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Development of employee well-being initiatives to improve engagement and performance: an innovative study

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Development of employee well-being initiatives to improve engagement and performance: an innovative study

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DEVELOPMENT OF EMPLOYEE WELL-BEING INITIATIVES TO IMPROVE
ENGAGEMENT AND PERFORMANCE:
AN INNOVATION STUDY

By

Marina Serobyan

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2022

Copyright 2022 Marina Serobyan

ii
Dedication
To my family, I could not have achieved this endeavor without you. My amazing parents and
brother, your unconditional love and unwavering support kept me going in the toughest of times
during this journey. I am extremely grateful for all that you have done as I experienced several
difficulties these last few years while simultaneously determined to earn my doctorate. You are
the most precious part of my life and I am forever thankful.
To my dad, you are the sweetest soul I have ever known. You have endured unimaginable pain
and suffering, yet you somehow smile through it all. Your strength and positivity are incredibly
inspiring and have been foundational to my own resilience. I admire your courage, intelligence,
generosity, and above all, your caring heart. I can never fully describe how much I love you as it
is beyond words. Thank you for being who you are.
I would also like to dedicate this to all those aspiring to reach a challenging goal. It may not be
easy but if it is meaningful to you, then it will be worth it. With bravery, commitment, grit, and
grace you can accomplish incredible things. Sometimes our greatest achievements are only
possible if we are willing to step beyond what is comfortable – and I hope that you can give
yourself permission to value the process, not just the outcome.
May love, light, peace and blessings fill up your lives, God bless everyone!

iii
Acknowledgements
I have tremendous gratitude for all those who have contributed in any capacity towards
me being able to experience this gratifying academic advancement. From my professors, to the
research study participants, and everyone in between – each person was an imperative part of this
invaluable process of helping me become a more fruitful scholar. My incredible chair, Dr. Krop,
your dedication to your role is truly remarkable. I can only hope I am able to express the
immense appreciation I have for you, and the high level of knowledge, expertise, and
empowerment you have provided me continuously throughout this journey. You are not only
brilliant intellectually but such a kind and thoughtful person as well, thank you for everything.
My awesome committee members Dr. Datta and Dr. Canny, you have both had such a significant
role in my success. As two of my favorite professors in the program, your genuine devotion,
support, and care was always evident. You are incredibly talented educators, and also, such
wonderful human beings.
My cohort classmates turned friends, I am grateful for each and every one of you. Those
that were just a phone call or message away and still continue to be, I am thankful for special
souls like yourselves for all the encouragement and making this mission more delightful.
The research I have conducted in this study will provide insight and important
information to a hospital that works diligently to render quality patient care, and may possibly
lead to new approaches to improving employee well-being. Additionally, it will hopefully also
contribute to the field of well-being and organizational development in other capacities. This
work has allowed me to merge my knowledge and skills of behavioral science as a
psychotherapist with new abilities that can make a difference on a more macro level via systemic
changes and individual/organizational improvements.

iv
Table of Contents
Dedication ....................................................................................................................................... ii
Acknowledgments .......................................................................................................................... iii
List of Tables ............................................................................................................................... viii
List of Figures ................................................................................................................................ ix
Abstract .......................................................................................................................................... xi
Chapter One: Introduction to the Study ...........................................................................................1
Organizational Context and Mission ...............................................................................................2
Current Performance and Organizational Goal ....................................................................3
Related Literature .................................................................................................................3
Importance of Addressing the Problem ...............................................................................6
Description of Stakeholder Groups ......................................................................................7
Stakeholders Groups’ Performance Goals ...........................................................................8
Stakeholder Group of Focus ................................................................................................9
Purpose of the Study and Research Questions .....................................................................9
Conceptual and Methodological Framework .....................................................................10
Impact of Covid-19 on the Study .......................................................................................10
Organization of the Study ..................................................................................................11
Chapter Two: Review of the Literature .........................................................................................12
Evolution of Ideas on Employee Well-being .....................................................................12
Origination of Workplace Wellness .......................................................................12
Multi-faceted Approaches to Well-being ...............................................................13
Current Concepts of Employee Well-being ...........................................................14
Role of Work-life Balance in Employee Well-being .........................................................17

v
History and Theoretical Definitions of Work-life Balance ....................................17
Implications of Work-life Balance .........................................................................18
Moderators of Work-life Balance ..........................................................................19
Connections Between Employee Well-being and Engagement .........................................21
Understanding Engagement ...................................................................................21
Focus on Personal Resources .................................................................................22
Focus on Job Demands-Resources .........................................................................24
Clark and Estes Framework of Influences on Performance ...............................................25
Assumed Knowledge, Motivation, and Organizational Influences on Performance .........25
Knowledge and Skills ............................................................................................25
Motivational Influences .........................................................................................29
Organizational Influences ......................................................................................32
Conceptual Framework: Interaction of Knowledge, Motivation, and Organization .........36
Conclusion .........................................................................................................................40
Chapter Three: Research Methods .................................................................................................42
Participating Stakeholders and Sample Selection ..............................................................42
Quantitative Data Collection and Instrumentation ............................................................43
Survey ....................................................................................................................44
Survey Procedures .................................................................................................45
Validity and Reliability .......................................................................................................46
Ethics ...................................................................................................................................48
Chapter Four: Results and Findings ...............................................................................................51
Participating Stakeholders .................................................................................................51
Knowledge, Motivation, Organizational Influences Findings ...........................................58

vi
Knowledge Results and Findings ...........................................................................58
Conceptual Knowledge ..............................................................................59
Procedural Knowledge ...............................................................................61
Metacognitive Knowledge .........................................................................63
Summary of Knowledge Findings .............................................................65
Motivation Results and Findings ...........................................................................66
Utility Value ...............................................................................................66
Self-efficacy ...............................................................................................70
Summary of Motivation Findings ..............................................................72
Organizational Findings ........................................................................................73
Cultural Models .........................................................................................74
Cultural Settings.........................................................................................78
Summary Organizational Findings ............................................................83
Chapter Five: Recommendations ...................................................................................................87
Purpose of the Project and Questions ................................................................................88
Recommendations to Address Knowledge, Motivation, Organizational Influences .........88
Knowledge Recommendations ..............................................................................88
Motivation Recommendations ...............................................................................94
Organization Recommendations ............................................................................97
Summary of Knowledge, Motivation, and Organizational Recommendations 104
Integrated Implementation and Evaluation Plan ..............................................................104
Implementation and Evaluation Framework ........................................................105
Level 4: Results and Leading Indicators ..............................................................106
Level 3: Behavior .................................................................................................107

vii
Level 2: Learning .................................................................................................110
Level 1: Reaction .................................................................................................113
Evaluation Tools ..................................................................................................114
Data Analysis and Reporting ...............................................................................114
Summary of the Implementation and Evaluation ................................................115
Limitations and Delimitations ..............................................................................117
Future Research ...................................................................................................118
Conclusion ...........................................................................................................119
References ....................................................................................................................................122
Appendix A ..................................................................................................................................133

viii
List of Tables
Table 1: Organizational Mission, Global Goal and Stakeholder Performance Goals .....................8
Table 2: Knowledge Influences, Types, and Assessments for Knowledge Gap Analysis ............29
Table 3: Assumed Motivation Influence and Motivational Influence Assessments ......................32
Table 4: Assumed Organizational Influences ................................................................................36
Table 5: Knowledge Assets or Needs as Determined by the Data ................................................66
Table 6: Motivational Assets or Needs as Determined by the Data ..............................................73
Table 7: Organizational Assets or Needs as Determined by the Data ...........................................85
Table 8: Summary of Knowledge Influences and Recommendations ...........................................89
Table 9: Summary of Motivation Influences and Recommendations ...........................................94
Table 10: Summary of Organization Influences and Recommendations ......................................98
Table 11: The New World Kirkpatrick Model Four Levels of Evaluation ..................................106
Table 12: Outcomes, Metrics, and Methods for External and Internal Outcomes ......................107
Table 13: Critical Behaviors, Metrics, Methods, and Timing for Evaluation .............................108
Table 14: Required Drivers to Support Critical Behaviors ..........................................................109
Table 15: Evaluation of the Components of Learning for the Program ......................................112
Table 16: Components to Measure Reactions to the Program .....................................................113

ix
List of Figures
Figure 1: Interaction of Stakeholder Knowledge & Motivation within Organizational Cultural ..39
Figure 2: Number of Respondents Per Department .......................................................................53
Figure 3: Respondents Professional Role at TMC .........................................................................54
Figure 4: Number of Years in Current Role ..................................................................................55
Figure 5: Respondents Gender .......................................................................................................56
Figure 6: Respondents Birth Year Ranges .....................................................................................56
Figure 7: Respondents Marital Status ............................................................................................57
Figure 8: Respondents Trained in H3 ............................................................................................58
Figure 9: Frequency of Feeling Stressed or Overwhelmed ...........................................................60
Figure 10: Employees Ability to Identify Sources of Stress ..........................................................61
Figure 11: Knowledge of Well-being Improvement Strategies .....................................................61
Figure 12: Employees Willingness to Expand Well-being Enhancing Skills ................................62
Figure 13: Employees Knowledge of How to Engage in Reflection .............................................63
Figure 14: Factors Influencing Employee Well-being ...................................................................64
Figure 15: Value Seen in Programs and Practices that Enhance Well-being ................................67
Figure 16: Value Seen in Programs and Practices to Improve Performance .................................68
Figure 17: Desire for Additional Programs to Fortify Well-being ................................................69
Figure 18: Types of Well-being Initiatives of Interest to Employees ............................................70
Figure 19: Employees Ability to Develop Skills that Enhance Well-being ..................................71
Figure 20: Impact of Well-being Improvement on Professional Role ...........................................72
Figure 21: Organization Modeling Culture of Well-being ............................................................74
Figure 22: How the Organization Models a Culture Valuing Well-being .....................................75
Figure 23: Department Modeling Behaviors that Promote Well-being .........................................76

x
Figure 24: How the Department Models the Promotion of Well-being ........................................77
Figure 25: Organization Being Perceived as Supportive ...............................................................78
Figure 26: Employee Needs and Well-being Important to the Organization ................................79
Figure 27: Organization Offers Programs Aimed at Improving Well-being .................................81
Figure 28: Importance of Organization Offering Well-being Enhancing Resources ....................82
Figure 29: Additional Programs or Resource to Foster Well-being ..............................................83
Figure 30: Example of Proposed Department Performance Dashboard ......................................115

xi
Abstract
The purpose of this research study was to explore employees’ perceptions of well-being and
examine the implications for improving their well-being as a potential contributing factor to
work engagement and performance. The stakes of employee engagement are high, as it can
impact not only the bottom line but foster creativity and influence quality of service as well as
the image of an organization. Disengagement may be detrimentally consequential on variables
such as employee satisfaction, absenteeism, productivity and retention. Given the substantial
impact of engagement, companies often dedicate efforts into measuring engagement and
understanding the determinants of engagement to address gaps. This innovation study used Clark
and Estes’ (2008) gap analysis conceptual framework to understand employees’ knowledge,
motivation, and organizational (KMO) influences affecting their organization’s implementation
of well-being initiatives aimed at improving employee health, engagement, and, ultimately,
performance. Key findings include that employees need to know how to improve their well-
being at work and the organization needs to model behaviors that promote an organizational
culture of well-being. Based on the needs identified and anticipated future needs,
recommendations for practice were offered along with an implementation and evaluation plan.
Keywords: Employee well-being, engagement, performance, productivity, organizational
change, organizational development, leadership, workplace culture, work-life balance,
wellness, healthcare, psychology.

1
Chapter One: Introduction to the Study
Employee engagement is an essential area of concern for organizations due to its
implications for organizational performance. According to Gallup survey results, 66% of
employees in the United States are not engaged, this figure represents a decline for the first time
in a decade and is continuing to show a downward trend (Harter, 2022). Employee engagement
can be defined as the cognitive, emotional, and behavioral energy an employee directs toward
organizational outcomes (Shuck & Wollard, 2010). Engaged employees are more likely to be
productive (Saks, 2006), remain with their employer (Harter et al., 2002; Saks, 2006; Shuck et
al., 2011), and contribute to overall revenue generation (Harter et al., 2010; Xanthopoulou et al.,
2009). Increasing knowledge of the multitude of factors that can impact engagement is crucial
for individual and collective success.
There is emerging research supporting the connection between employee well-being and
engagement, with well-being identified as an important predictor of engagement, and
subsequently, organizational performance (Wright et al, 2007). Apart from the individual
responsibility an employee carries in well-being improvement, leadership, including supervisors
and managers within an organization, is also a key influencer in fostering a culture of well-being
by supporting, motivating, educating, encouraging and being role-models for health promotion
(Wieneke et al., 2019). There is an opportunity for organizations to realize the role employee
well-being can have on influencing engagement and driving performance and productivity, and
that dedicating strategies aimed at enhancing well-being may be of significant business value.
The American Institute of Stress (2022) reports that work-related stress is estimated to cost
companies in the United States $300 billion a year in lost productivity and absenteeism.
According to the Global Benefits Attitudes’ Survey (2014), 57% of employees who experience

2
high stress levels also report being disengaged. In the 2017 State of the Industry: Employee
Wellbeing, Culture and Engagement Survey conducted by Virgin Pulse, 88% of respondents
(comprised of 620 Human Resources leaders from various industries) reported that they
prioritize increasing employee engagement. However, the survey concluded that there is a lack
of consensus around the strategies to use, indicating a need to bridge the gap between theory and
practice. This research seeks to examine specific strategies related to employee well-being as a
means to improve engagement, and ultimately, employee and organizational outcomes.
Organizational Context and Mission
Thrive Medical Center (TMC, a pseudonym) is a public teaching hospital located in the
Western United States and provides both inpatient and outpatient healthcare services. The
hospital has been operating for over 140 years and has grown to become a 550-bed acute care
facility with more than 1,500 physicians in a multitude of specialties and 1000 medical residents.
The organization employs a staff of approximately 10,000 people. The facility consists of an
emergency department with trauma specialty care, a burn center, surgical services, rehabilitation
and therapy services, radiology, obstetrics, orthopedics, psychiatry, pediatrics, and a spectrum of
other medical services.
The mission of TMC is to be a leading healthcare provider in the community and provide
quality care and education to their patients in a compassionate manner. The organization’s
leadership is comprised of various individuals including a Chief Executive Officer, Chief
Operating Officer, Chief Medical Officer, Chief Quality Officer, Associate Medical Director,
Chief Nursing Officer, Chief Information Officer, and other clinical and non-clinical
departmental directors. Hospital personnel include licensed practitioners such as physicians,
nurses, medical assistants, technicians, and other medical professionals. The organization strives

3
to be an indispensable partner and resource for improving the well-being of its community and
nearby communities.
Current Performance and Organizational Performance Goal
TMC’s goal is to implement at least two new programs aimed at enhancing employee
well-being and improving employee engagement by December of 2023. These initiatives will
integrate activities and practices that foster a positive organizational culture which values the
well-being of employees. A recent organization wide-employee survey collected feedback
pertaining to various aspects of employee job satisfaction, such as relationships with
management and work environment. Furthermore, the survey assessed different areas that
measure levels of employee engagement. The broad overview of publicly shared results
indicated that there are some departments in the hospital where employees are unmotivated and
disengaged. In addition, reports of failing to take action when a problem arises or failing to adapt
to challenging and crisis situations were some of the areas that demonstrated a link between lack
of engagement and poor performance.
TMC has developed an organizational goal that is aligned with its mission to provide
quality care with compassion and respect, improving the well-being of its community. As such,
this performance goal has been formulated to focus on addressing gaps that may be influencing
employee performance, and ultimately, the rendering of patient care. The achievement of this
goal will be measured by administering employee surveys and reviewing the results of these
questionnaires.
Related Literature

Well-being is a complex and multifaceted construct that can encompass several
dimensions ranging from personal factors to organizational conditions. One line of research on

4
employee well-being and performance is rooted in the behavioral, cognitive, and health benefits
of positive feelings and positive perceptions (Isen, 1991; Warr, 2002). This well-being
perspective suggests that the presence of positive emotional states enhances performance and
quality of life. This notion proposes that psychological affect has implications on the broadening
or limiting of available cognitive resources for an individual, which consequently expands
human capital and contributes to performance (Fredrickson & Joiner, 2002). The concept of
positive psychology has gained recognition in organizational psychology with a concentration on
enhancing human resource strengths and psychological capacities for performance improvement
(Luthans, 2002). This relatively newer discipline is described as the scientific study of human
strength and optimal functioning, as opposed to the traditional approach in the field of
psychology focusing on disorder and disease (Seligman & Csikszentmihalyi, 2000). An
additional component posited as essential in this approach is having a sense of purpose that gives
direction and meaning to people’s actions, further enhancing the impact that positive emotions
can have on well-being (Robertson & Cooper, 2010).
Additionally, a significant element within the area of employee well-being is the
construct of work-life balance (WLB), which is a perception-centered concept unique for each
person and dependent on an individual’s life values, goals, and priorities (Kossek et al., 2014).
Dundas (2008) describes WLB as effectively managing work and all other activities that are
important to people such as family, personal development, community activities, voluntary work,
leisure and recreation. WLB is a complex issue that can have profound implications for
employee well-being, and therefore, understanding contributing factors can be essential to
improve individual and organizational performance.
In terms of organizational features, a noteworthy factor related to employee well-being

5
and performance is organizational climate. A primary component of organizational climate is
referred to as psychological climate. That is the employee’s perception of the psychological
impact the work environment has on their own well-being (James & James 1989). Subsequently,
the collective perceptions and shared experiences amongst employees of psychological climate
contribute to the organizational climate (Jones & James, 1989). This concept focuses on
understanding employee perceptions of the organizational environment that influence outcomes
(Brown & Leigh, 1996). The inferences employees make about climate are based on the policies,
practices, procedures, and routines that they are subject to, as well as on the kinds of behaviors
that are expected and that get rewarded and supported. Rafferty and Rose (2001) found a strong
connection between organizational climate and employee outcomes such as stress levels,
absenteeism, and participation.
Related, according to O’Neil and Arendt (2008) employees make decisions about how
hard they will work, how satisfied they are, and how committed they will be to the organization
based on their interpretation of workplace climate. As suggested by Schaufeli (2012), an area
worthy of exploration is the identification of the vital elements within a workplace climate that
foster employee well-being and stimulate their engagement. If these can be identified,
organizations can assess organizational climate and potentially enable leaders to evaluate and
implement strategies to address areas of concern. Moreover, this identification of vital elements
may impact the perspective of human-based initiatives being seen as an “investment” rather than
a “cost.” Organizational change can take root and produce intended results when leaders focus
on the climate of their organizations (Schneider, Brief, & Guzzo, 1996), including a climate of
employee well-being.

