“It Isn’t Joy in Work; Joy IS the Work”

Kate Hilton of the IHI Open School, Helen Bevan of the NHS England, Hans Hartung of the NHS Scotland, and Marianne McPherson of the IHI 100 Million Healthier Lives team describe how leaders can embrace their role as facilitators of joy in work.

Improvement guru W. Edwards Deming had a clear vision of a leader’s role: “Management’s overall aim should be to create a system in which everybody may take joy in his [or her] work.” Studies have shown that joy in work leads to higher service user satisfaction, better staff engagement, more cooperation among staff, higher productivity, and more efficiency.

But what exactly is “joy in work,” and how can we, as leaders, elicit it? We tackled that question during a unique session at the 2016 IHI National Forum on Quality Improvement in Health Care.

As we prepared for the session, we wanted to develop a shared understanding of joy from our work as leaders of large-scale change efforts. We believe joy is a lived experience, not a theoretical one. While we may possess strategies and methods for creating joy, they must pass the “sniff” test: we know when we feel “joy” — and when it is inauthentic or forced. We experience joy as a feeling of pleasure, happiness, and wellbeing that results in energy, connection, a sense of purpose, meaning, and fulfilment. In other words, we all have an internal “joy calibration system.”

We took that knowledge and challenged ourselves to teach about joy with joy at the Forum, where we gathered with 20 frontline leaders of change in health care. As pre-work, we asked participants to submit “personal anthems of joy,” which played throughout the session. As participants entered the room, we welcomed, acknowledged, and thanked each one of them for their presence. We asked them questions about themselves, helped them find their seats, and introduced them to one another. We shared pictures and stories of who we are and what brings us joy. We ignited the senses in small groups around smell, touch, taste, sound, and breath. And during our break, we conducted a “Randomized Coffee Trial” to deepen authentic connections.

Our workshop’s aim was to create a Joy Manifesto that explored how we experience joy from within, together, and across a system. The following seven design principles for joy emerged from the group’s work. Central to these principles is the understanding that while joy is a lived experience at personal and interpersonal levels, creating the sustained conditions for joy is a system responsibility. These system conditions, then, lead to personal and interpersonal joy at work:

• Create conditions for people to identify sources of joy from within. We cannot give what we do not have. Because joy lives within, we must identify the personal practices and habits that connect us to our internal sources of joy, like journaling, being in nature, exercising, meditation, and singing. Test to Try: Notice for yourself: what makes you joyful?
• Encourage people to bring their whole selves to work. This is about moving from knowing what brings you joy to living it at work. How might you bring other joyful parts of your life into the workplace? Participants offered examples like writing thank-you notes to others at work, building a quiet walk into each work day, and sharing a joke, personal stories, or pictures. Test to Try: By next Tuesday, what one joyful life practice can you integrate into your work day?
• Create conditions for human connection. To live is to be connected to — and helpful to — each other. Human connection is an organic process that emerges whenever people meet. Workshop participants noted that connections amplify collective learning by building on one another’s strengths and recognizing weaknesses. The quality of our connections is a predictor of our happiness. Sharing stories and facilitating a social environment help to build authentic connections. Attentive listening without interruption, humble inquiry, and genuine curiosity are human ways to build empathic bridges. Test to Try: In the next week, listen to someone without interruption and with curious interest in what they want to share. How is it different?
• Make it safe to be joyful. Deming also said, “Drive out fear, create trust.” Trust and absence of fear are the foundation to go beyond “safe space” to “brave space” where people can try new things and be vulnerable, honest, and light-hearted together. Joy lives at the edge of taking risks and knowing that it is okay to fail forward. Ask “open and honest” questions, demonstrate acts of kindness, greet everyone within a 10-foot radius, adopt an “eyes up, hearts open” hallway culture with no smart phone use, and celebrate courage. Be nice, consistently. A culture that values recognition and respect encourages trust. Leaders have a particular responsibility to create these conditions by modelling these behaviors. Test to Try: Put away your smart phone for one day and acknowledge those around you. See what happens.
• Create a space for others to lead. Be authentic. Don't give power and take it away; instead, help others see and use their agency. Ignite people’s autonomy by asking them to break the rules when the rules stop serving the intended purpose. Empower people to refine and redefine measures that don’t make sense. Replace micro-management with mutuality by spending time at the front lines to speak with and listen to people. Test to Try: This week, make rounds on the floor or in the field with the intent of unleashing others’ capacity and will to solve their own problems.
• Build systems for joy: When we think about joy, we typically think about intrinsic motivation: connecting with people’s internal motivation, linking with their values and the things that matter to them at the deepest emotional or spiritual levels. But we can also create systems of extrinsic motivation to support joy. By this, we mean introducing levers or system drivers that encourage specific behaviors or “prod” people to engage in particular activities. Examples include:
  • Defining joy as a stated value of the organization, developing metrics around joy, making joy a deliverable to which all staff dedicate a percentage of time each month, and including joyfulness as a qualification in job descriptions
  • Creating conditions for joy to emerge, as Swedish leaders do with “FIKA,” a break with coffee and cake
  • Backing off if incentives are experienced as "compliance for joy,” making them inherently un-joyful

Test to Try: By the end of the month, explore one concrete step for your organization to take to design for joy.

• Create conditions for people to learn, improve, and innovate. Having fun designing joy in work, actually enjoying the process, was one of the most exciting insights from the workshop. Improvement and innovation stimulate creativity and intrinsic motivation, resulting in joy. As Deming noted, “Innovation comes from people who take joy in their work.” Co-ownership, playful improvisation, experimentation, valuing failure, the appreciating of stories behind the data, and a focus on collaboration make change come alive. Joy in improvement work results from the knowledge that any improvement contributes to the bigger picture and is connected to others’ learning. Joy builds confidence, and confidence builds intrinsic motivation for continuous learning. As Deming stated, “We are here to learn, to make a difference, and to have fun.” Test to Try: Have fun! (Really!)

All in all: It isn’t “joy in work”; joy is the work. Being an improvement leader who creates the conditions for joy means knowing it, being it, sharing it, and designing for it. For Deming, there was no doubt that the experience of joy in work was a prerequisite for any high-performing organization. Joy must be how we do business — within ourselves, together with others, and across our systems.

Sources and additional reading:

• Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ QualSaf. 2015;24:608-610.
• Sirota D, Klein D. The Enthusiastic Employee: How Companies Profit by Giving Workers What They Want (2nd edition). Pearson FT Press; 2013.
• Stress in America: Paying With Our Health 
• Finding joy and meaning in work: In support of the Quadruple Aim