England’s health and social care workforce is burning out, and this project will test whether changing entire workplace cultures—not just offering yoga classes—can fix it. The problem is stark: staff shortages and rising psychological ill-health mean the current approach, which focuses on individual resilience, is failing. This research argues that only system-wide culture change, combining supportive interventions with proactive prevention and continuous monitoring, can create workplaces where staff truly flourish. The team will work across five integrated care systems in four English regions—Surrey, Devon, North West London, and South Yorkshire—using realist methods to uncover what levers trigger change, for whom, and under what conditions. If successful, the project will leave a lasting legacy: a practical framework for designing and evaluating healthy workplace interventions, plus tools like economic models to help employers weigh costs against benefits. It will also amplify the voices of “forgotten staff”—those in marginalised or less visible roles often excluded from wellbeing initiatives. The impact is not a quick fix but a replicable blueprint for how the NHS and social care can systematically stop losing its people to stress and burnout.
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Background: Current staff shortages and high rates of psychological ill-health in the health and social care (H&SC) workforce support the need for radical changes to create healthy workplaces where staff can flourish. Previous work suggests a focus on individuals is obscuring the need for system wide multi-strand culture change interventions. These need to include supportive interventions and preventative proactive measures with embedded monitoring and evaluation. Aims: • To work in partnership with 5 integrated care systems (ICSs) in 4 regions to change unhealthy workplaces, creating healthy ones where staff can flourish. • Using realist methods, we will determine how multi-strand culture change interventions work (e.g. the levers required and mechanisms they trigger), in which contexts and for which staff. • To leave a legacy of how to create healthy workplaces where staff can thrive, including capacity building in skills and knowledge for design and evaluation of interventions. Methods and setting: Mixed methods realist informed research across 4 health and care regions in England; Surrey, Devon, NW London, and S Yorkshire. Identified gaps in knowledge will be prioritised in the first 24 months in 5 linked work packages (WP); to inform how healthy workplace interventions can be developed and evaluated in the final 3 years, including identifying the system levers to ensure sustainability. WP1: Knowledge mobilisation and building system capacity: work to develop research and evaluation capacity and understand how best way to co-create and share learning across the workforce/nationally. WP2: Forgotten staff: to analyse surveys and interview staff (in 5 ICSs) to better understand staff wellbeing needs of forgotten staff (including those seldom heard or previously excluded, e.g. marginalised/less visible roles). WP3: Scoping international/new ideas/good practice: to review published reports and studies for healthy workplace initiatives, including outside UK and in other industries/ professions. WP4: Workforce data metrics and linkage: to identify local/national databases containing NHS staff workforce and wellbeing data and explore how to link the data to better understand the effects of work on staff wellbeing. WP5: Economic evaluation of staff wellbeing initiatives: to develop a framework to help employers assess the relative costs/benefits of different healthy workplace initiatives. Co-design: Evidence from WPs1-5 will be shared for debate, advice and input with our CIE and ICS groups and other stakeholders throughout all WPs and bought together at a workshop at 18 months. Co-design principles will be used to develop 1-2 multi-strand culture change interventions for the final 3-5 years. Team: Our H&SC partnerships are extensive, and we are a uniquely well-placed team. We have extensive subject expertise, realist, statistical, implementation science, co-production/design, EDI, patient and staff involvement and health economics expertise, with substantial real-world evaluation experience in H&SC settings. Anticipated impact and dissemination: Our dissemination plan is ambitious, accessible, and novel (animation; guides, films) as well as traditional (academic papers, conferences, and events). Our partnership will have impact through evaluation of culture change in real-world ICS partnerships, leaving a strong legacy of knowledge and learning, including capacity building in skills and knowledge for intervention design and evaluation.
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