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Importance of Addressing the Problem

The problem of employee wellbeing, and ultimately, engagement is important to address
for a variety of reasons. Employee well-being impacts employee health, affects turnover and
retention, and can contribute to the overall culture and climate of the organization. With
mounting research demonstrating that employee well-being has implications for engagement, it
is important to understand how this connection can be beneficial for organizational effectiveness.
According to a Gallup survey in 2015, engaged employees (those that can be described as
involved, committed, and enthusiastic) tend to report that their work benefits them
psychologically. Those that are disengaged (or mentally checked-out and unmotivated), in
contrast, feel that their work lives have a negative impact on their psychological well-being.
Additionally, the Gallup State of the American Workplace report (2019) indicates that employees
find greater work-life balance and better personal well-being to be the second most important
factor for them when considering leaving their job for a different organization. Similarly, a
survey conducted by Pulse (2017) further established that wellness programs support employee
engagement, and additionally, that they had a positive effect on recruitment, retention and overall
company culture.
According to the National Healthcare Retention and RN Staffing Report (2017), the
average annual hospital staff turnover rate in 2017 was 18.2 percent with the healthcare
industry’s turnover to be second worst and the hospitality industry being first. According to this
report, the average cost of turnover across all occupations in the healthcare industry is around
$60,000, although there are significant differences based on position in terms of impact on a
hospital’s bottom line. There are also hidden costs such as reduced quality of care and patient
safety, lost productivity and lowered morale. As reported by the World Health Organization in

7
2000, the consequences of mental health problems in the workplace include, among other
outcomes: poor work performance (including reduction in productivity and output, increase in
error rates, and poor decision-making), an increase in disciplinary problems and absenteeism, a
loss of motivation and commitment, burnout, diminishing returns, and turnover. The employee
workplace experience is an integral part of keeping employees satisfied, and engagement is a
pressing problem that perpetuates turnover rates and needs to be focused on as a retention
strategy. As such, the development of employee well-being strategies and the significance of
engagement for companies are becoming increasingly important.
The impact of employee well-being in healthcare settings highlights the need to
understand job related or environmental factors that can contribute to employee well-being.
Cultivating a culture that emphasizes employee well-being and occupational health can have a
significant impact on organizational performance. Healthcare workers experience higher levels
of work-related stress and higher rates of sickness absence than workers in other sectors (Strauss
et al, 2018). As a provider of services that directly impact patients’ lives, it is important for
healthcare organizations such as TMC to consider strategies that promote employee well-being
and to understand the various implications of a lack of employee well-being. This will enable
TMC to incorporate skills and strategies that can help foster employee well-being. For the health
of organizations, and those in them, there needs to be dedicated strategies integrated into policies
and programs that look to enhance employee well-being.
Description of Stakeholder Groups
TMC is comprised of several groups of individuals that are key to reaching the
organization’s performance goal related to enhancing employee well-being. One key stakeholder
group is the employees of TMC. It is their well-being that is of concern for purposes of this

8
investigation, and they know best what is hindering it or could enhance it. Subsequently, it is
their level of well-being and work-life balance that may potentially be impacting engagement-
related outcomes. A second stakeholder group is the organization’s mid-level managers and
departmental directors. These are the individuals whom the employees directly report to and
support employee development. It is this stakeholder group that employees engage with on a
regular basis. A third stakeholder group is the organization’s senior leadership and executives.
These are the key decision makers who have the capacity to implement new practices and
policies and allocate resources, including those related to employee well-being. Table 1 below
describes the stakeholder performance goals.
Stakeholder Groups’ Performance Goals
Table 1

Organizational Mission, Global Goal and Stakeholder Performance Goals

Organizational Mission
To be a leading healthcare provider in the community and provide quality care and education to
patients in a compassionate manner
Organizational Performance Goal
By December 2023, Thrive Medical Center will implement at least two new programs that
enhance employee well-being and improve engagement.
Employee Goal Mid-level Management and
Departmental Director’s Goal
Senior Leadership’s Goal
By September 2022,
employees will provide input
on their needs related to
enhancing their well-being at
TMC.
By July 2023, mid-level
managers and departmental
directors will work with
employees to design programs
to support their well-being.
By December 2023, senior
leadership will provide
necessary resources to
implement two programs
related to enhancing employee
well-being.

9
Stakeholder Group of Focus
While a complete analysis would involve all stakeholders, for practical purposes, the
stakeholder group of employees were the focus of this study. Specifically, the group of
employees participating in this research study were nurses and nursing staff, which includes
nursing assistants and few administrative personnel from within the nursing unit. Examining this
group of employee’s perceptions of well-being, including work-life balance, helped to better
identify possible influences on their well-being and target strategies to address their specific
needs. This is essential, ultimately, to improve their engagement and performance. It is the
employees who have direct patient interactions and render services that have a significant
bearing on patient outcomes. Employees are the day-to-day face of the organization and their
well-being is of utmost importance for organizational effectiveness and achievement of the
organizational mission.
Purpose of the Study and Research Questions
The purpose of this study was to conduct a needs’ analysis in the areas of knowledge,
motivation, and organizational resources necessary to reach the organizational performance goal
of implementing two new programs to enhance employee well-being, leading to improved
engagement. The analysis began by generating a list of possible needs and then moved to
examining these systematically to focus on actual or validated needs. While a complete needs’
analysis would focus on all stakeholders, for practical purposes, the stakeholder group of focus in
this analysis were Thrive Medical Center’s employees, specifically nursing staff.
The following questions guided this study:

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1) What are employees’ knowledge, motivation and organizational needs related to Thrive
Medical Center achieving its organizational goal of enhancing employee well-being and
improving engagement?
2) What recommendations, based on the current knowledge, motivational and organizational
resources of employees, could help increase employee well-being, and ultimately,
engagement?
Conceptual and Methodological Framework
Clark and Estes’ (2008) gap analysis, a systematic, analytical method that helps to clarify
organizational goals and identify the gap between the actual performance level and the preferred
performance level within an organization, was adapted for an innovation model to examine
stakeholder needs to reach the organizational performance goal of new programs to enhance
employee well-being. Assumed knowledge, motivation and organizational needs were generated
based on personal knowledge and related literature. These needs were assessed using surveys,
literature review and content analysis. Research-based recommendations were offered to address
areas of continuing employee need.
Impact of COVID-19 on the Study
This study was conducted amidst a global and nationwide health pandemic. The initial
attempt to collect data was during a time where the organization was identified to be in a state of
crisis due to a heightened surge of Covid-19 cases which impacted organizational operations
significantly. There were staff shortages and unprecedented events which included managing the
emotional trauma of the pandemic as well as the physical demands of having to help other units
manage Covid-19 patients on an ongoing basis. Large numbers of healthcare workers have left
the profession due to the stress and exhaustion faced during this time. The difficult

11
circumstances facing hospitals, medical centers and employees meant this study needed to be
scaled back as the medical center did not want to burden their employees in any additional way.
At the same time, Covid-19 has shown the importance of focus on healthcare employees’ well-
being. This study, while limited in scope, points to a vital area needing more attention.
Organization of the Study
This study is organized into five chapters. Chapter One introduced the problem of practice
and its importance and provided the organizational context, goals, stakeholder group of focus for
the study, and described the study’s purpose and research questions. Chapter Two provides
literature with a focus on the evolving understanding of employee well-being and contributing
factors to employee well-being and engagement. Additionally, Chapter Two includes a
discussion of the Clark and Estes (2008) conceptual framework guiding the study and the
employee knowledge, motivation, and organizational needs for TMC to reach its performance
goal of implementing two new programs to enhance employee well-being and engagement.
Chapter Three presents the research design and methods for data collection and analysis to
understand employee knowledge, motivation, and organizational needs. Chapter Four discusses
the results and findings. Based on the findings, Chapter Five presents recommendations for
practice for TMC to improve employee well-being and foster their engagement. Chapter Five
also presents a plan for implementation and assessment as well as recommendations for future
research.

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Chapter Two: Review of the Literature
This literature review examines the status of employee well-being and engagement within
the workplace. The review begins with general research regarding key elements that define well-
being, including history, growth, and factors that are believed to impact employee well-being and
engagement. This is followed by an overview of individual and organizational benefits of
employee well-being, along with reviewing work-life balance as a significant aspect of employee
well-being and an area of focus in this current research. The review will also present a discussion
on empirically supported characteristics of employers who have implemented practices that have
demonstrated high employee engagement and retention. Following the general research
literature, the review turns to the Gap Analysis Framework (Clark & Estes, 2008). The Gap
Analysis Framework is used to examine possible knowledge, motivation, and organizational
influences that are affecting employee well-being at Thrive Medical Center (TMC).
Evolution of Ideas on Employee Well-being
As workplace wellness has become an increasingly important area of focus for
organizations, the field has seen significant progress and change. Ideas have evolved from
focusing on physical needs to broader and more holistic concepts to support the workforce and
meet the evolving expectations of a healthy workplace.
Origination of Workplace Wellness
During the 1950s, there was the emergence of Employee Assistance Programs (EAPs), a
wellness-related intervention that companies offered their employees primarily focused on
alcoholism and mental health (Owens, 2006). Worksite wellness programs eventually evolved to
consist of features that focused on more comprehensive offerings such as nutrition and fitness.
The Johnson and Johnson Live for Life program that started in 1979 was one of the first

13
corporate worksite wellness initiatives that served as a prototype for other organizations. This
program focused on collecting health-related data through questionnaires and conducting
physical assessments. The company then provided support and education on behavior
modification tools pertaining to weight control, nutrition, and stress management (Pencak, 1991).
Workplace wellness programs began appearing in academic literature in the early 1980s.
During this time, the articles mainly focused on the effects of physical fitness efforts on workers’
health and performance. In 1982, the Journal of Occupational Health began featuring articles that
discussed how workplace wellness programs could reduce absenteeism and other costs related to
illness. Outside of EAPs, the emphasis of worksite wellness programs in the Unites States were
primarily focused on physical health initiatives, which often resulted in employers providing
fitness and nutrition programs aimed at health promoting behaviors such as exercise and healthy
eating. However, in the late 1980s companies started addressing issues of psychological well-
being as part of a more complete workplace wellness strategy. In 1986, an Occupational Safety
and Health (OSH) movement began emphasizing employees’ mental health. Its purpose was to
address the issue of work-related mental health disorders, which mainly focused on stress-related
illness. This was then followed by another initiative in 1991 known as Managing Depression in
the Workplace, launched by the National Institute of Mental Health (Reardon, 1998).
Multi-faceted Approaches to Well-being
Beginning in the early 1990s, there has been a continuous and gradual shift from a focus
on physical health to increasingly including psychological health as part of well-being. The
American Psychological Association (APA), identifies five elements that should be considered in
workplaces to make it a psychologically healthy workplace or well-being oriented environment.
These included work-life balance, health and safety, employee growth and development,

14
employee recognition and employee involvement. This wide-ranging approach that considers
multiple areas of importance for well-being is a valuable framework for employers to consider
when identifying and evaluating their employee wellness programs. With more organizations
recognizing the importance of including emotional well-being as an important component in
their wellness initiatives, there has been an increase in more far-reaching policies and practices
pertaining to employee well-being.
For example, Hoffman and Kennedy-Armbruster (2015) proposed several best practice
design principles for worksite wellness programs which include leadership support through
modeling and resource allocation; relevant and personalized programs using employee interests
and available aggregate data; partnerships between employees and employers, organizations and
the local community; and comprehensive, evidence-based programs (such as the eight
dimensions of wellness tool which includes emotional, environmental, financial, intellectual,
occupational, physical, social, and spiritual dimensions). Additional principles identified within
this model include implementation that is well planned and coordinated which includes
evaluating for success and accountability, encouraging employee participation, utilizing formal
communication strategies and plan, and making data driven decisions that include measurement,
evaluation, and reporting. This perspective can allow organizations to develop and implement
more informed and integrative programs in efforts to enhance their employees’ well-being as it
supports the notion that well-being should be viewed as a holistic concept comprised of many
factors.
Current Concepts of Employee Well-being
The evolvement of well-being initiatives in the workplace resulting from a focus on
emotional health has led organizations to offer new and creative ways to promote well-being for

15
their employees. One such concept is an emphasis on and prioritization of stress management
programs. Psychological approaches have the potential to provide healthcare workers the
knowledge and skills to recognize stress and to manage it effectively (Strauss et al., 2018).
Employers that offer stress management education and resources help raise employee awareness
of the negative consequences of mismanaged stress and understand the importance of averting
such repercussions by being proactive about engaging in well-being promoting activities.
There are a multitude of activities being taught and used in workplaces that can minimize
the effects of stress, such as meditation and mindfulness as well as teaching self-care strategies
and relaxation techniques (Janssen et al., 2018). Mindfulness is one approach that has gained
tremendous traction in workplace settings. Mindfulness is defined as the awareness that emerges
through paying attention on purpose, in the present moment, and nonjudgmentally to the
unfolding experience moment by moment (Kabat-Zinn, 2003). The flexibility of mindfulness
allows it to be practiced both as a formal meditation as well as an informal practice aimed at
bringing attention and awareness that permeates one’s life in all aspects.
One of the few randomized control trials of mindfulness training in the workplace was
conducted at a Midwestern marketing firm with 60 employee participants being asked to learn
and practice mindfulness skills during a range of activities in a half-day workshop. After
completion of this training, participants were assigned to two groups that either continued to
utilize their learned skills as a daily practice for six weeks post-training, or a group that did not
engage in the extended mindfulness practice program. Longer term practice of mindfulness was
associated with improved work focus, job satisfaction and positive relationship to work (Slutsky
et al., 2019). For healthcare professionals, mindfulness has been found to reduce stress, anxiety,
burnout, and increase resilience (van der Riet et al., 2018). Additionally, mindfulness is

16
associated with a range of other well-being outcomes such as more effective coping strategies
used in stressful situations (Weinstein et al., 2009). The myriad of benefits research supports
related to mindfulness makes it a promising practice to consider in the development and
implementation of organizational well-being initiatives.
Assessing and understanding employee well-being is an important aspect of fostering a
more integrative approach to optimizing employees’ well-being. Information can be obtained
through the administration of surveys or questionnaires that examine the needs, interests, and
experiences of the workforce. Examining well-being in the domain of the workplace is often
achieved through measuring affective well-being, which is a multi-dimensional construct that
reflects the frequency in which individuals experience various positive and negative affects
(Diener et al., 1999). Warr (1990) proposed three dimensions of affective, work-related
wellbeing: enthusiasm-depression (measured by engagement and burnout), anxiety-comfort
(measured by occupational stress), and pleasure-displeasure (measured by job satisfaction).
Additionally, Russell (2003) examined subjective well-being (SWB), which is how people
evaluate their lives, through positive and negative types of work-related well-being. Work
engagement, happiness at work, and job satisfaction were identified as positive indicators of
SWB, and workaholism and burnout as negative indicators. As evidenced by these correlations,
it is important for organizations to promote and preserve employee well-being to not only benefit
the individual but the organization’s health as well. In addition, current concepts of employee
well-being have increasingly focused on work-life balance as will be discussed in the following
section.

17
Role of Work-Life Balance in Employee Well-being
Organizations are becoming increasingly aware of the strains employees experience as a
result of the multitude of roles and responsibilities they have. Demonstrating understanding of
this concept and its implications is an imperative component in building and sustaining healthy
workplaces.
History and Theoretical Definitions of Work-Life Balance
The notion that employees may experience conflict between work and other life roles was
originally conceptualized by Kahn in 1964 (Haar & Bardoel, 2008). During this time, the
primary emphasis was on work-family balance, a more traditional label that recognizes these two
role domains as the most demanding of attention and time, and therefore, being most likely to
result in conflict with one another. However, as the field grew many researchers have replaced
the word “family” with “life” and argue that the terms are not interchangeable as “work-family”
oversimplifies people’s work and non-work roles (Yuile et al., 2012). In recognition of people’s
diverse life demands, leisure activities, and social roles, many authors have adopted the more
inclusive term work-life balance (WLB). The concept of WLB is drawn from the
acknowledgement that an individual’s multiple life roles can influence one another, such as non-
work demands impacting work, and consequently impacting health and performance.
Due to its subjectivity, WLB is a broad concept and researchers have defined it in
multiple ways. As such, the literature does not contain one specific definition or a measure of
work-life balance. According to Kalliath and Brough (2008), WLB can be defined as an
individual’s perception that work and non-work activities are compatible and promote growth in
accordance with their life priorities and that they are achieving satisfying experiences in all life
domains. WLB is a perception-centered and holistic concept, unique for each person and

18
dependent on the individual’s life values, priorities, and goals (Kossek et al., 2014). A consensus
of the meaning of WLB may be useful to validate current theoretical models describing the
relationships between common antecedents, moderators and mediators, and outcome variables of
work-life balance (Kalliath & Brough, 2008).
Implications of Work-life Balance
Research recognizes WLB as an important area of focus impacting the employee and
their professional role, and in turn, influencing organizational outcomes. By examining the
relationship between WLB and job satisfaction, life satisfaction, anxiety, and depression, Haar et
al. (2014) found that WLB was positively related to life and job satisfaction and negatively
associated with anxiety and depression. Brough et al. (2014) also reported WLB exhibits
significant negative relationships with work demands, turnover intentions, and psychological
strain, and significant positive relationships with job and family satisfaction. The consequences
can be placed into three groups: work-related outcomes, non-work-related outcomes, and stress-
related outcomes. These outcomes can include dissatisfaction, distress, absenteeism, lateness,
and poor performance.
Moreover, Haar and Bardoel (2008) highlighted the impact of WLB on the individual’s
well-being, as they found that positive spillover (i.e. resulting from reduced work-life conflict)
reduced employees’ psychological distress, while negative spillover (i.e. resulting in increased
work-family conflict) was significantly linked to psychological distress. Employees with higher
life satisfaction reported less psychological distress and was linked to increased job satisfaction
further demonstrating the spillover effect. The multiple demand spillover is bidirectional, it can
be life impacting work and work impacting different areas of life.

