Restoring the joy: dealing with post-Covid-19 burnout

Jesse McCall: All right, so we are here to talk today about joy in work, and that may be a kind of different term than we’ve heard before. We often hear about burnout or stress and chaos at work, but at IHI, we like to take a positive spin and then put some positivity on things. So we like to talk about joy in work, and in trying to bring joy into our workforce. Before I get started, I will admit that most of my work has been in human healthcare. I’ve done a bit of research into the veterinary profession for the talk today, but you know, these joy in work principles come from multiple industries. So, I think they are absolutely applicable no matter where you’re working, whether it be in patient care, animal care, manufacturing, education, these are principles that we can use across all our industries. As we said, this session was brought to you in partnership with RCVS Knowledge. And I thank them for inviting me into talk to you all today.

So, during our session, we are going to talk about recognising the value of increasing joy and wellbeing at your organisations during and after COVID-19. We are going to identify some key changes in your systems that you might take to improve joy in work for yourself and your staff. And hoping that you take away at least one intervention, where you can test immediately to try and bring about a more increased feeling of meaning choice, safety, comradery, equity in the midst of COVID-19, as we’re still kind of wrestling with this pandemic, and beyond the kind of areas of work that I’ll suggest, and talk about are definitely applicable now. But we’ll set up systems to foster joy in work, well beyond the pandemic. I will also introduce my orange cat Sawyer. That’s his about the author picture there. And he’ll pop up a couple of times throughout the presentation.

First a little bit about IHI. We are a kind of medium-sized not-for-profit based in Boston, Massachusetts in the USA with a global footprint. So we work on all continents, save Antarctica in different care settings around the world. And our goal is to improve the lives of patients, the health of communities, and the joy of the healthcare workforce. We do that through harnessing the power of improvement science, and we try to ignite action to connect the healthcare workforce to the values of healthcare. The reasons why people got into the profession, and to bring about a greater sense of joy and a sense of purpose in their work. So we first started really looking into joy in work about five years ago. And to do so, we turned to one of the founders of improvement science being that is what our organisation is grounded in. One of those founders being W. Edwards Deming, who really spoke to the systems that we need to create to think about joy in work. It’s not, you know, telling our staff to be more resilient or be happier at work, or, you know don’t be so burned out that we are creating an operating systems that our staff and ourselves work in. So management’s overall aim really should be to create a system in which everyone may take joy in their work along the same lines. He had said that people are entitled to joy in their work. And again, it’s management’s real job to create the culture, the system and the environment that fosters that sense of joy or pride in someone’s work.

We also looked to Aaron Antonovsky, who was a a psychologist and a researcher into the connection between stress, fatigue, burnout and how that affects people in both work and their lives outside of work. And through him, we are coming to understand that joy is more than the absence of burnout. When we first approached this we had thought, you know, that’s a kind of linear scale that joy is on one side and burnout is on the other, but joy is more than the absence of burnout. They almost exist on different, but interrelated scales. So the absence of burnout is not being burnt out, or the absence of joy in work is having no joy in work. And he said that health is not just the absence of disease, but rather the process by which individuals maintain their sense of coherence, their kind of enjoyment of the life that they have a life that’s comprehensible, manageable, and meaningful, and their ability to function in the face of changes in themselves and their relationship and their environment. So it kind of a bit to that resilience piece, but again, it’s the systems that create an environment, where our staff can be resilient. With some of that as background, we know that also joy in work is individual to every person, everyone experiences their home environment, their work environment very differently. And different things bring that feeling of joy to your work, whether that is happy and satisfied customers, a feeling of autonomy or control over your work. Being able to get away from work and spend time with a family. And that’s my family on the top right hand corner there, my wife and my two year old daughter. It may be getting to spend time with your pets, or in your case, the kind of patients that you see each and every day. And that’s, again, my orange cat Sawyer on the bottom left. Could be the sense of satisfaction in a job well done, or working with a team and supporting that team to achieve your goals.

