Of all the presentations at the 3rd APAC Forum 2014, arguably the one that’s had the greatest impact on the way we think about our work was the keynote by Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement (IHI). Ms Bisognano spoke about joy.
Joy is the key to providing the kind of care we want for our patients. Through joy, we gain the energy and resilience to do our jobs well. And that’s an important concept, because healthcare is tough – it’s one of the most intellectually challenging, physically demanding and emotionally draining professions there is. So what do we mean by joy?
Joy is about gratitude, hope and an awareness of abundance. People who are filled with joy don’t talk only about problems; they talk about the assets and abundance they find in each other, and that gives them the energy and resilience to care for others.
Improving the joy of the healthcare workforce is a core part of the IHI’s mission, alongside more predictable commitments to improving the lives of patients and the health of the community. People are often surprised by that, because they’re not used to thinking of the workplace as somewhere they expect to encounter joy. But to the IHI, joy is fundamental to coping with the demands of the 21st century workforce.
The pace of change workers face today is exhausting – every day brings new challenges, new technologies and new demands to deliver better care with fewer resources. These things add up to confound joy and lead to burnout, which impacts dangerously on patient safety and reduces our ability to feel empathy and engage with our patients in a way that creates a positive experience. The answer to this huge challenge is the integration of improvement methods and tools with joy. We need to find better ways of working that focus on the resilience and satisfaction we find through joy.
Ms Bisognano shared some examples of burned out healthcare professionals who created new and better models of care by focussing on joy:
- A midwife in a socioeconomically vulnerable part of Boston who was struggling with a high patient load replaced the traditional model of clinician-patient appointments with ten two-hour group sessions where women at a similar stage of pregnancy would share experiences and advice and monitor their own weight and vital signs. Each woman saw a clinician privately at some point during the two-hour session, but they also got a lot of advice and support from each other. Patients and clinicians are both more satisfied, and the area now has fewer pre-term births and a higher breastfeeding rate.
- A community nurse transformed home care nursing in the Netherlands by creating a ‘Neighbourhood Care’ system where 10-12 RNs work in a team to provide care to a neighbourhood. The nurse had become dissatisfied with the way home care was provided after a decision requiring healthcare professionals to work only at the top of their licences made it difficult to establish any rapport with patients. Under Neighbourhood Care, each nurse got to know the families in their neighbourhood well. They delivered better care at a lower cost, and the scheme grew from four nurses to 10,000 within a few years. It’s lean and agile, and both patients and nurses are more satisfied.
- A nurse at Yorkhill Children’s Hospital in Scotland who was frustrated about not having enough time to get to know her young patients used posters to understand them better. Each child drew a poster showing what mattered to them, and the poster was pasted on the door to the child’s room. In one PDSA cycle, the nurse transformed the culture of care at Yorkhill.
The IHI uses several techniques to foster joy among its staff that any organisation can adopt.
Every Monday morning, when the senior team meet to discuss the week ahead, ‘One Good Thing’ is at the top of the agenda. Each person around the table relates one good thing that happened to them. It creates a positive tone for the meeting, and enables people to get to know each other in a different way.
At the end of the working day, each IHI employee drops a coloured bead into a tin cup. If they had a good day and feel like they made progress, it’s a clear bead. If they had a day of setbacks, it’s a silver bead. They count the beads weekly and run PDSA cycles to improve the joy of the workforce. The project started a year ago and has helped them to pull together as a team.
Another tool, ‘Three Good Things’, has been enthusiastically adopted at home by IHI staff to use with their families. It asks people to write down, or tell somebody about, three good things that happened that day before they go to bed. It checks the tendency to dwell on worries and stresses, and makes people think about positive things.
Staff at Ko Awatea have taken Ms Bisognano’s ideas on board. Joy boards, where staff write about what gave them joy that day or messages of appreciation to others, have sprung up around the building. Reading about the joy in others’ lives helps us to focus on the good things in our own. Finding your joy really does make a difference.
Watch Maureen Bisognano’s keynote: