Table 3.

Summary of factors affecting EWH implementation by construct

1. Key factors by construct from the extended Lean Enterprise Transformation model
Construct	Facilitator	Barrier
EWH initiatives	Sites implemented a variety of EWH activities in various formats to engage staff	Sites faced challenges to reach specific groups of employees
Multilevel leadership support	Senior leadership • Provided clear directives for and engaged in strategic planning for EWH • Personally took part in EWH activities Middle management • Understood the importance of employee self-care • Allowed time for staff to engage in EWH activities Program leadership • Drive for results helped achieve program goals • Champions engaged staff by making connections across services • Worked in well-functioning EWH committees	Senior leadership • Did not support giving staff protected time to engage in EWH activities • Turnover at times decreased the level of support for EWH implementation Middle management • Support was not uniform across services within a medical center • Limited or denied employees protected time to engage in EWH • Concerns for staff productivity led to lack of support for EWH Program leadership • Uncertainty about EWH’s place in the organizational structure • Struggles to advocate effectively for program in the absence of formal EWH committee to guide implementation efforts
Alignment	• Leadership facilitated the acquisition of equipment • Leadership provided staff protected time for EWH • Dedicated physical space	• Leadership either denied or prevented resource provision • Lack of protected time prevented staff from engaging in EWH activities • Inadequate space for EWH activities
Integration	• Networks provided direct advocacy and support for local EWH programs • Partnerships/collaborations across services within sites helped with communication and increased awareness	• Perception that networks had little to no direct involvement with local EWH programs • Lack of collaboration between services at some sites hindered engagement in EWH activities
Employee engagement	Employees • Understand the importance of health and well-being • Interest in, enthusiasm for, and receptivity regarding EWH activities • Testimonials, word of mouth and positive feedback Spread of EWH • Synergies across services and departments • Focus on specific services or workgroups	Employees • Religious beliefs preventing participation in EWH activities • Not being used to self-care • Reluctance in the absence of clear guidance for participation • Fear of retaliation or to be misperceived by managers • Conflicts with timing of sessions offering (e.g., after working hours) Spread of EWH • Uneven opportunities to engage in EHW for some services • Lack of awareness or exposure in specific services (e.g., canteen staff)
Communication	• Technology helped build communities and made leadership direct interaction on platforms visible • Clear and consistent messages from senior leadership promote EWH • Inclusion of EWH in new employee orientation and the use of flyers and printed materials at events helped raise awareness and interest in EWH	• Some employees disliked mass emails • Employees who were not added to EWH-specific group lists didn’t receive the information on EWH activities • Limited access to communication tools prevented wider scale information-sharing
Staffing	EWH implementation team • Staff consistency and longer tenure contributes to efficient work • Timely hiring of team members with the right skillsets was valuable • Having a Whole Health department leveraged human resources for EWH	EWH implementation team • Missing key roles due to slow hiring process or site-imposed limitations • Understaffing (e.g., split positions, staff detailed due to COVID-19) • Loss of key implementation roles disrupted established processes that they managed Employees • Staff with heavy workload due to understaffing could not engage in EWH activities
Culture	• Employee-positive culture on self-care motivated employees • Newer staff in sites with mixed culture were enthusiastic about EWH	• Staff with longevity at sites with mixed culture did not embrace EWH • Being in a state or community where culture did not prioritize health • Being at a site where the culture prioritized work duties above all else
2. Emergent factor
Construct	Facilitator	Barrier
Impact of COVID-19 pandemic	• Moving to virtual platforms allowed for inclusion of larger workforce segments • Increased interest in using EWH to help address employees’ burnout	• Limits placed on the types of EWH activities to maintain safety • Human resources were mobilized to address the pandemic and diverted from the EWH program • Shifting priorities reduced traction for EWH, and overall resources made available for EWH activities