Developing and sustaining animal-assisted services at a tertiary medical center: A qualitative study.

BACKGROUND AND PURPOSE: Animal-assisted services (AAS) are increasingly implemented in healthcare settings, yet existing literature has focused primarily on efficacy and safety rather than how hospital-based programs are implemented, sustained, and adapted within complex organizational environments. This first-of-its-kind qualitative study explores the development of Mayo Clinic's AAS program to identify practice-relevant factors that shaped program growth and sustainability. MATERIALS AND METHODS: We conducted semi-structured qualitative interviews with four participants who had direct, sustained involvement in the development, leadership, or operational support of Mayo Clinic's AAS program. Interviews were audio recorded, transcribed verbatim, de-identified, and analyzed by reflexive thematic analysis with an inductively developed codebook. RESULTS: Participants reflected on the therapeutic impact of the human-animal bond for patients, families, and staff, as well as the organizational conditions that shaped this impact and program success. Key factors influencing implementation and sustainability included leadership and administrative support, physician partnership and advocacy, formalized standards for team vetting and onboarding, organizational alignment, ongoing education, quality control, and continuous improvement. Participants also emphasized ethical stewardship of therapy animals and the need to balance program expansion with animal welfare, handler preparedness, and institutional trust. CONCLUSION: The evolution of Mayo Clinic's AAS program demonstrates that sustainable hospital-based AAS requires more than evidence of therapeutic value; it depends on supportive champions, operational fit, standardized practices, data-informed advocacy, and a clear commitment to quality and animal welfare. These findings offer practical insights for institutions seeking to develop or refine evidence-aligned hospital-based AAS programs across healthcare settings.