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Having What Matters to You conversations are essential to support workforce well-being and joy. In these discussions, managers and leaders listen to learn. They give staff the opportunity to express their values, priorities, and concerns while demonstrating vulnerability in sharing some of their own. These conversations lay the foundations for an asset-based approach to improvement, build will for change, and can transform even the most cynical among us.
Questions to guide joy and well-being conversations can include:
- 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?
These conversations are the first step of the IHI Framework for Improving Joy in Work and comprise an essential part of the IHI’s Joy & Workforce Well-being Results-Oriented Learning Network. This Network is a collaborative launched by IHI intended for health care systems and organizations that are looking to improve well-being and joy, increase staff engagement and productivity, and improve the overall quality of care and experience for staff and patients. The Network initially launched in March 2020 and just completed its second wave.
The teams participating in the Network took a variety of approaches to these conversations. At the University of Mississippi Medical Center (UMMC) School of Dentistry, for example, the facilitator asked questions: What part of your job makes your day brighter? What made you want to do this job?
Harold Mark Livingston, DDS, MS, Chairman of UMMC’s Hospital Dentistry and Advanced General Dentistry, decided to separate the faculty, staff, and students into different discussions. He wanted to avoid a situation where a faculty member might say, for example, “I’m so tired of students coming to class unprepared,” leading to hurt feelings, misunderstandings, or defensiveness. Mixing the groups together “could have provoked a confrontation,” Livingston explained, “or all the turtles could have pulled back in their shells.”
At the Newcastle upon Tyne NHS Trust in the UK, multiple support options were available for managers who were leading What Matters to You conversations. One possibility was fairly self-directed but offered guidance on how to facilitate a conversation. The second provided more of a framework. Managers attended three weekly sessions and learned skills such as how to analyze feedback, create Pareto charts, and use the Model for Improvement for staff experience.
Some managers expected the conversations to be difficult. “What are the tools that help with resilience when you’re having conversations that feel a bit stomach-churning?” asked Jill Cordes, Senior Workforce Development Officer at Newcastle upon Tyne NHS Trust. Anticipating this, managers were offered help in learning how to receive feedback.
Multiple themes emerged from these conversations, ranging from the practical to the more psychological. Communication emerged as a common challenge. For example, Tumi Divine Bahtila, MD, at Mbingo Baptist Hospital in Cameroon recounted how their hospital leaders directed the doctors to work on a way to collaborate more effectively when the nurses disclosed that they did not feel heard by the doctors.
Another theme was meaning and purpose. At Dartford and Gravesham NHS Trust, the staff compared the Trust’s stated strategy with the day-to-day experience of work. “The team was saying there was a mismatch between those two things,” said Ebenezah Otoo, Continuous Quality Improvement Specialist. “How do we better align our work with the leadership’s expectations? How do we have a collective shared vision?” They also discussed autonomy and input. “When decisions are being made, the people who are being affected are not always informed,” Otoo explained. The staff expressed interest in “participative management,” wherein they could have more of a say and communicate more effectively with leadership.
Other themes that emerged were practical concerns related to finances and staffing shortages. At Mbingo Baptist Hospital, Bahtila said one common concern was late salaries. For faculty at UMMC, Livingston said, the message was simply, “We need help. We’re stretched thin.”
Despite differences in the specifics, Livingston said he found it eye-opening to discover that teams working in different parts of the world were often facing similar struggles, including feeling stressed and dealing with bureaucracy. “No matter how different we thought we were, we’re really not that different,” he said.
Acting On What Was Learned
The next step for the teams was to decide what to do with the information that emerged from the What Matters conversations. At Mbingo, Bahtila has been talking to their finance administrators about making sure salaries are paid earlier. In response to staffing concerns, UMMC’s dean went to the upper administration, and secured a budget increase for more faculty positions. “Change is not going to happen overnight,” Livingston acknowledged, “but you do have a good feeling about the fact that he listened and lobbied very vigorously for us.”
In addition to monthly faculty meetings, UMMC started shutting down all clinics once a month so the dean can hold sessions with the staff to discuss issues and solutions. “If you have some constructive criticism,” said Livingston, “this is your vehicle for that.” Prior to these meetings, there had been no open forum for staff at the School of Dentistry. Added Livingston, “In the past, their input was not asked for or valued as much as it should have been.”
At Dartford and Gravesham, each team is pursuing a QI project that responds to themes identified in the What Matters to You conversations. “They are looking at specific barriers as a team, each team coming up with a specific project,” said Otoo. One team, for example, “knew they were working overtime, but there was no way that was being documented and measured. How do they measure their workload? How do they measure their resources?”
While it is crucial to follow up on these conversations with concrete actions, leaders have noticed that the open discussions themselves have value. Cordes of Newcastle upon Tyne NHS Trust recalled that one staff member described feeling better after the What Matters conversation but before any subsequent activity. Said Cordes, “We’ve been surprised, but we know that there’s [already] been a lot of therapeutic benefit.”
You may also be interested in:
IHI Leadership for Workforce Well-being Professional Development Program (In-Person and Online starting March 27, 2023)
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