PEER REVIEW PLEASE DOA PEER REVIEW ON THE ATTACHED Dissemination of Evidence Lauren M. Pieplow Grand Canyon University HCA – 699 Prof. Paluch 11/24/2021

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PEER REVIEW PLEASE DOA PEER REVIEW ON THE ATTACHED Dissemination of Evidence
Lauren M. Pieplow
Grand Canyon University
HCA – 699
Prof. Paluch
11/24/2021


1

Problem
Employee needs not being met
Employee health and well-being impacts care
Leadership impacts health and well-being
Workplace environment impacts health and well-being

Employee health and well-being is influenced by many aspects of the work that is done in a health care system and by the workplace culture and environment. When employee needs are not meet, and they do not feel cared for by the organization that they work for they are more likely to make mistakes, which leads to poor patient experience. It is important that organizations place focus on the health and well-being of their employees in order to ensure that employees feel cared for, supported, comfortable, and that they have a full understanding of their job duties and role within the organization.

Leaderships has a huge impact on how employees feel about their position and the organization. When leadership is supportive and provides feedback and assistance employees feel positively towards their jobs, but what leadership is not supportive and does not provide constructive feedback employees may feel discouraged and perform poorly or leave the organization.

Workplace environment and flexibility also impacts employee health and well-being. If departments are short-staffed and employees are overworked they will begin to feel stressed and burned out, which will have a negative impact on performance. However, when organizations prioritize employee health and well-being by ensuring that they have enough staff, employees are able to take breaks, and health and wellness programs are offered among other things, employees feel cared for and there is a positive impact on performance.
2

Stakeholders
Employees
Patients and their families
Health care organization
Government agencies
Insurance companies
Health care policymakers

Aside from health care employees, there are many other stakeholders that can be impacted by employee health and well-being. These stakeholders include patients and their families, the health care organization as a whole, government agencies, insurance companies, health care policymakers, and health care researchers (Cottrell et al., 2014). All of these individuals and entities are effected by employee health and well-being because when an employee’s attitude is impacted it can influence the way they perform their job, causing them to missing things or upset a patient. However, health care workers are the ones who will feel the effects of any changes to workplace conditions or changes in the behavior of their leadership, which is what will affect their health and well-being.

Leadership is a stakeholder sub-group of employees that will be impacted by implementation of training programs. This is because they may be required to take extra classes and practice different leadership styles in order to best care for their teams, on top of the work they already have to complete daily.

Finally, patients will be largely impacted because the care they receive is dependent on employee health and well-being, as attitude towards work can affect performance.
3

Organization Culture
Provide quality care
For every patient
For employees
Aligns with community culture
Expect the best care for community members

The goal of all health care organizations is to provide the best care possible to all patients. By focusing on caring for employees, organizational leaders can ensure that patients receive the best care. When employees feel as if they are important to the organization, they are likely to put more effort into the care they provide to patients. Caring for the employees goes along with the community culture, where it is expected that if members of the community go to a health care facility seeking help they will be cared for to the best of the providers’ abilities. Employees are only able to perform at their best when they feel cared for and supported.
4

Research Methods
Four databases used
Keywords and articles included
Studies that fit criteria
Over 20,000!
Relevant studies
Twelve

Four different databases were used to find journal articles and past studies done to determine how leadership training and flexible workplace conditions affect the health and well-being of health care workers. These databases The Grand Canyon University library, Cochrane Database of Systematic Reviews, Google Scholar, and PubMed. All databases provided journal articles that were trustworthy, reputable, relevant, peer-reviewed, and related to the health care industry.

When searching keywords used were health care, hospital, employees, healthcare workers, leadership training, workplace conditions, flexible workplace, health, mental health, and well-being. These keywords were used in different combinations in order to collect the most relevant data. Results that were included were English-only journal articles where full PDF files could be viewed for free. Journal articles were included if they were published in the year 2008 to the present, and excluded if they were published before 2008, but ultimately not articles published before 2010 were used.