So I’d like to ask everyone to take kind of a minute to reflect on really what brings you joy in work? I don’t think we have the ability to chat here. So I’ll just ask you to reflect on that for about a minute. What brings you that sense of joy in your work? All right. And I imagine a good number of answers, kind of aligned with the different pictures that I have up here on the slide that I described. But if not, again, that’s personal to you, and I hope you’re able to at least identify or think about really what brings you that sense of joy, when you’re in the workplace. What’s the reason that you got into this field to begin with and are you able to feel that reason, or that meaning each and every day?

So we knew burnout was important before the pandemic, and I think even more important now, as I mentioned I did have an opportunity to look into some stats around the veterinary profession, and learned that there’s a great amount of core kind of similarity between the health and healthcare workforce, and the veterinary workforce, and these factors or these stats, I think, expand out to just the general workforce as well as there’s more pressures are put on us as a staff to do more with less and to meet our organisational, and customer goals more and more. But in the veterinary profession, we see that 75% of vets are concerned about stress and burnout in the profession as a result of COVID-19. And that comes from the British Veterinary Association. Looking to a survey that was done in Canada, 51% of Canadian vets consider themselves to be suffering from burnout and 31% needing to stop work for an average of 90 days. So to step away from the work, because they were feeling so burnt out. I will say that that is a, you know, it takes some kind of self-awareness to be able to say, “I’m burnt out and need to step away.” It shouldn’t get to that point, but good on those folks for recognising that they needed to step away for a bit, but hopefully we don’t get to that point. And then finally from Vetlife, UK veterinary professionals are three times more likely to commit suicide than the general public, and two times more likely than the medical profession. And we see that risk of suicide and suicide ideation in the healthcare workforce.

And, again, a lot of similarities between vets and doctors and nurses that are caring for humans. So to try and mitigate the effects of burnout, or to build that joyful workforce, we need to move away from some old ways of thinking and establish some new mental models in that old way of thinking. You know, we already have a great wellness and staff recognition programme. Shouldn’t that be enough for our staff. Individuals are responsible for their resilience and wellbeing. You know, you just be happier at work, do a better job, but we need to really move to a new way of thinking, where we are reframing focus on individuals and systems, and we build on what’s working to get results. So of course, if we do have a great staff recognition or a wellness programme, what in there is really working that we can really build upon and strengthen, and what might not be working in there? And how do we recognise that? And try and do something different. The old way of thinking of our HR or organisational development teams, they’re responsible for joy in work, they’re managing the workforce. They put on educational programmes to make sure people know how to do their job and do better, but we need to think about leaders at all levels, focusing on factors beyond resilience to drive that joy in the work.

There is a role for everyone in an organisation to play to build the culture of a joyful workforce. The old way of thinking that staff satisfaction leads to lower turnover needs to move to really be thinking about improved outcomes for patients, families, and the organisation, you know, that kind of feeling of achievement or a job well done, or meeting your purpose for why you got into this profession rather than just thinking about keeping our staff satisfied, then they won’t leave our organisations. And this thinking around staff just want money and benefits. If we look to some of the kind of workplace psychology thinkers, they are big proponents that meaning purpose, comradery and teamwork and equity matter for joy. Of course, we all want and need to get paid for the work that we do, but there are much deeper purposes for us taking on a career that we follow through on our lives rather than just getting that paycheck, or the benefits available to us. The key drivers that are leading to burnout or detracting from joy in our workforce are complex and interrelated. And they are kind of systems that we’ve created for managing our practise, managing our staff that create this feeling of burnout. So excessive workload and unmanageable work schedules on top of that heavy workload, inadequate staffing, trying to do more with less, the burden of administration and documentation and reporting that exists pervasively across so many professions.

