Why It Matters
Health care professionals are always willing to do their work without fanfare, but the enormity of the COVID-19 pandemic means health care leaders must think differently about the sacrifices their staff are being asked — and expected — to make.
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Does Joy in Work Matter During a Pandemic?

By Derek Feeley | Tuesday, March 31, 2020

Line of Sight

At a time when health care professionals across the globe are working around the clock against COVID-19, running toward what others flee, it may seem insensitive at best — or callous, at worst — for leaders to talk about joy in work.

Let me be clear: I fully recognize that the top priority for all health care leaders should be doing everything we can to expand testing and provide enough of the proper equipment and other resources for staff. In the health care world’s current hierarchy of needs, these are undoubtedly at the top.

So, why talk about joy now? If I thought joy in work was only about throwing pizza parties and eating cake, then I would agree that there are more important issues to raise in the middle of a pandemic. However, I believe joy in work is about cultivating a sense of purpose, meaning, and fulfilment. Consequently, I feel compelled to note that the effects of the long hours, stress, frustration, fear, and unprecedented risk health care professionals are facing right now will likely last long after the current crisis abates.

We all know that burnout was a big problem in health care before COVID-19. What health care professionals are experiencing now goes well beyond burnout. 

Health care professionals are working like firefighters in continuously burning buildings, committed to saving others while facing grave dangers themselves. As our colleague Lakshman Swamy, MD, of Boston Medical Center said recently, “As an intensive care doctor, [caring for patients during this pandemic] feels like what we were born for. This is what I've spent years training for. We’re all here for this . . . But the challenge is that, when we don’t feel safe, it’s terrifying.”

Health care professionals have always been willing to do their work without fanfare, but the sheer enormity of this disease commands health care leaders to think differently about the sacrifices their staff are being asked — and expected — to make.

One way to do this is to pose a deceptively simple question. As a first step in cultivating joy in work, IHI recommends organizations ask their staff what matters most to them. This query is more important than ever because my sense is that the answers we hear may well have changed in recent weeks.

For example, many people working in health care — nurses, physicians, allied health workers, environmental service workers, food service workers, techs, and others — have understandable concerns about their own personal safety or lack thereof. They may worry in new ways about elderly or immune-compromised family members or kids who are staying home from school or college. We as leaders must help staff address these issues in ways we may never have before.

I humbly expect the people closest to the evolving pandemic will teach us a tremendous amount about the potential — and possibly also the limitations — of how joy in work can strengthen the health care workforce in times of extreme stress. For now, IHI continues to believe that whole system solutions are necessary to achieve joy in work, especially in times of crisis. Again, the top priorities for leaders should be to equip and protect staff and expand testing. I’m also respectfully advocating for the following actions:

  • Articulate constancy of purpose — In times of pressure and challenge, it can be easy to focus on the urgent issue in front of us and lose sight of our principles. People are struggling to sift through all their daily tasks, new requirements, and changes in policy and operating environments. It is at times like this that leaders need to spend time with the staff at the point of care, see the challenges they’re facing, remove barriers, recognize the value of their efforts, and keep everyone pointed in the direction of True North – providing the best care possible for their patients.
  • Enhance individual resilience and sense of meaning — Though we shouldn’t rely solely on individual resilience as the answer to our current challenges, we must do all we can to make sure people see that their work makes a difference in the lives of their patients and colleagues.
  • Maintain teamwork — Teams are being sorely tested as they get refocused, reallocated, and pulled to different parts of our system. Managers need to find ways to maintain teamwork even as some teams are being fragmented as they adapt to the changing needs of their patients and organization.
  • Create and encourage psychological safety — As described in the Framework for Safe, Reliable, and Effective Care, a psychologically safe environment is one in which “anyone can ask questions without looking stupid. Anyone can ask for feedback without looking incompetent. Anyone can be respectfully critical without appearing negative. Anyone can suggest innovative ideas without being perceived as disruptive.”
  • All health care leaders are being tested as never before. What gives me hope during these difficult times is the number of leaders I have seen reach out to help one another, with humble generosity. At a time when it might be easier for them to focus only on what they need in their own health system, they are helping colleagues across the globe, across the country, and sometimes across town at “competing” organizations. It just blows me away.

IHI will continue to do all we can to learn along with others. We’ll share the best of what we find and develop because we’re more likely to get the answers we need if we navigate our way through these troubled times together.

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

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

IHI Framework for Improving Joy in Work white paper

More COVID-19 Guidance and Resources

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