ISSN: 2940-3243

Research

Tailoring a Mind-Body Intervention to Outpatient Healthcare Settings: Insights from Qualitative Interviews

by Jule Uhl¹, Maren M. Michaelsen^1,2 and Tobias Esch¹

Abstract
Employees in the outpatient healthcare sector are required to meet a wide range of caregiving, medical, and administrative demands. In qualitative interviews with outpatient healthcare professionals and experts in patient safety, the study examined, among other aspects, which factors need to be considered when designing a mind-body intervention for adequate stress management. Participants identified various facilitating and hindering factors that should be taken into account during the implementation.

Keywords: Mind-Body-Medicine, Outpatient Healthcare, Primary Care, Salutogenesis, Resilience

Background
Healthcare professionals are exposed to a wide range of stressors, such as high workload, increasing work density and a perceived illegitimacy of certain tasks (Werdecker & Esch, 2021, 2022). High rates of absenteeism in the healthcare sector compared with other industries (IWD, 2025) suggest that these stressors are not successfully managed by all employees. Work-related stress among nursing staff is also negatively associated with patient safety culture (Li et al., 2024), indicating that higher stress levels are linked to an increased occurrence of errors and adverse outcomes (Zabin et al., 2023).

In addition, workforce shortages lead to an increased burden on healthcare personnel. This constitutes a self-reinforcing effect, as several studies indicate that high workload in the healthcare sector can increase turnover intentions (Jiang et al., 2022; Kowalczuk et al., 2020; Maniscalco et al., 2024). Depersonalization and job dissatisfaction have been identified as key factors associated with existing intentions to leave the profession (Maniscalco et al., 2024) and burnout (Werdecker & Esch, 2021).

However, health-related resources at the individual level (e.g., resilience) and at the team level (e.g., healthy learning and error culture) are gaining relevance (Uhl, Wallkamm, Kriegesmann, et al., in progress). A modern learning and error culture requires a climate in which open and honest communication is possible. Edmondson (1999) refers to this as psychological safety.

A holistic mind-body intervention (with the health pillars: behavior, exercise, relaxation, nutrition - BERN (Esch, 2020)) represents a promising approach to enhancing individual and group stress management competencies, e.g., by fostering a positive learning and error culture, resilience and psychological safety (Esch & Esch, 2016; Esch & Stefano, 2022; Hötger et al., under review). 

Contextual Conditions

Formats (On-site and Digital)
The on-site intervention was associated with advantages such as personal contact, group exchange, and a better feasibility of practical exercises. Given the high relevance of team, delivering the course on-site was considered particularly valuable. However, the requirement that the entire team be present could posed a substantial barrier. It was also viewed positively that the on-site intervention would take place within the practice, as the need for participants to travel was perceived as a potential barrier.

In contrast to the on-site course, the digital intervention was associated with reduced interaction. However, the flexibility (temporal and spatial) of the digital format was perceived as a key advantage. This format seems to be easier to reconcile with work and family responsibilities, as participation would be location-independent. To be able to take advantage of this benefit, one general practitioner highlighted the need to choose whether the digital intervention should be completed as a whole team, in small groups, or individually (e.g., at home). This is particularly necessary because not all employees work full-time. Moreover, the option to complete the digital course alone helps to prevent the risk of an “awkward atmosphere” (I11) that might occur when participants carry out the practical exercises from the digital course together. 

Based on the distinct success factors and barriers associated with both formats, a blended approach was proposed, in which theoretical content is delivered digitally while practical exercises are conducted on-site.

Time & Timing
The anticipated concerns were primarily related to time constraints and limited capacity. In some cases, Wednesday or Friday afternoons were reported to work well, whereas Mondays, Tuesdays, and Thursdays were considered less suitable due to typically longer working hours. Weekend sessions were clearly discouraged. In contrast, the lunch break was proposed as a feasible option. Integrating the intervention into existing team meetings or quality management meetings was suggested, with the additional benefit that such meetings might actually take place as intended.

Target Group
Due to differing stressors across medical specialties, one general practitioner recommended at least distinguishing “between general practitioner and specialists” (I03). She justified this by noting that patients typically “arrive” first in general practice, for example for initial assessments or following hospital discharge. In contrast, patient expectations in specialist care differ, given substantially longer waiting times, which increases the likelihood of dissatisfaction.

Interruptions
A general practitioner noted that strategies for managing interruptions should be considered prior to implementing the intervention. Potential sources of interruption included telephone calls or patients arriving. It should be communicated in advance whether such interruptions would be permitted and, for example, whether a designated person would quietly leave the session if necessary.

Content
The interviews provided several indications regarding relevant intervention content. 
Participants emphasized the importance of designing the intervention to be practice-orientated (n=4). Accordingly, applied examples should be integrated alongside theoretical components. Participants were more likely to feel engaged when problems from everyday professional practice were explicitly addressed (e.g., interpersonal conflicts, performance pressure, feelings of overload). In contrast to the strong emphasis on practical application, participants also stressed the importance of learning theoretical concepts, such as salutogenesis. At the same time, participants further emphasized that it would be advisable to avoid the use of foreign words and technical jargon, and instead simplify the content to ensure accessibility for all participants. 

Communication was the most frequently mentioned specific topic for the intervention (n=5). Open and honest communication was seen as a means of preventing stress from arising in the first place. In particular, participants anticipated considerable added value from training in nonviolent communication. Strengthening collaboration between physicians and staff, and subsequently in interactions with patients, was also regarded as particularly important.

One participant recommended addressing participants underlying understanding of errors, how they learned to deal with mistakes, and how learning from errors occurs was seen as a way to foster initial awareness and sensitivity.

Within the intervention, it was also considered highly beneficial to analyze existing workflows and identify common sources of errors as well as opportunities for improvement. In this process, setting priorities was emphasized as essential in order to achieve tangible outcomes. Furthermore, it was suggested that teams should be actively involved in the participatory development of solutions. Rather than providing prescriptive answers, the trainer should assume a facilitative role to help identify solutions that are optimally suited to the respective team. This approach was viewed as helpful for engaging participants, fostering acceptance, and maintaining motivation, as well as for identifying solutions that are feasible within the specific organizational context.

Resilience was identified as another relevant topic to be integrated into the intervention. Participants also emphasized the importance of conveying the relevance of stress management beyond the immediate work context, encompassing both mental and physical health. In this regard, developing an appropriate “mindset” (I13) was considered helpful.

At the same time, establishing the appropriate “framing” (I06) was regarded as crucial. Stress management was viewed as essential, as stress largely unavoidable. However, participants noted that preventing stress from arising in the first place is preferable to merely managing it once it occurs.

Another physician suggested that many physicians might feel personally challenged or threatened if the intervention implied that they should begin by addressing their own well-being. Participants also critically reflected on the prevailing belief that physicians do not become ill. Consequently, one physician emphasized that the framing of mindfulness exercises is highly relevant, cautioning against approaches that appear overly missionary or patronizing.