Being distracted or getting interrupted during your workflows and having to kind of start the same task over and over again. Having new technologies that aren’t very user-friendly, or don’t connect well to other systems that we use in our organisation. And then back to that time pressure can leave us really feeling like the picture on the right hand side of the slide here, where you just don’t know where to go. You don’t know where to start, because all of these things are so tied together, and driving that feeling of stress, chaos, and burnout in our workplaces. And we know that joy and wellbeing cannot happen when those work demands and pressures are not matched to the knowledge, abilities or needs of our staff, it can’t be joyful when they aren’t supported by supervisors or peers. They can’t be joyful when they have little control over their work processes. When they’re just sort of turning in that cog in the wheel, that doesn’t help them practise at the top of their licence or connect to their meaning, and purpose of why they got into the profession. Thinking about joy is very difficult to be joyful under unsatisfactory working conditions, having that super heavy workload over a long period of time, working in an accelerated pace for long hours. It’s just not a joyful environment. And finally, joy can not happen when moral injury is repeatedly happening over and over again. I think we’ve seen this, especially during the pandemic of having to take over roles of family members, due to them being quarantined. So having to say a goodbye to patients who are moving on, and not being able to connect them to their family. And the weight that that puts on your conscious and your morality, it’s very difficult to be joyful in the face of that.

So with all of that, as background, you know, I hope I painted a bleak picture of the systems that are out there that, that drive joy out of our workforce and lead to that feeling of being really burnt out and not being able to connect to why you got into the profession. So to address this issue of burnout, we worked to develop a two-part framework. And this is going to be really what I hope you take away from the talk is this framework, and the ability to hopefully try it out or work it in your practises. This framework starts with asking staff what matters to you. And, you know, there’s more specificity behind that question that I’ll get into in just a second. Once you’ve asked staff what matters to you, and what your workforce values or even asked yourself what matters to me and what do I value? Then you want to move on to identifying unique impediments to joy in work in your local context. Our systems are all similar, but also unique. So what are the unique things that are impeding joy in work or leading to burnout in our organisations? Once we’ve identified those unique local impediments, or like to also I’ll call them kind of the pebbles in your shoe or the, you know, sometimes the boulders in the way of having a good day at work. Once you’ve identified those unique impediments, you can commit to making joy in work or wellness at work a shared responsibility at all levels of your organisation. And as I said before, there’s kind of a roles for each and every person in an organisation, or practise to play, to create that joyful environment. And then finally, once you’ve made that commitment, you use improvement science to test approaches to improving joy in work in your organisation. So being rigorous in trying out new things, in improving your systems and measuring the outcomes that you’re achieving, which we know having a joyful workforce will lead to an increased or improved patient experience, it’ll lead to improved organisational performance. And of course, decreased staff burnout, when we’re removing those impediments to them feeling joyful, that will decrease burnout. So I said, this was a two-part framework.

This is the first part. It’s really the how, how you try and establish that culture of joy in your organisation or in yourself. Once, we have a second part to that framework as well. And this is really the first part was the how, the second part is the kind of what you would work on. So I mentioned the first step is to have those what matters to you conversations, the second one to identify those unique local impediments to joy in work. And those unique local impediments can be bucketed into one of these nine different areas, physical and psychological safety, meaning and purpose, choice and autonomy, recognition and rewards, participative management, comradery and teamwork, daily improvement, wellness and resilience, and real-time measurement. If you can find an impediment that can’t be bucketed in one of these, please let me know, because we will kind of add that into the framework. These are meant to be intentionally broad.

Again, reflecting that the factors that sit underneath these topics are kind of unique to each organisation in each system that exists out there. We’ll come back to some of these in a couple of minutes. I do want to spend a little bit of time with what matters to you conversations and give a bit of guidance around that. If you come away with kind of one thing from my talk today, I hope it it’s to go out and at least try to have a what matters to you conversation with your staff, or to reflect on it yourself. So the purpose of these what matters to you conversations is to increase joy in work. And senior leaders and core leaders engage in effective meaningful conversations with colleagues, and staff to understand what matters to you in your daily work. How do we build on assets? What helps make a good day? When are we at our best as a practise? What does that look like? And then also what gets in the way of having a good day? What are those pebbles in your shoes that kind of just bite at you all day long or all week long, all month long? And what can we do to remove those?

