Photo by Charles Tyler | Unsplash
Why It Matters
At a time when we often hear that burnout is increasing in the global health care workforce, there are cases worth noting that demonstrate this is not inevitable. Last year, for example, 38 teams from 15 organizations across England participated in a one-year improvement collaborative on the topic of enjoying work. They were different types of organizations at various stages of their quality journey, but the data indicated that after a year they reduced the percentage of people experiencing burnout, increased people’s joy in work, and increased the percentage who would recommend their team as a place to work.
How can we learn from those who defy the odds and increase the joy and well-being of the health care workforce? Firstly, health care leaders must make the people in our workforce one of our topmost priorities. If we do not have the staff we need and they are not experiencing the best possible conditions in which to work, it is unlikely our patients are going to get the best possible care. We must find a way to make sure that we are looking after our people, holding onto them, and helping them thrive in the workplace.
It does not matter whether we call it joy or creating the conditions in which people can do what they come into work to do. Whatever language we use, the key message is that leaders must help people manage their work better, build strong relationships with others, and do the best they possibly can for their patients.
At East London NHS Foundation Trust (ELFT), we began this work in 2017 when the Institute for Healthcare Improvement (IHI) published the IHI Framework for Improving Joy in Work. We were curious about how we could apply the systematic science of improvement to this topic. We began with five teams from a range of different clinical settings and non-clinical settings, and over time we have scaled that up. We have now incorporated a whole range of teams from every aspect of clinical care that we offer, including inpatient to community-based teams, co-located teams, dispersed teams, but also corporate teams, including our executive team.
We have now supported over 80 teams to apply the systematic improvement method with the aim of improving joy and well-being. Here are some of the lessons we have learned along the way:
- Remember that active, curious leadership matters. In all improvement work, the role of leaders is absolutely critical. When we ask teams to improve the system, we want them to experiment and be willing to fail and learn from trying new things. Leadership plays an important role in creating the psychological safety within which teams can do that. Whether teams are working on patient safety or flow or joy, the role of a senior leader as an active, curious sponsor is to pay close attention, help when teams get stuck, and champion the work.
- Help teams come up with their own solutions. As leaders, most of us have become adept at problem-solving. In fact, we have often risen up the ranks by being good at managing problems. What I advise leaders to do, though, is to let go of problem-solving responsibility, enable their team to understand the system they are working in, and encourage them to come up with their own solutions. Leaders should help the team connect their work to their organization’s strategic priorities, but also give them permission to try new things.
- Focus on team-level interventions. I see too many organizations introducing big, shiny interventions at the whole organization-level and often they do not work because well-being, experience at work, and engagement are largely related to the people we interact with day to day. In addition to my patients, this means my colleagues and the system within which I deliver care. The best approach to enhancing team well-being and experience at work arises when every team comes up with their own ideas that are unique to their experience and their context. You may be surprised by the results.
- Engage patients in the work. We ask all our teams to make sure their patients are involved in this improvement work. Our patients can tell when we are having a good day or a bad day. One of the reasons it can be powerful to have them as part of this work is to help us understand the impact of our experience at work and to help us think about the things we can do differently.
- Understand that most good change ideas do not cost any money. Once you start looking at the system and the way in which you do your work, you will spot small things that you can do that aggregate together to have big impact. These ideas have ranged from restructuring meetings to make them more efficient and effective, to thinking about ways to bring camaraderie back after years of COVID disruption. People have discontinued activities, audits, and forms that they no longer need to complete to spend more time on what really matters. One team’s idea to show more appreciation for one another was to spread what they called “positive gossip.” They started saying positive things about someone else in another person’s ear and allowed that to spread through the team.
- Keep measurement simple. There are now many places around the world doing this work who have come up with their own ways of measuring joy and well-being. There is no one perfect way. In improvement, no data is perfect. We just need “good enough” data to learn. So, keep the measurement simple, and use what is out there already. There are plenty of examples. The focus has to be on teams owning this, starting to test changes, and having just enough data to know whether changes are making a difference.
It is important for leaders to remember that joy is a byproduct of using quality improvement. Using quality improvement to tackle a complex, meaningful issue gives a team autonomy and control. When you start applying improvement to something that matters, you feel more connected to meaning and purpose.
At the start of this work, though, it is common for people to feel a sense of helplessness, powerlessness, and even a bit of skepticism. They may not be convinced by all this talk about joy and well-being because it may feel a long way from their current experience.
Then they start to understand what matters to them as a team. They begin to develop and test ideas aimed at connecting more deeply to their true meaning and purpose. The moment a team starts to try something, it starts to have a sense of agency that they may have lost or maybe never knew they could have. And then they start to hear the stories of the impact this work is having on members of their team or their patients. For me, it is the most rewarding part of doing this work.
Amar Shah, MD, is a consultant forensic psychiatrist and Chief Quality Officer at East London NHS Foundation Trust.
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