Wellbeing Matters
An Okanagan Charter Implementation Toolkit
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Why Wellbeing Matters
About This Toolkit
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Getting Started
Health-Promoting Environments
The Okanagan Charter
PPC Safety
EDIA
5-Step Implementation Guide
Overview
Key Components
Putting into Practice
Cases
Roles
Resources
Overview
Key Components
Putting into Practice
Cases
Roles
Overview
Key Components
Putting into Practice
Cases
Roles
Overview
Key Components
Putting into Practice
Cases
Roles
Overview
Key Components
Putting into Practice
Cases
Roles
Overview
Key Components
Putting into Practice
Cases
Roles
Case Studies
The case studies in this toolkit connect the strategic directions of the Okanagan Charter and the pathways for turning principles into practice.
These examples are not intended to prescribe a single solution. Rather, they are designed to support dialogue, identify opportunities for change, and help institutions apply health-promoting principles within their own unique contexts.
Policy Case Studies
Policy Case Study #1
“Workplace Accommodation and Policy Clarity”
Dr. Chen, a researcher experiencing long COVID, encounters unclear processes for accessing workplace accommodations. Multiple offices (HR, occupational health, faculty affairs) provide conflicting information, resulting in delays, stress, and uncertainty.
Accommodation policies are fragmented, difficult to navigate, and inconsistently applied across the Faculty.
When policies are unclear or inconsistently applied, they can unintentionally increase burden and contribute to inequity, particularly for individuals already navigating health challenges. Clear, coordinated health-promoting policies are essential to creating a supportive and equitable environment.
Understand Current State: Identify confusion and gaps
Identify Priorities: Focus on high-impact policies
Review Policies: Assess clarity, equity, coordination
Engage & Co-Create: Engage lived experience in design
Monitor & Improve: Ensure accountability
Understand the Current State
- How easy is it to access and understand accommodation policies?
- Where do confusion, delays, or conflicting information typically occur?
- What legal and labor requirements are involved?
Identify Policy Priorities
- Which aspects of the current process are creating the greatest burden or risk?
- Which policies or procedures should be prioritized for review (e.g., leave, accommodation, return-to-work, workload)?
- Where could a small change have the greatest impact?
Review Policies – General
- Are current policies clear, accessible, and written in plain language?
- Are timelines, expectations, and responsibilities applied consistently across departments or sites?
- Do current policies support confidentiality, protection from retaliation, and legal requirements?
Review Policy – Apply the lenses!
Equity & Social Justice: Does it promote equitable access to opportunities and resources?
Wellbeing & Human Experience: Does the process reduce burden, or harm, or add to it? Is it trauma-informed and mindful of diverse lived experiences?
Inclusion & Accessibility: Were the people affected by this policy involved in its development?
Human Values: Is it written and enacted in a way that feels human, not purely procedural?
Engage and Co-Create
- How are people with lived experience of disability or chronic illness currently involved in shaping policy?
- Are there safe and meaningful ways for faculty and staff to share experiences of barriers or harm?
- Which groups need to work together to create a more coordinated process and ensure legal requirements are met?
Monitor and Improve
- Who is responsible for ensuring the policy is followed?
- How are delays, complaints, or inconsistencies tracked and addressed?
- How will you know whether the revised process is more timely, fair, and effective?
- If Dr. Chen worked in your institution, what would their experience have looked like?
- Where do similar gaps exist in your current system?
- What would a unified and supportive accommodation process look like in your institution?
Applying the policy implementation pathway, you might:
- Conduct a policy audit to map current processes and identify gaps.
- Prioritize accommodation-related policies for review.
- Review policies using wellbeing, accessibility, and equity lenses to assess clarity and consistency.
- Co-design policy revisions with individuals who have lived experience, including legal expertise.
- Develop and implement a unified accommodation policy that may include:
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- Clear entry points and contacts
- Defined timelines and responsibilities
- Confidential and trauma-informed processes
- Anti-retaliation protections
Health-promoting accommodation policies are clear, coordinated, equitable, and centred on the lived experiences of those they are intended to support without unnecessary barriers.
Policy Case Study #2
“Environmental Sustainability in Clinical Education”
A Faculty of Medicine relies heavily on disposable materials in simulation centres and teaching labs. Students express concern about environmental impact and feel discouraged that healthcare education is contributing to excess waste and emissions.
No formal sustainability policy exists for teaching and educational spaces.
Environmental sustainability is closely linked to human health and wellbeing. When institutional practices conflict with values of care and responsibility, learners may feel disengaged or conflicted.
Understand Current State: Assess environmental impact
Identify Priorities: Focus on high-impact policies
Review Policies: Review gaps in policy & accountability
Engage & Co-Create: Engage partners across the system
Communicate and Implement: Support behavior change
Monitor & Improve: Measure and sustain progress
Understand the Current State
- What environmental impacts are associated with current teaching practices (e.g., waste, energy use)?
- What concerns or values are being expressed by learners and staff?
- Where does the absence of policy create uncertainty or inaction?
Identify Policy Priorities
- Which areas offer the greatest opportunity for impact (e.g., plastics, procurement, waste)?
- What changes are feasible in the short term?
- Where could early wins build momentum?
Review Policies – Apply the lenses!
Wellbeing: How might sustainability efforts support meaning, engagement, and morale?
Equity: Could changes unintentionally burden certain groups (e.g., cost, workload)?
Systems Thinking: How do procurement, operations, and teaching practices interact?
Global Responsibility: How does this align with broader health and climate commitments?
Engage and Co-Create
- How are people with lived experience of disability or chronic illness currently involved in shaping policy?
- Are there safe and meaningful ways for faculty and staff to share experiences of barriers or harm?
- Which offices or groups need to work together to create a more coordinated process?
Monitor and Improve
- Who is responsible for ensuring the policy is followed?
- How are delays, complaints, or inconsistencies tracked and addressed?
- How will you know whether the revised process is more timely, fair, and effective?
- What sustainability challenges exist in your Faculty’s teaching spaces?
- Where is there existing interest or momentum for change?
- What is one practical step you could take to begin?
Applying the policy implementation pathway, you might:
- Conduct a sustainability or waste audit
- Prioritize high-impact areas (e.g., plastics, procurement)
- Identify gaps in existing policies and expectations
- Co-design policy revisions with individuals who have lived experience.
- Engage learners, faculty, and operations teams in co-design
- Develop and implement a sustainable operations policy that includes:
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- Reduced reliance on single-use materials
- Sustainable procurement practices
- Clear waste reduction targets
- Defined roles and accountability
- Monitor outcomes and refine based on feedback and data
Sustainability policies can strengthen both planetary health and a sense of purpose, alignment, and wellbeing within an institution.
Spaces Case Studies
Spaces Case Study #1
“Inconsistent Expectations Around Hybrid Work”
Administrative and research staff across a Faculty of Medicine experience inconsistent hybrid work expectations. Some departments allow flexible arrangements, while others require full-time on-site work for similar roles without clear rationale or guidance.
As a result, staff report confusion, frustration, and perceptions of inequity, particularly those managing health needs, caregiving responsibilities, accessibility needs, or long commutes. Over time, these inconsistencies begin to affect team trust, collaboration, morale, and retention.
The Faculty lacks a consistent, evidence-informed hybrid work approach that balances operational needs with wellbeing, accessibility, equity, sustainability, and organizational culture.
Health-promoting spaces include the virtual, social, and organizational environments that shape how people work and learn. Hybrid work practices influence accessibility, inclusion, wellbeing, psychological safety, and team culture. Transparent and equitable approaches can support healthier, more sustainable, and adaptable work environments.
Accessibility and Universal Design: Flexible work arrangements may reduce barriers related to accommodation, health needs, caregiving, or commuting challenges.
Inclusion, Belonging, and Cultural Safety: Transparent and equitable practices help foster trust, fairness, and belonging across teams.
Health, Wellbeing, and Restoration: Flexible work can support a healthier work-life balance, reduce stress, and improve wellbeing.
Physical and Psychological Safety: Clear expectations and psychologically safe communication support trust and accountability.
Supportive Organizational Cultures: Consistent, equitable leadership practices influence collaboration, morale, and organizational culture.
Sustainable and Adaptable Environments: Hybrid work models may support more sustainable space use and organizational adaptability.
Accessibility and Universal Design
- Are current hybrid work expectations flexible and accessible enough to support diverse needs, abilities, and responsibilities?
- Do employees have equitable access to the tools, technology, and supports needed to work effectively across environments?
- Are hybrid policies and processes easy to understand, navigate, and apply consistently across teams and roles?
