Participatory organizational intervention: improving staff wellbeing in specialized hospital units

Healthcare professionals in specialized hospital units face high psychosocial demands. Generic wellbeing interventions often fail to address unit-specific dynamics. Context-sensitive approaches engaging staff as owners and agents of change are needed in hospitals. A participatory organizational intervention was implemented at a critical care unit and a paediatric specialty ward in a Belgian university hospital (2025-2026). The intervention follows a five-phase cycle: preparation, screening, action planning, implementation and evaluation. Three measurements with validated instruments (BAT-12, UWES-9, BRS-6, DASS-21, BPNS-Work-21, COPSOQ) occur at baseline, post co-creation, and post-intervention. Co-creation workshops identify demands and resources; the IGLO-framework structures these across individual, group, leader, and organizational levels. Staff hold ownership of change and prioritize themes and develop action plans. Realist evaluation guides analysis of how context shapes implementation. Preliminary results show contrasts between units. The paediatric ward developed seven action lines, ranging from communication training to mutual-expectations exercises on leadership. The critical care unit progressed on work organization but stalled elsewhere. Three insights emerged: formal leadership engagement is decisive for momentum; anchoring interventions in existing structures proves more sustainable than building new ones; and informal leadership through emotional contagion can block progress when frustration dominates group dynamics. Participatory interventions require facilitation within prior agreed boundaries: enabling ownership but focusing on things that can change. Leadership and active engagement from supervisors shapes feasibility. Documenting contextual factors and dynamics is as essential as measuring outcomes. Combining co-creation and realist evaluation offers an innovative approach for translating staff voice into sustained organizational change.

Key messages

• Participatory organizational interventions can translate staff voice into targeted change when ownership is supported by clear boundaries and structured facilitation.

• Sustainable hospital change requires attention not only to outcomes, but also to leadership, informal dynamics and the conditions for implementation.