Abstract
Guided by the theoretical underpinnings of the whole-person approach to wellness, we critique and adapt this framework to explain the combined complexities of organizational stress and wellness communication processes in a pediatric residency program. Using a qualitative, thematic analysis, we explore the link between employee stressors and participation in wellness resources found in a workplace wellness program (WWP). We find that despite good intentions, the organizational resources reproduced institutional norms, work, and stress, not wellness. Our findings suggest having a WWP that meets the four whole-person dimensions is not enough to ensure employee well-being and program success. Rather, WWPs must be connected to employees’ daily experiences and address the structural constraints of work. We conclude by proffering wellness-in-practice, a practice-theory extension to the whole-person approach, which weaves wellness into the everyday fabric of organizational life and promotes meaningful connections between work, stress, and WWPs.
Keywords
Stress is an inescapable part of work, and its effects can be detrimental to employees and their organizations (Ganster & Rosen, 2013; Hassard, Teoh, Visockaite, Dewe, & Cox, 2018; Ray & Miller, 1991). To help employees reduce stress, many organizations have taken keen interest in implementing workplace wellness programs (WWPs) (Berry & Mirabito, 2011; World Health Organization, 2010), but research on the effectiveness of WWPs has generated mixed results. Empirical studies suggest WWPs can positively impact employees’ physical activity (Conn, Hafdahl, Cooper, Brown, & Lusk, 2009), diet (Maes et al., 2012), productivity (Kuoppala, Lamminpää, & Husman, 2008), and sense of belonging at work (Dailey & Zhu, 2017). Sangachin and Cavuoto (2018) found that stress can bring employees into a WWP, and in turn that WWP can reduce their stress. However, the effectiveness of these programs has been questioned (Mattke et al., 2013; Stephens & Harrison, 2017), and they have been critiqued as being marginalizing and intruding (Ford & Scheinfeld, 2016; James & Zoller, 2018; Kirby, 2006). Considering the escalating conversations in academic circles—as well as in industry groups such as human relations professionals—around issues of mental health, stress, and well-being, it is time to interrogate how we conceptualize WWPs and instead view wellness as an integrated practice helpful in a stressful work environment.
A promising way for scholars to explore the connection between workplace stress and WWPs is through the whole-person framework (Geist-Martin, Ray, & Sharf, 2011; Geist-Martin & Scarduzio, 2011). Scarduzio and Geist-Martin (2016) take an organizational communication approach to wellness by proposing four dimensions that WWPs should communicate and fulfill for complete employee care: physical, psychological, social, and spiritual wellness. The whole-person framework helps scholars and practitioners better understand both employees’ perceptions of stress and wellness resources, as well as evaluate if and how the communication and utilization of wellness resources help employees cope with stress. Our study focuses on one group of employees particularly vulnerable to the adverse effects of stress: medical residents (henceforth called “residents”). These individuals are medical school graduates who are completing their training in a specialized area of medicine. Previous research has shown residents experience stress such as a poor learning environment, sleep deprivation, and too many patient care responsibilities (Goldhagen, Kingsolver, Stinnett, & Rosdahl, 2015), and their stress has been linked to high rates of depression, burnout, and suicidal ideation across specialties (Slavin & Chibnall, 2016).
To date, few studies have explored specific linkages between residents’ stress and wellness resources. This study builds a case to integrate these concepts and advocates for wellness-in-practice—a practice-theory extension to the whole-person approach, which weaves wellness into the everyday fabric of organizational life and promotes meaningful connections between work, stress, and WWPs. In this article, we first review extant scholarship on workplace stress and wellness, with a particular focus on the context of medical residency. We then describe the research site and methods used to guide our data collection and analysis, and we present the findings to our research questions. We conclude by discussing the theoretical and practical contributions of this research, as well as the limitations of our work and directions for future research.
Situating Workplace Stress
Folkman and Lazarus (1985) defined stress as “a relationship between the person and the environment that is appraised by the person as relevant to his or her well-being and in which the person’s resources are taxed or exceeded” (p. 152). Their foundational definition situates stress as the dynamic and reciprocal connection between people and the environment, as each affects—and is affected by—the other. Furthermore, stress is a process, as it involves assessing whether a particular stressor is an actual threat, evaluating the resources available to address the threat, and engaging in efforts to overcome, manage, or reduce the stress based on the severity of the threat and options perceived (Folkman & Lazarus, 1980; Glanz & Schwartz, 2008).
In work contexts, factors such as organizational climate (Wright, 2005), role overload (Cooper, Dewe, & O’Driscoll, 2001), lack of organizational support (Vagg & Spielberger, 1998), multiple communication technologies (Stephens et al., 2017), and job insecurity (Maysent & Spera, 1995) can lead to stress at work. Although occupational stress can have beneficial and adaptive outcomes (Boren & Veksler, 2015), the effects of stress can have severe negative consequences for employees and organizations (Farrell & Geist-Martin, 2005). At the micro-level, work stress has been linked to poor physical health, such as decreased immune function (Eddy, Heckenberg, Wertheim, Kent, & Wright, 2016). Employees can also experience psychological repercussions of stress, such as depression, anxiety, and burnout (Maslach & Leiter, 2016). At the macro-level, stress affects the organization via reduced productivity and efficiency, absenteeism, employee mortality, and billions of dollars each year in health care costs (Ganster & Rosen, 2013).
Health care professionals have some of the highest levels of work stress across industries (Ricker, 2014). As the U.S. Surgeon General reported, “If health care providers are not well, it is hard for them to heal the people for whom they are caring” (Friedan, 2016, para. 3). Residents are often the primary point of contact for patient care and are particularly vulnerable to the adverse effects of work stress (Sargent, Sotile, Sotile, Rubash, & Barrack, 2004). Previous research has identified that residents often experience stress such as uncertainty in treatment decisions (Timmermans & Angell, 2001), role ambiguity (Revicki, Whitley, & Gallery, 1997), fatigue (Baldwin & Daugherty, 2004), and lack of control and critical decision-making (Butterfield, 1988), and their stress has been linked to depression (Mata et al., 2015), burnout (Ripp et al., 2011), and suicidal ideation (Dyrbye et al., 2014).