Inclusion, Belonging, and Cultural Safety:
- Are hybrid work decisions communicated and applied in ways that feel fair, transparent, and inclusive?
- Which groups or roles may experience unintended barriers, inequities, or exclusion under current practices?
- How are diverse perspectives and lived experiences considered when shaping workplace expectations?
Health, Wellbeing, and Restoration:
- How do current hybrid work arrangements affect stress, workload, work-life integration, and overall wellbeing?
- Are there opportunities to improve flexibility, restoration, or balance without compromising operational needs?
Physical and Psychological Safety:
- Do staff feel comfortable discussing flexibility needs, concerns, or accommodations without fear of judgment or consequences?
- Are expectations and decision-making processes clear enough to reduce confusion, tension, or mistrust?
- Are staff provided with ergonomically safe and appropriate work environments, equipment, and supports for both on-site and remote work settings?
Supportive Organizational Cultures:
- How do current hybrid work practices influence collaboration, team culture, mentorship, and trust?
- Are leaders and supervisors supported in applying expectations consistently and compassionately?
- How are connection, communication, and shared team norms maintained across in-person and virtual environments?
Sustainable and Adaptable Environments:
- How might hybrid work practices contribute to more sustainable and adaptable use of institutional space and resources?
- Are current approaches responsive to evolving organizational, technological, and community needs?
Consider how hybrid work practices currently operate within your institution, department, or team:
- Are hybrid working and learning expectations clear, equitable, and consistently applied?
- Is flexibility balanced with operational needs?
- Which groups may experience unintended barriers or inequities?
- Do current hybrid approaches align with institutional values related to wellbeing, inclusion, accessibility, sustainability, and organizational culture?
- What opportunities exist to improve communication, accountability, or flexibility over time?
Engaging staff, faculty, operational leaders, human resources teams, clinical partners, and individuals with lived experience can help ensure hybrid work approaches are practical, inclusive, and responsive to community needs.
Applying a phased implementation approach, your institution may:
Establish Shared Leadership and Guidance
- Develop faculty-wide principles for hybrid work grounded in wellbeing, accessibility, operational needs, and equity.
- Clarify decision-making responsibilities and expectations across departments and sites.
- Align approaches, where possible, with university and clinical partner policies.
Understand Staff Experiences
- Gather feedback through surveys, listening sessions, or focus groups.
- Identify recurring concerns, inequities, or barriers across roles and departments.
- Assess how current practices affect wellbeing, collaboration, accessibility, and retention.
Implement Inclusive and Flexible Approaches
- Introduce role-based flexibility where appropriate.
- Ensure equitable access to technology and hybrid meeting tools.
- Support managers in applying expectations consistently and transparently.
- Create intentional opportunities for collaboration, mentorship, and connection across hybrid environments.
Evaluate and Adapt
- Monitor engagement, retention, and wellbeing-related indicators.
- Review hybrid work approaches regularly as organizational and operational needs evolve.
- Pilot small changes and refine approaches based on feedback and outcomes.
Opportunity for Change – Quick Wins: Identify one or two immediate actions that could improve consistency and transparency across teams, such as establishing shared communication principles, piloting designated hybrid work guidelines, or creating role-based flexibility criteria for similar positions.
Health-promoting spaces extend beyond physical infrastructure to include the organizational, virtual, and cultural environments that shape how people work and connect. Thoughtful hybrid work practices can support accessibility, wellbeing, inclusion, sustainability, and organizational culture when implemented transparently, consistently, and with shared accountability.
Spaces Case Study #2
“Unsupportive Clinical Space”
Dr. Kaur, a staff internist affiliated with a Faculty of Medicine and teaching hospital, works on a busy inpatient unit with residents, fellows, students, nurses, and interprofessional staff. Although wellbeing is an organizational priority, the clinical environment does not support rest, recovery, or connection during demanding shifts.
The unit’s only staff lounge is overcrowded, poorly lit, and often used for storage, leaving little space to eat, rest, or decompress. Clinicians and learners frequently eat at workstations while charting or responding to pages, despite guidance discouraging food consumption in clinical areas. Over time, breaks become difficult to take and increasingly viewed as optional, contributing to stress, fatigue, and strained team communication.
Although physical environments are recognized as influencing wellbeing, safety, and team functioning, there is no clear process or accountability for addressing space-related concerns. Responsibility is fragmented across multiple teams, making sustained improvements difficult to implement.
When environments do not support rest, nourishment, or recovery, unhealthy workplace norms can become normalized. Supportive spaces help reduce stress and fatigue, strengthen team culture, and reinforce wellbeing as part of safe, sustainable clinical practice.
Accessibility and Universal Design: Rest and shared spaces should be physically accessible, functional, and usable for individuals with diverse needs and abilities.
Inclusion, Belonging, and Cultural Safety: Staff and learners should feel welcomed, respected, and supported within shared environments.
Health, Wellbeing, and Restoration: Working and learning environments should provide opportunities for rest, nourishment, decompression, and recovery during demanding shifts.
Physical and Psychological Safety: Safe and supportive spaces help reduce stress, support infection prevention practices, and foster psychological safety around taking breaks.
Supportive Organizational Cultures: Workplace culture and leadership practices influence whether rest and wellbeing are viewed as legitimate and supported.
Sustainable and Adaptable Environments: Space planning and operational decisions should support long-term wellbeing, adaptability, and effective use of shared environments.
Accessibility and Universal Design
- Is the current space physically accessible, functional, and comfortable for all users?
- Are there barriers related to mobility, sensory needs, shift schedules, or workload that affect access to rest spaces?
- Does the environment include appropriate lighting, seating, ergonomics, ventilation, and noise considerations?
Inclusion, Belonging, and Cultural Safety
- Do all members of the care team feel equally welcome and able to use the space?
- Are some groups (e.g. trainees, night-shift staff, or temporary staff) disproportionately affected by current conditions?
- How might the design or use of the space affect feelings of belonging, inclusion, or respect?
Health, Wellbeing, and Restoration
- Does the environment support staff and learners in taking meaningful breaks, eating meals, and decompressing during shift?
- How are current conditions affecting stress, fatigue, morale, and energy levels?
- What immediate changes could better support rest, nourishment, and recovery?
Physical and Psychological Safety
- Do staff feel psychologically safe taking breaks without fear of judgment or appearing unproductive?
- Are staff provided with ergonomically safe and appropriate environments for rest, charting, and clinical work?
- Are current practices aligned with occupational health, safety, and infection prevention expectations?
Supportive Organizational Cultures
- What messages do current spaces and practices communicate about wellbeing and workplace culture?
- How are leaders and supervisors modeling healthy behaviours?
- Is there shared accountability for maintaining respectful, supportive, and functional environments?
Sustainable and Adaptable Environments
- Is the current use of space sustainable and responsive to the needs of staff, learners, and teams?
- Are there underused or flexible spaces that could be repurposed to better support wellbeing?
- How are space-related concerns identified, reviewed, and improved over time?
Consider how clinical, academic, or shared staff environments currently support or hinder wellbeing, inclusion, accessibility, and restoration within your institution:
- Do staff and learners have access to functional and restorative break spaces?
- Does workplace culture influence break-taking and wellbeing practices?
- Do physical environments align with occupational health, infection prevention, and accessibility standards?
- Which groups may experience disproportionate barriers to accessing supportive spaces?
- What opportunities exist to improve accountability, communication, or space design over time?
Engaging learners, staff, physicians, operational leaders, facilities teams, occupational health and safety representatives, and individuals with lived experience can help identify practical and inclusive solutions that fit the unique needs of your institution.
Applying a phased implementation approach, your institution may:
Establish Shared Leadership and Guidance
- Clarify who is responsible for identifying, maintaining, and improving staff and learner restorative and wellbeing spaces.
- Embed supportive space planning into operational, facilities, and strategic planning discussions.
- Establish shared expectations around protected and functional rest spaces within the working and learning environment.
Understand Staff and Learner Experiences
- Conduct walkthroughs, space audits, or listening sessions with staff and learners.
- Gather feedback on accessibility, comfort, functionality, and psychological safety within shared spaces.
- Identify how workload, workflow, and operational pressures affect the ability to take breaks.
Implement Inclusive and Flexible Approaches
- Declutter, redesign, or repurpose existing spaces to better support rest and recovery.
- Improve lighting, seating, ergonomics, ventilation, and noise reduction where possible.
- Ensure spaces are accessible, welcoming, and inclusive for diverse users and shift schedules.
- Reinforce workplace norms that support taking breaks and stepping away from clinical work when appropriate.
