Co-designed mindfulness program for aged care staff fails at implementation stage

A carefully planned, co-designed program to bring mindfulness training to staff at five Australian residential aged care homes collapsed not because the intervention failed, but because almost nobody could take part. Of roughly 1,090 staff invited, only 22 registered for the eight-week Mindfulness in Motion (MIM) program, and just 11 actually began attending sessions. The result, reported in a Type 2 hybrid effectiveness-implementation study published in Frontiers in Health Services, offers a sobering lesson about how chronic staffing shortages and organisational dysfunction can defeat even theoretically grounded implementation strategies.

The research team, led by Sharon Andrews of the University of Tasmania, partnered with a not-for-profit aged care organisation operating five residential services with a combined workforce of about 1,000 staff. Their design was deliberately ambitious: a registered, three-stage project that began with capacity building through a Mindfulness Action Group of six staff champions, moved into co-design of an implementation strategy mapped to the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) tool, and finished with program delivery and a mixed-methods evaluation. The trial was registered as ACTRN12623000795695 and approved by the University of Tasmania Human Research Ethics Committee.

MIM itself is an established program developed at Ohio State University that combines guided mindfulness meditation, gentle yoga, reflective writing and relaxing music. In prior studies in high-stress healthcare environments, including surgical and neonatal intensive care units, the program has been associated with reductions in perceived stress and burnout and improvements in sleep, mood and resilience. At one US medical centre, MIM was linked with a 27 per cent reduction in burnout prevalence. Those promising results, together with the program’s capacity for online delivery across multiple sites, made it a plausible candidate for residential aged care, where burnout is a persistent driver of turnover and degraded care quality.

The stakes in the Australian sector are considerable. In 2020, 277,671 people were employed in residential aged care, including 208,903 direct care workers, of whom 70 per cent were personal care workers. An estimated 65,000 employees leave the aged care workforce each year, and more than one-third of the current workforce plan to leave within five years. By 2050, an estimated 3.5 million Australians will require aged care support, with workforce demand approaching one million workers. Against that backdrop, the study team hypothesised that MIM participation would reduce perceived stress and burnout and increase resilience and work engagement, and would also reduce sick leave and turnover.

Delivery was meticulous. Three MAG members completed facilitator and fidelity training through Ohio State University, and each weekly one-hour online session was delivered with a second trained facilitator performing a session-level fidelity check. Sessions were scheduled at 7 am and 2 pm to align with shift changeovers, dedicated rooms were available at every site, and staff were promised paid release and backfill to attend. Recruitment was promoted through CEO emails, face-to-face information sessions, the staff wellness newsletter, posters and a QR-code expression-of-interest link. None of it was enough: attendance among the 11 participants was highly variable, ranging from a single session for one participant to full attendance for another.

The quantitative evaluation fared even worse than delivery. Because so few staff enrolled, only baseline and immediate post-program data could be collected; the planned two-month and twelve-month follow-ups and the organisational sick leave and turnover data were abandoned, since further collection would have imposed additional burden for negligible analytical value. Of the 11 Stage 3 participants, only two completed both surveys. Combined with the six MAG members, who had completed the same measures during the earlier capacity-building phase, the exploratory effectiveness sample numbered just eight people, a self-selected group far too small to test the hypotheses.

Within that tiny sample, the exploratory analyses showed mixed patterns. Work engagement increased significantly from baseline to follow-up, with a moderate-to-large effect size, and the dedication and vigor subscales also showed statistically significant one-tailed improvements, although confidence intervals for some estimates crossed zero, signalling considerable uncertainty. Resilience increased and perceived stress decreased with nominally significant p-values, but again with imprecise effect-size estimates. Burnout subscales showed small, non-significant shifts, and personal accomplishment moved in the direction of worse burnout. The authors themselves stress that the small, self-selected sample precludes any definitive conclusion about effectiveness in this setting.

The qualitative findings were more consistent. Interviews with four MIM participants and post-program meetings with the six MAG members revealed that those who took part found the program acceptable and often transformative on a personal level. Participants described greater calm, improved sleep through breathing techniques, a daily meditation practice, and more deliberate interactions with residents. One enrolled nurse reported stopping to look residents in the eye rather than hurrying past; a personal care worker described a regular 30-minute walking meditation as the best outcome. Yet even here there was dissent: one MAG member acknowledged the sessions were interesting but said the program simply did not resonate with her.

The barriers to wider engagement were structural and, in the authors’ analysis, largely beyond the reach of local strategies. Heavy workloads and chronic staffing shortages were cited as the primary reasons staff did not participate, with one participant noting that most staff now work double shifts and that taking an hour away was unthinkable. Scepticism about backfill ran deep: staff doubted, based on past experience, that their shifts would actually be covered, and worried that attending would simply shift the load onto already stretched colleagues. The 2 pm session clashed with shift handover obligations, and many personal care workers held jobs at multiple facilities, further crowding out any spare hour. Emails promoting the program went unread, and although the CEO championed the project, middle managers did not consistently encourage their teams to attend, with one MAG member lamenting that the organisation could not even get people to turn up for the information sessions.

The authors conclude that implementation breakdown, not intervention ineffectiveness, was the central finding. Co-design identified real barriers in advance, but staff scepticism about backfill and the poor fit of session timing only became visible once implementation began, and theoretically matched strategies proved insufficient when contextual conditions were resistant to change. They recommend structured readiness assessment before rollout, continuous monitoring during delivery with predefined thresholds that trigger real-time adaptation, more flexible delivery formats such as shorter or blended sessions, and larger multi-site trials to determine whether MIM’s benefits elsewhere can be replicated in residential aged care. Their broader message is a paradox worth heeding across the sector: the very conditions that create the need for staff wellbeing interventions, namely chronic shortages, heavy workloads and workplace stress, are the same conditions that make such interventions nearly impossible to deliver.

Subject of Research: Implementation of a mindfulness-based wellbeing program in residential aged care

Article Title: Understanding implementation breakdown: lessons from a type 2 hybrid effectiveness-implementation study in residential aged care

Article References: Andrews, S., Edwards, K., Stirling, C., Lees, D., Van Dam, P., Klatt, M., Caputo, J., Kornhaber, R., & Williams, P. (2026). Understanding implementation breakdown: lessons from a type 2 hybrid effectiveness-implementation study in residential aged care. Frontiers in Health Services, 6, Article 1813706. https://doi.org/10.3389/frhs.2026.1813706

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1813706

Keywords: implementation science, residential aged care, mindfulness, burnout, CFIR, co-design, workforce shortages, staff wellbeing, hybrid effectiveness-implementation, nursing homes, Mindfulness in Motion, organisational readiness