To combat these adverse effects, there have been recent changes in medical education policy and resident duty hours (Accreditation Council for Graduate Medical Education [ACGME], 2017; Asch, Bilimoria, & Desai, 2017). Furthermore, the ACGME and leading researchers have advocated for WWPs that pinpoint residents’ specific stressors, highlight effective resources to help them work through their stress, and in turn improve residents’ overall health (Daskivich et al., 2015). Therefore, it is important to build on existing work concerning resident stress and better understand how residents’ stress functions when their organization has a WWP. This leads to the first research question:
Expanding Conceptions of Workplace Wellness
Because of the negative consequences of occupational stress, organizations are taking notice (World Health Organization, 2010). Wellness—defined as the “complex and multifaceted nature” of well-being and health at individual, group, and organizational levels (Wallace, Lemaire, & Ghali, 2009, p. 1714)—is a buzzword in organizations today, as many workplaces are aiming to create more physically and mentally healthy employees (Scarduzio & Geist-Martin, 2016). Indeed, over half of U.S. employers have WWPs (Mattke et al., 2013), offering initiatives such as diet and exercise courses, employee assistance programs, and health screenings (Dailey, Burke, & Carberry, 2018). WWPs have been shown to impact positively employees’ physical activity (Conn et al., 2009), productivity (Kuoppala et al., 2008), and sense of belonging at work (Dailey & Zhu, 2017). The literature also holds workplace wellness as a potential solution to alleviate occupational stress (Berry & Mirabito, 2011; Farrell & Geist-Martin, 2005). For example, Sangachin and Cavuoto (2018) studied university employees and found that perceived stress was a main reason for WWP participation, and participation in the WWP reduced employee stress. However, these scholars note their participants had high job control and flexibility in their work, and they caution these factors could influence WWP participation.
Although many studies have highlighted the benefits of WWPs and their potential effects in stress reduction, other researchers have argued WWPs do little to help employees. In one of the most comprehensive assessments of WWPs, Mattke and colleagues (2013) found that less than 20% of U.S. employees actually participated in WWPs, and the majority of organizations in the study failed to evaluate the effectiveness of their wellness programs. Critiques of WWPs have emphasized why low participation and ineffectiveness in some programs may be the case. For example, Zoller (2003) and Kirby (2006) described WWPs as an exertion of managerial power and an avenue for workplaces to discipline and control employee identities and bodies. Ford and Scheinfeld (2016) claimed WWPs intrude upon employees’ privacy, often do not consider cultural and gender differences, and can violate confidentiality and ethical boundaries between employers and employees. Other scholars have described WWPs as red herrings that divert attention away from the organization as a source of stress and illness, and instead shift focus to making the employee responsible for their health (Dale & Burrell, 2014; Zoller, 2003). In turn, these negative implications of WWPs can foster employee resentment and WWP resistance (James & Zoller, 2018; Zoller, 2004).
In consideration of the potential adverse effects of WWPs, scholars have begun to emphasize the organization’s role and responsibility in employee wellness (Stephens & Harrison, 2017). Perhaps the most prominent theoretical development in this arena is the whole-person approach to wellness, in which mind, body, and spirit needs are integrated into a holistic care program (Farrell, Geist-Martin, 2005; Scarduzio & Geist-Martin, 2016). The whole-person approach is distinct in that it focuses on the organizational context rather than the individual, couple, or group context. As Scarduzio and Geist-Martin (2016) described, “The whole-person approach to wellness moves away from simply focusing on a scientific or biomedical approach to wellness, and considers aspects of individuals’ organizational experience that can contribute to their illness” (p. 173). As organizational discourses and the process of organizing are “central to preventing illness and promoting well-being” (Zoller, 2010, p. 483), the whole-person approach can be a helpful tool in reducing organizational stress. Scarduzio and Geist-Martin (2016) proposed four dimensions that any WWP should communicate for complete employee care: physical wellness, psychological wellness, social wellness, and spiritual wellness. Physical wellness involves maintaining physiological health and fitness. Psychological wellness means keeping employees mentally healthy, whereas social wellness means maintaining relational well-being. Finally, spiritual wellness is associated with inner peace and connectedness to organizational life. This type of wellness can include, but is not limited to, religious well-being.
To move the whole-person approach from theory to practice, Scarduzio and Geist-Martin (2016) recommended WWPs include resources that align with the whole-person dimensions, such as incorporating a fitness center for physical wellness or holding meditation sessions for psychological and spiritual wellness. In U.S. medical training, WWPs are relatively new and have yet to be widely adopted. American medical boards have called for residency programs to make “meaningful changes to improve the learning environment, to identify and address stress in residents, and to provide systems that support wellness” (Daskivich et al., 2015, p. 147). Yet little is known about how whole-person wellness resources can be targeted to alleviate residents’ stressors or the effectiveness of such initiatives. Thus, we ask the following research question:
Method
Qualitative research methods are recommended for discovering “processes and nuances under investigation” (Kreiner, Hollensbe, & Sheep, 2009, p. 707; emphasis in original). Because we are interested in the process of stress and wellness, a qualitative study design was employed. The site chosen for this study was a 248-bed pediatric teaching hospital, with a 55-person residency program, in a large southwestern U.S. city. We chose this particular site and sample of residents because of the relatively large resident pool in each class, and administration expressed interest in conducting a study on their current resident wellness initiatives.
Data Collection
Data were collected from January to March 2016. We used a variety of data collection methods in this study to gain a comprehensive and triangulated understanding of stress and wellness communication at this particular hospital. Although focus groups were the primary data analyzed for this study, organizational documents and observational sessions were imperative to grounding our research team in residents’ day-to-day experiences and were essential in guiding and crafting the focus group schedule of questions. We present our data collection techniques in the order in which they occurred.
Document analysis
First, to situate this work within organizational practices and policies, we reviewed all archival data on stress and wellness information provided to the residents by the hospital in early January 2016. For example, this hospital documented the wellness initiatives in place (see Table 1), such as quarterly resilience lectures, a wellness scavenger hunt, peer mentoring, and “end-of-block” social events. WWP initiatives took place during and after work hours, with at least one wellness activity occurring each week. Residents were informed about wellness activities through weekly emails and text messages from the chief residents, and face-to-face announcements at the monthly resident meetings.
Formal Wellness Resources Provided in the Workplace Wellness Program.
Observations
Second, as stressors arise through the person–environment relationship, it was important to see firsthand how residents operated within their work environment. Upon obtaining informed consent from participants, the first author took an observer-as-participant stance (Gold, 1957) and conducted 35 observational hours with 20 residents from January to mid-February 2016. According to Lindlof and Taylor (2011), the observer-as-participant approach allows the researchers to “enter a scene, to foster goodwill, and to validate the explanations [participants] generate” (p. 147), as well as to “sample a larger number of incidents, time periods, persons, or groups” (p. 148) than other observational stances.