Evaluate and Adapt
- Establish regular processes for reviewing and maintaining spaces.
- Monitor staff feedback and wellbeing indicators over time.
- Incorporate supportive space planning into broader quality improvement and wellbeing initiatives.
- Reassess space needs regularly as teams, workflows, and environments evolve.
Opportunity for Change – Quick Wins: Identify low-cost improvements that could immediately enhance the staff environment, such as decluttering the lounge, improving lighting, adding ergonomic seating, or repurposing nearby underused space for breaks and restoration.
Supportive, accessible, and restorative spaces are not optional amenities; they are essential components of safe, sustainable, and health-promoting learning and work environments. Thoughtful space design, shared accountability, and supportive workplace cultures can help foster wellbeing, teamwork, and higher-quality patient care.
Spaces Case Study #3
“Unsupportive Clinical Space”
Chloe, a third-year medical student returning from parental leave, is completing a clinical rotation in a busy teaching hospital while breastfeeding. She needs access to a clean, private space to pump several times throughout the day, but the nearest lactation room is located on another floor, requires signing out a key, and is frequently occupied by staff from multiple departments. Without a dedicated nearby space, Chloe often pumps in supply rooms, call rooms, or empty offices that are not appropriate or hygienic. She feels rushed, embarrassed, and worried about falling behind, sometimes delaying or skipping pumping altogether. Over time, she becomes reluctant to advocate for her needs due to concerns about stigma or being perceived as less committed to training.
The site lacks consistent policies, processes, and accessible spaces to support lactation needs across training environments. Without clear guidance and supportive learning cultures, postpartum learners may face barriers to wellbeing, participation, and equitable learning experiences during clinical training.
Supportive, accessible, and inclusive environments help ensure learners can meet both educational and personal health needs without fear of judgment or academic disadvantage.
Accessibility and Universal Design: Lactation spaces should be accessible, functional, private, and designed to support diverse physical and caregiving needs.
Inclusion, Belonging, and Cultural Safety: Learners should feel respected, supported, and able to access accommodations without stigma or exclusion.
Health, Wellbeing, and Restoration: Access to safe and appropriate lactation spaces supports physical health, comfort, recovery, and wellbeing.
Physical and Psychological Safety: Learners should feel psychologically safe requesting accommodations and taking protected time for lactation needs.
Supportive Organizational Cultures: Leadership, preceptors, and teams influence whether caregiving needs are normalized and supported within learning environments.
Sustainable and Adaptable Environments: Clinical training environments should be responsive to evolving needs through proactive planning and accessible infrastructure.
Accessibility and Universal Design
- Are lactation spaces easily accessible, private, hygienic, and appropriately equipped?
- Do learners have equitable access to lactation spaces across clinical sites, shifts, and training environments?
- Are spaces designed to support diverse mobility, sensory, caregiving, and accessibility needs?
Inclusion, Belonging, and Cultural Safety
- Do learners feel comfortable requesting lactation accommodations without fear of stigma or judgment?
- How are caregiving and postpartum needs discussed and supported within the learning environment?
- Are some learners disproportionately affected by limited access to supportive facilities?
Health, Wellbeing, and Restoration
- How do current conditions affect learners’ physical comfort, stress levels, recovery, and overall wellbeing?
- Are learners able to meet their lactation needs without compromising nutrition, rest, or clinical learning?
- What supports could better enable learners to balance personal health needs with clinical responsibilities?
Physical and Psychological Safety
- Do learners and staff feel psychologically safe advocating for protected pumping time and appropriate accommodations?
- Are there clear processes for requesting support without fear of academic consequences?
- Are lactation spaces physically safe and secure?
Supportive Organizational Cultures
- How are preceptors, supervisors, and clinical teams modeling support for caregiving and lactation needs?
- Do current practices reinforce wellbeing and caregiving responsibilities as compatible with professional training?
- Are expectations around scheduling, breaks, and accommodations applied consistently and compassionately?
Sustainable and Adaptable Environments
- Are lactation supports integrated into broader planning for learner wellbeing and inclusive spaces?
- How are institutions identifying and responding to changing learner needs over time?
- Are there opportunities to repurpose or redesign existing spaces to better support postpartum learners?
Consider how learners, staff, and faculty with caregiving or lactation needs are currently supported within your institution and clinical environments:
- Do accessible and appropriate lactation spaces exist across clinical and academic sites?
- How are accommodation processes communicated and implemented?
- Do learners feel safe requesting support or protected time?
- Which groups or training environments may face disproportionate barriers?
- What opportunities exist to improve infrastructure, communication, accountability, or workplace culture?
Applying a phased implementation approach, your institution may:
Establish Shared Leadership and Guidance
- Develop faculty-wide guidance and accommodation processes for lactation needs across clinical and academic settings.
- Clarify roles and responsibilities related to access, scheduling, maintenance, and communication.
- Align policies with human rights, accessibility, and workplace accommodation requirements.
Understand Staff and Learner Experiences
- Gather feedback from postpartum learners about barriers, unmet needs, and current experiences.
- Conduct audits of lactation spaces across teaching and clinical sites.
- Identify gaps related to accessibility, scheduling, location, privacy, and availability.
Implement Inclusive and Flexible Approaches
- Create or repurpose clean, private, and accessible lactation spaces near clinical teaching areas.
- Provide comfortable seating, refrigeration access, electrical outlets, cleaning supplies, and clear signage.
- Incorporate protected pumping time into scheduling practices where possible.
- Train preceptors and supervisors to support lactation needs respectfully and consistently.
- Include lactation supports and accommodation information within learner orientation materials.
Evaluate and Adapt
- Monitor learner feedback, satisfaction, and unmet accommodation needs over time.
- Regularly review policies and space availability across sites.
- Build ongoing collaboration between learner affairs, facilities, wellbeing offices, and clinical partners.
- Integrate lactation space planning into broader wellbeing, accessibility, and supportive space initiatives.
Supportive and inclusive spaces help ensure learners can meet both professional and personal health needs safely, respectfully, and without unnecessary barriers. Accessible lactation facilities, clear accommodation processes, and supportive learning cultures are essential components of equitable, health-promoting environments.
Culture Case Studies
Culture Case Study #1
“Off-Service Residents Feeling Like Second-Rate Learners”
Leo is a first-year pathology resident completing an off-service rotation on a busy inpatient unit. Although eager to learn, he quickly feels out of place and undervalued. Teaching and feedback are primarily directed toward core service residents, while off-service residents are often assigned additional administrative tasks or heavier call responsibilities.
During rotation evaluations, off-service residents repeatedly report feeling “invisible,” excluded from meaningful learning opportunities, and valued more for service support than education. Despite recurring feedback, these concerns have become normalized within the rotation culture. Many learners hesitate to speak up for fear of being labelled “not a team player.”
This case highlights how hidden curriculum, hierarchy, and competing service pressures can unintentionally create inequitable learning environments. When off-service residents are treated primarily as workforce support rather than learners, it can reinforce harmful cultural messages about belonging, value, and professional identity.
The issue extends beyond individual interactions and reflects broader cultural and structural challenges related to workload, supervision, inclusion, psychological safety, and accountability within medical education.
Supportive learning environments are essential for learner wellbeing, psychological safety, equitable education, and professional development. When learners consistently feel excluded, undervalued, or unable to advocate for their needs, it can negatively affect confidence, engagement, learning, and trust in the educational environment.
This case also demonstrates how the hidden curriculum can reinforce inequities when efficiency and service pressures unintentionally prioritize workload over learning and inclusion.
Psychological Safety and Respect: Learners may feel unable to speak up or advocate for their needs.
Equity, Inclusion, and Belonging: Off-service residents experience exclusion and inequitable learning opportunities.
Connection, Community, and Relational Leadership: Team culture and leadership behaviours influence inclusion and support.
Growth-Oriented Learning and Support: Service pressures may undermine learner-centered teaching and feedback.
Reflection, Accountability, and Continuous Improvement: Recurring concerns require ongoing review, dialogue, and action.
Individual Reflection
- What hidden messages about belonging, hierarchy, or value are being communicated in this environment?
- How might these experiences affect learning, wellbeing, confidence, or professional identity?
- What behaviours or assumptions may be reinforcing the problem?
- What factors might make learners hesitant to speak up or ask for support?
Team and Leadership Reflection
- How are workload expectations, supervision practices, and team culture influencing off-service learner experiences?
- What changes could improve inclusion, equitable learning opportunities, and psychological safety?
- How are recurring concerns identified, discussed, and acted upon within the program or institution?