When you’re having is what matters to you conversations, you should really be in listening mode. It can be easy to jump into kind of defence, and offer your own perspective on how it’s not like that. But to really put yourself in listening mode, allow who you’re asking the questions to respond. And then sometimes even to kind of teach back, or repeat back what you heard to make sure that you’re capturing your sentiments right. In these conversations, and it’s kind of important to be comfortable with silence, and to really, again be in that listening mode, not to just hear but to understand. Silence is important because it gives the person you’re talking to time to really reflect on what does matter to me, what gets in the way of my good day, and to do some internal processing. So silence is okay in these conversations. Also recognising and framing the conversation, that you know we’re not going fix everything right now. You have to understand all of the issues that are happening, that are impacting how our workforce feels before we can try and do some prioritisation of these issues, and then make a real plan to address them in a methodical way. And we want to ensure that this work is done with colleagues, and with colleagues and team members not just to them or for them, but we are all partners in this work, and we’re all kind of creators or shepherds of the culture of our organisations that can either support or detract from joy in work.

So I think there’s a very helpful resource out there called the “What matters to you? Conversation Guide”, my slides I think are available and you can click the link on this slide or even just Google, “What Matters to You? Conversation Guide.” And this resource will come up. It’s got a lot of different prompts that you can use, and to kind of examples or stories of other folks who have had these conversations. So from those other folks who have had conversations, a couple of lessons to offer, and again I hope you do go out and actually have some of these what matters to you conversations. Just start. So these can be easily over-planned, but I think the best way to really plan for them is to have a couple of them find maybe a trusted colleague, and have this conversation or find a partner who’s willing to have these conversations together, and practise with each other first. As I said before, really not do with this your staff or with your colleagues, not to them, or for them, to be helpful to huddle in pairs with someone who’s really listening and driving the conversation, but then also someone to take some notes. So you’re now trying to have a meaningful engaging conversation with someone, but also trying to remember what they’re saying intently and take a lot of notes down. So a scribe can be helpful.

Once you’re comfortable having these conversations, you can also have them in some open spaces so that others could see and join in and offer their perspective. If you do have some basic QI skills, you can start to test some things right away. Once you’ve been able to do some prioritisation, or some things might surface that just start, you know we need to get on this now. When you are testing or making changes in your organisation, you should think about starting small first to then go big. Once you are confident that this change is right for your organisation. And sometimes that can mean going a little bit slow in the beginning to actually be able to go faster at the end, as you are sure that this change is going to actually work or this staffing change, or management change is really going to be effective in your organisation. When you’re having these conversations. You know, these are meant to be ongoing conversations. They’re not one and done. They should be done periodically throughout the year with different staff in different roles, at all levels of the organisation and a useful tool to be able to track all of this information. There’s an example here up on the screen is a Kanban board. This is really a visual management system of work through a pipeline. On the left-hand side here, we’ve got kind of all the ideas that we’ve collected, or the things that we’re going to start to work on in the next column over here. Here’s what we’re going to do next. Here’s the work that we have in progress on the third column. And here’s all that we’ve done. Here’s the work that we’ve finished on the right hand side. This can be a great signal to staff that here’s everything that you’ve said, and here’s where it is in the work process. Also an opportunity for people to add additional ideas, or to kind of add some nuance to the ideas, or work in process that might be up there also a good idea on these Kanban boards, or visual management systems to share some data that you’re tracking around staff experience, or patient or customer experience, but what are we ultimately trying to affect here? And are we sharing that data transparently?

So I would like to go back to that joy in work framework, the real, you know, what we would work on here. I realised nine domains is a lot to carry. We recommend three areas that you can really start in, that we think are the biggest levers to pull around joy in work. And that’s physical and psychological safety, meaning and purpose, and choice and autonomy. And I’ll dive into each of these a little bit more deeply. When we think about autonomy and control, I’ll first put out kind of a definition around that. So characteristics that support autonomy choice and control of someone’s work mean that a job is comprehensible. It’s understandable. It makes sense, people know what they’re doing, and how it fits into the broader picture of the organisation. I know when I’m finished with this process, who’s picking it up, or I know really how my role fits into the strategy of the organisation, the mission, vision values of our collective. That the work is manageable, the volumes proportional to the time and resources available to actually complete the job. So is it realistic? Is their work controllable? Do people have a say when work is done, and how much work they’re able to do? Do they have input into that kind of their role in the definition of that role? Is there flexibility in the way work is done and where the work is done? Of course, within reason, because we do know that having standards in our work increase the efficiency, and effectiveness of our work, but where we are able to, are we able to offer our staff flexibility in how, where, and when they do their work. And finally, we want to have a sufficient time to accomplish our work in our day. Is our job designed that is actually able to be accomplished in one day, and that we don’t have to bring work home or stay late at the office or come in early, just to do the regular job that we have.

