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Health care systems are experiencing unprecedented challenges globally because of the COVID-19 pandemic. With health care staff in harm’s way and many health care systems in command and control mode, one might reasonably think that joy in work is irrelevant, but there is no more important time to address it.
Health care staff have been going above and beyond the call of duty to support patients and communities. In addition, almost every health care worker is experiencing some form of loss, including patients, family members, or friends taken by the virus. Some have lost a role at work or their family has suffered a loss of income. The potential impact of all this is difficult to fathom, but we need to help our people work through their grieving process and find ways to come to terms with their new reality. Unless we recognize and manage this proactively, the COVID-19 crisis might well contribute to a future wave of staff burnout.
Now is an opportune time for health and social care leaders to use the systematic approach of improvement science to look after the wellbeing and health of our workforce. Using the IHI Framework for Improving Joy in Work (see Figure 1) can help. The true essence of joy in work focuses on what matters most. It’s about looking after ourselves, each other, and our patients. Joy in work means finding ways to work better as teams and gaining more control over the systems we work in.
Figure 1 – IHI Framework for Improving Joy in Work
East London NHS Foundation Trust (ELFT) in the UK provides mental health and community services to a diverse and largely low-income population. For the past three years, ELFT has been using what we’ve learned about quality improvement and the joy in work framework to support 6,000 staff.
Around 50 ELFT teams have gone through a step-by-step process to understand what matters as a team and as individuals. We’ve also identified what brings people joy in their work and tested ways to create more of these experiences within the workday. Before the coronavirus, teams had tested a range of ideas, including identifying ways to spend quality time together (through sharing meals regularly, for example), celebrating and appreciating each other’s contributions, and involving more of the team in decision making.
Even during the COVID-19 pandemic, we at ELFT are using the joy in work framework. For example, we have been regularly applying the real-time measurement component to better understand the experience of our staff. We ask a sample of staff four simple questions three times every week: What matters to you in daily work? What helps make a good day? When we are at our best, what does that look like? What gets in the way of a good day?
We track both qualitative and quantitative data over time. This gives ELFT managers and leaders a systematic approach to paying attention to how staff are feeling, spot any notable changes, and ensure we keep improving the way we support staff.
Physical and Psychological Safety
It is imperative for health system leaders to ensure staff have both physical and psychological safety. Staff working at the point of care must be equipped to make the best possible decisions, sometimes under challenging circumstances. All staff must have the right equipment and training to do their jobs and know they have the support and gratitude of their leaders. Creating psychological safety means setting aside time to listen to each other’s feelings and welcoming ideas. Leaders must treat failures as opportunities to learn, not blame.
During the COVID-19 pandemic, ELFT is refocusing skilled internal psychological expertise to help staff process and manage the changes, challenges, and trauma they are experiencing. A dedicated support line for staff has been established to offer one-on-one conversations. ELFT is also providing guides and resources to help staff and patients maintain their own health and wellbeing.
Simple things like encouraging staff to take time off are so important. We all need rest, even more so at times of extreme stress and challenge. As leaders, we need to model this for our staff.
Teamwork and Camaraderie
Teamwork and camaraderie are also vital during the pandemic. For teams that are physically separated because they are working from home, it’s important to remain connected to each other and to a shared purpose and to foster camaraderie in the virtual workplace. Pay special attention to team member morale because physical distance can make it more difficult to spot loneliness, loss of purpose, or feelings of helplessness.
For staff who work in services that have been reduced in scope or scale, there may be a real sense of anxiety or disconnection. They may worry about how to best provide support when normal services resume, particularly since there is likely to be a huge, potentially unmanageable, backlog of demand.
We have developed a new online tool to support care teams. Many of them have acknowledged that they need to start focusing on improving the experience and wellbeing of their staff, so the online tool helps teams use a systematic process to work through the joy in work framework.
We have seen the amazing dedication and selflessness that health and care staff have demonstrated to keep us all safe during the pandemic. We now need to predict and proactively manage the likely long-term effects of this prolonged period of extreme stress and loss on our physical, emotional, and psychological health. IHI’s joy in work framework can help teams and team leaders give these issues the serious attention they deserve.
Amar Shah, MD, is Consultant Forensic Psychiatrist and Chief Quality Officer at the East London NHS Foundation Trust, an IHI Strategic Partner.
You may also be interested in:
Conversation and Action Guide to Support Staff Wellbeing and Joy in Work During and After the COVID-19 Pandemic
Tips for Improving Staff Wellbeing During COVID-19
More COVID-19 Guidance and Resource