- Who has the greatest ability to influence culture in this environment, and how might they model allyship or intervene when inequities occur?
Reflect on how learners are integrated into clinical, research, academic, or administrative environments within your own institution:
- Are some learners or groups unintentionally excluded from meaningful learning opportunities?
- How are expectations communicated and modeled within teams?
- What aspects of the hidden curriculum may reinforce hierarchy or inequity?
- How comfortable do learners feel speaking up about concerns or unmet learning needs?
- What systems exist to monitor and respond to recurring cultural concerns?
Leadership and Governance
- Clearly communicate expectations for equitable teaching, supervision, and workload distribution across all learner groups.
- Reinforce that all learners are valued members of the educational environment, regardless of specialty or rotation status.
- Recognize and support leaders, faculty, and residents who model inclusive and learner-centered practices.
Policies and Systems
- Review rotation policies and expectations to ensure service demands do not override core educational requirements.
- Establish transparent processes for reporting and addressing inequitable learning experiences.
- Monitor rotation evaluations for recurring patterns related to exclusion, workload inequities, or psychological safety concerns.
Teaching and Learning
- Encourage faculty and senior residents to routinely discuss learning goals with all learners, including off-service residents.
- Promote equitable access to teaching opportunities, case discussions, procedural experiences, and feedback.
- Provide faculty development on hidden curriculum, psychologically safe supervision, inclusive teaching, and coaching-based feedback.
Culture and Relationships
- Foster team cultures that intentionally welcome and include all learners.
- Encourage allyship and active responses to exclusionary or dismissive behaviours.
- Model respectful communication, inclusive introductions, and shared responsibility for supporting learner wellbeing and belonging.
Health-Promoting Programs and Supports
- Ensure learners can access confidential wellbeing, mentorship, coaching, and learner support services.
- Provide opportunities for learners to discuss challenges related to workload, supervision, or belonging.
- Offer mentorship or peer-support opportunities for learners navigating unfamiliar or high-pressure environments.
Reflection, Measurement, and Continuous Improvement
- Collect and review feedback from off-service and core residents separately to identify recurring inequities.
- Use focus groups, pulse surveys, or facilitated discussions to better understand learner experiences.
- Include learners in rotation review, quality improvement, and culture change efforts.
Off-service inequities are often normalized within clinical learning environments, but small relational, structural, and organizational changes can significantly improve belonging, psychological safety, and equitable learning experiences for all learners.
Culture Case Study #2
“Research Pressure and Hazardous Lab Culture”
Dr. Wong leads a translational research lab within a Faculty of Medicine. Following delays caused by equipment repairs and reagent shortages, the lab faces growing pressure to produce results for an upcoming grant milestone.
As timelines tighten, some trainees and staff feel encouraged (implicitly or explicitly) to skip routine safety practices to maintain productivity. Junior team members hesitate to raise concerns because they fear being viewed as slowing progress or jeopardizing funding success. After a recent near-miss involving a laboratory spill, several staff quietly questioned whether ongoing time pressures contributed to the incident.
This case highlights how funding pressures, productivity expectations, hierarchy, and normalized workplace behaviours can unintentionally contribute to unsafe research environments. Although formal safety procedures exist, the day-to-day culture of the lab may communicate that efficiency and output are prioritized over physical and psychological safety and wellbeing.
Research environments shape wellbeing, psychological safety, mentorship experiences, and research integrity. When individuals feel unsafe speaking up about concerns, harmful shortcuts and unsafe norms may become normalized over time.
This case also demonstrates how organizational pressures and incentive structures can influence behaviour within academic environments. Sustainable research excellence depends not only on productivity, but also on cultures that prioritize safety, inclusion, accountability, and supportive leadership.
Psychological Safety and Respect: Junior staff may feel unable to raise safety concerns or question unsafe practices.
Equity, Inclusion, and Belonging: Power dynamics and hierarchy may affect whose concerns are heard or valued.
Connection, Community, and Relational Leadership: Mentorship, leadership behaviour, and team culture influence trust and accountability.
Growth-Oriented Learning and Support: Trainees require supportive supervision, safe learning environments, and mentorship that prioritizes both wellbeing and research integrity.
Reflection, Accountability, and Continuous Improvement: Near-misses and recurring pressures require ongoing dialogue, review, and systems-level improvement.
Individual Reflection
- What hidden messages about productivity, safety, or success are being communicated in this environment?
- How might time pressures and hierarchy influence decision-making or willingness to speak up?
- What behaviours, norms, or assumptions may be reinforcing unsafe practices?
Team and Leadership Reflection
- How are productivity expectations, mentorship practices, and team culture influencing psychological safety and physical safety behaviours?
- What changes could help staff and trainees feel safer raising concerns or asking for support?
- How are near-misses, workload pressures, and recurring safety concerns identified, discussed, and addressed within the lab or institution?
- Who has the greatest ability to influence culture in this environment, and how might they model allyship, accountability, and safe leadership practices?
Reflect on the learning, research, clinical, or workplace environments within your own institution:
- Do productivity pressures unintentionally encourage harmful shortcuts or unsafe practices?
- How comfortable do trainees, staff, or faculty feel raising concerns about safety, workload, or wellbeing?
- What hidden curriculum messages exist around productivity, success, or asking for help?
- How are leaders and supervisors modeling psychological safety, accountability, and supportive mentorship?
- What systems are in place to identify, review, and respond to recurring concerns or near-misses?
Leadership and Governance
- Reinforce institutional expectations that safety, wellbeing, and research integrity are non-negotiable priorities.
- Support leaders and supervisors in modeling psychologically safe, transparent, and supportive leadership practices.
- Recognize mentorship and leadership behaviours that foster safe, inclusive, and sustainable research environments.
Policies and Systems
- Establish clear expectations that productivity goals must not override documented safety procedures.
- Develop transparent and psychologically safe reporting pathways for safety concerns and near-misses.
- Review workload expectations, staffing pressures, equipment maintenance processes, and operational barriers that may contribute to unsafe practices.
Teaching and Learning
- Provide ongoing education on laboratory safety, research integrity, psychological safety, and ethical leadership.
- Support mentorship practices that encourage reflection, open dialogue, and safe questioning.
- Promote onboarding and supervision practices that clearly communicate expectations related to safety, inclusion, and respectful team culture.
Culture and Relationships
- Foster team cultures where individuals feel safe raising concerns, asking questions, and discussing mistakes or near-misses.
- Encourage allyship and active responses to unsafe or exclusionary behaviours.
- Create regular opportunities for team reflection, check-ins, and supportive discussion around workload, stress, and safety pressures.
Health-Promoting Programs and Supports
- Ensure staff and trainees have access to confidential occupational health, mental health, and employee assistance supports.
- Provide mentorship, coaching, or peer-support opportunities for individuals experiencing stress, moral distress, or burnout.
- Encourage proactive check-ins and support following stressful events or near-misses.
Reflection, Measurement, and Continuous Improvement
- Track and review near-misses, safety concerns, equipment downtime, workload pressures, and staff experiences over time.
- Use pulse surveys, facilitated dialogue, or focus groups to better understand lab culture and psychological safety.
- Engage staff and trainees in continuous quality improvement initiatives related to safety, wellbeing, and research culture.
Research excellence and safety are not competing priorities. Supportive leadership, psychologically safe environments, and strong accountability structures help create research cultures where safety, wellbeing, integrity, and innovation can be sustained together.
Personal Development Case Studies
Personal Development Case Study #1
“Early-Career Faculty – Struggling With Boundary-Setting”
Dr. Patel is a new faculty member. Eager to contribute and concerned about building a strong reputation, she routinely volunteers for additional teaching responsibilities, joins multiple committees, and supervises several students. She has heard colleagues suggest that “you need to say yes to opportunities” to succeed in academic medicine and worries that declining requests could negatively affect her promotion prospects or reputation as a “team player.”
Over time, the cumulative workload becomes overwhelming. Dr. Patel begins experiencing emotional exhaustion, difficulty concentrating, reduced energy, and declining satisfaction in her work. Her teaching quality begins to suffer, and she feels increasingly isolated and unsure how to ask for support.
Early-career faculty in medicine often face unclear expectations, competing responsibilities, and hidden curriculum messages that reward overcommitment. Without adequate mentorship, workload transparency, or support for boundary-setting, individuals may struggle to align responsibilities with their capacity, goals, and wellbeing.
Meaningful personal development includes building reflective capacity, sustainable work practices, healthy boundaries, and professional confidence. When individuals feel unable to manage competing demands or ask for support, wellbeing, engagement, learning, and long-term career sustainability may be negatively affected.
