I was recently meeting with a physician I like and respect. He tends to speak his mind. As part of a rich and honest conversation, he told me how jarring it has felt to be in the midst of a complex and distressing consultation and receive a cheery email from me or a member of my team about “joy in work.”
This conversation and others have made it increasingly clear to me that joy is a word that is open to interpretation. Depending upon how you understand it, the word can elicit a variety of responses, including irritation, cynicism, and even guilt.
I’m part of a team responsible for the planning and commissioning of health care services for our local area. We enable innovation and evidence-based change for primary care practices in the Tower Hamlets borough of East London. We help to build quality improvement (QI) into one of the most deprived environments in the country. On a yearly budget of less than £90 (approximately US$115) per registered patient, general practice services are asked to offer responsive, high-quality care within a reality of exceptionally high disease burden.
Let’s be clear: Joy is a word that my team and I use intentionally and in the face of open challenge. The debates and resistance that the word generates externally first took place within the very team who went on to make joy its main aim and measure.
We debated and challenged the concept of joy. We invited others to help us take it apart and explore it. We reflected on its synonyms and alternatives.
I am aware that the word joy gets reactions — sometimes allergic ones. Verbal marmite. That is, in part, why my team and I chose it in the first place. Love it or hate it, the word joy gets reactions. Happiness, contentment, and meaning are words that can easily slip by without comment. Joy is aspirational, ambitious, and slightly alien.
To consider joy as part of our team’s core deliverables has required years of conversations, and learning to trust evidence, people, and our own ability to manage risk and uncertainty. Our aim is to go beyond QI. We believe in widespread cultural change, where new ways of relating and feelings of empowerment and, yes, joy feel within everyone’s reach.
Joy doesn’t mean work each day is easy. Joy doesn’t mean that the nuances of human emotion are to be steamrollered over with a smiling emoji. It doesn’t mean that our patients’ illness and deprivation are to be forgotten the moment they leave the room. It doesn’t mean that dealing with pain and even death should be experienced with good cheer. Joy has nothing to do with any of these things. If it helps to draw pictures, this is how the Institute for Healthcare Improvement visualizes joy:
IHI Framework for Improving Joy in Work
Joy is not fun for the sake of it. It’s not silliness, or the lack of respect for pain, fatigue, or long hours.
Joy is the experience of a meaningful life, in the happiness, sadness, and fullness of all its moments.
Joy is the humbling experience of offering care, and the privilege of enabling any betterment where this is possible. Joy is knowing that what you do is worthwhile. It is connection, it is authenticity.
Joy is the word that best describes the highest ambitions of empowered leadership at a personal and team level, and in wider communities. Joy means going home at the end of the day knowing that you’ve participated in something that matters to you, and that you have asked others, including patients, what matters to them. Joy means nurturing clinical and psychological safety, purpose, autonomy, recognition, teamwork, development, and measurement.
We know that there’s a way to better honor our talents and our efforts, and we know that our patients will be better for it. The privilege of working in the caring professions is too precious to be wasted. As W. Edwards Deming said, “People are entitled to joy in work.”
Virginia Patania is the Transformation Partner at The Jubilee Street Practice in East London and a board member of the NHS Tower Hamlets Clinical Commissioning Group.
You may also be interested in:
The IHI Framework for Improving Joy in Work white paper
The IHI Joy in Work Results-Oriented Learning Network
Joy in Work sessions are part of IHI’s National Forum this December.