Residents were selected for observation based on diversity of training year, gender, rotation/work unit, and shift time to obtain a broad sample of experiences. The 10 observational periods ranged from 1.5 to 7 hr and included observations of both individuals and teams across hospital units and shift times. For example, the first author shadowed one senior resident during a Pediatric Intensive Care Unit (PICU) night shift for 2 hr and conducted a 3.5-hr observation of a team of three residents working in day shift “wards” (i.e., the main acute care admission floors). Although most observational time was non-interruptive, occasional requests for clarification or inquiry about feelings occurred. Out of the 20 observation participants, eight were first-year residents (40%), eight were second-year residents (40%), and four were in their third and final year of the residency program (20%). Seventeen participants were female (83%), and the remaining identified as male (17%). Fifteen observational participants (75%) identified their race/ethnicity as Caucasian, three as Asian American/Pacific Islander (15%), and one as Hispanic/Latino (5%).
In all, observational sessions helped our team begin to unearth how residents’ day-to-day experiences and workflow related to their perceptions of stress and wellness, and observational notes were used to guide subsequent focus group discussions. For example, during observations, the first author noticed “informal” wellness resources that were not part of the residency program’s official WWP were significant to residents’ coping processes. The research team then edited the focus group question guide to include inquiries of both formal and informal wellness resources. Our observations also provided insight into—and clarification of—organizational jargon. As our participants spoke sizably in hospital acronyms and medical terminology, having insight into their language minimized points of clarification, and maximized use of time, during focus group sessions.
Focus groups
Third, in mid-February through March 2016, we led eight focus groups with 34 participants to gain an in-depth understanding of how residents communicate about work stress and wellness and to clarify archival and observational data. The majority of the data collected that addressed the two research questions stemmed from the focus groups. Focus group sessions were held in hospital conference rooms, and they ranged in size from three to six people (two groups of three, three groups of four, two groups of five, and one group of six). Out of the focus group participants, 13 were first-year residents (38%), 10 were second-year residents (29%), and nine were in their third and final year of the residency program (26%). Seven focus group participants were male (21%), and the rest self-identified as female (79%). Twenty-three participants (67%) identified their race/ethnicity as Caucasian, six as Asian American/Pacific Islander (18%), four as Hispanic/Latino (12%), and one as African American (3%). Combining observation and focus group participants (with some overlap in participation occurring), 45 out of 55 residents in the program (82%) participated in the study.
Upon arrival for the focus groups, participants provided consent and selected a pseudonym prior to recording to ensure confidentiality. The focus group schedule contained 22 questions, and 16 were used to guide this study. We asked participants questions such as “What stress do you experience here at work?” “How do you cope with your work stress?” “What wellness resources are available for you to deal with work stress?” “How were WWP resources shared with you?” and “Which workplace wellness resources are helpful/unhelpful for you, and why?”
Data Analysis
All data were transcribed verbatim into 294 single-spaced pages. Thematic analysis was conducted to discern analytical categories that addressed our research questions. This process first involved open coding (Emerson, Fretz, & Shaw, 1995), where we coded any instances of stress and wellness communication in the data. Open codes were largely in vivo or descriptive of what we saw in the data, such as verbatim quotes (e.g., “It’s just the way it is” when talking about stress) or broad categories (e.g., yoga for instances where they talked about WWP yoga classes). Next, we conducted focused coding (Lofland & Lofland, 1995) and collapsed the most frequent and theoretically interesting open codes into more fine-tuned categories. For example, overload, busywork, Wellness Wednesday, and prioritizing work were frequent focused codes in our data set. We then conducted axial coding to better understand the theoretical relationships among the categories. For instance, honing in on the overload code revealed the tension residents felt in both wanting to attend WWP events such as Wellness Wednesday and worrying their attendance would leave them with an even greater workload stress. Throughout the coding process, we organized categories based on theoretical and practical similarity to other categories, leaving us with a total of seven themes and eight subthemes.
To enhance the reliability of our analysis, our research team employed negotiated agreement (Garrison, Cleveland-Innes, Koole, & Kappelman, 2006) at each coding phase, in which we coded transcripts, compared categories, identified any discrepancies in coding, and resolved inconsistencies through discussion and agreement. We followed Owen’s (1984) criteria to guide our coding process and intercoder discussions: (a) recurrence, in which a shared idea or meaning materializes and is salient among participants; (b) repetition, in which key words, phrases, or sentences surface multiple times across participants; and (c) forcefulness, in which words or phrases are stressed vocally by participants. Next, we describe the major findings from our data analysis.
Findings Linking Stressors and Resources
Our findings address the research questions regarding the relationship between residents’ work stress and the WWP. Namely, we sought to discover workplace stressors communicated by residents when a WWP was in place (RQ1) and the role of WWP resources as residents coped with work stress (RQ2).
RQ1: Contextualizing Work Stress
Residents’ workplace stressors serve as important background material that set the stage to understand the connections between organizational and interpersonal resources used in response to their stress. However, as the role of stressors is to contextualize our WWP findings, we present them briefly and clarify the links between these stressors and organizational processes. In addressing RQ1, the analysis revealed two primary categories of stressors communicated by residents: overload and expectations.
Overload
Overload entails a state of “too much” (Eppler & Mengis, 2004). Resident stress stemmed from overload in two ways: task overload and communication overload. First, residents described their daily tasks as a significant source of work stress because they were overloaded with tasks. Residents’ chief complaint was multitasking, or the need to handle multiple tasks near-simultaneously (Stephens & Davis, 2009). Regina, a second-year resident, explained that multitasking led to feelings of defeat and compromised work quality: You’re always pulled in a thousand directions. You have to upset parents who want to talk to you. You have to go see this child who’s in ten-out-of-ten pain and give them some medicine. Meanwhile, your other child is seizing, and a nurse keeps calling because this kid has a rash and that becomes the last thing on your to-do list . . . Oftentimes, nobody is happy with you because you’re just trying to do so much and feel like you can’t do anything well because you’re doing too many things.
Residents also claimed that “busywork” or nonmedical work, such as paperwork like notes on the electronic health record (EHR), dictations, discharges, and placing orders, added frustration to their workday. Moreover, this “busywork” contributed to residents feeling less prepared and aware of clinical practice. Elizabeth, a second-year, female resident, summarized this well: I think when I get the most stressed is when most of my time is spent doing non-medical things . . . Those are days that I go home grumpy, saying that I went to school too long to be a secretary. So then you spend all your time doing those sorts of tasks and don’t have time to be doing actual learning—what we’re supposed to be doing. So then, when medically acute situations come up, sometimes I don’t always feel the most prepared. But I’m really good at putting in orders.
In addition to being overloaded with tasks, residents also felt overloaded by communication demands, a concept we categorized as communication overload. Although task overload entails job demands broadly, communication overload specifically addresses feeling overwhelmed by the quantity and quality of messages and communication tools (Stephens et al., 2017). Thus, communication overload taps into communication and organizing processes that induced feelings of stress.