Those are some ideas or some change concepts, that you could apply, that would drive an increased feeling of autonomy, control or choice in someone’s work. The first one is to optimise team composition, and assure adequate staffing to allow people to spend more time on what they’re uniquely qualified to do to allow people to practise at the top of their licence, whether that’s an actual top of the licence or a theoretical top of the licence. But are we letting our staff and ourselves use all of our skills that we bring to the workforce in a way that is meaningful to them? We can also establish a system of schedule flexibility. I was working with a team in Southern California, who due to COVID-19 had to increase their office availability and their office hours. So they could be able to see the same volume of patients, but also maintain social distancing protocols, and contact protocols. So they increase their hours and also offered weekend appointments. The first thing they did was just to assign staff, you know you’re working on nights, you’re working on weekends, and there was an almost immediate staff revolt you know, I can’t work nights. I can’t work weekends. I have things going on outside of work. So they pivoted and said, “All right, staff, you select when you want to work”, “we have these responsibilities to fill to meet our patient needs”, “who can work on nights? “Who can work on weekends?” And just through asking staff, they were able to fill all of all their expanded appointment slots.

And the staff was much happier to show up to work in those extended hours, because they had a say in when they were doing that work. We always want to think about reducing unnecessary work. Is there waste in our system that we can remove? Have we changed things? And are we doing certain processes, or tests that aren’t leaning anywhere anymore. And how do we periodically take a look at all of our work to determine what’s really necessary and what isn’t. And can we distribute leadership and embrace a shared leadership model? Do staff have a say in the values of the organisation, in how decisions are made at the organisation? What kind of vocal power voice do you have, do staff have in a organisational decisions? The next area is around meaning and purpose. You know, we are all kind of in career professions here, and hopefully you all stick with the veterinary profession. But think back to why you got into being a vet. What meaning did that bring about for you, or was that your purpose that you were called to? And do you still feel after working maybe for several years in this profession, that you’re still pursuing that same meaning and purpose.

Are your systems set up to allow people to connect to and recognise that meaning and purpose, and how often is it talked about or communicated in your organisation? So some change concepts around meaning and purpose to keep people, patients and relationships at the centre of work. So are we building strong teams internally that care for our patients or even our pet guardians that are out there, are they at the centre of our work and how our processes, and systems are designed? And are our staff able to engage with them and connect with people and with animals? Oftentimes, that’s the reason that they got into this profession is to really connect them in those two fronts. You can create a shared purpose and a line of sight from an individual to their unit leadership. If it’s a kind of multiunit system, or to the organisational mission, vision, and values. And then we can create a shared purpose and assure that line of sight.

Another example here, I have a team in here in Boston that I’m working with, and they wanted to try out a way to connect their point of care staff there, you know, nurses on the ward to the values of the organisation. So each month, they have a kind of value of the month. And in rounds for that month, they will talk about that value and have each person who’s participating in a morning huddle, kind of talk about what that value means in action. So trying to connect to that individual’s daily work, up to the values of the organisation that are in alignment with the mission and vision of what that organisation is trying to do. So even creating space for that conversation around organisational values, we know that that helps people connect. That can sound a little bit soft or hokey, but again, it’s something, if you just try, I think you will see the value in it and your staff will also feel the value in it. And that ability to connect back to the values of the organisation, their own personal values, and why they got into the profession to begin with.

So we’ll finally turn to look at physical and psychological safety. So physical safety actually being physically safe at work, are we in danger of getting stuck by a needle, or in the veterinary profession and getting harmed by the animals that we’re caring for, or that even goes to thinking about workplace bullying. Do we have an environment where people feel physically safe? Psychological safety speaks to the ability to speak up, when you see an error about to happen or if an error in care has happened, can you raise that up safely without fear of retribution, without fear of someone coming back down on you, or fear of even potentially losing your job, because you spoke up and said an error happened. Psychological safety is really taking those opportunities to create a learning environment. You know, why did that error happen? What systems led to that error and what can we put in place to prevent that from happening again?

