Authors' objectives: The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively.

Authors' results and conclusions: Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or ‘curative’). Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor’s well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support. Phase 3: our ‘Workplace well-being MythBuster’s guide’ provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2. Misaligned well-being solutions can cause harm. It is paramount to prioritise improvements in working environments, instead of well-being ‘add-on’s, and to involve doctors and other relevant staff in identifying problems and in planning how to address these.

Authors' methods: Three inter-related sequential phases of research activity: Phase 1: a typology of interventions and mapping tool to improve hospital doctors’ workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders. Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors’ workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers/practitioners and leaders. Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors’ workplace well-being – drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops. Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR136245

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/PASQ1155

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: United Kingdom

DOI: 10.3310/PASQ1155

Organisation Name: NIHR Health and Social Care Delivery Program

Contact Name: Rhiannon Miller

Contact Email: rhiannon.m@prepress-projects.co.uk