“It changed the atmosphere, but how long will it last?”: healthcare professionals’ experiences of an intervention to improve positive communication in intensive care - 07/03/26

Doi : 10.1016/j.aicoj.2026.100047

Anita Barth ^a,⁎ , Maurizio Cecconi ^b, Carole Boulanger ^c, Elie Azoulay ^d, Nancy Kentish Barnes ^d

^a European Society of Intensive Care Medicine (ESICM), Brussels, Belgium, Department of Nursing and Midwifery, University of Debrecen, Debrecen, Hungary

^b Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini, Pieve Emanuele, MI. 2IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy

^c Royal Devon University NHS Foundation Trust, Barrack Road, Exeter, United Kingdom

^d Department of Intensive Care and Intensive Medicine, Paris-Cité University, Saint-Louis Hospital, APHP, Paris, France

^⁎ Corresponding author.

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Abstract

Background

Burnout among healthcare professionals (HCPs) working in intensive care units (ICUs) has reached alarming levels, with detrimental effects on staff well-being, patient care, and organizational functioning. The HELLO randomized controlled trial (RCT) tested a multicomponent intervention aimed at reducing burnout by promoting positive communication and teamwork. This qualitative study complemented the RCT by exploring participants’ experiences and perceptions of the intervention, identifying barriers, facilitators, and factors influencing sustainability.

Methods

This qualitative component was conducted alongside the HELLO cluster-RCT in ICUs across multiple countries. Data sources included (1) 1,155 pictures of messages placed in “HELLO” boxes and on noticeboards, and (2) 26 semi-structured interviews with 27 ICU professionals from 18 ICUs, conducted 4–5 months after the intervention. Data were analysed using thematic analysis.

Results

Box messages from 26 ICUs in 20 countries revealed recurrent themes of appreciation, recognition, kindness, teamwork, and motivation, often expressed through short, personal notes of gratitude or encouragement. Interviews identified six overarching themes: understanding of the intervention and initial reactions; facilitators and barriers to implementation; focus on messages; local adaptations; immediate positive outcomes; and long-term potential outcomes. Participants reported improved team cohesion, communication, and workplace atmosphere, with leadership engagement emerging as a key facilitator. Barriers included scepticism, workload, and pre-existing workplace tensions. Although many perceived short-term benefits, most noted that the effects diminished over time unless reinforced through continued initiatives.

Conclusions

This qualitative study provides insight into healthcare professionals’ experiences of the HELLO intervention, highlighting perceived improvements in communication and team atmosphere, as well as challenges related to engagement, workload, and sustainability. These findings can inform future adaptations and implementation strategies for similar low-cost interventions in intensive care units.