Residents highlighted their stress arose from physically carrying multiple communication devices, similar to Stephens and colleagues’ (2017) theorization of “using many ICTs” (p. 278). Residents at this particular pediatric hospital typically carried, at a minimum, their work mobile phone and personal mobile phone on their person at all times. Some residents carried around tablets, laptops, or a pager phone depending on the unit. Other residents opted to push around computer carts, especially when entering data into the EHR. Residents described managing multiple devices as distracting, as the buzzes and dings sounding from the devices often interrupted their patient care. As Daven, a first-year male, explained, “It’s nothing for me to respond to but it’s just like another bell that goes off in my pocket while I’m thinking about other things and diverts me from something I really need to focus on.”
In addition to being distracted by their information and communications technologies (ICTs), residents also described communication overload as the stress of “feeling responsible to respond” and “piling up of messages” on their devices (Stephens et al., 2017, p. 278). Residents stated how they felt they must be able to respond quickly to each message they received, as it could be an urgent situation. However, this need to respond frequently overwhelmed residents and detracted from their patient care, as there was no way of knowing the urgency of these different communication demands. As Jodie, a first-year female resident, elaborated, You’re getting text messages on your work phone, and all you’re trying to do is take care of this patient. And you’re getting calls from all over for no reason. And sometimes I’m like, really, does this need to be done right now? [It’s] my biggest pet peeve.
Both task and communication overload revealed that even when residents were in a program that offered a WWP, they still identified organizational factors—such as the type of work they had to perform and how they were supposed to communicate—as underlying reasons they experienced stress. Furthermore, their work was structured to reinforce overload stress, which had become an assumed aspect of organizational life. Although health care professionals are trying to address some of the structural issues found in medical graduate education (i.e., ACGME, 2017; Asch et al., 2017), and scholars are advocating for WWPs (Daskivich et al., 2015), these findings suggest that residents still feel overloaded, a key part of the stress they reported.
Expectations
A second overarching stressor identified by residents was expectations—from themselves, patients and families, their work colleagues, and the institution of medicine. Once again, we found that despite being in an organization that offered a WWP, these residents reported extreme levels of stress. Residents in all focus groups remarked on the high expectations they placed on themselves, specifically their need to be right and fear of making a mistake. For example, second-year resident Lynn said, “I do give myself a lot of expectations, and I feel like I move really slowly because I double check things that I do because I’m so scared of making a mistake and not showing that I’m great.” Similarly, some residents explained how the symbolic meaning attached to the title of “doctor” affected their own expectations. As Caleb, a first-year male, described, Now that someone is calling me a doctor and I’m calling myself a doctor I want to be what people expect a doctor to be. I want to know everything, and I know that’s not realistic at this point in my training, but there’s this disconnect between what I know should be going on and what I expect from myself.
Residents’ stress associated with perceptions of others’ expectations also permeated our data. Residents commented that they felt patients’ family members often expected them to provide answers to all of their questions, which was overwhelming to these newly minted doctors. First-year female Ritu noted, “It’s not that long ago we were just med students and now we’re quote-unquote ‘physicians’, right? And we’re expected by families to know everything, and that’s not fair.” Residents felt patients’ families seldom understood their sick child was one of many under the residents’ care, so the expectation of immediate responses seemed unreasonable to residents.
Expectations arising from misunderstandings in interprofessional differences and communication also contributed to their stress. Residents felt nurses misunderstood important details concerning residents’ job roles, such as being unaware of how many patients were under each resident’s care. Nurses at this hospital were responsible for three to six patients at a time, while residents coordinated the care of anywhere from three to 30 patients. Furthermore, residents felt nurses were often unaware of the number of different interprofessional conversations—that is, with other nurses, physicians, specialists, pharmacists, and social workers—residents had on a daily basis. Thus, residents’ perceptions of nurses’ expectations, particularly for quick response turnaround, seemed unreasonable to them. As Asher, a first-year male, described, Some nurses get very impatient with, “Have you responded?” or “Can you come see this kid?” . . . And you’re like, “I’m admitting a kid who could potentially [be an emergency].” I feel like they don’t understand what we’re going through, and when we don’t respond to a page within ten minutes, there’s an explanation. None of us see a page and say, “I’m not going to return that.”
Finally, residents were stressed by the need to uphold expectations within the institution of medicine, namely maintaining emotional neutrality and being the ultimate person responsible for patient care. First, residents discussed the institutional norm of being “emotionally neutral” with patients and how upholding this emotional wall often came at a cost. Similar to emotional labor findings (see Grandey, 2000; Larson & Yao, 2005; Miller, Considine, & Garner, 2007), residents described the vagueness of this emotional line—how they were told to connect with patients and have good bedside manners, but also needed to distance themselves and be objective. Max, a second-year male resident, described the stress of this blurriness and the weight of the emotional boundary on his own medical practice: So, there’s this line that everybody talks about that nobody really knows what it is, even though I’ve been reprimanded numerous times about it. “Do not give yourself an out to anyone. Otherwise people are going to abuse it.” “How dare you pray with that family whose kid just passed away?” That to me is more draining than anything else. When I’m told that I’m crossing the line and being essentially a bad doctor because I’m caring more.
In addition to the stress of maintaining an emotional barrier, residents also described the stress of being the ultimate person responsible for patient care. Residents described the challenge of taking ownership of patient care, particularly in situations where they felt like the outcome was not their fault. Residents used phrases such as “I’m the one who takes the bullet,” and they found it challenging to “sit there and take it” and “clean up the pieces” for decisions in which they did not take part.
In all, our analysis of this residency program that had a WWP in place pointed to overload and expectations as primary workplace stressors residents experienced. Specifically, residents were overwhelmed by volume of task and communication demands, as well the mounting pressures to meet the expectations of themselves, their patients, their work colleagues, and the institution of medicine. Although the overload data suggested structural issues in the management of residents and their responsibilities, the expectations data speak to an institutional norm that appeared to be reinforced throughout residents’ medical education. For example, residents came to understand their role as a doctor during their medical school classroom education, and the pressure and expectations they internalized were then fortified through the structural mechanisms of the residency program.
In light of these findings, it is especially noteworthy that the two chief residents were the driving force in establishing a WWP at this hospital. The chiefs were selected residents who stayed a fourth year and were responsible for resident scheduling, management, and programming. Attending physicians (i.e., those who supervised and evaluated residents) supported the chiefs’ vision, but this implementation was not a top-down approach. The chief residents’ goal was to develop WWP resources that helped address some of the stress they had faced during residency. Therefore, in addressing RQ2, we explain the wellness resources available in their residency program.
