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Leadership + Teamwork + A New System = Joy in Work

By Frederick Southwick | Tuesday, March 15, 2016

Joy in work quality improvement health care

In January, I served as the team leader for our multidisciplinary inpatient medical team. Before I began my rotation, I wondered two things: 

  1. “Will my team and I experience joy at work?”
  2. “How can I encourage everyone to have fun?”

We’ve all heard the phrase, “create joy at work” — one of the bold and important goals promoted by the IHI Leadership Alliance — but how do we actually achieve this goal?

As we began the rotation, I led a team discussion about our mutual goals. I found myself stepping back and thinking, “We are so lucky that our goal is to improve the health and wellbeing of our fellow man. Shouldn’t this goal naturally foster joy at work?” But those of us who experience the typical inpatient ward know all too well the many obstacles to that goal. We know what we want to do, but we are often are unable to experience the joy of our accomplishments because we must devote a large percentage of time working around those obstacles.

For example, because many hospitals, like ours, are experiencing occupancy rates above 90%, patients on each team cannot be housed on a single floor. Instead, they end up on four or five different wards, requiring the care team to spend over 30 minutes per day traveling to see their patients. This condition leaves less time to interact with our patients and bedside nurses, and less time to effectively meet their needs.

Our team realized we had two options:

  1. We could complain to administration, and become frustrated and angry.
  2. Or we could create a system under our control that adapted to the reality.

We chose the latter approach.

Our team of residents created a game plan each morning that designated what time we would arrive at each patient’s bedside. At 9 AM, we began rounds in the Intermediate Care Unit that housed our sickest patients, and then systematically moved to the other general medical floors. We established a time expectation of 10 minutes per patient, understanding that some patients would require longer and others shorter visits. We informed the charge nurses on each floor of our expected time of arrival to assure that our bedside nurses could participate on rounds. We rounded at each patient’s bedside and discussed our management plans, queried each patient and bedside nurse about our plan for the day, and listened to their suggestions for improvement. We ensured all orders were written electronically at the bedside to assure the accuracy and timeliness of our plan.

What happened?

We consistently completed our work rounds in less than two hours, and completed all electronic progress notes and entered all orders before noon each day. As a consequence, our patients received their diagnostic tests and treatments more quickly than the other medical teams. Our patients experienced shorter lengths of stay (our daily census was 10-11 vs. 14-16 for the other medical services), allowing us to devote more time and energy to each patient. Team morale was outstanding, and our patients repeatedly expressed their deep satisfaction with our care. The bedside nurses who experienced our approach thanked us, and felt their input had made a difference. Our rounding system had created joy for both patients and providers.

Our conclusion: a systems approach that fosters effective teamwork can create joy at work.

Editor’s Note: Learn more rounding at the University of Florida College of Medicine and learn more about IHI’s focus on joy in work. Photo courtesy of the University of Florida.

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