Over 20,00 different studies fit these criteria from the combined databases. After all articles were thoroughly screened, only twelve studies were completely relevant to the topic.
5

Research Findings
Employee health and well-being impacts many things
Focus on whole-system interventions
Leadership impacts employee well-being
Impacts job satisfaction
Work environment impacts health and wellness
Workplace flexibility impacts employees

It has been found for individuals who work in health care, health and well-being not only impacts their motivation and achievement but also the organization as a whole and the outcomes of every patient with which they come in contact (Berlanda et al., 2020). If all employees are not cared for by the organization, there could be poor and potentially dangerous outcomes for patients and the entire healthcare organization.

In an attempt to offer suggestions to improve well-being, another study found that it is important that organizations focus on whole-system healthy workplace interventions, in order to provide the best care for employees and ensure that they are able to provide high quality care to patients (Brand et al., 2017). This means that an employer ensures that an employee is cared for mentally, physically, and emotionally.

Multiple researchers across different studies found that leadership plays a large role in employee health, well-being, and job satisfaction ((Hafsteinsdóttir et al., 2017), (Kuehnl et al., 2019), (McKee et al., 2011), and (Munir et al., 2011)). Organizations should consider this when sending leaders to training classes and when promoting leadership styles.

In multiple studies, another group of researchers looked at how work environment impacts employee health and well-being. These researchers found that the flexibility of a workplace and the overall work environment can effect a health care workers overall health and well-being ((Blake et al., 2020), (Inauen and Zhou, 2020), (Joyce et al., 2010), (Jun et al., 2020), (Oakman et al., 2020), and (Xiao et al., (2020)).
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Overall Limitations
Lack of past research
Unable to follow-up
Rely on self-reports
Different views

All research studies face some limitations, because there is only so far a study can go. One limitation to the idea that health care organizations should focus on whole-system interventions is that there has not been much research done on the topic in the past (Brand et al., 2017). Another limitation faced by all studies analyzed is that participants leave organizations, so they are not always available for follow-up long-term. Finally, one of the biggest limitations to most of these studies is that they rely partially on self-reports from participants. This is problematic because all participants perceive things differently and score differently on self-reports.
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Validity of Research

Internal Validity
Connection
All factors considered
External validity
Different settings and participants
Same results

When a research study has internal validity that means that the researchers were able to thoroughly explain the connection between what they were testing and the outcome, and others will not find holes in the researchers’ logic (Cuncic, 2021). Internal validity also means that when other individuals read the study they will not find other factors, not considered by researchers, that could have caused the outcomes. All studies have internal validity and the researchers ensured that all factors were considered.

When a research study has external validity it means that the study can be recreated by other researchers in different settings, and the same results can be expected (Cuncic, 2021). Due to the fact that research for all studies was conducted across different settings, with different participants, and in different hospitals, all studies also have external validity.
8

Proposed Solution
Long-term plans
Reduce stress and burnout
Implement health and wellness programs
Offered to all employees
Implement leadership training
Required of all

Long-term solutions include promoting a workplace of trust, respect, and openness, reducing the stigma that is typically associated with health care workers seeking mental health care, and discussing self-care and prevention of burnout, PTSD, and other mental health illnesses (Søvold, 2021). These are all extremely important because employees need to feel comfortable asking for help when it is needed.

When health care workers are healthy and have a feeling of well-being at work they are more motivated to achieve, which is beneficial for the organization and all patients that employee may come in contact with during their employment (Berlanda et al., 2020). Having health and wellness programs targeted at healthy eating, stress relief, sleep improvement, and exercise groups offered to all employees can help improve well-being at work and outside of work.

Leadership must focus on their employees because stress due to long shifts, lack of staff, difficult patients/cases, and lack of physical or psychological safety, among other things, can cause employees to be less efficient, provide a lower quality of care, and have less ambition towards their job (Søvold, 2021). Leaders should be able to recognize when employees need help, be open, and use leadership styles that promote trust and openness.

