Why It Matters
IHI didn’t invent the concept of joy in work, but we do believe now is the right time to flip the thinking around the whole issue of burnout.
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Joy in Work: More Than the Absence of Burnout

By Derek Feeley | Tuesday, August 1, 2017
Derek Feeley Line of Sight joy in work and burnout

People sometimes ask me why IHI focuses on increasing joy in work rather than on reducing burnout. It’s a reasonable question.

Everywhere I go, clinicians tell me they’re exhausted, frustrated, and experiencing overwhelming stress. People are feeling overburdened and overregulated. They spend more time looking at computers than their patients’ faces. Former IHI executive and Senior Fellow Jim Conway describes it as feeling as if you’re at the bottom of a waterfall that never stops. And clinicians in the US aren’t the only ones feeling this way — I hear this from people all over the world.

In the face of all of this, it seems almost counterintuitive to talk about joy in work. So, why does IHI frame the issue this way — finding joy instead of just battling burnout? Because addressing burnout is necessary, but not sufficient. 

Focusing on Assets

W. Edwards Deming talked about joy in work, so it’s not new. Joy in work has long been part of IHI’s mission. When you step out of the elevators at IHI, one of the first things you see are words about how IHI will “bring joy in work to the health care workforce.” 

IHI didn’t invent the concept of joy in work, but we do believe now is the right time to flip the thinking around the whole issue of burnout. Often, when people talk about burnout, they speak in terms of deficits. What’s wrong? What are we lacking? We think it’s time to address the very real problem of burnout with assets-based thinking. What’s working? What are our advantages? Framing the issue in terms of joy in work will help us build upon the strengths of the health care workforce. 

Aaron Antonovsky said that health is more than the absence of disease. I believe joy in work is more than the absence of burnout.

A Step-by-Step Approach

To shift the conversation from burnout to joy in work, the key is for leaders to approach this issue one step at a time.

First, we as leaders need to do the same with staff that we recommend clinicians do with patients: ask, “What matters to you? What brings job satisfaction? What creates pride in the organization? What does it look like when we’re at our best?”

The next step is to identify the specific things that get in the way of attaining what matters most to staff at the local level. There will be some common issues, but there will also be variation depending on the individual, ward, department, unit, program, clinic, project, or team. What wears down the energy and morale of staff? What are the pebbles in their shoes?

The third step is for leaders to clearly demonstrate that joy in work is a shared responsibility at all levels of their organization. Leaders cannot hand over primary responsibility for joy in work to their human resources department and expect staff to believe it’s an organizational priority.

Step four is to use improvement science to design changes to test, and develop an approach to assess whether or not these changes are leading to improvement. By combining the discipline of PDSA cycles with some of the known approaches to improving employee satisfaction — and co-designing these tests with staff from the start — you can increase staff’s engagement in meaningful improvement. 

Skepticism about Joy in Work

I’m well aware that the term “joy in work” doesn’t play well with every audience. When we first started to talk about it in the UK, for example, I actually saw people cringe. 

A bit of healthy skepticism is understandable. People quite rightly point out that there’s an enormous chasm between where we are right now and joy in work. 

Leaders must meet skepticism in two ways. First, you need to meet it with ambition. It’s important to convince your staff that there is a future that’s more attractive than the status quo. Providing a compelling vision of how things could be better is part of the antidote to burnout. That’s part of many approaches to change and promoting joy in work is essentially a change process. Secondly, you counteract skepticism with practical tools and proven methods. The IHI Framework for Improving Joy in Work white paper offers both.

We also have to remember that most people go into health care because they want to help people. Leaders have an obligation to help demoralized staff members reconnect with their original sense of purpose, compassion, and caring.


More than Pizza Parties

I like pizza as much as the next person, but no amount of pizza is going to connect me to IHI’s purpose. What does? Seeing that we are making a difference in the lives of the people we serve. No amount of pepperoni or mozzarella is a substitute for that.

Having said that, pizza parties can be useful. One of the elements of the joy in work framework is camaraderie and teamwork. By all means, celebrate. Gather together to informally share food and build connections between staff members.

But you don’t have to use your scarce resources on parties. The great thing about joy in work is that it’s often free. It costs nothing for leaders to help every staff member to see the connections between their work and your organization’s mission and purpose. 

Make no mistake. There’s no quick fix for what’s ailing health care today. Cultivating joy in work is hard work. To help the health care workforce experience joy will take resilience, ambition, and unwavering leadership support. 

Derek Feeley is IHI President and CEO. He will be faculty for the Finding & Creating Joy in Work virtual training beginning March 1, 2018.

Editor’s note: Look for more from Derek Feeley (@derekfeeleyIHI) on leadership, innovation, and improvement in health care in the “Line of Sight” series on the IHI blog.

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