Self-Awareness and Reflective Practice: Recognizing early signs of stress, reflecting on personal capacity, and identifying hidden curriculum messages may support decision-making and lessen burnout.
Communication and Relational Skills: Boundary-setting, workload discussions, and help-seeking may support healthier relationships and more sustainable workloads.
Emotional Awareness and Psychological Flexibility: Recognizing personal limits and responding thoughtfully to challenges can support wellbeing and sustainable professional practice.
Professional Identity, Meaning, and Values: Balancing external expectations with personal values may support professional fulfillment and sustainable career development.
Reflection, Accountability, and Continuous Improvement: Mentorship and developmental supports may reduce isolation and strengthen confidence and professional growth.
Reflecting on Personal Experience
- What beliefs or cultural messages may influence decisions to overcommit?
- What are early signs that workload or stress may be becoming unsustainable?
- What skills or supports could help with prioritization, boundary-setting, or self-advocacy?
- Who could provide mentorship, guidance, or support in navigating competing demands?
Reflecting on Team and Institutional Culture
- How are workload and promotion expectations communicated to early-career faculty?
- What hidden curriculum messages exist around productivity, overwork, or saying “no”?
- Are mentorship, coaching, or peer-support opportunities accessible and equitable?
- How are leaders modeling healthy professional behaviours and boundaries?
- Do policies and evaluation structures unintentionally reward overextension?
Consider how this scenario may appear within your own faculty, department, program, or organization:
- How are early-career faculty supported in developing sustainable work practices?
- What structures exist for mentorship, career planning, or workload discussions?
- How are teaching, committee, and service responsibilities distributed?
- What cultural norms may discourage individuals from asking for help or setting boundaries?
- Where could greater transparency, flexibility, or support improve faculty wellbeing and development?
Foster Reflection, Coaching, and Mentorship
- Establish structured mentorship or peer-support programs for early-career faculty.
- Integrate reflective discussions about workload, values, and career goals into faculty development processes.
- Create opportunities for coaching around prioritization, boundary-setting, and professional growth.
Create Supportive Conditions for Growth
- Encourage leaders to model healthy boundary-setting and sustainable work practices.
- Build psychologically safe environments where faculty can discuss workload concerns without fear of judgment or professional consequences.
- Normalize seeking support and adjusting responsibilities when capacity is exceeded.
Provide Opportunities for Applied Learning
- Offer practical skill-building sessions on workload planning, negotiation, prioritization, and self-advocacy.
- Incorporate personal development strategies into onboarding and orientation practices.
- Use facilitated discussions or peer-learning activities to explore hidden curriculum messages and workplace culture.
Strengthen Continuous Improvement and Evaluation
- Review workload distribution and promotion expectations for transparency and equity.
- Evaluate whether institutional policies unintentionally incentivize overcommitment.
- Include wellbeing, sustainability, and mentorship indicators within departmental reviews and faculty development planning.
Supporting meaningful personal development in medicine requires more than encouraging individuals to “be resilient.” Sustainable growth is strengthened when institutions intentionally create cultures, relationships, and structures that support reflection, mentorship, healthy boundaries, and realistic expectations for success.
Personal Development Case Study #2
“Clerkship Student Struggling With Emotional Regulation”
James, a clerkship student, witnesses his first patient death during a busy ward rotation. Deeply affected by the experience, he begins avoiding the ward, withdrawing from peers, and disengaging from learning activities. Unsure who he can talk to without appearing unprofessional or “too emotional,” he keeps his distress to himself as his performance and wellbeing decline.
Early clinical experiences involving death, grief, and trauma can be emotionally overwhelming for learners. Without psychological safety, mentorship, or opportunities for reflection and debriefing, learners may suppress emotions, withdraw from clinical learning, or internalize distress as weakness.
Personal development in medicine includes building emotional awareness, reflective capacity, coping skills, and professional identity. Supportive learning environments can help learners process grief, uncertainty, and emotionally challenging experiences in healthy ways, supporting wellbeing, professional identity formation, and long-term growth.
Self-Awareness and Reflective Practice: Recognizing emotional responses, reflecting on difficult experiences, and identifying early signs of distress may support wellbeing and professional growth.
Communication and Relational Skills: Seeking support, participating in reflective conversations, and discussing emotionally challenging experiences may strengthen connection and reduce isolation.
Emotional Awareness and Psychological Flexibility: Processing grief, stress, and uncertainty in healthy ways can support emotional wellbeing, self-awareness, and the ability to navigate challenging experiences.
Professional Identity, Meaning, and Values: Navigating difficult patient experiences may shape professional identity, compassionate practice, and understanding of the emotional realities of medicine.
Reflection, Accountability, and Continuous Improvement: Access to mentorship, debriefing, and developmental supports may strengthen coping skills, confidence, and long-term professional development.
Reflecting on Personal Experience
- What emotions may arise after difficult clinical experiences, and how might they affect learning or behaviour?
- What beliefs exist about how medical learners are “supposed” to respond to grief, death, or distress?
- What supports, relationships, or coping strategies could help process emotionally challenging experiences?
- How can difficult experiences contribute to professional growth and compassionate practice?
Reflecting on Learning and Clinical Environments
- How are emotional responses to patient death or trauma normalized within clinical learning environments?
- Do learners feel psychologically safe discussing distress or asking for support?
- What hidden curriculum messages exist around stoicism, emotional expression, or vulnerability?
- What formal supports or debriefing opportunities are available after difficult clinical events?
- Are clinical teachers prepared to recognize and respond supportively to learner distress?
Consider how this scenario may appear within your own faculty, department, program, or organization:
- How are learners prepared for emotionally challenging clinical experiences?
- What structures exist for mentorship, debriefing, or peer support following difficult events?
- How do clinical teams model emotional processing, compassion, and help-seeking?
- What barriers may prevent learners from accessing support?
- How might programs strengthen psychological safety and normalize emotional wellbeing conversations?
Foster Reflection, Coaching, and Mentorship
- Create regular opportunities for reflective discussion, debriefing, and mentorship following difficult clinical experiences.
- Encourage faculty and clinical teachers to model reflective practice and healthy emotional processing.
- Establish peer-support or mentorship opportunities that reduce isolation and normalize help-seeking.
Create Supportive Conditions for Growth
- Foster psychologically safe learning environments where emotional responses can be discussed without judgment.
- Integrate regular wellbeing check-ins within clinical learning environments.
- Encourage clinical teams to recognize emotional wellbeing as part of professional development and patient care.
Provide Opportunities for Applied Learning
- Integrate training on emotional regulation, grief, reflective practice, and coping strategies into medical education.
- Prepare learners proactively for emotionally challenging clinical experiences.
- Use guided reflection, narrative medicine, or facilitated discussions to support meaning-making and professional identity formation.
Strengthen Continuous Improvement and Evaluation
- Review whether current learning environments and supports adequately address emotional wellbeing.
- Gather learner feedback on psychological safety, debriefing practices, and access to support.
- Ensure faculty development includes recognizing and responding supportively to learner distress.
Emotionally challenging clinical experiences are an important part of professional growth in medicine, but learners should not be expected to navigate them alone. Supportive learning environments, reflective practice, mentorship, and psychological safety can help transform difficult experiences into opportunities for learning, compassion, professional identity formation, and meaningful personal and professional development.
Personal Development Case Study #3
“Department Chair Avoiding Conflict”
Dr. Nguyen, a newly appointed Department Chair, notices that a faculty member is repeatedly missing deadlines and failing to meet departmental responsibilities. Concerned about damaging relationships or appearing overly harsh, she avoids addressing the issue directly. Over time, workload inequities increase, team frustration grows, and communication and trust within the department begin to deteriorate.
Leadership behaviours strongly influence team wellbeing, psychological safety, communication, and workplace culture. Without support or training in conflict navigation, feedback, and accountability, leaders may avoid difficult conversations, unintentionally contributing to role confusion, inequitable workloads, and declining morale.
Personal development in leadership includes building communication skills, emotional awareness, reflective capacity, and confidence in navigating challenging situations. Supportive leadership practices can strengthen trust, accountability, collaboration, and healthier team cultures.
Self-Awareness and Reflective Practice: Recognizing how personal fears, assumptions, or leadership behaviours may influence communication, accountability, and team culture.
Communication and Relational Skills: Navigating feedback, conflict, accountability conversations, and collaborative problem-solving may strengthen trust and team functioning.