19
Additionally, Bell et al. (2012) claimed that when employees perceive high levels of job
stress, such as lack of control or feeling overwhelmed and hassled, this leads to less balance
between work and their personal lives and a decrease in well-being. Another theoretical approach
which delves into personal factors combined with organizational conditions as a determinant of
well-being is the person-environment fit theory, also referred to as the stress perspective. This
approach posits that worker performance and quality of life is hindered when demands exceed or
fall below the employee’s resources (Edwards et al., 1998). This results in the individual
experiencing undesirable states such as strain (when there is too much challenge) or boredom
(when there is not enough challenge).
Findings such as these further suggest the significance of allocating resources towards
WLB improvement. Not doing so may result in individuals experiencing poorer physiological
and psychological health. This, consequently, then leads to an organization experiencing an
increase in the likelihood of employee job dissatisfaction, absenteeism, turnover, and issues
related to productivity and performance.
Moderators of Work-life Balance
As WLB can have significant outcomes on the employee, their professional role, and the
organization, it is relevant to not only focus on factors that contribute to a decrease in WLB, but
also be informed of strategies that can help promote increased feelings of WLB. The evidence
highlights that multiple demands may facilitate, enhance, and enrich WLB outcomes (Rantanen
et al., 2013). Wu et al. (2013) found that organizational support, job value, work time, and
income were job-related correlates of WLB. According to McCarthy et al. (2013) supervisory
and organizational support for WLB are predictors of role conflict, job satisfaction, family
satisfaction and turnover intentions. Moreover, supervisory support enhances employee job

20
attitudes such as job satisfaction and mediates role conflict. Availability of WLB policies and
programs is not sufficient to address WLB outcomes as employees may be reluctant to take
advantage of them, unless the organization or supervisor is perceived to be supportive of them
doing so.
Yuile et al. (2012) report that life friendly policies, such as flexibility in work schedules
and managerial support contribute to employees having a higher level of work-life balance.
Similarly, Abendroth and Dulk (2011) found that having emotional workplace support has
moderating effects on WLB. Further supporting the notion of job-related moderators, Valcour
(2007) asserted that control over work time was positively associated with satisfaction with
work-family balance. Additionally, meaningful work leads to lower levels of absenteeism as
people tend to be more engaged, and the association between meaningfulness and engagement is
strengthened by well-being (Soane et al., 2013).
Zheng et al. (2015) concluded that employee well-being is the responsibility of both
individuals as well as their organizations, and furthermore, that there is a direct effect of
organizational work-life balance policies and programs on improving individual coping abilities.
In their research, overall employee well-being was measured by assessing employees’ perceived
level of stress and perceived level of work-life balance. By analyzing data from the 2014 annual
Australian Social Survey conducted by the Centre for Social Science Research, these researchers
found that personal coping strategies played a significant role in how well individuals deal with
their work and life demands. Individuals with positive attitudes were able to perceive and handle
pressures of competing demands of work and non-work life in a balanced manner. Moreover,
having coping abilities within the work and life interface helped effectively manage various roles
in each domain leading to achieving higher levels of well-being (Pienaar, 2008). Consequently, it

21
would be appropriate for organizations to provide resources in their employee development
programs that are aimed at developing such psychological coping skills. Organizations need to
understand these moderators of work-life balance and employee well-being as research
increasingly demonstrates their effect on employee engagement, and ultimately, organizational
effectiveness.
Connections Between Employee Well-being and Engagement
Employee well-being is comprised of a myriad of factors which may have a significant
impact on productivity and performance. Understanding how well-being is associated with
employee engagement levels is an area of focus that is gaining continued attention in research
and in various workplace settings.
Understanding Engagement
Engagement can be defined as a positive, fulfilling, work-related state of mind that is
characterized by vigor, dedication, and absorption (Schaufeli et al., 2008). Vigor is described as
high levels of energy and mental resilience while working. Dedication refers to being strongly
involved in one’s work and experiencing a sense of significance, enthusiasm, and challenge.
Finally, absorption is characterized by being fully concentrated and happily engrossed in one’s
work. There is supporting evidence suggesting that employee well-being may be a key factor
influencing employee engagement. Though research has often viewed these as two distinctive
and separate constructs, there is growing interest amongst researchers and organizations to
examine these two concepts combined together (Robertson & Cooper, 2010; Buckingham &
Coffman, 1999).
Bakker and Schaufeli (2008) identified the need for positive organizational behavior
(POB) research which they described as the study and application of positively oriented human

22
resource strengths and psychological capacities that can be measured, developed, and effectively
managed for performance improvement in today’s workplace. A study of Dutch employees from
different industries who scored high on the Utrecht Work Engagement Scale showed that
engaged employees have high energy and self-efficacy (Bakker et al., 2008). This helps these
individuals exercise influence over events that impact their lives. For instance, due to their
positive attitude and activity level, engaged employees create their own positive feedback, in
terms of appreciation, recognition, and success. Though these employees report experiencing
tiredness, they attribute this to a result of positive accomplishments. These employees are not
addicted to their work, and they find enjoyment in outside activities. These findings suggest that
improving outlook and attitude may in turn be associated with elevated engagement. Attempts to
enhance employee engagement will achieve limited success if organizations only focus narrowly
on employee’s commitment and citizenship, without seeking to nurture employees’
psychological well-being (Robertson & Cooper, 2010).
Focus on Personal Resources
With research recognizing that well-being is a vital component of employee engagement,
it is relevant to review related factors. According to the Broaden and Build Theory of Positive
Emotions (Fredrickson, 2004), certain positive emotions including, joy, interest and contentment,
all have the capacity to broaden people’s thought-action repertoires and build their personal
resources (which can range from physical and intellectual resources to social and psychological).
For instance, the positive emotion of interest, fosters the desire to explore, assimilate new
information and experiences, and grow. This perspective suggests that positive emotions can
build enduring psychological resources, and therefore, contribute to emotional well-being.
Wright et al. (2007) suggest that these resources provide long-term adaptive value making

23
employees more proactive and less likely to experience stress. This is supported by their findings
from a study of 109 managers which showed the strongest relationship between job satisfaction
and performance were from those reporting a high level of psychological well-being.
Conversely, depressive symptoms are associated with lowered work functioning,
including absences, impaired productivity, and decreased job retention (Beck et al., 2011).
Mauno et al. (2007) found that engaged employees tend to believe that they will experience
positive outcomes (optimism) and believe they can satisfy their needs by participating in roles
within the organization (organizational-based self-esteem). Furthermore, Xanthopoulou et al.
(2007) found that personal resources such as self-efficacy, organizational-based self-esteem and
optimism were predictors of work engagement. These results concluded that engaged employees
are highly self-efficacious in that they believe they can meet demands in a variety of different
contexts. Personal resources are positive self-evaluations that have been linked to resiliency and
refer to an individual’s sense of their ability to control and impact their environment (Hobfoll et
al., 2003). Research has demonstrated that such positive self-appraisals predict goal-setting,
motivation, performance, job and life satisfaction, career ambition, and other desirable outcomes
(Judge et al., 2004).
With higher levels of psychological well-being being directly correlated with
performance, well-being is a strong predictor of job performance and job satisfaction (Wright &
Cropanzano, 2000). In a meta-analysis on the effects of occupational stress management
intervention programs, cognitive behavioral therapy (CBT) interventions consistently produced
larger effects than any other type of intervention (Richardson & Rothstein, 2008). These findings
suggest that CBT is effective in improving work-related stress, depression, and anxiety.
Additionally, CBT has been found to increase work engagement. One of the primary premises of

24
the CBT model is that it encourages individuals to act by themselves to achieve their own goals,
further demonstrating that the development of personal resources may be critical to the
employee’s well-being, and in turn engagement levels (Ojala et al., 2018).
Focus on Job Demands-Resources
In addition to the personal resources model, the antecedents and consequences of work
engagement can be operationalized by examining the job-demands resources (JD-R) model. This
model suggests an important connection between employee well-being and engagement. The JD-
R model posits that job resources can help employees achieve work goals, reduce job demands,
and stimulate personal growth. Job resources such as social support from colleagues and
supervisors, performance feedback, skill variety, and autonomy can all influence engagement
and thus lead to higher performance (Bakker & Demerouti, 2007). These resources have the
strongest positive impact on engagement during times where job demands are high and
challenging (Bakker et al., 2007; Hakanen et al., 2005). Furthermore, job resources can impact
employee well-being by acting as a buffer of job demands on strain (Bakker et al., 2014). The
personal resources perspective suggests that job resources become more salient in conjunction
with individual resources such as optimism, self-efficacy, resilience, and self-esteem
(Xanthopoulou et al., 2007). This further demonstrates how the combination of both personal and
organizational factors contribute to outcomes.
The literature presented suggests an increasing understanding of the significant role of
employee well-being on personal and organizational health as well its connection to employee
engagement. The following section uses the Clark and Estes Gap Analytic Framework (2008) to
look at assumed knowledge, motivation, and organizational influences on employee well-being
within a healthcare organization, TMC.

25
Clark and Estes Framework of Influences on Performance
There is no single overarching theoretical framework for the effects of employee well-
being on work performance, however, there are a wide range of ideas that capture different
aspects of this relationship. Clark and Estes’ (2008) gap analysis, a systematic, analytical method
that helps to clarify organizational goals and identify the gap between the actual performance
level and the preferred performance level within an organization, was adapted in this study as an
innovation model to examine stakeholder needs to reach the organizational performance goal of
creating new programs to enhance employee well-being and improve employee engagement.
Assumed Knowledge, Motivation, and Organizational Influences on Performance
Assumed knowledge, motivation and organizational needs of TMC employees that
influence their well-being were generated based on personal knowledge and related literature.
These assumed needs served as the basis for data collection through a survey instrument and data
analysis and are discussed below.
Knowledge and Skills
There is strong empirical evidence that supports the importance of knowledge and skills
as a significant factor in reaching organizational goals (Rueda, 2011). Clark and Estes’ (2008)
gap analysis framework is designed to understand the root causes of problems of practice by
assessing knowledge and skills as well as motivational and organizational influences on
performance. A gap in any of these areas can hinder goal achievement and, therefore, assessing
these areas can help to improve individual and organizational performance (Clark & Estes,
2008). This section reviews literature that focuses on assumed knowledge-related influences
pertinent to the achievement of the organizational goal for TMC employees by December 2023
to implement at least two new programs aimed at enhancing employee well-being and improving

26
employee engagement. Based on the review of current literature, three assumed employee
knowledge influences related to achievement of this goal are discussed in the following sections.
Krathwohl (2002) categorizes knowledge into four types; factual, conceptual, procedural
and metacognitive. Factual knowledge includes basic elements such as facts, terminology and
definitions. As such, this type of knowledge can be easily accessed through recall (Krathwohl,
2002). Slightly more complex than factual knowledge is conceptual knowledge, which involves
understanding classifications, principles, and theories. The third type, procedural knowledge, is
knowing the actual process for how to perform a task. Lastly, metacognitive knowledge is having
awareness and knowledge about one’s own cognition. This involves being able to evaluate the
strengths and challenges one is facing and engage in self-reflection. Rueda (2011) explains that
metacognition allows one to know when and why to do something. Consequently, metacognitive
knowledge can be essential in allowing employees to be aware of their own mental processes and
solve problems.
This section discusses three assumed knowledge needs, one conceptual need, one
procedural need and one metacognitive need, for employees to engage in activities related to
improving their well-being as shown in Table 2.
Need to Know What Factors Impact Their Well-Being at Work
Employees need to know what factors may produce undesirable experiences such as
burnout that can impact their well-being and engagement. In an effort to improve wellbeing and
work-life balance employees need to have increased insight and understanding of the myriad of
factors that can influence these areas. This is categorized as conceptual knowledge as it would
involve knowing about a variety of states and conditions that may combine to compromise their
wellbeing. Research suggests that job demands are one of the primary antecedents related to

27
employee stress and burnout, and this state of emotional exhaustion consequently impacts
employee engagement (Bakker et al., 2014). Fernet et al. (2013) found that psychological
mechanisms such as perceived autonomy and competence can also be liable for explaining how
job characteristics contribute to burnout.
Additionally, Kossek et al. (2014) concluded that it is important for employees to identify
their conceptual understanding of “balance” as it can vary in meaning from one individual to
another. For instance, these researchers described two different interpretations; one is defined as
an equal allocation of time and energy for work and other life activities, whereas others have
described it as an allocation of time and energy based on the individual’s personal values and
needs (Kossek et al., 2014). This knowledge influence can be assessed through collecting data
about the employee’s perceptions of factors that are currently negatively, or positively, impacting
their well-being.
Need to Know How to Improve Their Well-Being at Work
Employees need to know how to improve their well-being and engage in practices that
promote work-life balance. This type of procedural knowledge is important to consider as it will
allow employees to both guide the organization towards programs that enhance their well-being
and implement effective strategies into their own lives. In addition to a positive organizational
culture and the offering of ongoing organizational support, there are a myriad of personal skills
that can help foster well-being and work-life balance. According to Bakker et al., (2014), it is
important for employees to know about recovery training efforts to counterbalance work-related
stress by engaging in remedial measures such as mindfulness, meditation, and relaxation
techniques.

28
The work of Malinowski and Lim (2015) examined the relationship between
dispositional mindfulness and work engagement. These researchers included positive affect and
psychological capital (i.e. hope, self-efficacy, resiliency, optimism) as mediators because both
have been implicated in promoting work engagement and well-being. Knowing how to manage,
recover, and strategize to promote well-being is procedural knowledge. This knowledge
influence can be assessed by asking employees to how they engage in strategies that increase
their sense of well-being.
Need to Know How to Reflect on Their Workplace Well-Being
To promote well-being, employees need to engage in reflection around their own well-
being and the various experiences that positively or negatively contribute to their wellness in the
workplace. This type of reflective knowledge is metacognitive. According to Rueda (2011),
metacognitive knowledge is a key aspect of strategic behavior in solving problems and allows
one to consider contextual and conditional aspects of an activity or problem. For instance,
employees with poor well-being may perceive the work environment negatively and this leads to
poor work outcomes (Innanen et al., 2014). Moreover, Innanen et al. found that achievement
optimism was associated with high work engagement and low burnout, further supporting that
individual factors can influence work-related outcomes.
Kossek et al. (2014) found evidence which supports that employees are being asked to
work harder, faster and smarter, and, therefore, individuals need to take more responsibility
towards work-life balance rather than relying on organizational initiatives. Part of this
responsibility relates to engaging in self-reflection.
Table 2 below provides the organizational mission, organizational goal, and information
specific to assumed knowledge influences, knowledge types, and knowledge influence

29
assessments. As Table 2 indicates, a combination of conceptual, procedural, and metacognitive
influences were explored as a basis for designing of programs and practices to improve employee
well-being and engagement.
Table 2
Knowledge Influences, Types, and Assessments for Knowledge Gap Analysis

Motivational Influences
Pintrich (2003) describes motivation as the driver that gets individuals moving. Clark and
Estes (2008) suggest that motivation is key to understand related to goal achievement. There are
various factors that can improve or impede motivation. Clark and Estes (2008) identify three
components involved with motivation: active choice, which is initiating an action in pursuit of a
goal; persistence, the ability to continue working towards the goal; and mental effort, the
Organizational Mission
To be a leading healthcare provider in the community and provide quality care and education
to patients in a compassionate manner
Organizational Global Goal
By December 2023, Thrive Medical Center will implement at least two new programs or
practices that enhance employee well-being and improve engagement.

Stakeholder Goal
By September 2022, employees will provide input on their needs related to enhancing their
well-being at TMC.
Assumed Knowledge Influence Knowledge Type Knowledge Influence
Assessment
Employees need to know what
factors impact their well-being at
work.
Declarative
(Conceptual)
Employees will be asked to
identify if they are aware of
factors that affect their well-
being at work and what those
are.
Employees need to know how to
improve their well-being at work.
Procedural Employees will be asked about
their knowledge of strategies that
increase their well-being.
Employees need to know how to
reflect on their own workplace
well-being.
Metacognitive Employees will be asked if they
know how to reflect on factors
that influence their well-being.

30
intensity of effort placed onto achieving the goal. In addition, Weiner (2008) describes how
attributions can impact behavior and motivation. These are an individual’s assumptions or
inferences about a task or goal which, subsequently, impacts their willingness to engage in the
task. Although these perceptions can be inaccurate, they can still impact outcomes since they are
believed to be true by the individual. For this study, two drivers of motivation, utility value and
self-efficacy, were explored to understand employees’ motivation to enhance their own well-
being and to inform the development of new programs at TMC to enhance employee well-being
and improve engagement. Table 3 presents these assumed motivational influences.
Employees Need to See the Value of Engaging in Practices to Benefit Their Well-Being
Utility value is a significant area to consider as it relates to TMC’s goal. The leadership at
TMC has endorsed prioritizing employee well-being and improving employee engagement. To
achieve this goal, employees need to place a high value on engaging with leadership to help
develop practices and programs that enhance their well-being and participating in the initiatives.
The value one places on an activity is influential on what they will commit to and for how long
(Wu et al., 2013).
Eccles (2009) describes two sets of beliefs that influence motivation and achievement.
One is the individual’s expectations of success and the other is the value that they attach to the
task. According to Eccles there are two fundamental motivation questions: “Can I do the task?”
and “Do I want to do the task?” The latter question illustrates the value component within the
model. There are four constructs that are associated with wanting to do the task: 1) intrinsic
interest, the amount of personal enjoyment one expects to experience; 2) attainment value, the
extent that the task is aligned with one’s self-image; 3) utility value, the impact of the task on
one’s immediate or long-term goals; and finally, the associated cost of engaging in the task.

31
Employees Need to Believe They Are Capable of Making Impactful Changes That Will
Improve Their Well-Being
According to Pajares (2008) self-efficacy can be defined as the self-judgment one holds
about their own capabilities related to learning or performing a specific task. The author also
highlights self-efficacy as foundational in human motivation, well-being and personal
accomplishment. Therefore, the belief that one holds about their ability will determine their
willingness to engage in a task or to avoid it.
Self-efficacy is developed in a myriad of ways. The vicarious experiences of others and
modeling can all impact one’s views of their own capabilities (Pajares, 2008). Additionally, it is
believed that positive mood and optimism can also promote self-efficacy (Totawar & Nambudiri,
2014). For instance, if the employees at TMC are optimistic about the use of strategies or
practices that may enhance their well-being, they might also have increased self-efficacy that
they will be capable of undertaking the tasks and making the changes set forth. The belief one
holds will be a determinant of their actions as explained by Bandura (2000). To that effect, there
is somewhat of a causal component related to one’s beliefs, and subsequently, their actions, or
lack thereof.
As Table 3 displays, both value expectancy and self-efficacy are important to consider as
TMC seeks to develop new programs and practices related to employee well-being.

32
Table 3
Assumed Motivation Influence and Motivational Influence Assessments

Organizational Influences
This section focuses on the organizational element of the Clark and Estes (2008) Gap
Analysis Model. The “O” in the KMO framework encompasses specific organizational factors
within the organization’s culture, such as processes, procedures, and resources, that play an
important role in the organization reaching its performance goal (Clark & Estes, 2008). In order
to achieve the organizational goal, the organization needs to focus on its culture. According to
Clark and Estes (2008) the environment of an organization can reveal how an institution aligns
employees’ job functions with its performance goals. In addition, the culture of groups can reveal
how employee beliefs can impact their ability to meet performance goals. In many organizations,
Organizational Mission
To provide quality care with compassion and respect.
Organizational Global Goal
By December 2023, Thrive Medical Center will implement at least two new programs or
practices that enhance employee well-being and improve engagement.

Stakeholder Goal
By September 2022, employees will provide input on their needs related to enhancing their well-
being at TMC.
Motivational Indicator(s)

Assumed Motivation Influences Motivational Influence Assessment

Utility Value:
Employees need to see the value of engaging in
practices that can enhance their well-being.
Survey item will examine employees’ beliefs
about the value they place on organizational
programs designed to improve their well-
being.
Self-efficacy:
Employees need to believe that they are capable
of making impactful changes that can improve
their well-being and workplace engagement.
Survey item will examine employees’
perceived self-confidence related to their
ability to implement meaningful changes for
enhancing their well-being.