So really creating that learning organisation. Some different change concepts around physical and psychological safety, creating a just culture that is free from fear. Again, I know I was speaking to this a lot on the last slide, one that balances that systems approach and individual accountability. So how did our systems contribute to this error? What was the amount of individual accountability here? And I will say that oftentimes, a vast majority of the times it is our systems, and how they work together that create the opportunity for those errors not the people themselves. A big thing here is to try and de-stigmatize mental illness and to make it okay for folks to say, I’m mentally not feeling well, and I’m mentally unwell. I need to either step away, or I need to seek help, but to try and normalise that more than it is now. You can promote an environment that supports that mental health and wellness of our employees. So oftentimes we have an EAP or an employee assistance programme, but how are we communicating our sort of mental health benefits, or our wellness benefits across the organisation?

First step is actually having some mental health or wellness benefits for our staff, but are we making sure that those are being utilised and again, removing the stigma around actually seeking help when you do need it. We can strive to create a more equitable workplace. So do people feel equally valued in their work? Are we creating a space where all genders, races, ages, sexual orientations feel welcomed and empowered to participate as themselves in the workforce. We can work to reduce cognitive overload. So is someone’s job again, back to this ties into that autonomy and control, do folks have a job that is understandable and accomplishable in the time that we’ve given them to be able to accomplish it? And of course, establish and support a physically safe work environment. So do we have the controls in place where our staff feel safe at work? Do they have the necessary PPE throughout COVID-19 to be able to to feel safe from not contracting the virus? While also caring for the patients and pets that we see.

To be a little more specific here, and to give you what I would call kind of a ready-made tool around psychological safety, or in a we call it the psychological PPE or personal protective equipment for your own kind of psyche. A lot of organisations have found this to be really effective as they’ve worked through the pandemic. There are actions here that an individual can take, and actions that a team leader can take. So an individual can take a day off, and create space between work and home life when we are able to do that, or to avoid necessary publicity and media coverage to seek mental health support. And when you need it to show gratitude and to create space to celebrate those opportunities, to show gratitude to our staff, to our leaders, to our customers, but are we practising being thankful for the job that each other are doing in our organisations.

And finally to sometimes really take a step back even though we are in what can seem like a never ending negative experiences. To pause and try and find the positive in some of those experiences. There’s a quote. I like, it’s a shame I don’t remember who it’s attributed to right now, but the negative often screams at you, the positive only whispers. Sort of to create some space to reflect and think about amidst all this negativity, what are the positive things that have happened in my day or in my week? Or even this individual interaction. So some concrete actions and individual can take there. On the leadership side, we could think about limiting staff time on site or on shift. Are we managing our staff effectively in the roles that they have. Having clear roles and leadership that is accountable and visible can increase that feeling of psychological protection for our staff.

And then doing some training and setting up systems, where managers are aware of key risk factors for signs of distress or any mental health issues that might be happening. You could establish peer support services, and make them available to staff. So pairing workers up together kind of as a buddy system, that’s something that comes from armed services, having a a battle buddy, that someone who you can confide in and really talk about here’s the issues that I’m having in an open, transparent and honest way, where that kind of culture of safety or just culture can really support that transparent exchange between staff. So you’re creating a system where people aren’t alone out there, people aren’t worrying alone. There’s a sense of we’re in this together, and we’re going to figure out kind of our solutions together and how to make this better.

I think even more concrete example that speaks to that idea of psychological safety is this going home checklist. This is a way to kind of create space between work and home life in the organisation, in the NHS that developed this has found it really effective. And it’s now been spread to dozens of facilities here in the United States, where at the end of each day, staff are kind of asked to reflect on the prompts that are in this checklist. Organisations have made big printouts and put them on the door or in the staff break room, to try and get people to reflect on these. The first is to really pause and take a moment to think about today, to acknowledge one thing that was difficult on your shift and to let it go, but to hold that for a second and say, “Yeah, that was challenging. “But since it’s in the rear view, there’s not much “I can do about it now, I need to let that go.” Take the time to consider three things that went well, again create the space to think about what are the positive things that happened today. In addition to letting some of those negative things go.