9

Outcome Impact
Improved quality of care
Less employee burnout
Fewer mistakes
Lower employee turnover rate
Better relationships

These programs will have the most significant impact on employees and patients. As employees begin to feel less stress and have a better sense of well-being, they will be able to provide better care and quality of care will improve. With less burnout and lower turnover rates there should all be less chance for mistake and accidents. Finally, relationships between patients and health care employees, and relationships between leadership and employees should improve as a result of the programs.
10

Change Model
Diffusion of Innovation Theory
Five adaptor categories
Organizational and employee stages during implementation
Factors involved

The Diffusion of Innovation Theory is a change model developed by E.M. Rogers that explains how an idea or process takes shape, gains momentum, and spread throughout the targeted population (LaMorte, 2019). This change model is an effective way to explain how acceptance of the new programs will spread throughout the organization because once some people begin to accept change, more will follow. There are five different adaptor categories in this model; they are innovators, early adaptors, early majority, late majority, and laggards (LaMorte, 2019). All of these adaptors help to drive adoption and acceptance of a new process or program, but difference approaches are often needed to reach each group. Innovators are the individuals that first recognize change is needed and are usually in high level management positions within an organization. Early adopters are typically employees in low level management within an organization, who understand change is needed and embrace it but was how-to manuals and information sheets on the changes (LaMorte, 2019). The early majority are a large part of the employees who are open to change but not typically leaders; they will also usually request proof that the process is effective, and they help to convince the rest of their team that the change is effective (LaMorte, 2019). The late majority are the group of employees who are somewhat against change, and they typically only adopt the change once others have proven that it is effective, and they can see evidence of the effectiveness (LaMorte, 2019). The final group is the laggards. The laggards are employees who are very set in their ways and against any changes in their normal workflow; they typically need pressure from the rest of the employees, and occasionally must face consequences to adopt the change in workflow (LaMorte, 2019).

The stages that an organization and its employees will go through during a program implementation are awareness (where the need for change is recognized), decision-making (where the decision to adopt or reject is made), initial use (first time testing of the process), and continued use (widespread implementation of the process) (LaMorte, 2019). The organization is aware that employee well-being needs improvement, and so the decision should be made to implement programs to help employees. After the initial use of these programs, organization leadership can determine any changes or adaptations that need to be made, and then with continued use the programs will be widespread across the organization. The main factors involved in the diffusion of innovation theory are relative advantage, compatibility, complexity, triability, and observability (LaMorte, 2019).
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Implementation Plan
Resources
Budget
Staffing
Space
Strategic Analysis
SWOT analysis

There are many resources and changes that are necessary in the implementation of programs to train leadership and create wellness programs for all employees. The budget is one resource that leadership must pay close attention to. When it comes to leadership training, the organization will need to budget for the development of training programs and for the programs to be taught. It is important that leaders use leadership styles that promote employee health and well-being and allow employees to feel cared for, because when health care workers feel cared for at work they are more motivated to achieve which leads them to perform better and provide better care to their patients (Berlanda et al., 2020). It is also important that the organization budget for the development of employee health and wellness programs, such as classes on healthy eating, stress relief, sleep improvement, and exercise groups, in order to better care for employees. Stress due to long shifts, lack of staff, and lack of physical or psychological safety among other things can cause employees to provide lower quality care to patients and have less ambition towards their jobs and the organization that they work for in general (Søvold, 2021). Leadership should also budget for and plan to hire more staff in order to relieve some stress felt by employees when they have to shoulder extra work due to staffing shortages. Leadership must ensure that they hire more staff if necessary in order to allow employees to take breaks and to participate in programs. More staff will help to reduce stress felt by current employees. Finally, another very important resource is space, which can be hard to find in a hospital. Organizational leadership but ensure that there is a place for leadership to take training courses and for employees to participate in health and well-being programs.

The SWOT analysis method of strategic analysis looks at a projects strengths, weaknesses, opportunities, and any threats to the implementation (Practice Builders, 2017). It is important that leadership praise the strengths of an implementation and not just focus on the weaknesses, as that can bring down employee spirit. They should also have a plan to address the weakness and the threats, and help staff with any opportunities to improve processes or programs. Organizational leadership should also determine a plan to address weakness and treats to the program, and help determine opportunities for improvement.
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Implementation Plan cont.
Barriers to implementation
Staffing and workload
Awareness
Lack of willingness
Mitigating barriers
Timeline

No matter what process or program is being implemented there will always be barriers to the process. Employees in general are a large barrier to any implementation plan. If the organization is short-staffed, employees may feel that they are too busy to take the time to participate in something to help their health and well-being (Quirk et al., 2018). Although employees may find relief with the use of these programs, they are too overwhelmed to see the benefits. Another barrier is that employees and leadership may not be aware that programs exist or how to participate in the program (Knurr, 2018). If no one knows that there are programs and help available, no one will use the programs. Finally, there may be a lack of willingness among employees to dedicate time to health and well-being. Everyone has work and home responsibilities, and by the end of the day employees may just be tired and want a little free time to unwind and not be thinking about programs offered through their employer.