33
culture is automated and unconscious (Clark & Estes, 2008), however, if an organization’s
leaders are not aware of the overarching culture, they will not be able to manage it (Schein,
2004).
Organizational culture is the shared values and beliefs among group members which
influence their meaning and purpose (Schein, 2004). Values are defined as shared basic
assumptions which have been adapted and integrated into a group, thereby defining their culture
and how they function. Understanding organizational culture and basic assumptions can guide
group members to develop a shared knowledge and identity as well as potentially improve
performance. An organization’s culture is strong or thriving when employees report being
engaged and empowered, held accountable, and having a clear understanding of company goals,
values, and norms (Ooi & Arumugam, 2006). Scholars have suggested that organizational
features are more influential in increasing employee engagement than an employee’s personal
attributes (Bakker & Demerouti, 2007).
An organization’s culture can be thought of in terms of cultural models and cultural
settings. The cultural models and settings of an organization should not be considered
independent and static, but instead relational and dynamic (Rueda, 2011). The cultural models
found within an organization are the attitudes, beliefs, norms and values that are generally
invisible and automated. Rueda (2011) defines cultural models as the shared mental schema of
how the world functions and shapes how an organization is structured, including values,
practices, policies, and reward structures. Cultural models can be described as tools for the mind
that focus on what is valued, traditions, perceptions, and group held beliefs that are often
automated and hidden (Gallimore & Goldenberg, 2001). Cultural settings, on the other hand, are
concrete, visible manifestations of the cultural models that are apparent in activities, policies, and

34
procedures within the setting. Assumed cultural model and cultural setting influences on the
development of well-being programs at TMC are discussed below.
The Organization Needs to Value Modeling Well-Being as Part of the Organizational Culture
Organizations must go beyond the surface level of mission statements and strategic plans
to change behavior of group members (Clark & Estes, 2008). New programs implemented to
enhance employee well-being and improve engagement may not have the intended impact unless
the organizational culture is one that values employee well-being. To foster change, leadership
needs to exhibit behaviors that demonstrate they value well-being by role modeling and
promoting engaging in well-being enhancing initiatives. For example, performance-focused
cultures frequently place emphasis on achievements rather than employee development and well-
being, rewarding employees for accomplishing objectives that impact the bottom line (Boyce et
al., 2015). This can hinder the development of a culture that prioritizes employee well-being. The
concern for organizational outcomes needs to match the concern for employee well-being
(Browne, 2000)
The Organization Needs to be Perceived as Supportive
Perceived organizational support (POS) is an employee’s belief about the extent to which
the organization values their contributions and cares about their well-being (Eisenberger et al.,
2002). POS may be a time-dependent construct. As employees lived experiences with the
organization change, their POS can evolve as well (Jones & Skarlicki, 2013). POS was found to
be positively related to a range of favorable employees’ work behaviors, such as job
performance, and negatively related to adverse attitudes at work, such as turnover intentions
(Eisenberger & Stinglhamber, 2011). POS may have a positive influence on employees’ work
engagement because it enhances the intrinsic interest in their tasks. Additionally, POS has been

35
found to be correlated to higher levels of job satisfaction and to lower employees’ psychological
strain (Caesens & Stinglhamber, 2014). Research consistently supports the advantages of
employees feeling supported. For TMC to reach its performance goal of enhancing employee
well-being and improving engagement, employees need to perceive TMC as having policies and
procedures related to being a supportive environment.
The Organization Needs to Provide Programs or Resources Aimed at Improving Employee
Well-Being
There are numerous factors that can hinder employee performance and provoke distress.
Organizations that provide resources to help employees manage cognitive overload may prevent
disengagement from their job (May et al., 2004). According to a study by the American
Psychological Association (2016), one in six employees say mental health problems make job
challenges more difficult to handle and a third of them say they typically feel tense or stressed
out during the workday. Furthermore, only four in ten employees (41%) report that their
employer provides resources to help meet mental health needs and even fewer (35%) report
receiving sufficient resources to manage stress.
Providing employees with various skills, tools and strategies that promote emotional
resilience and agility may be essential to promoting a culture of well-being. Options to improve
psychological health can include onsite programs such as attending group coaching and training
programs or individual sessions to learn and develop their knowledge of well-being promoting
practices, for example mindfulness and other cognitive-behavioral strategies. These initiatives
can be beneficial for the employee’s personal functioning, and consequently, impact their work
performance. Table 4 provides the assumed cultural models and cultural settings affecting the
organization in reaching its goal related to employee well-being.

36
Table 4
Assumed Organizational Influences
Conceptual Framework: Interaction of Knowledge, Motivation, and Organization
Maxwell (2013) describes a conceptual framework as a conception or model that
identifies various relationships and factors found within the area being investigated. It is a
tentative theory which informs the design of the study by borrowing constructs previously found
by other researchers. These existing theories contribute to the study being conducted with
limitations, as the actual framework is developed individually and based primarily on the ideas
of the researcher of the current study. Consequently, the conceptual framework recommended
here considers prior research on well-being and its potential implications for employee
engagement. The combination of these previously identified ideas and the researcher’s personal
Organizational Mission
To provide quality care with compassion and respect.
Organizational Global Goal
By December 2023, Thrive Medical Center will implement at least two new programs or
practices that enhance employee well-being and improve engagement.

Stakeholder Goal
By September 2022, employees will provide input on their needs related to enhancing their
well-being at TMC.
Assumed Organizational Influences

Organization Influence Assessment
Cultural Model Influence:
The organization needs to model behavior
that promotes an organizational culture of
well-being.
Survey item will examine employee’s beliefs
about the degree to which they perceive the
organizational culture to be well-being
oriented.

Cultural Setting Influence 1:
The organization needs to be perceived as
supportive.
Survey item will examine employee’s
perceptions about organizational support.

Cultural Setting Influence 2:
The organization needs to offer employee
programs or resources aimed at improving
well-being.
Survey item will examine employee’s needs
and interests related to programs the
organization can offer to help promote their
well-being.

37
beliefs assist in developing the conceptual framework that is most appropriate for Thrive
Medical Center. As such, this constructed framework and the merging of the following world
views further inform this study.
The intersection of philosophical assumptions or worldviews and specific research
methods formulate the approach used to guide research (Creswell, 2014). The worldview that
will frame this current study is constructivism. According to Creswell (2014), constructivism is
the worldview which seeks to construct meaning from and generate explanations about
phenomena, which this study aims to do by exploring factors that may be contributing to the
improvement or hindrance of employee well-being, and furthermore, its implications for
employee engagement. This approach is largely based on the subject’s perceptions of the
situation being investigated. Therefore, the research intends to understand and make meaning
based on other’s views (Creswell, 2014). Subsequently, theories are generated inductively and
grounded in the data that is collected from the participants.
The constructivist approach is applicable in this particular study as it allows the
employees to express how they perceive their own work-life balance and well-being and what
efforts the organization can undertake to improve it. Gathering this information from this
stakeholder group will help the researcher understand the current areas of strength and
continuing need related to enhancing employee well-being and improving engagement.
Furthermore, this data will help construct theories for the possible implications, including on
organizational performance. As such, the increased insight may help guide decisions that can
address any gaps and achieve the organization’s goal of implementing best practices that
improve employee well-being and engagement.

38
While the assumed knowledge, motivation, and organizational influences were
previously presented as independent elements affecting employee engagement, these three areas
of influences are entwined and operate in conjunction of one another. As such, these influences
need to be addressed simultaneously for purposes of goal achievement (Clark & Estes, 2008).
This conceptual framework section presents how knowledge and motivation work together
within Thrive Medical Center’s organizational context to achieve the goal of implementing at
least two programs to enhance employee well-being while also improving engagement. Figure 1
below illustrates this conceptual framework.

39
Figure 1
Interaction of Stakeholder Knowledge and Motivation within Organizational Cultural Models
and Settings

Thrive Medical Center

Cultural models: Communicating
values and modeling behavior.
Cultural settings: Employee support
systems, programs and practices.

Employee well-being

Employee Knowledge
-Declarative/Conceptual: factors
that impact well-being
-Procedural: knowing how to
engage in practices that can
improve their wellbeing
-Metacognitive: reflect on their
various experiences in the
workplace impacting well-being
Employee Motivation
-Utility Value: well-being
initiatives are valuable
-Self-efficacy: believe
capable of making changes
that improve outcomes

Stakeholder Goal
TMC will implement at least two
new programs that enhance
employee well-being and improve
engagement.
Key
Organization
Global goal
Influences
Simultaneous
Interaction
Interaction
leads
to
Goal

40
This figure outlines the relationship between the factors influencing employee well-being
at TMC, leading to the achievement of improved employee well-being influencing employee
engagement and performance. Specifically, in the figure the larger red circle represents TMC as
the organization of study and the cultural settings and models that exist within. Within the
organization, there is the innovation that grounds the subject of this study, the goal of
implementing new programs and practices that enhance well-being leading to improved
engagement, illustrated in the figure as the blue circle. Within the global goal are the knowledge
and motivation influences that contribute to employee engagement in strategies that will improve
their well-being and work-life balance. The knowledge influences include conceptual, procedural
and metacognitive knowledge. The motivation influences include value and self-efficacy. These
influences must interact with each other to achieve the goal (Clark & Estes, 2008).
Demonstrating simultaneous interaction, the connected black circles are addressed concurrently
to work towards the output goal in purple. This conceptual framework offers the tentative theory
that if knowledge, motivation, and organizational influences on employee well-being are
addressed simultaneously, this can possibly lead to increased employee engagement and
improved engagement.
Conclusion
This review of the literature presented an overview of research related to employee well-
being, the multitude of influences that help promote or inhibit it, and its connections to employee
engagement and performance. As the research demonstrates, these different variables can
influence the individual and their professional role in multiple ways while specific factors can
contribute to well-being and engagement issues or help moderate them. Further, evidence was
provided which supports that higher levels of well-being have a positive relationship with

41
employee engagement and organizational outcomes. Research suggests that employers that focus
on employee well-being also have more engaged employees (Innanen et al., 2014). To that end,
it is an important area to further explore to develop both people and environments that prioritize
and promote well-being.

42
Chapter Three: Research Methodology
The purpose of this study was to explore and understand employee knowledge,
motivation, and organizational needs for Thrive Medical Center (TMC) to implement new
programs and practices that enhance employee well-being and improve employee engagement.
Chapter Two documented assumed employee needs at TMC to achieve this and to better
understand their current gaps and assets in their workplace well-being. This chapter will discuss
the methodology that was used to gather data related to the assumed needs. While a complete
needs’ analysis would focus on all stakeholders, for practical purposes the stakeholder group of
focus for this analysis was nursing staff at TMC.
The questions that guided the study are as follows:
1) What are employees’ knowledge, motivation and organizational needs related to Thrive
Medical Center achieving its organizational goal of enhancing employee well-being and
improving engagement?
2) What recommendations, based on the current knowledge, motivational and organizational
resources of employees, could help increase employee well-being, and ultimately,
engagement?
Participating Stakeholders and Sample Selection
The stakeholder population of focus for this study was the employees of Thrive Medical
Center. TMC has approximately 10,000 employees, however this study focused on staff
members from three different nursing units or departments within the organization. Due to
budget, time restraints, and departmental participation limitations, a purposive, non-probability
sampling method was utilized. This sampling approach allowed me to select a specific segment
of the population based on accessibility dependent on departmental managers willingness and

43
interest to participate in the study. The participants professional roles include registered nurses
(RN’s), nursing attendants (NA’s), and supportive staff from the multiple participating units. In
total, the sample size was approximately 180 employees who received the survey from their
respective managers requesting participation. Of the 180 employees, 46 fully completed the
survey.
Quantitative Data Collection and Instrumentation
This study aimed to examine employee needs related to developing specific strategies to
enhance their well-being and ultimately engagement at Thrive Medical Center. For the purpose
of this study, a quantitative approach was utilized that involved the use of a survey instrument.
Quantitative research is the exploration of a phenomenon by collecting numerical data that is
analyzed through the use of mathematical methods. The focus of quantitative research is the use
of sound instruments to collect objective measures and the statistical analysis of that data. A
survey design provides a quantitative or numerical description of trends, attitudes, or opinions of
a population by studying a sample of that population (Creswell, 2014).
A survey was chosen as the method of data collection for this study for several reasons.
First, it provided the opportunity to collect sensitive information in a confidential manner as all
participants submitted their responses anonymously. Consequently, this may increase
participants’ transparency level and may address potential concerns related to responses leading
to unfavorable repercussions, for instance from leadership. Furthermore, a survey allowed for a
large number of responses to be received from a larger sample. Additionally, a survey can be a
diagnostic tool that assists the organization to make data-driven decisions and aid improvement.
Lastly, a survey instrument was the only method deemed most appropriate and allowed by the
organization for this study.

44
Survey
A survey instrument was designed to examine specific components of well-being. The
items focused on employees’ knowledge, motivation and organizational needs related to their
well-being as discussed in Chapter 2. The purpose of the survey was to gain understanding of the
knowledge, motivational and organizational needs of employees as the stakeholder of focus to
develop well-being initiatives that suit their needs. The survey aimed to yield meaningful
information and provide reliable, reproducible, and valid information pertaining to the area of
focus. Developing a good questionnaire has several components and is critical for receiving
accurate responses (Robinson & Leonard, 2019). Using a respondent-centered approach that
places careful attention on comprehension and interpretation as well as time and privacy plays a
large role in avoiding poor quality survey data. Therefore, carefully curating the questions’
wording and response options is essential for sensitive information and to avoid generating
responses that are not useful.
The survey was comprised of eight demographic questions that preceded 21 survey items
aligned with the assumed knowledge, motivation, and organizational influences discussed in
Chapter 2. These items explored employee perceptions of their subjective well-being in the
context of their workplace and assessed their needs to assist with the development of employee
well-being programs and practices. Completion of the survey was designed to take
approximately 10-15 minutes. The survey instrument consisted of statements which research
participants responded to using a four point Likert scale, a rating system that measures opinions
and attitudes about a given topic. This scaling method allowed me to assess the level of
agreement or disagreement the respondent had toward different statements using the following
continuum of response choices: 4-Strongly Agree, 3-Agree, 2-Disagree, and 1-Strongly

45
Disagree. This method of measurement was chosen as it allowed the respondent to have degrees
of opinion. Additionally, there were some survey items that required a response on a frequency
based scale, for instance, “how often do you feel stressed or overwhelmed at work” and the
response choices were 4-Always, 3-Often, 2-Sometimes, and 4-Never. The survey instrument is
included in Appendix A.
Survey Procedures
As part of this cross-sectional study, data were collected at a specific point in time as
determined by the organization being studied. The data were collected electronically using
Qualtrics, an online platform that allows participants to take the survey anonymously. I provided
a link to the survey to a designated staff member, an Emergency Medicine physician who is the
Patient Safety Officer (PSO) at the organization, and this individual then distributed the link to
four nursing managers requesting them to encourage participation from their staff. Each nursing
manager was asked to disseminate the survey to the employees in their respective unit by
sending an email with the invitation to participate and a link to the survey. The message also
included an explanation of the study. I had requested for managers to inform employees that
there would be a two-week period of time allotted to complete the survey and for managers to
send out a reminder email after one week to further promote participation.
I, as requested by the PSO, had limited contact with the managers. I attempted to gather
relevant information through the PSO regarding the initial survey launch period to learn how
many employees had received the survey and if a reminder email encouraging research
participation was sent. After a period of 2 months had elapsed without receiving information
from the nursing managers, the PSO granted permission for me to contact the nursing managers
directly and attempt to gather additional information via both email and phone. This led to

46
establishing contact with 2 nursing managers who shared that they had sent the survey to a total
of 130 employees. Given the constraints on front-line medical workers during the pandemic, of
the four managers, only one manager disseminated the survey link during the initial survey
period in December 2020. Two other nursing managers invited their staff to participate in the
study after the second request for participation was sent again to the managers by the PSO. This
request was sent after three months had elapsed from the initial survey launch, when the hospital
was not in the same state of crisis. One nursing manager, who oversaw the burn unit, stated they
were too overwhelmed by the pandemic to participate at that time. The second dissemination of
the survey led to an additional 29 responses bringing the total number of participants to 46
employees.
Electronic surveys offer an efficient, cost-effective method for data collection and can
allow access to a large sample that targets a population with specific study criteria (Cope, 2014).
This administration approach was appropriate given that it was time-efficient and hospital staff
often have demanding positions which entail direct care services, and consequently, may have
limited time to allocate towards alternate approaches that may be more time consuming.
Therefore, this approach may have promoted participation through its ease and convenience.
Furthermore, the online platform may have resulted in more transparency with responses as it
was self-administered and assured confidentiality.
Validity and Reliability
In quantitative research, reliability refers to repeatability, or the extent to which results of
a data collection instrument provide the same information each time it is used under the same
conditions with the same, or similar subjects (Salkind, 2017). Reliability adds confidence to the
results. Salkind (2017) referred to internal consistency as the degree to which different questions

47
or statements measure the same dimension, construct, or area of interest. Reliability requires use
of standardized collection instruments and survey procedures to enhance consistency.
Validity refers to the accuracy of the measurement. Salkind (2017) stated that validity is
affected by survey design because it is dependent on the survey items measuring what they are
intending to measure. There are different types of validity. Content validity is related to how the
researcher generates questions that reflect all the possible topics and ideas and that crucial areas
not be excluded. To ensure that the survey being utilized was valid, and measured what it was
designed to measure, I asked two individuals who were not partaking in the study to act as test
respondents. This allowed me to assess the clarity of the questions, ability to access the online
survey, and time required to complete the survey. The test respondents had an opportunity to ask
questions while completing the survey. If there were items that required modification, these
would have required an additional test respondent administration, however there were no
concerns reported by the test respondents with the items.
In any set of data there is some possibility of error. Errors in survey data result in poor
reliability and validity. To be reliable and valid, survey information needs to be free from
significant errors (Salkind, 2017). Summary data is an approximation of what would be found if
the entire population was to be examined. Sampling error is the discrepancy between sample and
population values. Sample size and procedures impact the extent of errors related to this. Bias is
also a factor that can create significant error.
In order to maximize reliability and validity of the survey instrument, the researcher
attempted to construct questions that would yield an accurate measure of employee well-being,
and consequently, result in useful data to draw conclusions about this domain and its possible
interaction with engagement and performance. The survey was developed using concepts

48
extracted from the literature. Therefore, face validity was utilized as a means of ensuring
accurate representation of those concepts.
To minimize non-response, I ensured the survey would take under 15 minutes to
complete and designated a response period of up to two weeks after the survey link was emailed
for completion. An additional request for completion was to be emailed as a reminder
encouraging participation one week after the initial email. I also planned to request one final
reminder to be sent three days prior to the close of the survey. However, at the time that this
research study was being conducted there was a global health coronavirus pandemic which
resulted in a crisis situation across the entire region and specifically in healthcare settings. Given
this circumstance, the researcher was unable to gather necessary logistical information on survey
dissemination and received minimal participation after the survey was initially launched.
Consequently, the response period was extended in an effort to accommodate the unforeseen
extenuating situation of the pandemic and provide an opportunity for participation from more
employees. The nursing managers received an additional request for participation from the PSO
which resulted in further survey responses.
Ethics
As the principal investigator of this quantitative research, it was imperative that I made
ethical decisions and ensured that human subjects were protected from harm, had a right to
privacy, understood and granted informed consent, participated voluntarily, and not be deceived
(Merriam & Tisdell, 2016). I am not associated with Thrive Medical Center in any capacity
beyond conducting this research study. Therefore, my efforts within this organization were by
and large from a neutral and non-biased perspective due to having no established prior
relationship with study participants. However, I still assured participants that I was not acting in

49
a monitoring or judging role, but rather as a learner working to gather information on areas that
could help employee and organizational outcomes.
Ensuring that no harm will come to participants, ethical considerations were included in
the interaction with study participants. To deal ethically requires no deceit or pressure (Rubin &
Rubin, 2012). Participation in this study was entirely voluntary and participants were informed
that they could terminate their involvement at any time. Moreover, to facilitate this study
ethically, I treated participants with respect during all interactions, which occurred entirely
through the electronic survey platform, and additionally, all promises that were made were kept.
The University of Southern California (USC) Institutional Review Board (IRB) ensures
that the rights and welfare of participants are protected through informed consent, ensuring
voluntary participation and confidentiality of the data obtained. To ensure the safety of the
participants, I submitted this study to the USC IRB and adhered to their regulations and
guidelines regarding the protection of participants rights and welfare in this study. Informed
consent is necessary to confirm participants are aware their involvement is voluntary and
understand all relevant information about the study and the nature of their participation.
Furthermore, informed consent ensures that participants understand they have the right to
withdraw from the research without any repercussions (Glesne, 2011). Information about
informed consent was provided to participants prior to their involvement and received from
study participants.
To ensure confidentiality, all data were collected electronically without personal
identifiers and maintained the full anonymity of participants. An anonymous survey link was
provided by the researcher to the designated individuals at the organization who were then
responsible for emailing it to prospective participants requesting them to respond to a self-

50
administered survey. The survey data were stored on my password protected computer. To
further ensure privacy, a pseudonym was given to the organization and was utilized in all
instances that refer to it.
Study participants were informed that I as the researcher had no direct benefit or profit
from this study, and that its intent and purpose would be to relay meaningful information to
leadership who would then utilize it as best seen applicable to enact changes and improvements
related to employee well-being. My role in this research was to contribute data that may help
with the implementation of employee well-being initiatives and consequently improve employee
engagement and organizational performance outcomes.