To check on your colleagues before you leave, are your colleagues or your peers, okay? Are they ready to go home for the day as well? Ask yourself, are you okay? And to create an environment where the senior team are there to support you. So if someone says, “I’m not okay, I need some help.” Do you have a leadership system? Or is there someone who clearly they can go to to seek that help. And then finally trigger to switch your attention to home, or wherever you’re going after work to rest and recharge, and get ready for the next day or the next week, but to really call that out explicitly, you know you’re leaving for the day, don’t carry with you what happened at work today? This is an opportunity to internalise that, let it go and transition on to your next activity, whatever that might be.

Our teams that we’ve worked with on joy in work on improving joy in work or decreasing burnout have really adopted this framework, and have seen great results in their organisations, both anecdotally as well as in data that they’ve collected around the number of staff, who have had good days at work and the number of staff who are feeling burnt out while they’re at work. But some quotes here up on the screen, joy in work project has given me back joy in work. So actually doing this work and seeing that the organisation is interested in their staff’s joy in work, has increased their joy in work. Having something collectively to work on as a team can really drive joy in work. It’s a great way to improve the patient or customer experience. It’s a great way to improve team spirit and comradery having that shared sense of meaning purpose, and work that we’re all in this together to try and reduce the burnout that we’re all feeling, and hopefully to foster that sense of joy.

And finally, I knew things weren’t great, but I didn’t know how bad they were until we started doing this. It’s given our team motivation and enthusiasm back. So some great quotes here around, what being involved in this work has really meant to the staff who have been involved in it, calling it out and saying, this is a priority for our organisation back to my original kind of stair-step framework that I had shown committing to it as an organisation is a great signal. And even that in itself can read some attention and activity around joy in work in our staff. A very quick plug. We are continuing to offer a joy in work results oriented learning network. We are just finishing up our first wave of this network, with 17 participating organisations. And you can see kind of all the health systems represented up here on the screen. We are launching wave two of this with hopefully 20 organisations, who will kind of work this framework with us, have the what matters to you conversations to find those unique “impediments” to joy and then test out different changes they can make to create that sense of joy in our workforce.

So if you are interested in joining us in this network, I’d encourage you to go to ihi.org/JoyResults. And you can learn more about what the programme is. And if you want to talk to someone about potentially joining, we can have that conversation. If anything, there are some great resources there that align with all the concepts that I’ve talked about, during the presentation here today.

And finally, I do want to kind of leave in action or sum this up, bringing together a lot of the principles that I talked about here today. So the first is to introduce the idea of a focus on joy in work at your next staff meeting, get reactions and feedback from your staff. What do you think about joy in work? Even to say does that word resonate with you? Or do we want to think about wellness at work, or even just go back to do you want to think about reducing burnout in our staff? But what would we think about as an organisation, making joy a strategic priority? Second action I’d encourage you to take, is to hold those what matters to you conversations with maybe three or five staff members in the next couple of weeks, and three simple questions that you can ask here, tonnes more in that conversation guide that I mentioned, but the three questions are what matters to you in daily work? What helps make a good day? When we’re at our best, what does that look like for us as a practise? And then finally what gets in the way of a good day?

So in these conversations, it really helps to start with a positive, to look there and then go into kind of what gets in the way of having a good day. And then, once you’ve done those set of activities, introduce that as a priority or have the conversation of do we want to make this a priority? Have those what matters to you conversations, and to really identify one concrete idea for change in your organisation that could be removing one of the pebbles in the shoes that folks surface during those what matters to conversations, or maybe trying any of the ideas or examples that I’ve talked about here today, and to try those out in a small scale in your organisation.

So again, I really hope that you do take some action away from my talk here, and try something by next Tuesday. I know that seems fast, but again I think the best way to get started on some of these things is to just do it, just try it on a small scale and see what happens.