In order to mitigate these barriers, health care organizations should offer employees ways to focus on well-being during the work day such as offering extra time during their lunch break if they use it to exercise (Knurr, 2018). The organization should also make sure that programs offered appeal to a large number of employees. Most importantly they should be sure to make all programs that are available known to all employees, and not just traditional health related programs (Knurr, 2018).

When it comes to a timeline the individuals developing training and health and wellness programs should take their time in order to ensure that the programs are effective. These individuals will need to determine the types of courses that will work best to improve employee health and well-being, and the style of training that will be most effective for leadership. They will also need to collect data on employee health and well-being and patient satisfaction before any projects are implemented. Next, they will need to develop and review training programs to improve leadership approaches and employee health and wellness programs. After that they will need to implement leadership training programs and employee wellness programs, and send out notifications to all employees that programs are available. Finally, they will need to send out surveys and collect data on patient satisfaction and employee health and well-being. They will also need to make final adjustments to the programs based on collected data from surveys.
13

Evaluation and Adjustment
Outcomes-based evaluation
Determine broad impacts
Evaluation plan
Implement change, collect data, assess outcomes
Adjustment plan
Adjustments made before, throughout and after implementation

Outcomes-based evaluation examines the broad impacts of a process or program and allows leadership to think about what other good may have come from the implementation (Funding for Good, 2020). By using outcomes-based evaluation organizational leadership will be able to determine how effective any health and wellness programs were with employees, how much of an impact leadership training had on employees, the impact on patient satisfaction, and any unforeseen outcomes. This method measures how well an implemented program or process has done and how many goals were achieved by determining if individuals impacted had a change in skills, behavior, attitude, or well-being (New York State Library, 2017). In this evidence-based project there are a few things that leadership should be looking for during evaluation. First, it is important to know if employees report an improvement in health and well-being and a decrease in stress after participating in health and wellness programs. It is also important to know if leadership learns new or better leadership styles after participating in leadership training programs and the impact that new leadership styles have on employees. Finally, organizational leadership can determine if the quality of care that patients receive is improved due to the implementation of processed, and look for any outcomes that may not have been expected.

The evaluation method should be used shortly after each training, after the leaders have had a chance to use new skills. Even if every leader in the organization has not completed the class, outcomes should be evaluated. This is because issues and challenges can show up at any point of the implementation process, and the classes must be flexible and changes made to improve outcomes and reach goals (Miller, 2020). Evaluation should also take place after employees have a chance to participate in health and well-being programs, in order to determine if the programs had a positive effect on employee health and well-being. Finally, surveys should be sent to patients after they receive care to determine if the programs ultimately had an effect on quality of care.

Organizational leaders must be prepared to make adjustments at every point of program implementation. If needed, changes should be made as soon as an issue is found with the leadership training programs in order to ensure they are effective. Adjustments should be made before, during, and after employee health programs based on employee feedback. For all programs, training or health and wellness, adjustments should be made based on data collected, employee feedback, and patient feedback.
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References
Berlanda, S., de Cordova, F., Fraizzoli, M., & Pedrazza, M. (2020). Risk and protective factors of Well-Being among healthcare Staff. A thematic analysis. International Journal of Environmental Research and Public Health, 17(18), 6651. https://doi.org/10.3390/ijerph17186651

Blake, H., Bermingham, F., Johnson, G., & Tabner, A. (2020). Mitigating the psychological impact of COVID-19 on healthcare workers: A digital learning package. International Journal of Environmental Research and Public Health, 17(9), 1–15. https://doi.org/10.3390/ijerph17092997
Brand, S. L., Thompson Coon, J., Fleming, L. E., Carroll, L., Bethel, A., & Wyatt, K. (2017). Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLOS ONE, 12(12), 1–26. https://doi.org/10.1371/journal.pone.0188418

Cottrell E, Whitlock E, Kato E, et al. Defining the Benefits of Stakeholder Engagement in Systematic Reviews [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Mar. Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK196176/