Emotional Awareness and Psychological Flexibility: Managing discomfort, responding constructively to tension, and adapting communication approaches may support healthier leadership practices.
Professional Identity, Meaning, and Values: Balancing compassion, accountability, leadership responsibilities, and professional values may strengthen confidence and integrity in leadership roles.
Reflection, Accountability, and Continuous Improvement: Access to mentorship, coaching, leadership training, and reflective practice may strengthen leadership effectiveness and ongoing professional growth.
Reflecting on Leadership Practice
- What beliefs or concerns may be contributing to avoidance of difficult conversations?
- How might leadership behaviours influence team trust, morale, and psychological safety?
- What communication or conflict-navigation skills would strengthen confidence in addressing concerns?
- How can accountability conversations remain both compassionate and constructive?
Reflecting on Team and Department Culture
- How do team norms around feedback and accountability influence workplace culture?
- Are workload expectations and responsibilities distributed equitably?
- What supports exist for leaders navigating conflict or performance concerns?
- How are communication, leadership development, and psychological safety prioritized within the department?
- What impact might unresolved issues have on team wellbeing and collaboration?
Consider how this scenario may appear within your own faculty, department, program, or organization:
- How are leaders supported in developing communication and conflict-navigation skills?
- What structures exist for mentorship, coaching, or leadership development?
- How does the department approach accountability, feedback, and workload equity?
- What cultural norms may discourage difficult conversations?
- How might psychological safety and communication practices be strengthened across teams?
Foster Reflection, Coaching, and Mentorship
- Provide mentorship, coaching, or peer-support opportunities for emerging leaders.
- Encourage reflective leadership practices, feedback conversations, and ongoing professional development.
- Create spaces for leaders to discuss challenges and share approaches to difficult situations.
Create Supportive Conditions for Growth
- Foster psychologically safe environments where concerns can be raised respectfully and constructively.
- Normalize timely, compassionate feedback as part of healthy team culture.
- Ensure leaders have access to organizational supports such as HR guidance, leadership coaching, or conflict-resolution resources.
Provide Opportunities for Applied Learning
- Offer leadership development training focused on communication, emotional intelligence, feedback, and conflict navigation.
- Use case discussions, simulations, or facilitated conversations to build practical leadership skills.
- Support collaborative approaches to workload planning, accountability, and team problem-solving.
Strengthen Continuous Improvement and Evaluation
- Review departmental practices related to workload distribution, communication, and accountability.
- Gather feedback on leadership culture, psychological safety, and team functioning.
- Incorporate leadership development and wellbeing considerations into evaluation and planning processes.
Healthy leadership requires more than academic expertise or operational oversight. Leaders who develop skills in communication, reflection, accountability, and emotional awareness can foster healthier, more collaborative, and psychologically safe environments that support both individual and team wellbeing.
Health Services Case Studies
Health Services Case Study #1
“Delayed Access to Mental Health Support”
Jade is a second-year medical student experiencing increasing anxiety related to workload, examinations, and clinical skills evaluations. As her symptoms worsen, she contacts the Faculty of Medicine’s mental health services but is told the earliest available appointment is six weeks away.
While waiting, Jade’s concentration declines, deadlines are missed, and she becomes increasingly withdrawn. Although other support options may be available, she hesitates to seek help because she worries it could affect how she is perceived by faculty members or future residency programs. Over time, her distress increases and her academic performance begins to suffer.
Jade’s situation highlights a common challenge in academic medicine: services may exist, but barriers such as wait times, uncertainty about available resources, concerns about confidentiality, and fear of professional repercussions can prevent individuals from receiving support when they need it most.
Without timely access to care and clear pathways to support, concerns that may have been addressed early can escalate, affecting both wellbeing and academic performance.
Timely access to trusted health services is essential to supporting learner wellbeing. Delays in care, concerns about confidentiality, and fear of professional or academic repercussions can create barriers to help-seeking and allow concerns to escalate.
This case highlights the importance of accessible, confidential, and well-coordinated health services that support learners when they need help most.
Accessibility and Equitable Access: Timely access to services and reduced barriers to care.
Confidentiality, Trust, and Psychological Safety: Confidence that support can be accessed safely and without negative consequences.
Awareness, Navigation, and Communication: Clear information about available supports, referral pathways, and alternative resources.
Comprehensive and Responsive Supports: Availability of services that meet diverse mental health and wellbeing needs.
Strategic Coordination and System Integration: Coordination between faculty supports, community resources, and external services such as Provincial Physician Health Programs.
For Individuals
- What factors may have contributed to Jade delaying help-seeking?
- How might concerns about confidentiality, academic standing, or future career opportunities influence decisions to seek support?
- What information or supports might have made it easier for Jade to access help earlier?
For Faculty and Preceptor
- What early signs might indicate that a learner is struggling?
- How could a supportive conversation be initiated without increasing pressure or stigma?
- What resources or referral pathways should faculty members be familiar with?
For Program Leaders and Administrators
- What barriers may be limiting timely access to support services?
- Are mental health supports easy to find, understand, and navigate?
- How are peak periods of learner stress anticipated and addressed?
- How does the institution communicate confidentiality protections and available support options?
Consider how this scenario may appear within your own faculty, department, program, or organization:
- How quickly can learners access mental health support when concerns arise?
- Are wait times monitored and addressed?
- Are referral pathways clearly communicated?
- How are concerns about confidentiality and professional repercussions addressed?
- Are supports equally accessible across campuses and distributed sites?
- What alternative resources are available when demand exceeds capacity?
Assessing and Mapping Existing Services
- Review wait times, service utilization, and access patterns.
- Identify barriers experienced by learners when seeking support.
- Assess awareness of available services and referral pathways.
Establishing Partnerships and Referral Pathways
- Develop clear referral pathways between faculty services, community providers, Employee and Family Assistance Programs, and Provincial Physician Health Programs.
- Establish processes for rapid referral when urgent support is needed.
Improving Access, Navigation, and Trust
- Provide clear and easily accessible information about available services, eligibility, confidentiality, and expected wait times.
- Offer virtual and flexible appointment options where possible.
- Strengthen communication regarding confidentiality and privacy protections.
Expanding and Integrating Supports
- Increase access to counselling, peer support, coaching, and wellness services.
- Consider stepped-care approaches or interim supports during periods of high demand.
- Ensure services are culturally responsive, trauma-informed, and accessible to diverse populations.
Fostering Awareness and Help-Seeking
- Normalize help-seeking through leadership messaging and orientation programs.
- Address stigma and hidden curriculum messages that discourage seeking support.
- Equip faculty and preceptors to recognize distress and connect learners with available resources.
Even when support services exist, barriers such as wait times, stigma, confidentiality concerns, and unclear pathways can prevent individuals from accessing care. Strengthening faculty health services requires more than offering programs—it requires creating coordinated, accessible, trusted, and responsive systems that enable individuals to receive support when they need it.
Health Services Case Study #2
“Delayed Access to Occupational Health Support”
Dr. Gomes, an experienced internal medicine physician, develops a significant lower back injury while moving equipment during a clinical shift. After reporting the injury, he contacts Occupational Health for an assessment and guidance regarding work restrictions and accommodations, but is told the earliest available appointment is four weeks away.
Without timely support, Dr. Gomes continues working while managing ongoing pain. His symptoms worsen, recovery is delayed, and concerns begin to emerge regarding workload, clinical performance, and schedule reliability.
Dr. Gomes’ situation highlights a common challenge within health service systems: support may be available, but delays in access can limit its effectiveness.
Without timely occupational health assessment, individuals may continue working while injured, delay treatment, or struggle to access appropriate accommodations and modified duties. These challenges can affect not only individual wellbeing, but also team functioning, workforce sustainability, and patient care.
Timely access to occupational health services is essential to supporting workforce wellbeing, safety, and recovery. Delays in assessment or accommodation planning can prolong recovery, contribute to presenteeism, and create uncertainty for both individuals and teams.
This case highlights the importance of accessible, responsive, and well-coordinated health services that support faculty members following injury or illness.
Accessibility and Equitable Access: Timely access to occupational health assessments and workplace supports.
Confidentiality, Trust, and Psychological Safety: Availability of occupational health, accommodation, and return-to-work services.
Awareness, Navigation, and Communication: Clear information about reporting processes, available supports, and expected timelines.
Strategic Coordination and System Integration: Coordination between occupational health, departments, leadership, and healthcare providers.
Evaluation and Continuous Improvement: Monitoring service capacity, wait times, and barriers to access.
For Faculty and Clinicians
- What factors might discourage someone from reporting an injury or seeking support?
