Female nurse patting elderly male patient on the shoulder while smiling

Improving joy in healthcare

It’s globally recognised that healthcare workers are under immense and unrelenting pressures as COVID-19 continues to add further strain to the healthcare system on a daily basis. Unfortunately, even before the added pressures of this pandemic, healthcare workers consistently ranked as one of the highest professions suffering from burnout and stress.

In 2019, the World Health Organisation (WHO) recognised burnout as a medical condition in its International Classification of Diseases, defining it as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed”. The syndrome is characterised by three dimensions:

  • Feelings of energy depletion or exhaustion
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and
  • Reduced professional efficacy.

As psychologists warn the overburdened Australian health system of a looming burnout crisis, healthcare leaders are looking to understand what factors are diminishing joy in work, what can be done to nurture their workforce, and how they can address the issues that drive burnout and sap joy from our work.

The backbone of any good healthcare system requires an engaged workforce. Recently, the Triple Aim framework (enhancing patient experience, improving population health, and reducing costs) was modified to the Quadruple Aim, with the addition of a fourth aim: “improving the experience of providing care”. This acknowledges the importance of the workforce (doctors, nurses, and all employees) in finding joy and meaning in their work. The National Health Service (NHS) in the UK, has captured this with the notion of an engaged staff that “think and act in a positive way about the work they do, the people they work with and the organisation that they work in”.

Similar to the Quadruple Aim framework, the Institute for Healthcare Improvement (IHI) framework for Improving Joy in Work recognises the impact healthcare professionals have on the success of healthcare delivery and is focused on improving the work-life of healthcare providers, including clinicians and staff.

IHI have conducted research that indicates that people who are joyous in their safety and/or quality focused work, are more curious, alert and eager to learn. They aren’t scared of asking questions like, “How can I help you more?”. The research found that joy and generosity go hand in hand, which leads to improved outcomes for patients. At the core of it, healthcare workers come to work to help people, so if an organisation can clear the noise, open dialogue and give their workers an opportunity to really help, they’ll find it more fun and be better at it. IHI surmised that increasing joy in the workplace is the most efficient way to focus on quality.

Considering this, we can confidently support the notion that joy is a resource for excellence. Unfortunately, as joy in the workforce erodes, the quality of work goes down. IHI believe that the same issues that drive burnout also diminish joy in work for the healthcare workforce. To start you thinking about ways in which joy can be impacted, IHI have identified the main impediments to joy, which include:

  • Concerns about physical safety
  • Psychological safety – bullying, harassment
  • Equity – equal pay, promotion, is their voice heard
  • Camaraderie – do they feel part of their team
  • Choice – how they execute daily responsibilities
  • Meaning – do they feel connected to the higher purpose

Joyful, productive and engaged staff feel physically and psychologically safe, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.

If we were to plot this list against Maslow’s hierarchy of needs, it would remind us – first things first – if an organisation doesn’t address concerns about physical and psychological safety, it may not be able to help people get to connection to meaning.

So, as a healthcare leader and caring manager, colleague, friend and/or family member, how can we make improvements to increase joy at work for ourselves and our staff?

To begin with it’s important to recognise that there seems to be a chasm between the current state of burnout and the achievement of joy amongst healthcare workers. We know that tackling burnout is essential, however there’s multiple moving parts when striving to improve joy the workplace. It’s important to have an overall aim to create a system in which everybody may take joy from their work while recognising that the journey you take to get there may take time and result in gradual improvements.

A healthcare organisation attentive to enabling joy and meaning in work in pursuit of the Quadruple Aim should embody shared core values of mutual respect and civility, transparency and truth telling and the safety of the workforce. Additionally, the organisation should recognise the contribution and accomplishments of the workforce regularly and with high  .

There’s no doubt that everyone is currently doing their best to navigate their way through this incredibly stressful global crisis. Healthcare workers face new challenges every day. However, if you can spare some time, be it a little or a lot, the CFEP Surveys Team has the IHI framework for Improving Joy in Work into four key principles to support and enable your team to find more joy in their work. For full details on how you can improve joy in your organisation, download IHI’s full whitepaper here.

1: Ask staff, “What matters to you?