RQ2: The Role of WWP Resources When Coping With Stress
Resources are individual and collective tools perceived as available for people to draw from when managing stressors. In this particular hospital, the residents had various social, physical, psychological, and spiritual wellness resources available to them as part of their emerging WWP. These whole-person resources are outlined in detail in Table 1. To answer RQ2, we categorize the whole-person wellness resources residents used to cope with their stress: daily resources, occasional resources, as-needed resources, and unused resources. We then outline reasons why residents did not participate in the WWP and conclude by describing residents’ perceptions of wellness as a trade-off.
Daily resources
This category included whole-person tools residents discussed leveraging on an everyday basis. The predominant resource residents drew upon each workday was “each other.” Although not a formal wellness outlet defined by the WWP, residents viewed their coresidents as “sound boards” for emotional concerns, social issues, and medical conundrums. As first-year Ren described, It really helps to have each other . . . Throughout the day to have little moments of venting when stuff happens keeps us sane during the day so that it doesn’t all pile up and you explode at the end of the day.
Residents used the “call room”—a residents-only area filled with couches, computers, and beds—as their main area for venting. In health care, call rooms are spaces for on-call physicians to wait or rest until their service is needed. At this pediatric hospital, residents defined the call room as their “safe space” where they could share hardships and decompress from the work grind. As second-year Ella shared, Our call room [is] the place in the hospital that I feel the most comfortable because that’s where the other residents are, because no one else is in there. There’s no attending, no nurses. [It’s] our little sacred area where we can just complain and talk to each other.
The call room also housed a community whiteboard where residents started writing down the “best of” complaints and pages they received that week, such as admitted patients’ chief complaints being “not hugging/kissing strangers when febrile” and “body slammed by 6-year-old sister.” During observations, first-year Rebecca explained the board provided comedic stress relief and “something to giggle about” on hard days.
Occasional resources
Residents described several WWP activities as occasionally used, meaning they invoked them daily or weekly, so long as their schedule permitted. First, residents occasionally attended Wellness Wednesdays—monthly, 1-hr lunchtime sessions—for social and psychological wellness. These sessions aimed to provide creative, social, and therapeutic outlets to help residents manage stress, with activities ranging from painting to creative writing to peer-support time. Many residents enjoyed the sessions and described them as “approachable.” They claimed it was a time to be with friends, step away from their work, and take their mind off of the workday when they were able. Samuel, a third-year male, described, It’s not medicine, so you’re making a jack-o-lantern or playing a game or doing something [fun]. It’s nice. It’s a time where the residents are together, so it’s more time with your peers to talk and not think about work. I thought it was helpful, just a little breather. I think sometimes we have a tendency to work through lunch, and I think if we have the opportunity it’s nice to be able [to step away].
However, many residents could not attend Wellness Wednesday as frequently as they would like. As first-year Crystal described, “In theory, Wellness Wednesday is a really good idea, but because of our work it’s really hard to go. If you’re able to go, it’s because you’re on a rotation that’s probably not as stressful.” Other residents did not attend Wellness Wednesday because they had a conflicting residency event, such as an attending physician’s academic lecture occurring at the same time, or that particular Wellness Wednesday did not match their coping needs. For example, second-year Regina said, “It does not sound good or fun or enjoyable to me to go talk about my stresses and how my life is going.”
Another occasionally used social resource was the wellness scavenger hunt, a year-long activity that encouraged residents to get outside the hospital and try new things, such as attend a music festival or go on a hike. Residents received “points” if they completed events with other residents and bonus points if they participated with residents in different cohorts (e.g., an intern and senior resident). The points accrued led to small prizes to encourage participation. Residents like Sheila, a second-year female, discussed how much they enjoyed the wellness scavenger hunt. It gave them an opportunity to explore the city and get to know their fellow residents. However, many residents opted not to participate in the wellness scavenger hunt because participation had to occur after work hours, and many residents felt their time off could be better spent. As Jenny, a third-year female resident, described, “I feel like it’s usually our personal time that gets carved out for these activities and I’d rather choose to do what I want to do. I’m sure if I went I would have fun but I’d rather do something else.”
A third occasional social resource was the end-of-block social. Once a month, residents would meet up after the day shift to “eat, drink, and be merry” with fellow residents. Many residents identified the end-of-block social as a time where they relaxed and caught up with fellow residents. Second-year Shandy talked about socials as no-work zones: We try not to talk about work. I don’t think socials are the place for that. I think it’s just to have fun and get to know each other more on a personal level . . . just stay more positive.
Other residents echoed Shandy’s sentiments of the social as an escape from the work grind and an opportunity to get to know their colleagues. Some residents said they opted not to go to the social because they were extremely tired from their shift. Others had to work and stated it was too difficult to get to the social because their shift ended at a different time or the social location was too far away. Residents working night shift could not attend because the social occurred during their shift time.
To take care of physical needs and relieve stress, residents discussed the hospital gym that was available for them to use. One resident mentioned getting to work at 4:30 a.m., so she had time to work out before her shift started at 6 a.m. Other residents said they liked to exercise on their own time when they were off duty, but this time was difficult to fit in because it meant sacrifices in other areas, such as time with family or time for sleep.
Residents also listed outlets that were not sanctioned by the WWP as occasionally used, particularly in relation to their psychological wellness. First, each focus group named the two chief residents as sources for psychological care. Residents mentioned the chief residents were wonderful systems of support, had a “door-always-open” policy, and made it easy for residents to share the challenges they were facing. However, as second-year, female resident Regina noted, having chief residents as a source of psychological wellness was not always the case—it was entirely dependent on the chief residents in place for the year and the relationships they aimed to build with the residents. As the chief residents at the time of this study had an active commitment to resident wellness, made it clear that well-being was one of their main priorities, and established a peer-like rapport, residents felt the chiefs were a safe space to discuss their stress.
For spiritual wellness, residents discussed the hospital’s tranquility garden as a resource to cope with stress and restore their spirit. The tranquility garden was designed as a quiet space for patients, families, and hospital employees to experience solitude and internal connectedness. Some residents claimed the tranquility garden was a refreshing mental escape from the day when they had the time to visit, but others said the last thing their mind and body needed was tranquility on a stressful day. Those residents mentioned that an “anger room” where they could break things, punch walls, or scream would be more cathartic for them.
As-needed resources
Residents described a few wellness resources as utilized only when absolutely necessary. First, Resilience Rounds occurred once per month over the lunch hour. This psychological and spiritual WWP resource was designed for residents to debrief their stressful patient and training experiences and to help finding meaning in their work. The hospital chaplain moderated the sessions. Some residents stated that although they knew this resource was available, they did not feel like they had experienced anything significant enough to attend the sessions and get help from the chaplain. “If things got bad enough” was a common phrase used by residents for help seeking, particularly when it came to attending Resilience Rounds.