- How might delayed access to occupational health services affect recovery, wellbeing, or professional responsibilities?
- What would make it easier to access accommodations or modified duties when needed?
For Department Leaders
- How are faculty members supported while awaiting occupational health assessment?
- Are expectations regarding injury reporting, accommodations, and modified duties clearly communicated?
- How might workplace culture influence whether individuals feel comfortable seeking support?
For Faculty and Hospital Administrators
- How does occupational health capacity align with current demand?
- What risks emerge when individuals continue working without appropriate assessment or accommodations?
- How are occupational health services evaluated for accessibility, effectiveness, and responsiveness?
Consider how this scenario may appear within your own faculty, department, program, or organization:
- How quickly can faculty members access occupational health services following an injury or illness?
- Are reporting and referral pathways clearly understood?
- What interim supports are available while individuals await assessment?
- How are accommodations and modified duties coordinated?
- Are occupational health services accessible across distributed sites and practice settings?
Assessing and Mapping Existing Services
- Review occupational health service capacity, utilization patterns, and wait times.
- Identify barriers to reporting injuries and accessing support.
- Examine trends related to workplace injuries, accommodations, and return-to-work processes.
Establishing Partnerships and Referral Pathways
- Clarify roles and responsibilities related to occupational health and workplace accommodations.
- Strengthen coordination between occupational health, human resources, faculty affairs, and clinical leadership.
- Develop clear referral pathways and escalation processes when timely intervention is required.
Improving Access, Navigation, and Trust
- Communicate available occupational health services and reporting processes clearly.
- Establish streamlined pathways for workplace injuries and urgent assessments.
- Provide transparent information regarding expected timelines and available supports.
Expanding and Integrating Supports
- Develop processes for temporary accommodations or modified duties while awaiting formal assessment.
- Improve access to rehabilitation, physiotherapy, ergonomic assessments, and workplace safety resources.
- Ensure occupational health services are accessible across diverse practice settings and distributed locations.
Fostering Awareness and Help-Seeking
- Normalize the use of occupational health services as part of maintaining a safe and healthy workplace.
- Address workplace cultures that encourage individuals to “push through” injury or illness.
- Support leaders in modelling healthy and safe workplace practices.
Occupational health services play a critical role in supporting workforce wellbeing, safety, and sustainability. Delays in access can affect recovery, workplace functioning, and patient care. Strengthening occupational health systems requires coordinated services, clear pathways, timely support, and a workplace culture that encourages individuals to seek assistance when needed.
Health Services Case Study #3
“Lost in the System”
Dr. Andrews is an early-career clinician-educator who holds both a university faculty appointment and a clinical position within an affiliated teaching hospital. Over the past year, increasing clinical, teaching, and administrative responsibilities have contributed to growing stress and burnout.
When she decides to seek support, she is unsure where to turn. Different colleagues suggest different options, including university services, hospital occupational health, community providers, and physician health programs. Dr. Andrews also worries about confidentiality and whether accessing support could affect her professional reputation, promotion, or future leadership opportunities.
Although services exist, the process feels confusing and difficult to navigate. After receiving inconsistent information and struggling to identify a trusted pathway to care, Dr. Andrews disengages and decides not to pursue support.
Dr. Andrews’ experience highlights a common challenge in academic medicine: supports may be available, but fragmented systems, unclear pathways, and concerns about confidentiality can make them difficult to access.
When individuals are uncertain where to go, who to trust, or how services connect, they may delay seeking help or disengage from care altogether.
Effective health services depend not only on what supports are available, but also on how easy they are to find, understand, and access. Faculty members often work across multiple organizations, each with different services, policies, and eligibility requirements. Without clear navigation, coordinated systems, and trusted pathways to care, even well-developed services may remain underutilized.
This case highlights the importance of accessible, coordinated, and transparent health service systems that help individuals connect with the right support at the right time.
Strategic Coordination and System Integration: Alignment across university, hospital, and external support systems.
Awareness, Navigation, and Communication: Clear information about services, eligibility, and referral pathways.
Confidentiality, Trust, and Psychological Safety: Confidence that support can be accessed safely and confidentially.
Accessibility and Equitable Access: Reducing barriers that make services difficult to navigate.
Inclusion, Cultural Safety, and Responsiveness: Ensuring supports are responsive to diverse identities, experiences, and needs.
For Faculty Members
- Would you know where to go if you needed support today?
- What concerns might make you hesitate to access available services?
- How confident are you that support systems are confidential and easy to navigate?
For Leaders and Administrators
- Could you clearly explain how a faculty member accesses support services?
- How well coordinated are services across academic and clinical environments?
- What barriers might discourage individuals from seeking help?
For Faculty Health Services and Human Resources
- Are service pathways clear, consistent, and easy to access?
- Where do individuals commonly experience confusion or delays?
- How are confidentiality and privacy communicated to those seeking support?
Consider how this scenario may appear within your own faculty, department, program, or organization:
- Is there a clear and trusted entry point for health and wellbeing services?
- Are referral pathways coordinated across university, hospital, and external providers?
- How easy is it for faculty members to understand what services are available and who is eligible?
- Are concerns about confidentiality proactively addressed?
- How are the experiences of diverse faculty populations reflected in service design?
Assessing and Mapping Existing Services
- Review available services, referral pathways, and points of access.
- Identify areas where information is fragmented, inconsistent, or difficult to find.
- Gather feedback on barriers to navigation and service utilization.
Establishing Partnerships and Referral Pathways
- Strengthen coordination between universities, hospitals, physician health programs, and community providers.
- Clarify roles, responsibilities, and referral processes across organizations.
- Develop shared approaches to supporting faculty wellbeing.
Improving Access, Navigation, and Trust
- Create a centralized Faculty Health and Wellbeing Hub or service directory.
- Establish clear points of contact for questions and referrals.
- Communicate confidentiality policies and privacy protections in plain language.
Expanding and Integrating Supports
- Ensure providers understand the unique realities of academic medicine.
- Offer culturally responsive and role-informed services.
- Improve coordination between health, occupational, and wellbeing supports.
Fostering Awareness and Help-Seeking
- Incorporate service information into onboarding and orientation processes.
- Regularly promote available supports and referral pathways.
- Encourage leaders to model help-seeking and openly support faculty wellbeing.
Even when services are available, unclear pathways, fragmented systems, and concerns about confidentiality can prevent individuals from accessing support. Strengthening faculty health services requires more than expanding programs—it requires creating coordinated, trusted, and easy-to-navigate systems that connect people with the support they need.
CQI & Evaluation Case Studies
CQI & Evlauation Case Study #1
“We Keep Asking, But No One Is Answering”
A Faculty of Medicine launched an annual wellbeing survey for learners, faculty, staff, and researchers. Despite repeated reminders, response rates remain low, particularly among clinical faculty and residents.
Informal feedback suggests that many people feel “nothing ever changes” as a result of these surveys. Others express concerns about confidentiality, especially within smaller departments. Leaders are frustrated by the lack of data, while members of the faculty community are increasingly reluctant to participate. Trust in the evaluation process is beginning to erode.
The faculty is collecting wellbeing data, but participation continues to decline. Without sufficient engagement, it becomes difficult to understand community needs, evaluate progress, or identify priorities for improvement.
The challenge is not simply how to increase response rates, but how to rebuild trust and demonstrate that evaluation leads to meaningful action.
Low participation is often interpreted as survey fatigue or disengagement. However, it may also signal concerns about confidentiality, uncertainty about how information will be used, or a lack of confidence that feedback will result in change.
Effective evaluation depends on trust. When people do not see visible action resulting from their input, future participation and engagement often decline.
Governance and Accountability: Clear ownership and accountability are needed to ensure feedback is reviewed, prioritized, and acted upon.
Purposeful and Meaningful Measurement: Evaluation efforts should be designed to inform decisions and improvements, not simply collect data.
Quality Improvement and Adaptive Learning: Feedback should be used to test changes, learn from results, and refine future approaches.
Closing the Loop: Trust is strengthened when participants can see how their input informs actions and improvements.
For Leaders and Decision-Makers
- What messages have we communicated about how wellbeing data is used?
- How often do we share findings and actions with the community?
- Are we collecting information that we are prepared to act upon?
For Faculty, Staff, Learners, and Researchers
- What would make participation feel worthwhile?
- What concerns exist around confidentiality or identification?
- What would increase confidence that feedback leads to change?
For System-Level Reflection
- Who is responsible for reviewing and acting on findings?
- How are priorities for action determined?
- How do we know whether evaluation processes are building or eroding trust?