51
Chapter Four: Findings
The purpose of this study was to explore and understand employee knowledge,
motivation, and organizational needs for Thrive Medical Center (TMC) to implement new
programs and practices that enhance employee well-being and improve employee
engagement. This included examining assumed knowledge, motivation, and organizational
influences, identified in the literature review and conceptual framework outlined in Chapter
Two, that may be contributing factors impacting employee well-being, and consequently,
engagement and performance outcomes. The study focused on the needs of employees
related to their well-being to enable Thrive Medical Center (TMC) to reach their
performance goal of developing at least two new programs that support greater employee
well-being and promote engagement. The research questions guiding this study were:
1) What are employees’ knowledge, motivation and organizational influences related to
Thrive Medical Center achieving its organizational goal of enhancing employee well-
being and improving engagement?
2) What recommendations, based on the current knowledge, motivational and organizational
resources of employees could help increase employee well-being, and ultimately,
engagement?
Participating Stakeholders
The stakeholder group for this study were employees of TMC, specifically staff from
nursing units. The participants’ departments that would partake in the survey were selected by
the organization. The study was conducted in the midst of the Covid-19 pandemic, and the
organization did not want to overburden their employees who were front-line medical workers.
The initial invitation to participate at the onset of the study was sent by the Patient Safety Officer

52
(PSO) to four nursing managers requesting them to recruit their staff (unit) into the study and
shared the survey link. Of these four, only one manager disseminated the survey link during the
initial survey launch period in December 2020. This resulted in 17 responses. Two other nursing
managers invited their staff to participate in the study after a second request for participation was
sent again to the managers by the PSO in March 2021. This request was sent after three months
had elapsed from the initial survey launch and the hospital was no longer in a state of crisis. The
second request asking the nursing managers to survey their staff resulted in 38 additional
respondents. Of the four nursing managers that had received the survey link and were
encouraged to invite their staff to participate, one nursing manager did not attempt to recruit their
unit for participation. This manager, who oversees the burn center, stated that they had not
participated as their unit had been too overwhelmed. Therefore, the staff members of three out of
four nursing manager’s units participated in the study. It is not known if the managers sent out a
reminder to participate after their initial invitation was sent to their staff members. The
researcher, as requested by the PSO, had limited contact with the managers and was unable to
obtain additional information.
The participating units were comprised of the Hematology ward (Unit #7B), the Adult
Outpatient Psychiatric Clinic (Unit #2E), and the Neuroscience Department (Unit #4C). Two
participants did not specify in the survey the unit to which they belonged, and therefore, were not
grouped with any unit. The three participating departments total approximately 180 employees
cumulatively. Figure 2 visualizes a breakdown of the participating units and the corresponding
number of responses received. A total of 55 responses were recorded, however nine of these
were disqualified as they had not completed at least 15 questions, or approximately 70% of the
survey. Therefore, this study used quantitative data from 46 completed surveys.

53
Figure 2
Number of Respondents Per Department

The data provided the employees’ professional roles at the organization. The majority of
respondents were registered nurses, followed by nursing attendants, and a few individuals who
held a clerical role. Figure 3 displays information on the employees’ roles, which exhibits that 31
out of 46, or approximately 67% of respondents, were registered nurses making this group the
majority of participants in this study.

54
Figure 3
Respondents Professional Role at TMC

Additional demographic data provided information on respondents’ length of
employment at TMC. The majority of participants had worked over ten years in their current role
and the second leading group in length of employment were in the one to five-year category. As
Figure 4 shows, the third largest category of respondents were newly employed for less than one
year in their current role.

55
Figure 4
Number of Years in Current Role

The respondent’s gender composition was 74% female and 26% male as shown in Figure
5. This gender disparity is consistent with the nursing profession more generally. The age range
of the majority of respondents was between 40 and 54 years old as can be seen in Figure 6.
Additional background data collected provided information on employees’ marital status, which
showed that the majority of respondents, 57%, were either married or in a domestic partnership
followed by the single or never married category, 35%.

56
Figure 5
Respondents Gender

Figure 6
Respondents Birth Year Ranges

57
Figure 7
Respondents marital status

The final demographic question inquired about respondents’ prior participation in a
training program offered by the organization that aims to promote mental health wellness for
employees. This peer to peer support program called Helping Healers Heal (H3) is designed to
help providers manage stress and avoid burnout. As can be seen in Figure 8, only five
respondents had participated in this training program.

58
Figure 8
Respondents Trained in H3

Knowledge, Motivation, and Organizational Influences Findings
Each knowledge, motivation, and organizational findings section below includes a
discussion of the related assumed needs to promote employee well-being and improve employee
engagement and draws key points from the survey data to substantiate the findings, including
graphs and tables provided to present evidence for the findings. In addition, each section ends
with a summary table that presents the assumed knowledge, motivation, or organizational needs
related to employee well-being and whether they were found to be a continuing need (a
definitive area for improvement) or a current asset (an identified strength in improving employee
well-being). If 75% or more of participants suggested in their survey responses that they had the
needed knowledge, motivation or organizational supports to promote their well-being, this was
designated as an asset. The areas of continuing need will be the focus of recommendations for
practice in Chapter 5.
Knowledge Results and Findings
The following section will review the results and findings of knowledge that TMC
employees need as it relates to their well-being. Survey responses suggested the participants have
the knowledge constructs needed, which were conceptual, procedural and metacognitive, to

59
promote their well-being. The survey contained six knowledge related questions that are
discussed below.
Employees Need to Know What Factors Impact Their Well-being at Work
To assess the current state of employees’ knowledge as it relates to their well-being,
participants were asked to share how frequently they experience feeling stressed or overwhelmed
at work. As Figure 9 displays, approximately 70% of respondents expressed that they feel
stressed or overwhelmed “sometimes,” and almost 22% of respondents felt that they are stressed
or overwhelmed “often.” Only four employees reported that they never feel stressed or
overwhelmed. Again, this survey was conducted during the Covid-19 pandemic which may have
influenced these results.
Of the nine participants who reported feeling stressed or overwhelmed often, there was a
nearly equal distribution between being married and single, however, the majority of these
responders were female at 78% and worked 31-40 hours per week. Of the four participants who
reported never feeling stressed or overwhelmed, three had been in their role less than one year
and one participant was between one and five years in their role, possibly indicating a correlation
between number of years worked and levels of stress experienced.

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Figure 9
Frequency of feeling stressed or overwhelmed at work

Gathering information about how often employees feel stressed led to the next item
which examined if employees felt that they are able to identify the source or sources of their
stress effectively when they are feeling overwhelmed. This data helped understand if employees
have knowledge of the factors impacting their well-being at work. The majority of employees
felt that they are competent in identifying where their stress stems from, as Figure 10
summarizes. This may be an important factor when it comes to improving employee well-being,
as their knowledge about the sources of stress may be helpful to design and apply preventative or
remedial measures when necessary. These results indicate that this knowledge area is currently
an asset as 98% of employees have conceptual knowledge of the factors that impact their well-
being at work.

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Figure 10
Ability to identify source of stress when feeling overwhelmed

Employees Need to Know How to Improve Their Well-Being at Work
To examine current knowledge of how to improve their well-being, participants were
asked if they know how to incorporate strategies and practices that can be useful to improving
their emotional well-being at work. The majority of respondents agreed that they know how to
improve their own well-being. As Figure 11 displays, only six employees stated that they do not
have knowledge as it relates to this. The responses did not differ by factors such as professional
role, years in role, gender, marital status or age.
Figure 11
Employees’ knowledge of well-being improvement strategies

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Employees were also asked if they would like to expand their knowledge of skills and
strategies that can be useful to improving their well-being. An overwhelming number of
respondents (98%) agreed that they would like that as presented in Figure 12. Though employees
endorsed having knowledge of well-being improving strategies, as the previous question’s results
revealed, their longing to expand current knowledge suggests this influence as a continuing need
and that providing them with additional tools, programs and support may help to further enhance
their knowledge. This strong desire to further grow their knowledge may be promising for the
implementation of prospective well-being enhancing initiatives. If the respondents had denied
having a need to further expand their knowledge, it may have indicated that future well-being
initiatives may not be as viable for this population due to a lack of perceived need or
receptiveness.
Figure 12
Employees’ willingness to expand well-being enhancing skills

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Employees Need to Know How to Reflect on Their Own Workplace Well-being
When the respondents were asked if they know how to engage in reflective processes
about factors related to their well-being, 93% reported that they believe they know how to
engage in such reflective processes as Figure 13 shows. With an overwhelming number of
employees having this type of metacognitive knowledge, it is a positive indication for the
implementation of well-being initiatives that the employees felt confident in their ability to
reflect on factors that are impacting them. This finding was consistent across unit, years in the
role, gender, age and marital status. All three of the respondents who reported not knowing how
to engage in reflection about their well-being shared the same professional role of RN.
Figure 13
Employees’ knowledge of how to engage in reflective processes

Since knowing how to reflect does not indicate that the employees are actually engaging
in this type of reflection as it relates to their well-being, the participants were next encouraged to
reflect by being asked to state one to two factors that influence their well-being at work. This
open-ended survey item received 34 responses with employees sharing a multitude of reflections
on factors that influence their well-being. These responses can be interpreted as a combination of

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both positive (helpful) and negative (unhelpful) influences, and many were inconclusive as to
how it impacted the employee. For instance, one respondent answered, “family and alcohol,”
while another employee stated, “management and staff,” and it is difficult to determine if these
factors are influencing their well-being positively or negatively. Whereas, another employee’s
response of “helpful co-workers” results in more conclusive information that this likely has a
positive impact for the employee on their well-being. There was a total of 11 employees who
mentioned “co-workers” or “teamwork,” seemingly alluding to this factor as a positive influence.
As seen in Figure 14, there are various factors that employees felt are influencing their well-
being, and they can be interpreted in more than one way.
Figure 14
Factors influencing employee well-being

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Summary of Knowledge Findings
The data provides evidence that TMC employees perceive themselves to be
knowledgeable about factors related to their well-being. Since employees suggest having
knowledge of what factors lead them to feeling stressed or overwhelmed at work, this may help
make it more feasible to develop new programs and trainings to focus on increasing well-being
skills and strategies. Furthermore, employees expressed that they know how to improve their
well-being at work when feeling overwhelmed which may indicate that this foundational
knowledge in the area of well-being can help support their receptiveness to incorporating new
practices as well.
Despite employees’ baseline knowledge related to improving well-being, the
overwhelming majority felt that they would like to expand their current knowledge of well-being
enhancing practices. This suggests that employees endorse the expansion of existing knowledge
as a continuing need and presents the opportunity for providing programs and practices that can
help achieve this. Another important factor in the knowledge domain was to identify employees’
reflection skills and determine if they are reflecting on factors that impact their well-being. The
participants were able to identify possible factors that are influencing their well-being,
suggesting that TMC employees are competent as it relates to reflection or metacognitive
knowledge.

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Table 5
Knowledge Assets or Needs as Determined by the Data
Assumed Knowledge Influence Current Asset or Continuing Need

Employees need to know what Current Asset
factors impact their well-being at work

Employees need to know how to improve Continuing Need
their well-being at work

Employees need to know how to reflect on Current Asset
their own workplace well-being

Motivation Results and Findings
Survey questions examined two employee motivation needs related to TMC
implementing new well-being initiatives to improve employee well-being and engagement,
which were utility value and self-efficacy. The survey contained six motivation-related
questions. If employee responses suggested a lack of utility value or self-efficacy related to their
well-being, then the assumed motivation need was classified as a continuing need. If employee
responses suggested that they had the motivation in question, then the assumed need was
classified as a current asset.
Employees Need to See the Value of Engaging in Practices That Can Enhance Their Well-
Being
To gain understanding about employees’ level of motivation towards initiatives aimed at
improving their well-being, survey items explored their perceptions of how valuable engaging in
well-being practices and programs are for them. This is helpful in determining the utility value of
this influence for the employees, or how much impact it may have on their current or future
goals. When asked to examine the extent to which participants saw value in engaging in practices

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or programs that may help enhance their well-being, 93% strongly agreed or agreed that they saw
value in it, with the exception of three participants who stated that they did not find it to be
valuable as displayed in Figure 15. The three respondents who disagreed shared similarities in
professional role (RN’s), gender (female), and marital status (single/never married). Since only a
small number of participants did not see value in engaging in practices that could enhance their
well-being, it could be coincidental that they shared these demographic characteristics and does
not necessarily imply any meaningful associations for this inquiry.
Figure 15
Value seen in programs and practices that enhance well-being

In addition to assessing employees’ perceived value in engaging in well-being enhancing
initiatives, they were also asked about their motivation towards engaging in programs or
practices that may enhance their performance at work. The slight difference in wording with
these two items led to similar results with the majority of employees seeing value in participating
in programs and practice that may improve their performance at work as shown in Figure 16.

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With both well-being and performance enhancement being seen as valuable to the participants,
this may indicate that employees feel that allocating time and energy toward developing these
skills and attributes is worthwhile for them. Based on the survey responses, employees’ need to
see value in engaging in practices to enhance their well-being is a current asset that may benefit
both the individual’s development and wellness as well as have an impact on performance
improvement and organizational outcomes.
Figure 16
Value seen in programs and practices to improve performance

To further examine employees’ motivation for participating in prospective new
initiatives, respondents were asked if they would like access to additional programs that would
focus on fortifying their well-being. The results for this survey item indicate that employees are

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interested in having additional programs that can enhance their well-being. A high level of
motivation to participate was seen amongst 11 respondents who strongly agreed and 33
respondents who agreed that they would like additional offerings.

Figure 17
Desire for additional programs to fortify well-being

In order for this research to help the organization make informed decisions when
developing new programs to enhance employee well-being, the researcher assessed employees’
specific interests related to different programs and practices. Employees were provided a
selection of options for possible well-being enhancing initiatives and asked to choose which
programs or presentations they would be most interested to participate in if offered. Participants
were allowed to select as many as they would like and also had the option to select “other” and
fill-in their own response. As Figure 18 displays, the results indicated that employees are most

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interested in stress management training (26 respondents) as well as mindfulness training (24
respondents). These results indicate that employees are most interested in trainings versus
receiving personalized coaching to help enhance their well-being.

Figure 18
Types of well-being initiatives employees are interested in

Employees Need to Believe That They are Capable of Making Impactful Changes That Can
Improve Their Well-Being and Workplace Engagement
As part of the motivational needs assessment, participants were asked to explore their
beliefs related to their personal ability to develop new skills and practices that are aimed at

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enhancing their well-being and engagement. This examined respondents perceived self-efficacy
that may impact their level of buy-in for participating in new practices based on the belief that it
is something that they are capable of doing. As Figure 19 presents, the employees expressed a
high level of self-efficacy as it relates to their belief that that they are capable of making
meaningful changes that can contribute to improving their well-being, with a total of 45
participants either agreeing or strongly agreeing and only one respondent strongly disagreeing.
These results may also suggest an increased likelihood that employees will be willing to engage
in new practices, as individuals often undertake tasks that they feel they are capable of
completing and that they see value in, as discussed in the previous section. Of the 13 respondents
who strongly agreed, 10 were female and had been working in their role either less than one year
or between one to five years, with only one respondent being over 10 years.
Figure 19
Employees’ ability to develop skills and practices that can enhance their well-being

Another facet of the motivational influence was to determine if the employees believed
that by improving their well-being, they would be able to perform their professional role and
responsibilities with greater ease. This question aimed to examine the extent to which the

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participants felt that their well-being was associated with their work performance. The data
suggests that the employees saw a significant connection between the two domains, as shown in
Figure 20. All respondents expressed that they believe improving their well-being will impact
how they fulfill their job roles/responsibilities. This may be encouraging for the development of
new well-being practices and programs as employees are endorsing the potential impact of well-
being initiatives on their performance, and subsequently, organizational outcomes. Those that
strongly agreed about the potential for improved well-being to positively impact their
performance were split nearly equally in terms of gender. As participants expressed a belief in
their ability to make changes that can improve their well-being and performance, this assumed
motivation need was determined to be a current asset.
Figure 20
Impact of well-being improvement on professional role

Summary of Motivational Findings
The data provide evidence that TMC employees have motivation towards engaging in
practices that can promote their workplace well-being and performance. Moreover, employees
expressed interest in additional programs that can fortify their well-being. Since over 95% of

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employees endorsed that they see value in enhancing their well-being, this motivational
influence was determined to be a current asset.
Another component of motivation examined the employees’ level of belief in their
capabilities to make changes that could help improve their well-being and engagement. As the
data suggests, TMC employees believe they are capable of making improvements to their well-
being and feel that doing this will help them fulfill their job role with greater ease, further
demonstrating employees’ self-efficacy levels and validating this assumed need as a current
asset.
Table 6
Motivational Assets or Needs as Determined by the Data
Assumed Motivational Influence Current Asset or Continuing Need
Employees need to see the value of Current Asset
engaging in practices that can enhance
their well-being and lead to improved
engagement

Employees need to believe they are capable Current Asset
of making impactful changes that can improve
their well-being and workplace engagement

Organizational Findings
The following section reviews and discusses findings related to the assumed
organizational influences on employee well-being and engagement. Survey questions examined
cultural models and settings that may affect employee well-being, and subsequently, their
engagement. The survey included a total of nine questions that explored organization-related
factors impacting employee well-being. The factors were determined to be current assets if 75%
or more of participants indicated in their survey responses that the organization supported their
well-being in the stated way either “always” or “often.” Other factors that did not meet this

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criterion were designated as continuing needs, meaning more focus is needed there to support
employee well-being.
The Organization Needs to Model Behavior That Promotes an Organizational Culture of
Well-Being
This study used four questions to evaluate whether TMC currently promotes a culture of
employee well-being. Employees were first asked if their workplace currently models or
demonstrates a culture that values well-being. The data revealed that staff are nearly split in their
perceptions of how well their organization models such behaviors, with a total of 25 respondents
strongly agreeing or agreeing that the organization is currently modeling a culture that values
well-being and a total of 21 respondents disagreeing or strongly disagreeing, as shown in Figure
21. With almost half of the employees feeling that the organization does not demonstrate
behaviors that model a culture of well-being, the results suggest that there is a need for the
organization to improve how well they are demonstrating a culture that values well-being.
Figure 21
Organization modeling a culture of well-being

The next survey item asked employees to give one example of how the organization
demonstrates a culture that values well-being. As figure 22 shows, only 18 participants
responded to this open-ended question of which three of them submitted statements that

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supported the notion that the organization does not demonstrate valuing well-being. For example,
one participant wrote that “nobody cares about my emotional state” and the other stated “no
models.” Some of the others who responded to this item stated examples such as “H3,” and
“support system” which were responses identifying examples that do support a culture of well-
being as the question requested. The lack of responses to this survey question and some
answering it expressing how the organization does not model a culture that values well-being
further supports this as an area of continuing need.
Figure 22
How the organization models a culture of valuing well-being

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The following survey item further inquired if employees’ felt that their department
models or demonstrates behaviors that promote well-being. The data shows that there are
differences in how employees view their respective departments, as can be seen in Figure 23,
which shows that 24 participants agreed and 22 participants disagreed. These results suggest that
the employees are nearly divided in their opinions with some feeling that there is well-being
promotion and others feeling that there is not. Interestingly, 7 out of the 9 total respondents that
were from unit 4C either disagreed or strongly disagreed, possibly indicating that this influence
may be an increased area of need for that particular department. It is important to note that
almost all respondents that had previously expressed their workplace models a culture of well-
being also felt that their department models it as well, and similarly, the respondents that felt the
organization does not model well-being felt that their department does not either.
Figure 23
Department modeling behaviors that promote well-being

The last survey item that was part of examining this need asked the participants to
identify one specific example of how their department models the promotion of well-being as
Figure 24 shows. This open-ended question received 17 responses, of which three responses
were statements that did not correctly answer the question and instead indicated how their

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department does not promote well-being. From the 14 employees who did respond with
examples of how their department models the promotion of well-being, responses included:
“teamwork; checking in on each other; days off are usually granted; H3; proper communication;
supervisors being professional; and respect for one another.” With a minimal response rate for
this item, it is difficult for the researcher to conclude any specific trends for what the employees
found to be demonstrative of well-being from their departments.
Figure 24
How the department models the promotion of well-being

As the data suggests, TMC employees feel that the organization and their departments
demonstrate deficits in modeling a culture that values well-being, and therefore, validates this
influence as a continuing need.