When stuck in an academic or professional rut, residents mentioned seeking out their assigned academic advisors or attending physicians they respected to assist them with job and career concerns, but these relationships constituted a non-WWP resource. During observations at this hospital, we saw a specialist holding an impromptu kidney lecture with two senior residents who needed additional help on the renal portion of the medical board exams. However, most residents did not find it appropriate to discuss topics beyond academics with attending physicians and advisors. As second-year female Kaila described, “I don’t think I’d feel comfortable going to my faculty mentor about . . . my emotions. The role of my faculty mentor has been more so mentoring for getting a job and getting a career.”
Unused resources
Finally, participants never used some of the wellness resources. For example, the hospital offered a yoga class once a week at 5 p.m. for physical and spiritual wellness. Many residents were interested in attending the session, but they could never go. Residents got off of or started their shifts at 6 p.m., meaning the yoga classes were only attended by nurses and other professionals whose shifts ended by 5 p.m.
Formal peer mentoring was another unused psychological and social resource in the WWP. Interns were matched with senior resident mentors at the start of each academic year. Mentorship pairings were based on interests or similarities (e.g., residents with children, residents interested in a specific specialty, residents from out of state). Pairs were encouraged to meet up and help each other throughout the year. However, not a single resident mentioned the mentorship program as something in which they participated. When probed during focus groups about participation in this program, residents stated that they did not participate because of their busy schedules. Instead, they found camaraderie with residents they knew well or worked with on the same rotation.
Barriers to WWP participation
Most of the residents in this study utilized wellness resources to some degree, citing spatial limitations (e.g., working an outpatient shift across town), time constraints (e.g., their scheduled shift hour or taking up personal time), and different coping needs (e.g., preferring an “anger room” over the tranquility garden) as reasons for nonparticipation. However, approximately one third of the residents in our study did not utilize any wellness resources whatsoever to cope with their stress. Here, we outline additional reasons why residents did not participate in the WWP.
Stress as unaddressed and unfixable
Many participants commented that the WWP was not aimed to address their everyday stressors. Those who participated in the WWP claimed the resources were an escape and a way to avoid their daily work stress, but nonparticipating residents claimed WWP initiatives did not tackle their overload and expectation stressors. When asked to evaluate the WWP, first-year Nicolette stated, “I don’t think it’s helping. I mean, clearly it’s not helping because people are so upset and crying and wanting to go to counseling. I mean clearly that’s not a normal thing.” Moreover, many residents viewed their work stress as an inherent part of the job. As first-year Ren claimed, I feel like everyone knows that those stresses exist and it’s kind of unspoken, like no one talks about it . . . [Our stress] is not an issue that’s actively identified . . . I just figured it was part of the deal, like when you go to residency you get this [stress] and everyone expects it and that’s why they haven’t [addressed our stressors].
Residents who felt their work stress was unaddressed by the WWP often viewed their wellness as their own responsibility. For example, residents mentioned their psychological health suffered because of their overload and expectation stress, but being psychologically healthy fell on them to improve. As first-year Amy described, It’d be helpful if they offered us someone to talk to, like have a therapist around. But [with the way the program is now] you have to do it on your own. And you really can’t make a standing appointment with anyone [given our schedule].
Other nonparticipating residents described their stress as unfixable, making statements such as “it’s just the way it is” and “it’s the nature we live in.” These residents, like second-year Hannah, felt they had two options: accept the stress and keep going through the motions, or quit the program. In addition, residents articulated that the stress they experienced was not something a WWP could alleviate. As third-year Audra explained, “There’s no way to change the work hours, or how many patients you’re carrying, or what the culture of coping in medicine is.” Second-year Sara echoed Audra’s viewpoint: “I don’t know if anything is going to truly help because you still have to get though [the day]. I feel like the culture in medicine is one of like you just have to like grin and bear it.” Indeed, residents talked about their predecessors as “having it far worse” in residency and described an “unsaid rule about complaining to superiors” or asking for help, in fear of appearing weak.
Prioritizing work over wellness
The final, and most predominant, reason residents did not participate in wellness initiatives was because of their workload. As Asher, a first-year male resident, explained, “The encouragement [to participate in the WWP] is there, it’s just the [work] schedule. The reality of it is you don’t really have that option [to attend] so much without making a sacrifice to something.” Wellness and work often appeared at odds in our data set, and in every instance, work responsibilities won. Jacquelyn, a second-year female, stated, “My [work] obligations obviously were a lot more high priority . . . than the [wellness activities].” Lynn, another second-year female, reported similar concerns: Only a few people come [to the WWP] because of our busy schedules . . . If you have a bunch of notes to write and you know you need to get them done . . . you get your notes done. You get your job done.
Other residents discussed wellness involvement as a trade-off. By participating in wellness events, they missed out on work responsibilities or vital learning opportunities. When they missed out on these work activities, they felt even more stressed. Thus, instead of wellness resources alleviating stress, many residents in our study claimed participation in the program actually contributed to their stress. As third-year female resident, Dora, described, You’re there [at Wellness Wednesday] and you’re getting paged and then you’re like . . . this hour that I’m sitting here, that’s just one hour out of [my] workday that [I] really need. So you’re stressed out even though you’re there. A lot of times, it’s like, “Oh man, I really should’ve been working all this time instead of being here.”
Yet, almost paradoxically, nonparticipating residents also stated that even though they usually did not utilize the wellness resources, it was meaningful that the WWP existed. As second-year Elizabeth described, “I appreciate that they think about us and arrange the monthly socials, even if, to be quite honest, you don’t attend . . . It just shows that our chief residents are very supportive of us.”
Summary of Findings That Reveal the Stress and WWP Disconnect
Our findings suggest a partial disconnect between the reported reasons residents felt stressed and the WWP resources available to them. Overload-related stressors were primarily structural issues related to both their workload and how communication technology tools were used in their work environment. Expectation-related stressors, however, revealed institutional norms that were communicatively constructed and reinforced throughout the medical school journey. The intentions behind the WWP resources were to help residents cope with stress, and although they were helpful for some residents, these resources existed at one level of communicative coping—peer support—and did not address the structural or institutional stressors residents experienced.
