Why It Matters
At IHI, we teach that successful measurement is a cornerstone of successful improvement. That’s clear and relatively straightforward when we’re focused on infection rates, wait times, or patient falls. But how can you measure something like joy in work?
As we explain in the IHI White Paper, IHI Framework for Improving Joy in Work, right now, there is no single validated measure of joy in work. Until there is, leaders need to draw on other indicators known to contribute to, or signal trouble for, joy in work.
Measuring joy in work calls for both system-level and local-level measures:
- Two or three system-level measures (such as satisfaction, engagement, burnout, turnover, retention, employee wellbeing, workplace injuries, or absenteeism) that you can review annually to identify areas for improvement and to track progress over time
- Local-level measures or assessments that occur more frequently that local leaders can use for improvement on a daily or weekly basis. Staff themselves, along with the core leader of the unit, clinic, or department, should initiate and track daily or weekly assessments of joy in work. The timing of these local assessments matters. Assessments can occur after an event, such as an adverse event; after an interval, such as a day or a week; or at random.
System-Level Measures
Within system-level measures, consider using:
Net Promoter Score: The Net Promoter Score (NPS) was originally devised by Harvard Business Review in 2003 to indicate customer engagement. It is adaptable, however, to measure internal team members’ engagement. If your organization is looking for one overall measure of joy in work, this may be a good measure to track as it provides a sense of how colleagues view the organization.
Mayo Clinic Leadership Dimensions Assessment: The Leadership Dimensions Assessment can be administered to individuals or to groups. Individual data highlights areas where multiple supervisors or areas of leadership need additional training or improvement. Completing this assessment with a group facilitates conversations about bright spots and areas for improvement.
Safety Attitudes Questionnaire: Use this survey to assess safety culture, identify areas for improvement, and highlight strengths across the organization. The survey can be used to establish baseline data on the existing culture of an organization, to compare culture internally between specialties, or to compare clinical performance between organizations.
AHRQ Patient Safety Culture Surveys: These surveys are used to assess the current safety culture within an organization, raise awareness of patient safety issues, identify areas for improvement, highlight strengths, and provide the ability to view the data over time. This data can be used for internal comparisons between specialties or areas of the organization, or external comparison across organizations and the health care industry.
Maslach Burnout Inventory: The Maslach Burnout Inventory measures respondents’ relationship to work; it is typically used to assess a group of staff members in an organization, rather than as an individual diagnostic instrument. The group scores can be correlated with other demographic information and used as baseline data to determine the impact of an intervention.
Mini Z Burnout Survey: The short, 10-item survey measures burnout and the health care practice environment. The survey is intended to be distributed annually and completed individually by all providers within a practice. The data can be used as a baseline measure and as a gauge of overall staff wellness over time.
Nine-Item Survey to Measure Physician Engagement in Addressing Health Care Disparities: Because equity and fairness are central to a joyful workplace, assessing engagement levels can guide efforts for improvement. The nine-item survey is used to measure engagement (physician or staff) in addressing health disparities.
Hackman and Oldham Job Characteristics Model to Job Satisfaction: This tool is best used with efforts seeking to improve meaning and purpose in work (e.g., efforts focused on job enrichment and improving the essential nature of the work performed).
Local-Level Measures
Within local-level measures, consider using:
Daily Visual Measure: To measure joy in work in real time, IHI created a visual measure — a glass jar placed by the elevator into which staff drop one marble each day: a blue marble for a good day, where the individual made progress (J), or a tan marble for a day without progress (L). A designated staff member counts the number of blue and tan marbles each morning and tracks the total count. A quick glance at the jar enables staff to gauge the daily mood of the organization. Leaders also use this data to assess levels of joy in work over time.
Three Daily Questions: To find joy and meaning in their daily work, each person in the workforce must be able to answer affirmatively to three questions each day:
- Am I treated with dignity and respect by everyone?
- Do I have what I need so I can make a contribution that gives meaning to my life?
- Am I recognized and thanked for what I do?
Core leaders can use these questions as a basis for conversation in daily huddles or team meetings.
Pulse Survey: Pulse surveys are a fast and frequent survey system, designed purposefully to avoid complex questions and give quick insight into the health of a company. At IHI, pulse surveys are short (10 questions or fewer) questionnaires on a 5-point Likert scale (“Strongly Agree” to “Strongly Disagree”) that are distributed monthly or quarterly (as opposed to annually). They provide the organization with frequent data to assess overall staff engagement and to see whether the efforts to improve joy in work are making a difference.
With any of these tools (which you can learn more about in the white paper), it’s particularly helpful to stratify data by unit, department, discipline, and other demographic factors such as race and ethnicity. By drilling down into different units or groups of staff, organizations can identify areas in which to focus their improvement efforts first. More frequent and tailored data collection, and transparent sharing of results with each work unit and its leaders, allows for more real-time improvement and a better way to track the impact of changes over time.
Regardless of what is measured, leaders need to track data regularly, make the results transparent, and address issues identified as a priority. It’s important for joy in work to be a key organizational metric, on the same level as other organizational priorities and measures. This sends an important message to staff about the culture and values of the organization. Measuring joy in work can also help secure an organizational sense of “we’re in this together for our mission” when such measurement is used to demonstrate the link between joy in work and the patient experience, and to its impact on costs (e.g., staff turnover, recruitment and retention).
To learn more about how you can measure your efforts to improve joy in work, explore the IHI Framework for Improving Joy in Work white paper.