Consider a recent survey, consultation, listening session, or feedback process within your institution:
- What information was collected?
- What actions followed?
- Were results shared with the community?
- Did participants see evidence that their input influenced decisions?
- What might improve participation and trust in future evaluation efforts?
Applying a Continuous Improvement Lens:
1. What Evidence Already Exists?
Before launching another survey, review existing sources of information.
Examples may include:
- Previous wellbeing surveys
- Accreditation findings
- Focus groups and listening sessions
- Human resources data
- Health service utilization data
- Committee reports and recommendations
2. What Is the Real Problem?
Explore why participation may be declining.
Possible contributing factors include:
- Survey fatigue
- Concerns about confidentiality
- Lack of visible follow-through
- Competing demands and workload pressures
- Unclear purpose or value of participation
3. Which Strategic Directions May Be Contributing?
This challenge may involve multiple areas of the toolkit:
Policy: Are there clear expectations for reporting back on evaluation findings?
Culture: Do individuals trust that feedback will be used constructively?
Personal Development: Are leaders equipped to discuss findings and facilitate local improvements?
Health Services: Have previous evaluation findings informed visible improvements to supports and services?
Continuous Improvement and Evaluation: Are governance structures in place to review findings, prioritize actions, and close the loop?
4. What Improvement Actions Could Be Tested?
- Coordinating evaluation activities across units to reduce duplication.
- Simplifying surveys and focusing on high-priority questions.
- Introducing alternative feedback mechanisms such as listening sessions or focus groups.
- Developing a formal “We Asked, We Heard, We Did” communication process.
- Establishing a wellbeing working group responsible for reviewing findings and monitoring follow-up actions.
5. How Would You Know If Improvement Is Occurring?
- Increased participation rates.
- Improved trust in evaluation processes.
- Greater awareness of actions taken in response to feedback.
- Increased engagement in consultations and improvement initiatives.
- Evidence of changes implemented as a result of community input.
Low survey participation is often a symptom rather than the problem itself. Continuous improvement requires more than collecting information—it requires governance, trust, visible action, and ongoing communication. When people can see how their feedback informs decisions and improvements, engagement becomes more meaningful and sustainable.
CQI & Evlauation Case Study #2
“The Canary in the Coal Mine”
A Faculty of Medicine reviews its annual wellbeing survey results. Rates of burnout, moral distress, and emotional exhaustion are elevated across multiple groups, including learners, faculty, and staff.
Leadership acknowledges the findings, but discussion quickly shifts toward questions about the data. Are these results driven by workload, culture, system pressures, broader societal stressors, or something else entirely? Why do some units appear to be struggling more than others? Do the results reflect temporary challenges or deeper organizational issues?
Some leaders argue that the findings are too nonspecific to guide action. Others worry that acting without clear evidence of causation could lead to ineffective interventions. As discussions continue, no concrete changes are implemented, and similar patterns appear in subsequent surveys.
The faculty has identified a concerning signal, but uncertainty about its meaning has created paralysis. Leaders are reluctant to act without definitive explanations, while members of the faculty community become increasingly frustrated that concerns continue to be measured but not addressed.
The challenge is not whether distress exists, but how to respond when evidence points to a problem before the root causes are fully understood.
In mining, canaries were once used as an early warning system for toxic gases. The canary could not identify the source of the danger, but it signaled that something required attention.
Wellbeing data often function in a similar way. Elevated burnout, moral distress, or psychological strain may not explain precisely what is wrong, but they can indicate that further exploration and action are needed.
Continuous improvement depends on recognizing these signals, investigating them thoughtfully, and responding proportionately rather than waiting for perfect certainty.
Purposeful and Meaningful Measurement: Wellbeing measures can help identify areas of concern, even when the underlying causes are not yet fully understood.
Multiple Sources of Evidence: Survey findings are most useful when interpreted alongside qualitative feedback, operational data, and lived experience.
Quality Improvement and Adaptive Learning: Continuous improvement encourages organizations to test and refine responses rather than waiting for perfect certainty.
Interpretation and Sense-Making: Data become actionable when they are discussed, contextualized, and translated into priorities for improvement.
For Leaders and Decision-Makers
- What assumptions do we make when we see elevated distress scores?
- How much certainty do we believe is necessary before action should occur?
- What risks arise when we wait for definitive explanations before responding?
For Evaluation and Improvement Teams
- What additional information might help explain these findings?
- Are there patterns across roles, departments, career stages, or locations?
- What existing sources of evidence could help deepen understanding?
For Faculty, Staff, Learners, and Researchers
- Do these findings resonate with lived experience?
- What factors seem most connected to wellbeing challenges in your environment?
- What actions would demonstrate that leadership is taking these findings seriously?
Consider a recent survey, report, or consultation that identified a concern within your institution:
- How was the information interpreted?
- What additional evidence was sought?
- Were actions implemented while further learning continued?
- Did uncertainty lead to exploration, or did it delay decision-making?
- How might your institution respond differently in the future?
Applying a Continuous Improvement Lens
1. What Evidence Already Exists?
Before collecting additional information, review existing sources of evidence.
Examples may include:
- Wellbeing surveys
- Focus groups and listening sessions
- Accreditation findings
- Human resources and workforce data
- Turnover, absenteeism, or leave data
- Health service utilization data
- Incident reports or professionalism concerns
2. What Is the Signal Telling Us?
The goal is not to identify a single cause immediately, but to understand what the data may be signaling.
Possible contributing factors include:
- Workload and staffing pressures
- Moral distress related to system constraints
- Psychological safety concerns
- Inequities across roles, departments, or learner groups
- Barriers to support and recovery
3. Which Strategic Directions May Be Contributing?
This challenge may involve multiple areas of the toolkit:
Policy: Are workload, scheduling, accommodation, or leave policies contributing to strain?
Spaces: Do learning and work environments support restoration, connection, and wellbeing?
Culture: Are psychological safety, respect, and belonging being experienced consistently across the organization?
Personal Development: Do individuals have access to mentorship, coaching, reflection, and professional growth opportunities?
Health Services: Are supports accessible, trusted, and responsive to community needs?
Continuous Improvement and Evaluation: Are findings being interpreted, discussed, and acted upon in a structured way?
4. What Improvement Actions Could Be Tested?
- Conducting focused consultations within areas experiencing elevated distress.
- Reviewing workload, scheduling, or staffing patterns.
- Implementing targeted pilot initiatives in high-concern units.
- Increasing opportunities for dialogue and feedback.
- Strengthening leadership visibility and communication around wellbeing priorities.
The goal is not to solve every issue immediately, but to begin learning through action.
5. How Would You Know If Improvement Is Occurring?
- Improved wellbeing survey results over time.
- Increased psychological safety and trust.
- Reduced reports of distress or moral strain.
- Greater engagement in improvement initiatives.
- Positive feedback regarding organizational responsiveness.
Wellbeing data are often early warning signals rather than definitive explanations. Continuous improvement does not require perfect certainty before action can begin. By combining multiple sources of evidence, exploring patterns thoughtfully, and testing proportionate responses, Faculties of Medicine can learn from the signal rather than becoming stalled by the search for a single cause.
"Early-Career Faculty – Struggling With Boundary-Setting"
"Clerkship Student Struggling With Emotional Regulation"
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Developed by the Association of Faculties of Medicine of Canada’s Culture of Academic Medicine Initiative (CAMI) in collaboration with the Okanagan Charter Collaborative.
Suggested Citation
Do, V. Wellbeing Matters: An Okanagan Charter Implementation Toolkit. Association of Faculties of Medicine of Canada (AFMC), Culture of Academic Medicine Initiative – Towards Improved Provider Safety (CAMI-TIPS); 2026. Available from: [URL placeholder]
Help Improve the Toolkit
We welcome your feedback to help improve future versions of the toolkit. Questions, suggestions, and corrections are always appreciated.
Developed by the Association of Faculties of Medicine of Canada’s Culture of Academic Medicine Initiative (CAMI) in collaboration with the Okanagan Charter Collaborative.
Suggested Citation
Do, V. Wellbeing Matters: An Okanagan Charter Implementation Toolkit. Association of Faculties of Medicine of Canada (AFMC), Culture of Academic Medicine Initiative – Towards Improved Provider Safety (CAMI-TIPS); 2026. Available from: [URL placeholder]
Help Improve the Toolkit
We welcome your feedback to help improve future versions of the toolkit. Questions, suggestions, and corrections are always appreciated.
Wellbeing Matters: An Okanagan Charter Implementation Toolkit ⋅ Version 1.0 ⋅ September 2026