This first step is about asking the right questions and really listening to the answers to identify what contributes to – or detracts from – joy in work for your staff. By asking staff “What matters?” as a leader you’re able to engage in a form of appreciative inquiry that taps into strengths or bright spots. It can also allow you to identify what’s already working in the organisation, allowing focus to be placed here to offer energy for change. Conversation questions may include:

  • What makes for a good day for you?
  • What makes you proud to work here?
  • When we are at our best, what does that look like?

This then sets the context for asking what gets in the way of a good day or what makes for a bad day. When leaders and team members are frank about what makes for a bad day, whether it is an overload of patients in the practice or an inability to act on patients’ wishes for care, leaders and colleagues are then able to share the problems and ultimately the solutions. This creates a sense of “we are in this together”.

2: Identify unique impediments to joy in work in the local context

Steps 1 and 2 usually happen in the same conversation and continue over time. In Step 2, identifying unique local impediments to joy in work is how you as a leader can identify impediments that exist in daily work – the “pebbles in their shoes” – and then set priorities and address them together. This offers everyone a chance to contribute on which impediments to address, build camaraderie by working together to remove impediments, and practice equity in respecting all voices.

3: Commit to a system approach to making joy in work a shared responsibility at all levels of the organisation

It’s important to note that although there is a shared responsibility, making a workplace joyful should be driven by leaders. Organisations can’t just delegate responsibility for joy in work to the Human Resources department; it’s everyone’s job. Everyone from senior executive leaders to clinical and administrative staff has a role to play. From creating effective systems, to building teams, to bolstering one’s own resilience and supporting a positive culture, each person contributes. According to IHI research, it’s critical for leaders at all levels to dedicate time, attention, skill development, and necessary resources to improving joy in work. It’s vital to have a constant champion dedicated to joy in work to ensure momentum and sustainability.

4: Use improvement science to test approaches to improving joy in work in your organisation

There are many ways to take a systems approach to improving joy in work. The aim is to make the change process rewarding and effective. Using principles of improvement science, organisations can determine if:

  • Changes being made are leading to improvement
  • Strategies and initiatives are effective in different programs, departments, and clinics, and
  • Improvements are sustainable.

Your team should set an aim for their work, decide on measures that would tell them if they were making progress, and selected components of the IHI Framework for Improving Joy in Work as areas in which to test changes. You might find that the joy uncovered by implementing these four key principles, in large part, may be your own.

It’s important to measure progress on this fourth goal in the Quadruple Aim through metrics focusing on workforce engagement and workforce safety. Workforce engagement can be assessed through regular surveys (every 6-12 months) using evidence-based tools such as the Maslach Burnout Inventory, the gold standard for measuring burnout. Workforce safety metrics could include quantifying work-related deaths or disability, reported injuries and lost time injuries. Even though, these measures do not fully quantify the experience of providing care, they provide a practical start and allow for a baseline assessment and ongoing monitoring for improvement.

According to IHI President and CEO, Derek Feeley, it will become apparent when there is joy in the healthcare workforce when you see the following behaviour amongst staff:

  • Expressions of gratitude
  • Hope replacing feelings of hopelessness and being overwhelmed
  • Awareness of abundance – having the necessary tools to make the progress that needs to be made, and
  • Deep satisfaction from serving others – fulfillment of the core purpose of joining the health care profession in the first place.

Improving joy in work is possible and important, especially in these difficult times when there is more strain on our precious healthcare workforce. No other industry has more potential to effectively use its resources to save lives and reduce human suffering than healthcare. The key is creating the conditions for the healthcare staff to find joy and meaning in their work and in doing so, improving the experience of providing care. Efforts towards addressing and improving the other areas of the Quadruple Aim will also help improve this fourth aim of improving the experience of providing care.

The CFEP Surveys Team is able to provide formal feedback and survey solutions to provide staff, patient and colleague insights to support healthcare organisation in achieving the Quadruple Aim. CFEP Surveys is proud to also be approved as an approved patient feedback provider under the RACGP Standards.

To learn more or to speak to our team about these offerings, contact us via the details below:

P: 07 3855 2093

E: [email protected]

W: www.cfepsurveys.com.au