Discussion
This study explores (missed) connections between stress and WWP participation, and it advances ideas to help reconceptualize workplace wellness. Although past research has suggested that WWPs can be a solution to employee stress (Sangachin & Cavuoto, 2018), we find that unless WWPs acknowledge the organizational constraints employees face, these programs can instead perpetuate work stress. Our findings suggest that for WWPs to be successful—particularly among employees with little job control and schedule flexibility—they must meet people where they are: Wellness needs to be accessible, individualized, and integrated into the daily practices of a stressful work environment. Furthermore, wellness resources cannot ignore structural and institutional issues. To propel this argument, we first outline the theoretical implications of our work and proffer our contribution of wellness-in-practice. We then outline the practical implications of wellness-in-practice and conclude with study limitations and directions for future research.
Theoretical Implications
Our study found that residents felt overwhelmed by their task and communication load, as well as their desire to meet self and others’ expectations. When their schedules would allow, some residents attended WWP programming—primarily in the form of social or physical activities—with the intention to escape or avoid the pressures of their work and to commiserate with peers. However, some residents did not utilize the WWP; namely because the current wellness resources did not match their stress and coping needs, they felt they must prioritize their work, or participation in the WWP induced stress as opposed to reduced stress. In other words, residents’ overload and expectation stressors (such as their task list, work colleagues’ expectations, and upholding the cultural norm to “power through it”) blocked them from participating in the WWP. When residents instead chose to attend the WWP to cope with their work stress, some left the activity feeling more stressed: wellness became, as second-year Cindy described, a “double-edged sword.”
Geist-Martin and Scarduzio (2011) claim organizations can fall into a trap when “they offer programs which they believe will enhance the health of employees . . . but at the same time, do nothing to change the working conditions or organizational culture that are inherently stressful” (p. 122). Our findings confirm Geist-Martin and Scarduzio’s argument that having whole-person resources in place does not guarantee wellness. Indeed, residents in our study were constrained by organizational and institutional structures in three ways. First, residents’ schedules prevented them from participating in the WWP. As documented in the yoga class example, residents’ shifts conflicted with scheduled times for wellness activities they wished to attend. In other instances, residents were presented with options scheduled at competing times: either attend a wellness activity or go to an academic event. Participants in every focus groups prioritized academic events over the WWP.
In a similar vein, power dynamics in the hospital also constrained residents’ participation in the WWP. Academic events, for example, were led by attending physicians. Residents wanted to meet their superiors’ expectations, and choosing Wellness Wednesday over an academic lecture did not seem like a wise decision for the residents to make. Furthermore, the powerlessness residents felt in relation to their workload also influenced their WWP participation. Residents described being at the mercy of their patient load and felt they had no agency in prioritizing their self-care and workplace wellness. Just as Wallace and Lemaire (2009) found, participants in our study were “caregivers first and foremost who must look after others before looking after themselves” (p. 550).
Third, our findings point to the culture of medicine as constraining residents’ WWP participation. Perceptions of the “grin and bear it” mentality in medicine deterred residents from taking part in WWP activities. The residents believed that participating in self-care was viewed as a sign of weakness, something they did not need when they were trying to prove themselves. Thus, despite the push in medical literature to reduce stress and promote wellness in residency (Daskivich et al., 2015), our findings reveal instances of residents equating wellness participation to norm-defying help-seeking behavior. Accordingly, the organization reproduced work, not wellness, a finding similar to many critiques of WWPs (see Dailey et al., 2018; James & Zoller, 2018; Zoller, 2003).
Localized symbolic meaning
Yet we also found that this reproduction of work, in the form of a WWP, had symbolic value for residents despite their lack of participation. We explain this finding by viewing their WWP as an emerging ritual (see Koschmann & McDonald, 2015, for a similar argument); it functioned as a symbol of social, physical, psychological, and spiritual wellness by helping the residents feel supported in the whole-person dimensions despite their lack of participation. However, a key feature of established rituals is their agentic power. Rituals transcend the actions of individuals and “make present the full force of the organization—its values, norms, and relations of power” (Koschmann & McDonald, 2015, p. 247). Our findings reveal that the “full organizational force” was lacking in this particular WWP. Residents seldom talked about the “hospital” or the “program” promoting wellness activities. Instead, participants referenced the WWP in relation to specific actors, such as the chief residents or their fellow residents. Thus, the WWP was not discursively constituted as an organizational practice. Rather, it was constructed as a localized, actor-oriented practice designed by chief residents who lacked organizational connection, authority, and legitimacy.
Integrated, informal wellness initiatives
The data also reveal how residents integrated wellness into their daily practices through communicative avenues beyond the WWP. For instance, the predominant wellness resource was “each other” because residents leaned on one another for psychological and social support throughout the workday. We also documented residents taking advantage of space within the organization to cope with stress and foster wellness, such as utilizing the call room to decompress psychologically and socially, or using the tranquility garden as a spiritual spot to breathe and commune with nature. This builds on the work of Real, Bardach, and Bardach (2017), who argue that space—that is, the built environment—matters in the communication practices of health care professionals. Farrell and Geist-Martin (2005) point out individuals “often flourish in informal situations . . . where people feel more at ease to be themselves” (p. 559). In our results, these “informal” and impromptu situations—as well as designated spaces perceived as accessible and acceptable for participants to use—allowed residents to incorporate wellness into their daily work lives. Thus, our findings suggest leveraging a WWP that meets the four whole-person dimensions is not enough to ensure employee well-being and program success. Rather, WWPs must be connected to employees’ daily experiences and conditions of their work.
Toward wellness-in-practice
Linking WWP resources to the employees’ work conditions and the stressors they face is at the heart of how scholars and practitioners can complement the whole-person approach and enhance the effectiveness of WWPs. To build this connection, we proffer the theoretical angle of wellness-in-practice, which we define as integrating wellness into the daily folds of organizational life. Our theoretical contribution is grounded in practice theory (Feldman & Orlikowski, 2011), which focuses on “the everyday activity of organizing in both its routine and improvised forms” and argues that these daily actions are “consequential in producing the structural contours” of the organization (p. 1241). From a practice perspective, recurring actions that people take edify the organization, and the organization mutually constitutes and influences the ongoing actions of organizational members (Feldman & Orlikowski, 2011).
When viewing workplace wellness through a practice lens, as individuals regularly engage with wellness in their everyday work routines, the repeated enactment of wellness affects their ongoing organizational experiences. These experiences, in turn, reconstitute and sustain the organizational structure. Thus, practice bridges the current divide we see in WWP participation by discursively and materially creating organizational structures that address stress and help employees put the four dimensions of whole-person wellness into everyday action. Wellness-in-practice would mean WWP participation is no longer a trade-off or a sign of weakness. Wellness becomes a part of work and helps scaffold organizational members’ days—it is a practice that is created and sustained through the organization, through organizing, and through encouraged informal communication practices.