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The Organization Needs to be Perceived as Supportive
This organizational need was assessed using two survey items. The first question asked
employees if their workplace offers the support they need to succeed and achieve their goals, to
which respondents had the option to select either always, often, sometimes, or never. Of the 43
participants that answered this question, a total of 20 felt that the organization provides the
support they need “always” or “often,” as can be seen from the results presented in Figure 25.
Another 17 employees responded with “sometimes” and 6 employees with “never.” Almost all of
the individuals that stated “never” worked between 31-40 hours and were from a mix of different
departments (three employees from 2E, two from 7B, and one from 4C) showing how employees
can have different experiences and opinions within the same environment. The results from this
item indicate that the employees are divided in their opinions of how supportive they perceive
the organization to be, which suggests that there is an opportunity to improve in this area and
take additional measures that may help more employees feel supported.
Figure 25
Organization being perceived as supportive

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In the next question, employees were asked if their needs and well-being are important to
the organization. As Figure 26 displays, 26 employees agreed or strongly agreed with this
statement and 17 disagreed or strongly disagreed. The results show that more employees, 60
percent, felt that the organization sees their needs and well-being as important. Although there is
a perceived lack as it relates to offering support to succeed and achieve goals as the prior
question’s results indicated, the majority of employees appear to feel that their needs and well-
being are important to the organization. This feeling of importance among employees provides a
foundation for the organization to build on as they work to implement new programs that can
enhance employee well-being and improve engagement.
Figure 26
Employee needs and well-being seen as important to the organization

The data shows that the research participants overall perceived the organization as
supportive, with 46.5% of employees feeling that the organization demonstrated support always

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or often, 39.5% expressing they felt supported sometimes, and 14% reporting that the
organization never supports them. The results similarly suggested that while the majority of
employees felt their well-being was important to the organization, a sizeable percentage
disagreed. The results suggest some areas of continuing need as it relates to organizational
support for employee well-being.
The Organization Needs to Offer Employee Programs or Resources Aimed at Improving
Well-being
This final organizational influence assessed employees’ beliefs related to current well-
being enhancing practices and programs that are offered at TMC and explored the need for
additional resources. The first of three survey items evaluating this influence asked participants if
the organization offers programs or resources aimed at improving well-being. The results of this
question, as displayed in Figure 27, showed that almost the same number of people felt that the
organization offered resources to help improve their well-being (18 respondents) as those who
did not know if the organization did (20 respondents), while another five individuals felt that the
organization did not offer any resources. Based on these results, a significant number of
employees do not know whether programs or resources are being provided to improve their well-
being, suggesting a continuing need in this area, including improved communication of current
offerings.

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Figure 27
Organization offers programs aimed at improving well-being

The next survey item examined how important it is to employees for the organization to
offer additional resources that can enhance their well-being. According to these results, 91% of
participants either strongly agreed or agreed that it is important to them for TMC to offer new
resources that can improve well-being and only four participants did not endorse it as important
as Figure 26 shows. Therefore, these findings suggest that based on this surveyed population, the
organization would benefit from offering additional programs and resources to enhance
employee well-being.

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Figure 28
Importance of organization offering additional well-being enhancing resources

The final survey item assessing this organizational influence asked participants in what
format or method they would like to see possible programs or resources offered. This could help
gauge the employees’ preferred programs and hopefully contribute to informed decisions when
developing new initiatives. According to the results, the most popular type of program from the
list was “lunch and learns” which was selected by 28 employees, followed by a tie between
“onsite presentations/workshops” and “virtual trainings/resources” which were both selected 22
times, and lastly “coaching” was selected by 19 people as can be seen in Figure 28. Participants
also had the option to write in their own suggestion by selecting “other.” Only one participant
selected this and stated that “other units are very stressful and can dump on us when we float.”
Overall, the findings suggest that employees may be receptive to new initiatives delivered via the
suggested forms of programs and could possibly include a combination of these top favored
methods.

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Figure 29
Additional programs or resources that can foster well-being

The results of this influence suggest that TMC has a continuing need to offer additional
programs and resources that can help support employees’ well-being in the workplace. Based on
the results of this study, employees seem to be willing to participate in a variety of programs
should they be offered by the organization. Moreover, a majority of employees are unaware of
currently available resources to help with their well-being. Therefore, the organization may need
to increase their communication efforts as it relates to well-being promotion.
Summary of Organizational Findings
The data analysis provided additional insight and understanding pertaining to the
organizational assumed influences that need focus as summarized in Table 7. Since nearly half of
the respondents (46%) felt that the organization does not model or demonstrate a culture that
values well-being, this is an area of need for the organization to focus on. Similarly, the data also

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suggests that almost half of the surveyed employees (48%) do not feel that their department
models or demonstrates a culture that promotes well-being either further validating this influence
as a continuing need.
Although 47% of employees believed the organization is supportive frequently, as
indicated by their responses of “always” or “often,” another 53% felt that the organization was
only supportive “sometimes” or “never.” The large number of “sometimes” responses indicates
that the organization is not demonstrating support as often as desirable, therefore warranting
focus on this area as a continuing need. As it relates to respondents’ perceptions about how
important employee needs and well-being are for the organization, 60% endorsed feeling that
their well-being was significant for TMC, therefore supporting this influence as the strongest
aspect of the organizational influences, although it was still less than 75%, and therefore, not
deemed as a current asset.
The final organizational influence assessed participants’ beliefs around the need for
offering well-being enhancing programs and practices by TMC. These results suggested that the
organization needs to make employees better aware of available programs as many did not know
what TMC currently offered. Additionally, employees felt that the organization needed to offer
additional resources aimed at fostering well-being. From the few methods that were explored as
possible new initiatives, it appears that the organization may have multiple options that the
employees would be receptive to participating in including lunch and learns, in-person and
virtual workshops or trainings, and onsite coaching services.

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Table 7
Organizational Assets or Needs as Determined by the Data
Assumed Organizational Influence Current Asset or Continuing Need
The organization needs to model behavior Continuing Need
that promotes an organizational culture of
well-being

The organization needs to be perceived as Continuing Need
supportive

The organization needs to offer programs Continuing Need
or resources aimed at improving well-being

Summary of Results
Chapter 4 provided an analysis of the data collected through a survey of three nursing
units or departments within TMC that included registered nurses, nursing attendants, and clerks.
The survey sought to understand the participants’ knowledge, motivation and organizational
needs to increase their work-related well-being and improve engagement. Based on the
quantitative data analysis, the researcher found that the participants had knowledge of the factors
that impact their well-being at work and how to reflect on their own workplace well-being, these
serving as assets to the employees. At the same time, participants had continuing knowledge
needs related to how to improve their well-being at work. Further, the participants had needed
motivation to improve their workplace well-being, including seeing the value of doing so and
confidence in their ability to make changes to improve their well-being. The organizational
findings suggest several areas of additional need to fully support employee well-being and
improve employee engagement. These include modeling behaviors that promote a culture of

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well-being, providing employees the support they need and emphasizing the importance of their
well-being, and offering additional programs or resources aimed at improving well-being.
Chapter 5 will provide tailored recommendations to continue to build on current assets
and address the continuing needs to establish a desirable level of well-being and engagement.

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Chapter Five: Recommendations and Evaluation
Purpose of the Project and Questions
The purpose of this study was to examine employee knowledge, motivation, and
organizational (KMO) needs to reach Thrive Medical Center’s (TMC) organizational
performance goal of implementing at least two new programs to enhance employee well-being,
leading to improved engagement. The analysis began by generating a list of possible needs and
then examined those systematically to determine if they were current assets to reaching the
performance goal or continuing needs. While a complete needs’ analysis would focus on all
stakeholders, for practical purposes the stakeholder group of focus in this analysis was
employees in three different nursing units or departments within TMC.
As such, the questions that guided this study were:
1) What are employees’ knowledge, motivation and organizational needs related to Thrive
Medical Center achieving its organizational goal of enhancing employee well-being and
improving engagement?
2) What recommendations, based on the current knowledge, motivational and organizational
resources of employees, could help increase employee well-being, and ultimately,
engagement?
Chapter Four examined research question one, and Chapter Five will address research
question two. The organization of this chapter will begin by presenting the recommendations for
practice to address the continuing knowledge, motivation, and organizational needs and build on
the current assets found in Chapter Four. Following the recommendations, an integrated
implementation and evaluation plan will be presented based on the New World Kirkpatrick

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(Kirkpatrick & Kirkpatrick, 2016). Lastly, limitations and delimitations of the study and future
research will be discussed.
Recommendations to Address Knowledge, Motivation, and Organizational Needs
This section is comprised of three parts: knowledge, motivation, and organizational
specific recommendations. Each KMO section consists of a brief overview of the continuing
needs to be addressed and research-based recommendations to address them. Specifically, the
discussion provides the findings from Chapter Four, the continuing needs and assets to build on
suggested by the findings, principles of change to address the needs, recommendations for
practice, and support for the recommendations based on the literature.
Knowledge Recommendations
The findings from this study support that the participating employees’ knowledge levels
vary as it relates to well-being related influences. Table 8 presents the assumed knowledge
influences on performance and whether, based on the results from survey responses, they were
determined to be current assets or continuing needs to improve the employees’ well-being and
engagement. Clark and Estes describe that in order for people to perform their roles they need to
know how, why, when and what to do (Clark & Estes, 2008). As employee knowledge and skills
level increases, achievement of performance goals increases as well. According to Krathwohl
(2002) there are four types of knowledge: factual, conceptual, procedural and metacognitive. A
combination of conceptual, procedural, and metacognitive influences was examined to
understand the knowledge the participating employees at TMC possessed related to their
workplace well-being. As Table 8 shows, the employees reported a range of knowledge that
served as an asset to support their workplace well-being. Recommendations are made to both
build on current assets and to address continuing needs.

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Table 8
Summary of Knowledge Influences and Recommendations
Assumed Knowledge
Influence
Current Asset
or Continuing
Need
Principle and
Citation
Context-Specific
Recommendation
Conceptual:
Employees need to know
what factors impact their
well-being at work.
Current Asset This type of
conceptual
knowledge is
important since
this will allow
employees to
implement
effective
strategies into
their work day
and lives.

It is important for
employees to
know about
recovery training
efforts to
counterbalance
work related
stress by engaging
in remedial
measures such as
mindfulness and
relaxation
techniques
(Bakker et al.,
2014).
Provide employees
with an interactive,
online tool that
allows them to
document specific
factors that impact
their well-being
and monitor and
track those factors
and how frequently
they occur.
Procedural:
Employees need to know
how to improve their
well-being at work.

Continuing
Need
Knowing how to
manage, recover,
and strategize to
promote well-
being is
procedural
knowledge.

Positive affect
and psychological
capital (i.e. hope,
self-efficacy,
Offer employees
monthly
workshops and
trainings that teach
well-being
enhancing tools
such as strategies
focusing on stress
reduction,
cultivating habits
of self-care, how to
incorporate

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Assumed Knowledge
Influence
Current Asset
or Continuing
Need
Principle and
Citation
Context-Specific
Recommendation
resiliency,
optimism) are
mediators because
both have been
implicated in
promoting work
engagement and
wellbeing
(Malinowski and
Lim, 2015).
positive activities
into their lives to
help manage times
of distress and
mitigate effects of
stress.

Additionally,
employees can rate
what strategies
they find to be the
most effective in
reducing negative
emotions and
promoting an
increased sense of
well-being.
Metacognitive:
Employees need to know
how to reflect on their
own workplace well-
being.
Current Asset Metacognitive
knowledge is a
key aspect of
strategic behavior
in solving
problems and
allows one to
consider
contextual and
conditional
aspects of an
activity or
problem.

“Employees with
poor wellbeing
perceive the work
environment
negatively and
this leads to poor
work outcomes”
(Innanen et al.,
2014).
Administer
quarterly surveys
that ask employees
to reflect on their
current practices
that promote well-
being and work-
life balance and
rate themselves on
the extent to which
they are
implementing
strategies that
nurture these
domains.

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Provide Tools for Monitoring and Tracking Well-being
The results and findings of this study indicated that 98% of employees perceived having
conceptual knowledge as it relates to the different factors that can precipitate stress and impact
their well-being. The findings revealed that employees believe stress and feeling overwhelmed
are frequently a part of their work experience, however they feel that they possess knowledge
about what can lead to increased stress levels, and consequently decreased well-being. Since this
knowledge influence is a current asset, the recommendation is for TMC to continue building on
this strength by providing an online tool that allows employees to track and monitor factors that
impact their well-being. Self-regulatory strategies, like using check lists, tend to enhance
learning and performance (Dembo & Eaton, 2000). This allows employees to remain actively
engaged in the state of their well-being as well as aware of any areas that may need to be
addressed.
As an additional supportive measure and preventative approach, it is recommended that
the organization provide an educational resource that outlines signs and symptoms of stress for
employees to recognize and report. Though providing resources can be highly useful, managing
intrinsic load is important to not overwhelm employees with knowledge. This can be achieved by
segmenting complex material into simpler parts which enables learning to be enhanced (van
Merriënboer et al., 2003). As such, educational resources should be created that are condensed
into one hour manageable modules that demonstrate a myriad of factors which can result in
increased stress and potentially lead to employee burnout. To help promote use of these
resources, it is recommended that all virtual tools be accessible through one platform.

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Offer Workshops and Trainings to Promote Well-being Enhancing Practices
Employees need to know how to improve stress levels and engage in practices that
enhance their well-being. Knowing how to manage, recover, and strategize to promote well-
being is procedural knowledge. Based on the survey findings, 87% of employees reported that
they know how to engage in strategies that can improve their well-being. Despite employees’
existing knowledge in this area, 98% of the participating group also endorsed a desire to increase
their current knowledge of well-being enhancing practices. This significant finding suggests that
though the employees expressed currently having knowledge related to improving their well-
being, they may still benefit from additional programs or practices that could further augment
and enhance existing knowledge in this area.
The recommendation is for TMC to offer its employees a quarterly workshop or training
that will teach staff effective tools and strategies to implement in order to improve their quality
of life. Clark and Estes (2008) suggest that training is an ideal way to provide people with
knowledge of how to do something. According to the literature, it is important for employees to
know about recovery training efforts to counterbalance work related stress by engaging in
remedial measures such as mindfulness and relaxation techniques (Bakker et al., 2014). Another
effective way to increase well-being is to incorporate positive activities into one’s daily life. A
framework of evidence-based practices to do so, known as The Five Ways to Wellbeing, is
centered on connecting, physical activity, awareness, learning, and giving (Aked, et al., 2009).
By providing employees with easily accessible resources such as workshops and trainings
comprised of concrete ideas and strategies that can be incorporated, TMC will be supporting the
employees’ need to increase their knowledge related to well-being. Based on the results of the

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study, it is recommended that these be offered both in-person as “lunch and learns” as well as
virtually to help increase likelihood of utilization.
Administer Surveys to Encourage Employee Reflection on Well-being
It is important for employees to have reflective practices which increase their self-
understanding pertaining to their personal influence on well-being and the role that they
individually play in the causation of their experiences. This metacognitive knowledge is critical
for employees to have in order to mitigate behaviors and beliefs that result in unwanted
outcomes, and subsequently having the insight that they can independently implement effective
stress management and reduction techniques to produce desirable consequences. The survey
responses showed that 93% of employees have metacognitive knowledge of self-reflection about
factors that influence their well-being at work. This finding supports self-reflection knowledge as
a current asset. However, when employees were asked to actually engage in a self-refection and
provide responses about what factors influence their well-being, the response rate was 74%,
possibly indicating that despite endorsing knowledge about this metacognitive ability, there may
be a gap in willingness to engage in such self-reflection.
It is recommended that employees be provided opportunities to engage in self-monitoring
and self-assessments as tools that allow them to remain aware and active participants in their
outcomes. Therefore, the recommendation is for TMC to implement regularly scheduled
surveying of employees to encourage self-reflection related to their well-being. By doing so, the
organization will promote self-awareness for each employee and enable them to set goals and
regulate their own performance. This will allow them to more easily know when it is necessary
to implement practices that improve and optimize their everyday work processes. Further, the

94
information gathered will provide meaningful information to the organization that can be useful
to design and develop tools that are specific to current needs and trends.
Motivation Recommendations
Table 9 represents the complete list of assumed motivational influences and their
accompanying theoretical principles of value expectancy and self-efficacy. It also indicates if
they were validated as current assets or continuing needs for achieving the stakeholders’ goal
based on survey results. Clark and Estes (2008) identify three indicators of motivation in task
performance, these components are choice, persistence and mental effort. Choice is initiating
action in pursuit of a goal. Persistence is continuing to pursue a goal in the face of distractions,
and mental effort is the intensity of effort placed onto achieving a goal. Motivation plays an
important role in achieving goals and there are different theories that try to explain the various
factors involved in motivation. As shown in Table 9, the survey responses revealed that
employees endorse the motivational assumed influences as current assets.
Table 9
Summary of Motivation Influences and Recommendations
Assumed Motivation
Influence

Current Asset or
Continuing Need

Principle
and
Citation
Context-Specific
Recommendation
Employees need to
see the value of
engaging in practices
that enhance their
well-being.
Current Asset Rationales
that include
a discussion
of the
importance
and utility
value of the
work or
learning can
help learners
develop
positive
Providing
educational
resources about the
potential
unfavorable
personal/health and
professional
ramifications of
not developing and
implementing
practices that

95
values
(Eccles,
2009;
Pintrich,
2003).
address their well-
being.
Employees need to
believe that they are
capable of making
impactful changes
that can improve their
well-being and
workplace
engagement.
Current Asset Learning
and
motivation
are
enhanced
when
learners
have
positive
expectancies
for success
(Pajares,
2008).
Provide employees
with practice-based
educational
programs where
they can learn and
practice strategies
and interventions
that can help
improve their well-
being and increase
their confidence to
make positive
changes.