Cuncic, A. (2021, July 31). Understanding internal and external validity. Verywell Mind. https://www.verywellmind.com/internal-and-external-validity-4584479

Funding for Good. (2020, December 3). What are evaluation methods? https://fundingforgood.org/what-are-evaluation-methods/

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References
Hafsteinsdóttir, T. B., van der Zwaag, A. M., & Schuurmans, M. J. (2017). Leadership mentoring in nursing research, career development and scholarly productivity: A systematic review. International Journal of Nursing Studies, 75, 21–34. https://doi.org/10.1016/j.ijnurstu.2017.07.004

Inauen, J., & Zhou, G. (2020). Health and Well‐Being in the early stages of the covid‐19 pandemic: Insights from applied psychology. Applied Psychology: Health and Well-Being, 12(4), 937–945. https://doi.org/10.1111/aphw.12245
Joyce, K., Pabayo, R., Critchley, J. A., & Bambra, C. (2010). Flexible working conditions and their effects on employee health and wellbeing. Cochrane Database of Systematic Reviews. Published. https://doi.org/10.1002/14651858.CD008009.pub2
Jun, J., Tucker, S., & Melnyk, B. M. (2020). Clinician mental health and Well‐Being during global healthcare crises: Evidence learned from prior epidemics for COVID‐19 pandemic. Worldviews on Evidence-Based Nursing, 17(3), 182–184. https://doi.org/10.1111/wvn.12439
Knurr, G. (2018, January 23). The 3 most common barriers to a successful workplace wellness program (and how to avoid them). CareATC. https://www.careatc.com/hr-insights/the-3-most-common-barriers-to-a-successful-workplace-wellness-program

Kuehnl, A., Seubert, C., Rehfuess, E., von Elm, E., Nowak, D., & Glaser, J. (2019). Human resource management training of supervisors for improving health and well-being of employees. Cochrane Database of Systematic Reviews, 2019(10), 1–106. https://doi.org/10.1002/14651858.cd010905.pub2

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References
LaMorte, W. (2019, September 9). Diffusion of innovation theory. Boston University School of Public Health. https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories4.html

Miller, K. (2020, February 25). A manager’s guide to successful strategy implementation. Harvard Business School. https://online.hbs.edu/blog/post/strategy-implementation-for-managers

McKee, M. C., Driscoll, C., Kelloway, E. K., & Kelley, E. (2011). Exploring linkages among transformational leadership, workplace spirituality and well-being in health care workers. Journal of Management, Spirituality & Religion, 8(3), 233–255. https://doi.org/10.1080/14766086.2011.599147

Munir, F., Nielsen, K., Garde, A. H., Albertsen, K., & Carneiro, I. G. (2011). Mediating the effects of work-life conflict between transformational leadership and health-care workers’ job satisfaction and psychological wellbeing. Journal of Nursing Management, 20(4), 512–521. https://doi.org/10.1111/j.1365-2834.2011.01308.x

New York State Library. (2017, September 7). Outcome-Based evaluation. https://www.nysl.nysed.gov/libdev/obe/

Oakman, J., Kinsman, N., Stuckey, R., Graham, M., & Weale, V. (2020). A rapid review of mental and physical health effects of working at home: How do we optimise health? BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09875-z

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References
Practice Builders. (2017, April 4). SWOT analysis in healthcare: A Self-Exam to identify primary areas of focus. https://www.practicebuilders.com/blog/swot-a-self-exam-to-identify-primary-areas-of-focus/
Quirk, H., Crank, H., Carter, A., Leahy, H., & Copeland, R. J. (2018). Barriers and facilitators to implementing workplace health and wellbeing services in the NHS from the perspective of senior leaders and wellbeing practitioners: A qualitative study. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-6283-y
Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021). Prioritizing the mental health and Well-Being of healthcare workers: An urgent global public health priority. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.679397

Xiao, Y., Becerik-Gerber, B., Lucas, G., & Roll, S. C. (2020). Impacts of working from home during COVID-19 pandemic on physical and mental Well-Being of office workstation users. Journal of Occupational & Environmental Medicine, 63(3), 181–190. https://doi.org/10.1097/jom.0000000000002097

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