We see wellness-in-practice is a noun and a verb. It is a construct sustained in the organization through the active doing of wellness by organizational members. By taking a wellness-in-practice approach, wellness becomes engrained in the organizational culture and is appropriated at both the individual and organizational level. This appropriation could, in turn, establish the organizational legitimacy of WWPs and grant agentic power to organizational members as they engage in wellness practices. We realize this is not a simple change for organizations to make, as it requires managerial commitment to begin to address structural barriers to wellness. Furthermore, the expectations-related findings in this study suggest that there are deep institutional barriers to wellness spread throughout the medical education system that need to be addressed. The policies being enacted by the graduate medical education community (e.g., ACGME, 2017) need to be a first step in making a cultural shift, but conversations that reset expectations to a level of achievability must also occur.
At our study site, wellness-in-practice could entail reducing psychological stress by doing actual learning as opposed to busywork, promoting social wellness by establishing transparency and understanding when interprofessional expectations clash and encouraging peer-to-peer communication, or finding time to breathe to remain spiritually grounded and mindful on days with high patient volumes (see Brummans, 2017, for similar arguments and recommendations). As these wellness practices persist over time, they become integrated into the organizational structure. For example, they might transform the residents’ workload and incorporate more academic opportunities, establish expectation setting and open communication among hospital professionals, and normalize deep breathing routines during in-patient rounding. Just as health care practitioners have advocated that the “solutions [to stress] should be focused on how to find fulfillment within work and not just how to escape it” (McKenna, Hasimoto, Maguire, & Bynum, 2016, p. 1197), we argue wellness-in-practice, as a theoretical and practical undertaking, can move organizations away from experiencing wellness as a separate experience (wellness at work) or choosing between work and wellness (wellness or work), and instead move us toward making structural changes that incorporate wellness as a part of employees’ daily, normalized work routines (wellness in work).
Practical Implications
The findings of this study illuminate several practical implications of wellness-in-practice. First, our study points to the importance of engaging all organizational members in the practice and promotion of wellness. At our site, the chief residents created the WWP, and information about—and support for—the WWP came from the chiefs and fellow residents. Interestingly, participants mentioned chief residents and their fellow residents—the two WWP information sources—as their primary wellness support. Other organizational members, like attending physicians, were largely excluded from the wellness conversation. Thus, our findings highlight the “who” of the WWP matters, as receiving wellness messages from only a few organizational sources may be insufficient for wellness-in-practice. Wellness messages coming from multiple organizational members along the chain of command, like attending physicians and program leadership in our study, may change employees’ perceptions of WWP legitimacy and importance, a suggestion congruent with literature on the implementation of planned organizational change (e.g., Lewis, 2011). Moreover, integrating numerous voices into the wellness process may also help embed wellness into the organizational culture.
In addition, our findings point to certain whole-person resources as privileged by residents in the WWP. Residents in our study discussed utilization of social and physical wellness resources far more than psychological and spiritual wellness activities. Indeed, we noticed a “want to” versus a “need to” divide in the data between occasionally used and as-needed WWP resources, as the vast majority of psychological and spiritual wellness tools fell in the as-needed category and were described as available “if things got bad enough.” As the stigmatization of mental illness is a harsh reality across industries (Follmer & Jones, 2018), wellness-in-practice is an opportunity to break stigmatization barriers and make all dimensions of wellness accessible to employees.
Our findings also point to the importance of emotion when creating WWP resources. Residents’ roles can be considered emotion work, as emotional experiences are an integral part of their job (Miller et al., 2007). Yet, there is considerable emotional labor residents needed to employ because showing authentic feelings was viewed as “unhealthy,” and they were taught to suppress their emotions. The most commonly discussed wellness resource was not a formal resource at all: It was having informal conversations with peers. Considering that these informal conversations with coworkers provided considerable social support for these residents, the emotional experiences of their work (Miller et al., 2007) and the quality of interpersonal networks are organizational communication factors that need significant attention as part of the wellness process.
Wellness-in-practice could be a way for employees to tackle their stress and promote wellness in positive, healthy ways. Participants in our study stated that they were “escaping” or “avoiding” their stress by participating in the WWP. Stress and coping research shows that although avoiding stress can be a helpful coping strategy in uncontrollable situations (Folkman & Lazarus, 1980), avoidance coping is often defined as maladaptive (Glanz & Schwartz, 2008) and has been linked to heightened distress and depressive symptoms (Holahan, Moos, Holahan, Brennan, & Schutte, 2005). By taking a wellness-in-practice approach and linking WWPs to employees’ lived experiences and work stressors, WWP participants may feel they have more control over their stress and well-being and potentially engage in more adaptive, problem-focused coping strategies.
Finally our findings show wellness is not a one-size-fits-all concept. Stress literature suggests people address their stress alone, in pairs, or in groups, depending on their preferred coping style (Lyons, Mickelson, Sullivan, & Coyne, 1998). Our site’s WWP primarily focused on using communal gatherings to accomplish wellness goals. Although some participants found group activities acceptable for dealing with stress, others said they prefer engaging in independent wellness activities, such as solo meditation or finding trusted peers to share frustrations. In addition, the timing of WWP activities hindered participation. Many residents commented they wanted to participate, but the wellness activity schedule conflicted with their work schedule. Practitioners should examine how wellness-in-practice can be achieved by providing accessible and diverse resources to meet employees’ stress and coping needs. For example, promoting a personalized mindfulness app and making wellness activities available in the break room are two ways to honor employees’ coping preferences and schedule demands.
Limitations and Future Research
Our study has notable limitations. Namely, we only examined one emerging WWP for one group of residents in a pediatric hospital, and our findings have yet to be applied in other institutions or professions. Furthermore, our findings may be limited to the dimensions of stress and wellness identified. For example, previous studies have identified financial concerns as a source of stress (Sargent et al., 2004) and point to the need for financial wellness. We do, however, see promising transferability of the theoretical and practical contributions to other high-stress and hierarchical work settings. Thus, we view our limitations as a call for future research and an advantage of taking a practice theory lens. By studying wellness-in-practice, we hope scholars can pinpoint communicative activities that ground wellness in employees’ day-to-day experiences and situate wellness within the organization and processes of organizing.
Footnotes
Acknowledgements
We wish to express our gratitude to the research site and participants for opening their doors, minds, and hearts to us. We would also like to thank Associate Editor Boris Brummans and the three anonymous reviewers for their invaluable feedback throughout the review process. Finally, we extend our thanks to the Moody College of Communication and the Center for Health Communication at The University of Texas at Austin for supporting this project.
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) received no financial support for the research, authorship, and/or publication of this article.
