 (1-40) (n = 24)	6 (NA)	6 (2-47)
Education
Graduated high school	1 (4)	0 (0)	0 (0)
Some college, technical, vocational school (eg, AA, LPN) but not a 4-year degree	9 (36)	1 (100)	1 (11)
Graduated with a 4-year college degree (eg, BS, BA)	3 (12)	0 (0)	2 (22)
Graduate or professional degree	12 (48)	0 (0)	6 (67)
Age, years	(n = 24)
<30	2 (8)	0 (0)	0 (0)
30-39	9 (38)	0 (0)	3 (33)
40-49	6 (25)	0 (0)	1 (11)
50-59	3 (13)	1 (100)	2 (22)
60-69	3 (13)	0 (0)	2 (22)
≥ 70	1 (4)	0 (0)	1 (11)
Sex
Female	24 (96)	0 (0)	5 (56)
Male	1 (4)	1 (100)	4 (44)
Ethnicity	(n = 24)
Hispanic or Latino	1 (4)	0 (0)	1 (11)
Not Hispanic or Latino	23 (96)	1 (100)	7 (78)
I do not wish to answer	0 (0)	0 (0)	1 (11)
Race
American Indian/Alaskan Native	1 (4)	0 (0)	0 (0)
Asian	1 (4)	0 (0)	1 (11)
Black	0 (0)	0 (0)	0 (0)
White	23 (92)	1 (100)	6 (67)
I do not wish to answer	0 (0)	0 (0)	2 (22)
Current employment status	(n = 24)
Full time	15 (63)	1 (100)	7 (78)
Part time	7 (29)	0 (0)	1 (11)
Supplemental	2 (8)	0 (0)	0 (0)
Retired	0 (0)	0 (0)	1 (11)

Abbreviations: AA, associate in arts (degree); BA, bachelor of arts; BS, bachelor of science; LPN, licensed practical nurse; NA, not applicable; RN, registered nurse.

Values are No. of respondents (%) or median (range).

As measured by the WBI, a low risk of burnout was present at baseline (median, 2.0; n = 34). Results for participants completing both the presurvey and postsurvey are shown in Table 2. Although effects uniformly favored improvement in well-being after participation in the virtual book club, the 1-point improvement in the median WBI scores was not significant (P = .69). The PEIS, however, showed significant improvement in emotional well-being (7-point improvement in the median; P = .04).

Table 2.

Total WBI and PEIS Scores for Participants Who Completed Both the Presurvey and Postsurvey (N = 9).

Instrument	Presurvey	Postsurvey	P value^a
WBI, median score (range)^b	−1 (−2 to 4)	−2 (−2 to 7)	.69
PEIS, median score (range)^c	12 (1 to 27)	5 (0 to 16)	.04

Abbreviations: PEIS, Pandemic Emotional Impact Scale; WBI, Well-Being Index.

Wilcoxon signed rank test.

Higher score on WBI indicates higher risk of burnout. Scores range from −2 to 9.

Higher score on PEIS indicates greater emotional impact of the pandemic. Scores range from 0 to 64.

Discussion

The focus of this small pilot study was to explore whether a virtual book club would contribute to well-being in the workplace for an interdisciplinary group of health care workers. Results of this pilot study uniformly favored improvement in well-being and showed the feasibility and potential benefits of virtual opportunities for interdisciplinary socialization among health care workers. Our findings suggest that a shared experience among health care workers may contribute to well-being and decrease occupational burnout.

Social relationships among individuals may create a platform for promoting a growth mindset. Cultivating a trusting environment for sharing helps strengthen social connections, inspires creativity, and promotes knowledge sharing.¹³ Prior study results support that shared experiences or activities, such as gardening,¹³ strengthen meaningful connections. Consequently, mutual sharing of positive experiences evokes joy and happiness.^13,14 Our experience with a virtual book club adds to the evidence that social connections improve emotional well-being. These positive emotions and experiences contributed to a small improvement in well-being and can be infused in communities including the workplace.¹⁵ Research findings in psychology support how positive emotions cultivate successful teams and foster meaningful work environments.¹⁶ Lower rates of turnover and burnout have been linked to positive emotions.¹⁷

Social relationships have been directly correlated to well-being and are known to decrease the risk of death.^4,18,19 During the COVID-19 pandemic, digital solutions have been widely used to stay connected.¹⁹ Despite these expanded ways to socialize, the time necessary for these connections to occur may be scarce. In health care settings, the demands of a busy clinical environment leave little to no time for social connections during the workday. A concern regarding a lack of social connection among health care workers is that the risk of burnout may become heightened.²⁰ An interdisciplinary study of early-career internal medicine clinicians described how a “cases and conundrums” conference promoted social connection and collaboration at work.⁸ Our virtual book club, another type of shared experience, was a way to connect health care workers with common interests and provide a platform for sharing and evoking positive emotions. Providing the opportunity for a shared and relatable interest among health care workers can provide value in mitigating burnout.²⁰

This study has some limitations. First, the small sample size may have resulted in a potential response bias. Second, we do not know whether the participants who responded to the survey were more likely than nonparticipants to be highly engaged in activities of social connection. Third, a potential selection bias may have occurred if workers were influenced to participate in the book club because of the book preselected by the organizing team or the scheduled meeting dates and time. Fourth, other factors that were not measured in this study most likely contributed to well-being in the workplace. The data in this pilot study could be strengthened with a larger sample and validated in a broader audience.

Our study results did show that offering a virtual book club in a health care setting is a feasible option to evoke well-being through a shared experience with colleagues. Our findings also contribute to the literature on well-being by evaluating a virtual leisure group activity among health care professionals. Finally, our results suggest future potential areas of inquiry, such as how to further engage health care workers at high risk for burnout in shared experiences with colleagues through virtual activities and gatherings outside the work day.

Conclusions

A virtual shared experience such as a book club among health care workers may evoke well-being in the workplace and mitigate the risk of occupational burnout.

Footnotes

Acknowledgements

Kathleen Louden, ELS, senior scientific/medical editor, Mayo Clinic, substantively edited the manuscript. The Scientific Publications staff, Mayo Clinic, provided proofreading, administrative, and clerical support.

Declaration of Conflicting Interests

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

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The book budget for this study was provided through an internal Joy at Work grant from Mayo Clinic.

ORCID iDs

Elizabeth A. Kelsey

Ivana T. Croghan

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