Provide Educational Resources on Possible Consequences of Neglecting Well-being
With 93% of study participants reporting that they perceive engaging in practices or
programs aimed at enhancing their well-being as valuable, this motivational influence is a
current asset for TMC employees. Since this assumed influence was an asset at the time of the
study, there are no specific tasks necessary for the organization to implement. It is recommended
that leadership continue to assess and monitor this need through future surveys or interviews
with employees.
Should there be an identified need to address this motivational influence over time, a
recommendation rooted in expectancy value theory could be utilized to close any motivation gap.
It is recommended that the organization provide rationales about the importance and utility value
of engaging in the associated tasks (Pintrich, 2003). Eccles (2009) and Pintrich (2003) propose
that discussion of the importance and utility value of the work or learning can help learners
develop positive values. The recommendation therefore would be for the organization to provide

96
information to employees demonstrating the relationship between individual well-being and its
influence on functioning and performance as well as the possible consequences of not placing
importance on well-being leading to stress or burnout. Such opportunities can help increase
motivation by helping hospital employees understand the utility value of developing skills and
strategies that promote well-being.
Eccles (2009) identified four constructs that are associated with wanting to do a task:
intrinsic interest, the amount of personal enjoyment one expects to experience; attainment value,
the extent that the task is aligned with one’s self-image; utility value, the impact of the task on
one’s immediate or long-term goals; and finally, the associated cost of engaging in the task.
Utility value is a significant area to consider as it relates to TMC’s goal of increasing employee
engagement and retention. To do so, employees placing a high value on establishing and
sustaining well-being is essential. Haar et al. (2014) concluded that values and beliefs influence
work-life balance, and subsequently, impact personal and professional outcomes such as mental
health and job satisfaction.
Provide Employees with Practice-Based Activities to Promote Self-efficacy
According to Pajares (2008) self-efficacy can be defined as the self-judgment one holds
about their own capabilities related to learning or performing a specific task. Additionally, self-
efficacy is proposed as foundational in human motivation, well-being and personal
accomplishment. Therefore, the belief that one holds about their ability will determine their
willingness to engage in a task or to avoid it. It is recommended that employees feel they are
capable of learning what is being expected. This can be implemented by allowing opportunities
to engage in activities that increase beliefs related to their capacity as it relates to engaging in
well-being promoting strategies and skills. Self-efficacy can be developed in a myriad of ways.

97
Pajares (2008) recommends the usefulness of providing goal-directed practice combined with
frequent, accurate, credible, targeted and private feedback on progress in learning and
performance. This allows for both delivery of the necessary information as well as follow up that
solidifies the learning. Additionally, it is believed that positive mood and optimism can also
promote self-efficacy. For instance, if the employees at TMC are optimistic about the use of
strategies or practices that may enhance their well-being and work-life balance, they might also
have increased self-efficacy that they will be capable of undertaking the tasks and making the
changes set forth. To that end, a recommendation is that TMC provides employees with practice-
based educational programs where they can learn and practice strategies and interventions that
can help improve their well-being and increase their confidence to make positive changes.
Surveyed employees at TMC expressed high levels of self-efficacy pertaining to their
abilities for making changes that can enhance their well-being and professional performance.
Since high self-efficacy can positively influence motivation (Pajares, 2008), this finding is a
good indication that employees may be receptive and willing to engage in practices or programs
aimed at improving their well-being and engagement. As with other findings, it is recommended
for leadership to continue assessing these motivational factors to determine patterns or changed
needs during different times and conditions following the Covid-19 health pandemic.
Organizational Recommendations
Clark and Estes (2008) suggest that the organizational influences on stakeholder
performance to consider include work processes, resources and workplace culture. Culture is a
way to describe the core values, goals, beliefs, emotions and processes learned as people develop
over time in their work environments. Culture is both a powerful force in performance and a
difficult characteristic to identify and to influence. Gallimore and Goldenberg (2001) propose

98
two constructs about culture – cultural models or the observable beliefs and values shared by
individuals in groups, and cultural settings, or the settings and activities in which performance
occurs. Thus, both resources and processes and cultural models and settings must align
throughout the organization’s structure to achieve the mission and goals.
The first assumed organizational influence in this study explored the possible impact of a
cultural model construct, specifically that the organization needs to model behaviors that
promote an organizational culture of well-being. The second assumed influence on performance
was that the organization needs to be perceived as supportive. The final assumed influence
focused on a cultural setting factor, identifying that the organization needs to offer employee
programs or resources aimed at improving well-being. Table 10 shows the assumed organization
influences and whether they were found to be current assets or continuing needs for achieving
the organization’s goal and also presents the recommendations for these influences based on
theoretical principles.
Table 10
Summary of Organization Influences and Recommendations
Assumed Organization Influence

Current Asset
or Continuing
Need
Principle and
Citation

Context-Specific
Recommendatio
n
Cultural Model Influence:
The organization needs to model
behaviors that promote an
organizational culture of well-being
Continuing
Need
A powerful
teaching tool a
leader has is
leading by
example, which
is occurring all
the time,
whether
intended or not,
conscious or
not.
The more a
leader acts in a
Leadership needs
to demonstrate
they value well-
being by taking
proactive steps
towards modeling
behaviors and
beliefs that
support
promoting well-
being and
balance, this can
be done by

99
way that
followers feel is
appropriate
ethical leader
behavior, the
more a leader
will be trusted
(Van den
Akker, Heres,
Lasthulzen &
Six, 2009).
leadership
engaging in well-
being enhancing
activities
themselves.
Cultural Setting Influence:
The organization needs to be
perceived as supportive
Continuing
Need
Change-
supportive
processes
should provide
a clear future
vision (Clark &
Estes, 2008).
Offer clear and
accessible
opportunities for
employees to
share feedback
and concerns as
well as providing
staff with tools
and resources that
can aid in the
development of
skills and
strategies that
will promote
well-being.
Cultural Setting Influence:
The organization needs to offer
employee programs or resources
aimed at improving well-being

Continuing
Need
Organizational
effectiveness
increases when
leaders ensure
that employees
have the
resources
needed to
achieve the
organization’s
goals (Waters et
al., 2003).

The allocation of
resources should
align with the
goals and
priorities of the
organization and
effective
communication
strategies should
be used to inform
and encourage
use of available
resources.
Model Behavior that Promotes an Organizational Culture of Well-Being
Approximately 46% of surveyed employees at TMC felt that the organization did not
engage in behaviors that demonstrated a focus on employee well-being. Similarly, another 46%

100
felt that their respective departments did not engage in behaviors that showed they valued
employee well-being. Open-ended questioning revealed that some respondents felt that TMC
demonstrates valuing employee well-being by offering support when needed and training
opportunities. With almost half of the employees feeling that the organization did not exhibit
behaviors that demonstrated concern as it related to employee well-being, indicating that this
influence was validated as a continuing need. It is important for TMC leadership to recognize
that well-being is deemed to be an important facet of the work environment and demonstrate this
understanding through actions and behaviors. A lack of attention on the matter can lead to
employee’s having negative experiences related to their work, and furthermore, could lead to
burnout and disengagement.
A recommendation rooted in Social Cognitive Theory has been selected to close this
organizational gap. The cultural model and setting of an organization should not be considered
independent and static, but instead relational and dynamic (Rueda, 2011). This suggests that the
dynamic interaction between cultural models and employees can influence individual beliefs and
behaviors. As such, observational learning—the modeling of strategies and behaviors to be
learned—can be used in the context of the organization to provide opportunities for employees to
observe the behaviors that leadership values. Each manager or leader should provide an
opportunity for employees to share any challenges and concerns related to well-being in a one-
on-one meeting on a regular basis as feasible based on individual scheduling. This high-level
listening strategy can help model that personal wellness of the workforce is valued by the
organization. Leadership can further demonstrate their commitment to well-being by engaging in
practices that promote well-being enhancement themselves. Employees may feel encouraged to
participate in available programs when they observe that it is also being utilized by their leaders,

101
demonstrating value towards the process and providing a more collective experience.
Rueda (2011) emphasized the importance of cultural models and settings in any
environment to provide a clear understanding of how people think, why they behave the way
they do, and how they respond to life circumstances. Scholars have suggested that organizational
features are more influential in increasing employee engagement than an employee’s personal
attributes (Bakker & Demerouti, 2008). Clark and Estes (2008) note that when workers are
stressed, their capacity of thinking about more than three new items at once significantly
decreases. High stress positions can also lead to increased employee turnover, disrupting
operations, routines, organizational learning, and morale (Hausknecht & Holwerda, 2013).
Employee performance in the healthcare arena has high human stakes. Consequently, a focus on
leadership modeling well-being practices and behaviors would benefit all stakeholders.
Offer Clear and Accessible Opportunities for Employees to Discuss Well-being Related
Concerns and Deficits
According to survey results, only 14% of employees felt that the organization “never”
provided the support they need and another 40% reported feeling supported “sometimes.” Since
more than half of the surveyed employees report that they are not feeling supported “always” or
“often” by the organization, this influence is a continuing need that should be addressed by
TMC. It is recommended that the organization offer easily accessible opportunities for
employees to consistently share their feedback and concerns as it relates to factors impacting
their well-being. This can be achieved by managers and supervisors demonstrating interest and
time to exploring any barriers the employees may be experiencing that are impacting their health
and wellness in the workplace as well as reiterating available resources and programs that may
help address any identified concerns. For example, managers designating time towards exploring

102
employee well-being related issues during regularly scheduled one on one meetings may be a
viable option to allow employees to address concerns. Providing employees opportunities to
share their thoughts will also allow them to feel that they are part of the well-being movement
and that their opinions count, possibly leading to greater buy-in and willingness to participate in
the developed well-being initiatives.
In addition to providing consistent opportunities for employees to share concerns with
management, the organization can also administer anonymous surveys that inquire about the
level of support employees feel they are receiving, as this is an important part of employee
satisfaction, and consequently, well-being and engagement. Additionally, these surveys should
also assess what supportive measures employees perceive as needs that they are not receiving
from the organization and believe would be helpful to receive. These recommendations will
allow employees to have platforms to share their thoughts and feelings, and consequently,
remain actively involved in their well-being and contribute to the well-being efforts of the
organization.
Offer Employee Programs or Resources Aimed at Improving Well-being
Almost one-half, 47%, of employees who completed the survey did not know if the
organization offered opportunities to increase their well-being. Therefore, this organizational
influence was validated as a continuing need. Another 42% of employees reported that the
organization did offer resources that are aimed at improving their well-being, while 12% stated
that the organization does not offer such support. These varying responses show that there were
discrepancies within employees’ level of awareness about currently offered programs at TMC
and suggest a need for improved communication organizationally. Organizational effectiveness
increases when leaders insure that employees have the resources needed to achieve the

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organization’s goals (Waters et al., 2003). A gap in employees’ awareness and access to
available resources creates inconsistencies in the level of support received within the
organization. Therefore, the proposed recommendation is that the organization utilizes effective
communication strategies to inform employees about and encourage the use of available well-
being related tools and resources. The organization can promote participation in well-being
enhancing resources by placing posters in community areas, emailing newsletters, and making
announcements during meetings. Also, the organization can collect reviews from employees that
have participated in an available well-being resource and anonymously include these
testimonials that describe any benefits experienced in company newsletters to encourage
employee utilization of available programs. Moreover, the organization can explore use of
meaningful incentives and rewards feasible to offer to employees as an additional method of
encouraging participation in available resources.
Organizational performance increases when leaders identify, articulate, and focus the
organization’s efforts on, and reinforce the organization’s vision (Clark & Estes, 2008). The
most powerful mechanism that leaders have available for communicating what they believe in is
what they pay attention to, measure, and control on a regular basis (Schein, 2004). This supports
the notion that the organization needs to continuously assess and respond to employees’ current
needs as they are likely to change and require new ways of providing support and meeting goals.
Communicating the vision around well-being will help employees see their desires and concerns
being heard and allow them to take ownership of the vision (Calegari et al., 2015). As such, the
organization can provide ongoing feedback opportunities from employees by conducting
meetings to specifically discuss any current needs or administer questionnaires that adequately
collect pertinent information that can then contribute to curating resources aligned with any gaps

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related to well-being and performance needs.
Summary of Knowledge, Motivation, and Organization Recommendations
The survey instrument used in this study identified TMC nursing staffs’ current
knowledge, motivation, and organizational influences related to enhancing their well-being and
improving their engagement. Based on the results, recommendations to bridge the gap for
knowledge influences included helping employees identify strategies that increase their sense of
well-being and creating a list of these as a resource to refer to proactively as well as during times
of distress. Additionally, employees could rate what strategies they found to be the most
effective in reducing negative emotions and promoting an increased sense of well-being.
Furthermore, a proposed recommendation was for the organizations’ leadership to model
behaviors that align with their goals and vision of increasing employee well-being. In addition,
the organization can offer employees tools and resources that focus on enhancing well-being and
effectively communicate available programs. These suggested resources include both trainings
and individual and/or group coaching sessions that focus on skill development for anxiety and
stress management, coping healthily and effectively with change, learning mindfulness practices,
resilience training, addressing self-limiting beliefs and other areas of concern as identified
through employee survey results.
Integrated Evaluation and Implementation Plan
TMC’s mission is to be a leading healthcare provider in the community and provide
quality care and education to their patients in a compassionate manner. The organization’s goal
is to implement new programs and practices that will enhance employee well-being and improve
engagement and performance. The goal of this implementation and evaluation plan is to integrate
best practices and provide stakeholders with new approaches that can be adopted to address this

105
goal. The recommendations for practice are intended to allow stakeholders to learn how to
effectively manage factors that can adversely impact their well-being and practice strategies that
can promote mental and emotional resilience, and consequently, improve work engagement and
overall role performance. By gaining the new skills that will be provided through trainings,
coaching and other learning opportunities, employees can help mitigate the potentially negative
repercussions of poorly controlled stress and other job role related challenges and conflicts. The
expectation is that stakeholders will be equipped with the ability to avert undesired outcomes
such as burnout, decreased engagement and turnover.
Implementation and Evaluation Framework
The New World Kirkpatrick Model (2016), consisting of four levels (Reaction, Learning,
Behavior, and Results), was utilized to design an integrated implementation and evaluation plan
for this study. It is imperative that both learning and implementation are evaluated because
organizations must understand if a training program has been successful and whether there are
any barriers to change (Kirkpatrick & Kirkpatrick, 2016). Such barriers can then be addressed to
not impede the change process. The model connects training to performance by ensuring plans
provide compelling evidence that the recommended training will deliver measurable results for
the organization and by keeping the focus on the outcomes that will be accomplished through
improved trainee performance (Kirkpatrick & Kirkpatrick, 2016).
As Table 11 displays, the framework deploys a descending approach starting with Level
4 which examines the extent to which targeted outcomes occur as a result of the training and
support provided to employees. Next, with Level 3, the model examines drivers required to
achieve the desired behaviors and results. With Level 2, the attitudes, knowledge, and skills
necessary to implement the desired change are established. Finally, level 1 of the model

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examines the degree to which employees are engaged with the learning experience, find it
relevant, and are satisfied overall (Kirkpatrick & Kirkpatrick, 2016).
Table 11
The New World Kirkpatrick Model Four Levels of Evaluation

Evaluation Level

Description

Level 4

Measures the results of the employees’ well-being
development program in the context of organizational
goals

Level 3

Measures the critical behaviors that employees will
demonstrate after participating in the implemented
programs

Level 2

Measures the learning goals established for the
program

Level 1

Measures employees’ reaction – How engaged are
they? How relevant is the program to their interest in
developing new skills to enhance their well-being?
How satisfied are they with the program?

Level 4: Results and Leading Indicators
Healthcare organizations need to express the desired results they aspire to achieve when
implementing a new program for employees. Table 12 shows the proposed Level 4: Results and
leading indicators in the form of outcomes, metrics, and methods for both external and internal
outcomes for developing a well-being program at TMC. If internal outcomes are achieved
following the trainings and other development opportunities provided, then the external
outcomes can also be achieved.

107
Table 12
Outcomes, Metrics, and Methods for External and Internal Outcomes

Level 3: Behavior
Critical Behaviors. The critical behaviors are an effective outcome for researchers and
trainers to use to determine if participants are applying what they have learned into practice
(Kirkpatrick & Kirkpatrick, 2016). These behaviors need to be specific and observable. The
stakeholder group of focus for this study were employees and how their well-being influences
engagement. The behaviors identified in Table 13 include the development of a strategic plan for
Outcome Metric(s) Method(s)
External Outcomes
The organization will
increase its patient
satisfaction scores
Percentage increase in positive
patient feedback
Compare previously completed
patient surveys with 2023
The organization will see
a decrease in negative
patient incidents as a
result of more engaged
and happier employees
Decreased in the percentage of
negative incidents
Compare incident reports post
implementation of new
programs
The organization will see
a reduction in stress
related costs
Percentage decrease in
healthcare spending
Compare data from previous
reports
The organization will see
improved retention
Percentage of reduction rates in
employee turnover
Compare turnover rates from
previous reports
Internal Outcomes
Increased employee
engagement levels
Percentage increase in
engagement levels
Employee surveys 60 days after
program implementation
Employees will be
participating in newly
implemented wellbeing
promoting practices and
programs
Percentage of participation Monthly review of participation
rates
Increased employee job
satisfaction ratings
Percentage increase of job
satisfaction
Employee surveys 60 days after
program implementation
Increased organizational
performance and
effectiveness
Operational performance metrics
through departmental goal
Compare annual survey results

108
increasing employee well-being and engagement. The first critical behavior identified is that
employees need to engage in the new programs aimed at skill development. The second critical
behavior is for employees to set goals for their individual development. The third critical
behavior is for employees to engage in self-reflection to monitor their usage of learned skills and
strategies.
Table 13
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
Employees need to
recognize when
there are factors
that are impacting
their well-being
and track this
information
List of challenges
being faced
Maintain a personal log
of challenges faced
Daily
Employees need to
take active
measures towards
mitigating stress
and other negative
emotions by
implementing
strategies that
reinstate or
improve their level
of functioning
The number of times
resources are accessed
Review of how often an
employee utilizes an
organizationally offered
resource
Monthly
Employees
demonstrate usage
of acquired skills to
make a meaningful
difference in their
emotional well-
being despite
external
circumstances
remaining the same
Reporting of
situations that resulted
in applying new
knowledge and skills
Employees will share
with their managers in
their meetings any
situations they
experienced that created
difficulty and was
managed effectively by
use of program content
Weekly

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Required Drivers. Required drivers includes processes that reinforce and reward
performance as well as monitor and encourage the performance of critical behaviors (Kirkpatrick
& Kirkpatrick, 2016). Hospital employees require the support of their executive leadership team
and the organization to reinforce what they learn in trainings to achieve both personal and
organizational goals. Rewards should be established for accomplishing performance goals.
Table 14 details the recommended drivers necessary to support the critical behaviors of
employees.
Table 14
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Reinforcing
Individual coaching sessions
that solidify training materials
and help apply them to
personally relevant situations
Weekly 1, 2, 3
One-on-one meetings with an
executive leadership team
member to discuss employee
progress and goals
Monthly 1, 2, 3
One-on-one meetings with
manager to discuss challenges
and employee’s alignment
with goals
Monthly 1, 2, 3
Job aids sent through
electronic mail on how to
effectively manage stressors
adaptively
Quarterly 1, 2

Encouraging
Feedback from leadership Monthly 1, 2, 3
Supplemental training offered
online
Ongoing 1, 2, 3
Rewarding
Public acknowledgement
when staff engagement levels
show an increase
Monthly 1, 2, 3

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Incentives and rewards for
participating in the program
Monthly 1, 2, 3
Monitoring
Incorporate critical behaviors
relevant data into employee
surveys
Annual 1, 2, 3

Organizational support. In order to support critical behaviors that encourage the
development of skills and knowledge necessary for improving well-being and engagement, the
organization needs to actively provide strategic leadership in the area of employee emotional
well-being. Recommendations include offering ongoing communication encouraging the
participation in available resources both via electronic platforms as well as through individual
and group meetings. Additionally, departmental leaders must model and incorporate the well-
being program’s strategies into meetings and daily operations. The organization should request
feedback from employees to help monitor the integration of the new concepts and practices into
their work day and the effectiveness of these measures. Furthermore, the organization can
allocate a budget each year that will allow for continuous trainings and programs to be offered so
that well-being initiatives will consistently remain in place.
Level 2: Learning
Learning goals. Leadership at healthcare organizations need to establish clear learning
goals that will guide the development and delivery of new employee programs. Following
completion of the recommended solutions, including the training and coaching components of
the program, the stakeholders will be able to:
1. Understand the extent to which they can influence individual and organizational
performance.
2. Recognize sources of stress that are precipitated by job related factors.

