Process evaluation of a multilevel intervention targeting emotional demands in a hospital

Purpose Multilevel interventions may prevent the negative consequences of emotional demands. However, a known barrier to implementing multilevel interventions is high workload, an increasing problem in the healthcare sector due to staff shortages and an aging population. This study investigates key factors for implementing a multilevel intervention targeting emotional demands at an entire hospital with staff shortages. Design/methodology/approach We conducted a process evaluation drawing on concepts from realist evaluation. We conducted individual semi-structured interviews before and after the intervention (39 in total) with managers, employees, the board of management, and intervention consultants. We also observed intervention activities, collected attendance registrations for all planned intervention activities, and analyzed data using thematic analysis. Findings In the context of staff instability, overcrowding and staff groups with low power distances we found that top-management support and a strong connection to patient safety could support a high degree of implementation. We found that the intervention activities led to participants experiencing improvements in social support, knowledge, action possibilities and prevention practices. Further quantitative analyses are needed to establish the effects of the intervention on more distal outcomes. Originality/value The study identified key factors for successful implementation of a multilevel intervention in hospitals allowing for implementation in a resource-scares environment. This knowledge is key for future efforts to prevent and manage emotional demands in healthcare.