111
3. Identify how stressors are impacting their functioning and job role performance.
4. Implement learned strategies as remedial measures to help reduce or manage negative
feelings.
5. Be confident that integration of new practices into their work life will promote
positive emotional changes.
6. Have understanding of how to reflect upon and express challenges, successes, and
goals.
Program. The learning goals described in the previous section will be achieved with a
training and coaching program that provides education, skills and strategies to employees in an
effort to improve their personal well-being, and consequently, increase engagement. These
trainings/workshops and coaching sessions will be facilitated by a qualifying behavioral health
professional. The participants of the program will have access to written and video materials that
provide worksheets, checklists, logs, application examples and other supportive resources that
can help solidify knowledge.
The program will be aimed at enhancing employee well-being as well as performance. A
broad range of strategies will be taught to help provide relief during stressful situations,
including cognitive behavioral strategies, mindfulness practices, resilience training, self-esteem
improvement, coping skills for managing changes and transitions, relaxation techniques, use of
affirmations, and a multitude of other areas of concern. The live training sessions will be
comprised of a myriad of teaching methods, including interactive opportunities to apply learning
that include immersive and in-vivo exercises, small group discussions, and role-playing.
Evaluation of the Components of Learning. To ensure that learning is taking place, it is
important to have approaches that verify desired learning outcomes. Demonstrating an

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understanding of declarative knowledge is often necessary as a prerequisite to applying the new
knowledge learned into practice. It is critical to evaluate learning for both declarative and
procedural knowledge being taught. Kirkpatrick and Kirkpatrick (2016) outlined five essential
components of level 2 learning to include in evaluation: knowledge, skills, attitude, confidence,
and commitment. Therefore, it is essential that employees value the training as it increases
motivation and a desire to learn and apply the new knowledge and skills on the job. They must
also be confident with their abilities to succeed in applying the newly obtained knowledge and
skills and show commitment to incorporating them during work. As such, Table 15 lists the
evaluation methods and timing for these components of learning.
Table 15
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge checks using multiple choice and
short answer items in the post-session feedback
forms
At the end of each training or coaching
session
Knowledge checks through discussions Periodically during the sessions
Procedural Skills “I can do it right now.”
Knowledge check by demonstrating ability to
teach one learned skill in pairs
During training sessions
Sharing strategies utilized to group During training sessions
Attitude “I believe this is worthwhile.”
Instructor’s observation of participants’
statements and actions demonstrating that they
see the benefit of what they are being asked to do
on the job.
During sessions
Discussions of the value of what they are being
asked to do on the job.
During sessions
Action plans of how to implement new skills During and after sessions
Confidence “I think I can do it on the job.”
Assessment using a self-efficacy scale regarding
ability to apply their learning
After each training session
Commitment “I will do it on the job.”
Create an implementation plan and schedule After training sessions

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Choosing another participant in the training as an
accountability partner
During sessions

Level 1: Reaction
According to Kirkpatrick and Kirkpatrick (2016), level 1 is the extent to which
participants enjoy the training, find it engaging, believe it is relevant to them, and have the
opportunity to apply what they have learned efficiently. Table 16 lists the methods that will be
used to determine how the participants react to the learning event(s).

Table 16
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Observation by facilitator/coach During training/coaching sessions
Attendance During training/coaching sessions
Course evaluation Two weeks after training sessions
Relevance
Brief pulse check with participants After each session
Course evaluation Two weeks after training sessions
Customer Satisfaction
Brief pulse check with participants online
and discussion
After each training session
Course evaluation Two weeks after training sessions

Evaluation Tools
Immediately Following the Program Implementation. Immediately following
educational and developmental initiatives, a summative evaluation will be administered in the
form of a brief survey with both open and scaled items and will be sent to participants via email
to assess the learners’ satisfaction with the content as well as their feelings of material relevance
in relation to their jobs and overall performance and expectations (Level 1). The survey will also

114
assess learners’ levels of confidence and commitment of applying what they were taught to their
work (Level 2). As Kirkpatrick and Kirkpatrick (2016) suggest, evaluations centering on learners
shifts the focus from critiquing the trainer to sharing personal experiences and viewpoints. This
approach also enables trainers to evaluate multiple levels at once and provides insight into what
is expected of the trainees once they return to their jobs (Kirkpatrick & Kirkpatrick, 2016).
Delayed for a Period After the Program Implementation. Approximately two months
after the implementation of the program, leadership will administer a survey containing open and
scaled items to measure, from the participant’s perspective, satisfaction and relevance of the
training (Level 1), confidence and value of applying their training (Level 2), application of the
training (Level 3), and the extent to which they have helped enhance employee well-being and
engagement.
Data Analysis and Reporting
The Level 4 goal of stakeholders is measured and reported by employee perceptions of
the level of enhancement experienced pertaining to their well-being and performance, and
additionally, by increases in engagement levels as demonstrated by survey results and work-
related measures such as decreases in incidents of employee errors, leaves, absences, and
turnover. The organization will conduct a quarterly review which analyzes data from reports of
employee health-related costs, patient satisfaction surveys, employee satisfaction surveys, and
retention rates. The dashboard in Figure 30 will report the data on the measures as a monitoring
and accountability tool, including assessing if the training was a good use of employee time, if
there has been an opportunity to apply learned material, and if additional training is desired.
Similar dashboards will be created to monitor Levels 1, 2 and 3.

115
Figure 30
Example of performance dashboard

Summary of the Implementation and Evaluation Plan
The Kirkpatrick and Kirkpatrick New World Model (2016), a training evaluation
framework, was applied to this study to plan, implement, and assess recommendations for Thrive
Medical Center’s optimization of its stakeholder goal. Targeting four levels (Results, Behavior,
Learning, and Reaction), the actions proposed in this plan place a strong emphasis on Levels 3
and 4, Behavior and Results, as the training’s outcomes demonstrate on-the-job application,
performance, and success (Kirkpatrick & Kirkpatrick, 2016). Evaluations conducted during and
after trainings enable researchers to analyze data and adjust components of the learning process
along the way (Kirkpatrick & Kirkpatrick, 2016).
An imperative advantage of integrating the implementation and evaluation stages is the
ability to alter the training while in process to meet the needs and expectations of the
participants. This tactic enables a researcher to influence the current training in order to
maximize programmatic results (Kirkpatrick & Kirkpatrick, 2016). Moreover, the application of

116
Kirkpatrick and Kirkpatrick’s (2016) Success Case Method (SCM) provides information on the
participants’ experiences in a training initiative which are carefully analyzed. Training is
evaluated quickly, concisely, and accurately, leading to actionable results and effective,
successful outcomes. The SCM’s data-based business case helps guide intervention
recommendations, reinforces learning, and influences performance changes (Kirkpatrick &
Kirkpatrick, 2016).
The recommendations presented in this chapter address TMC’s knowledge and
organizational gaps while meeting the needs of its employees. This plan is designed for success,
in part due to the required drivers having a strong emphasis on more strategic communication, as
well as processes and systems that reinforce and reward performance. These recommendations, if
applied as stated, monitor and encourage the performance of critical behaviors and will
positively affect outcomes for both TMC’s employees as well as the organization. Finally, it is
important to note that training itself does not produce results (Kirkpatrick & Kirkpatrick, 2016).
Organizations need to be dedicated to supporting their employees post-training. Although
business leaders want to see relevant, credible, compelling, and efficient outcomes (Kirkpatrick
& Kirkpatrick, 2016), it is important for them to examine changed behaviors of training
participants because those behaviors are the key to future organizational success (Kirkpatrick &
Kirkpatrick, 2016).
Limitations and Delimitations
Limitations are influences that the researcher cannot control and delimitations are the
boundaries set by the researcher that need to be addressed (Creswell, 2014). There may be
several limitations inherent in research. Therefore, some aspects of the study are susceptible to
the risk of producing inaccurate data (Merriam & Tisdell, 2016) that cannot be controlled. The

117
first limitation of this study was the small sample size. A total of 46 TMC employees completed
the survey, which makes it difficult to generalize the data across the entire employee population.
The second limitation is that the survey protocol used to collect data was developed specifically
for this study and not thoroughly tested for validity. A third limitation was a lack of responses
from all employees to the open-ended questions, which limited the researcher’s ability to extract
sufficient data necessary to formulate robust trends and patterns. The fourth limitation of the
study was that participants may not have been fully transparent in their responses based on the
possibility of concerns with identification, despite the disclosure that the survey was anonymous.
Also, the researcher assumed that all the research participants interpreted the survey items as
intended. Another limitation was that the data was collected during unusual times where there
was an active global health pandemic, possibly influencing participation and impacting responses
considering the added pressures and increased level of demand employees were presented with
in the field of healthcare during this time. The participants’ responses related to their well-being
and organizational support may have been different during non-crisis times, and hence may not
be generalizable across normal conditions. Furthermore, the researcher viewed this study through
a constructivist worldview and prioritized constructing meaning from the data presented and
current literature. Therefore, research of this nature is subjective.
In addition to limitations, this study also had some delimitations. These are factors that
affect the study which the researcher has control over and they clarify the study’s scope
(Creswell & Creswell, 2018). Considering that this particular sample focused on one stakeholder
group in one healthcare organization, generalizability to multiple stakeholder groups may not be
achievable. As a result, the small sample size would inhibit broad conclusions or widespread
generalizations across similar organizations as needs vary by organization. Future studies in a

118
similar manner can be conducted at other teaching hospitals using the same sub-specialty to
compare results. Delimitations may have also occurred due to use of multiple choice questions
with pre-determined response options and a limited number of open-ended responses.
Recommendations for Future Research
Employee well-being is an area of research that is continuing to gain increased attention
and is a growing area of interest amongst organizations and leaders in a multitude of industries.
There is not a single approach or practice that has been determined as the method by which to
resolve this problem of practice. There are several options for future research to examine that
may provide beneficial insight for the development of employee well-being and engagement
initiatives. One area of focus to better understand how to support employees with enhancing their
well-being status would be to explore the role of motivation factors. For example, if offering
incentives may have a role in encouraging employees to participate in programs that are aimed at
improving their well-being. Another area of focus to examine is understanding what are the most
effective ways to communicate available programs. Additionally, it would be important to
explore what factors are most strongly associated with reducing turnover. Furthermore, future
research on how employee well-being programs have improved engagement, work performance,
productivity, and employee/leadership relations can highlight the significance of implementing
such programs more frequently across workplaces amongst various industries and institutions.
Lastly, future research can focus on the continuing effects of the Covid-19 pandemic on
employee well-being, specifically in healthcare settings.
Conclusion
Feeling good and functioning well at work are important factors related to a person’s
overall well-being, and subsequently, experiencing a high level of well-being is associated with a

119
range of positive organizational outcomes. These positive outcomes include superior work
performance (Lyubomirsky et al., 2005), lowered turnover (Boehm & Lyubomirsky, 2008),
greater effort and thought put into work, less absenteeism and fewer work related injuries (Keyes
& Grzywacz, 2005). Given that one’s work affects their well-being, and that well-being is
important for organizational success, it is in an organization’s best interests to support and
promote well-being at work (Dewe & Cooper, 2012; Hone et al., 2015). Despite this area of
research continuing to evolve, there is still a need for organizations and their stakeholders to
focus on the importance of employee well-being as an integral part of workplace culture and
recognizing that it results in a more productive workforce (Boles et al., 2004). Concentrating on
nurturing emotionally and mentally healthy employees appears to be a promising approach to
fostering improved performance and may be an antidote to exhaustion and burnout.
The purpose of this research was to understand the knowledge, motivational, and
organizational influences that impact employee well-being and engagement. The stakeholder
group of focus that was chosen is an important population to study as they are direct care
providers whose well-being and engagement have significant consequences in the field of
healthcare and society at large. This study’s focus on exploring factors that contribute to
employees’ perceptions of their well-being and further understanding their feelings about desired
methods to achieve enhanced well-being is a critical area that warrants attention from leadership
as the consequences of not doing so can be detrimental for not only the employee and
organization but also society at large. This research provided direction for achieving the
organization’s performance goal to implement at least two new programs aimed at enhancing
employee well-being and improving engagement by December of 2023. The study was intended
as an initial step toward understanding what is needed for employees to participate in the

120
development of well-being related initiatives. Moreover, the study provided a basis for further
research on how various factors can influence employee outcomes. Some specific areas of future
research include examining motivational and communication strategies, and the role well-being
programs play in establishing life-long career success.
The Clark and Estes (2008) Gap Analytic Framework was essential as it structured the
review of literature, which identified eight assumed influences (three knowledge, two
motivational, and three organizational) on goal achievement. Each influence was validated
through survey responses which identified assets and continuing needs in employees’
knowledge, motivation, and organizational influences to achieving employee well-being. The
results suggested that employees have knowledge related to factors that precipitate stress and
other unwanted feelings or states. The research also indicated that employees are aware of ways
to improve their well-being. However, there was a strong indication for a desire to learn
additional ways to enhance well-being, suggesting that there is still a need for employees to
increase their knowledge in this area. The results also revealed that employees have self-
reflective skills to engage in reflection as it relates to their well-being. The study also found that
the organization and departmental leaders need to place greater emphasis on modeling behaviors
that support an organizational culture of well-being. Another finding of the survey was that
employees felt that it is important for the organization to offer programs and resources aimed at
well-being improvement. Lastly, the results discovered that there is a need for improved
communication of well-being related resources offered by the organization.
The healthcare industry is experiencing significant changes and it is essential for
organizations to strengthen and support employee well-being and functioning to help foster
continued success. Recognizing employees as human beings first and considering their well-

121
being has far reaching ramifications both for the individual, their work and the organization. As
providers who dedicate themselves to the health and wellness of others, it is essential to engage
in effective and consistent practices that can help maintain their own well-being. Skills such as
resilience and mindfulness can promote more sustainable lifestyles for those that work in high
stress environments and roles. By being proactive about their own well-being, employees may be
able to face their day to day responsibilities with greater ease, and also, possibly be better
equipped to handle escalated levels of distress when faced with unprecedented challenges, such
as that of the Covid-19 pandemic.
Employers need to start viewing nurturing healthier and happier employees as essential
factors that are foundational to favorable organizational outcomes. With positive effects such as
increased performance and productivity or decreased absenteeism, turnover and burnout,
concentration on employee wellness can be considered paramount to business and an
organization’s bottom line. Regardless of industry or field, directing attention on promoting a
strong culture of well-being needs to continue growing into an area of interest for organizations
as the benefits of doing so, and the detriments of not doing so, are becoming more evident than
ever before. If employers fail to recognize the connection between psychological well-being and
performance, they are missing a crucial component necessary to cultivate thriving staff, and
consequently, successful business outcomes.

122
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Appendix A
Employee Survey Protocol
Background Questions
What is your professional role at this
organization? (For example: MD, RN,
LVN, etc.)
(Open-ended response)

How many years have you been in this
role?
(Less than one year; One to five years;
Five to ten years; More than ten years)

What is your gender?
(Male, Female, Other [open-ended
response])

In what age range were you born?
(Before 1950, 1951-1965, 1966-1980,
1981-1995, After 1996).

What is your marital status?
(Single, never married; Married or
domestic partnership; Widowed; Divorced;
Separated)

How many hours per week do you
typically work?
(Less than 20 hours; 21-30 hours; 31-40
hours; More than 41 hours)

Please indicate the unit in which you
primarily work. (i.e., 4A, 7B, etc.)
(Open-ended response)

Have you participated in the Helping
Healers Heal (H3) training?
(Yes; No)

134
KMO Influences Survey Question

Knowledge Influences
Employees need to know what factors impact
their well-being at work.
1. At work, I feel stressed or
overwhelmed.
(Always, Often, Sometimes, Never)

2. I feel that I am able to identify the
source/s of my stress effectively when I
am feeling overwhelmed.
(Strongly agree, Agree, Disagree,
Strongly disagree)
Employees need to know how to improve their
well-being at work.
3. I know how to incorporate strategies
that improve my emotional well-being
at work.
(Strongly agree, Agree, Disagree,
Strongly disagree)

4. I would like to expand my knowledge
of skills and strategies that can be
useful to improve my well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)
Employees need to know how to reflect on their
own workplace well-being.
5. I know how to engage in reflective
processes about factors related to my
well-being.
(True or False)

6. Please briefly state one to two factors
influencing your well-being at work, if
any.
(Open-ended Response)
Motivation Influences
Employees need to see the value of engaging in
creating practices that enhance their well-being
and lead to improved engagement.
7. I see value in participating in programs
and practices that may help enhance
my well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)

8. I see value in participating in programs
and practices that may improve my
performance at work.
(Strongly agree, Agree, Disagree,
Strongly disagree)

135
9. I would like to have access to
additional programs that focus on
fortifying my well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)

10. Which of the following
presentations/programs would you be
interested in participating in if offered?
(Mindfulness training, resilience
training, stress management training,
one-on-one site coaching sessions,
group coaching sessions, other –
please specify).
Employees need to believe that they are capable
of making impactful changes that can improve
their well-being and workplace engagement.
11. I believe I am capable of developing
new skills and practices that can
contribute to improving my well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)

12. I feel that improving my well-being can
help me fulfill my professional
role/responsibilities with greater ease.
(Strongly agree, Agree, Disagree,
Strongly disagree)
Organizational Influences
The organization needs to model behavior that
promotes an organizational culture of well-
being.
13. My workplace currently
models/demonstrates a culture that
values well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)

14. Please give one specific example of
how your organization models this
value.
(Open-ended response)

15. My department models/demonstrates
behaviors that promote well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)

16. Please give one example of how your
department models the promotion of
well-being.
(Open-ended response)

136
The organization needs to be perceived as
supportive.
17. My workplace offers the support I need
to succeed and achieve my goals.
(Always, Often, Sometimes, Never)

18. My needs and well-being are important
to my organization.
(Strongly agree, Agree, Disagree,
Strongly disagree)
The organization needs to offer employee
programs or resources aimed at improving well-
being.
19. My organization offers employee
programs or resources aimed at
improving well-being.
(True, False, Do not know)

20. It is important for my organization to
offer additional resources that can
enhance employee well-being.
(Strongly agree, Agree, Disagree,
Strongly disagree)

21. What types of additional programs or
resources would you like to see offered
that can foster improved well-being?
Please indicate your top 3 choices.
(Onsite presentations/workshops,
Virtual trainings/resources, Lunch and
learns, Well-being and performance
coach, Other [open-ended response])

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Asset Metadata

Creator Serobyan, Marina (author)

Core Title Development of employee well-being initiatives to improve engagement and performance: an innovative study

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-12

Publication Date 09/17/2022

Defense Date 09/01/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag engagement,healthcare,leadership,OAI-PMH Harvest,organization change,organizational development,Performance,productivity,psychology,well-being,wellness,work-life balance,workplace culture

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Krop, Cathy (committee chair), Canny, Eric (committee member), Datta, Monique (committee member)

Creator Email mserobya@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111992648

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