Leadership

Applying Community Organizing Principles to Restore Joy in Work

Article · May 31, 2018

Health care leaders know that for their organizations to successfully adapt to the rapidly changing payment and service landscape, they need a motivated, engaged, and productive workforce — a workforce that finds joy in work. Caring and healing should be joyful activities, not sources of stress.

However, burnout is reaching epidemic proportions across health care. For example, burnout is now estimated to affect more than 50% of physicians, and one-third of new registered nurses seek another profession within a year. Burnout is a measurable syndrome that lessens staff engagement and can, in turn, lower the quality and safety of patient care. Increasing joy in work can help mitigate burnout and turnover.

Since its inception, the Institute for Healthcare Improvement (IHI) has been advocating for creating a joyful and productive health care workforce. Because caring for patients is a team effort, we need to optimize the experience of all health care workers. There is ample evidence that having a joyful, engaged workforce translates into fewer medical errors, better patient experience, higher productivity, reduced turnover, less waste, and better financial performance.

Fostering joy in work is about creating systems that promote staff engagement, satisfaction, and resilience. This should be a shared responsibility of caregivers, leaders, and organizations. To that end, IHI designed and tested a Framework for Improving Joy in Work that was based on published literature, expert interviews, site visits, and results from a prototype testing program developed by IHI and conducted in 11 health systems nationally.

Through the process of delving more deeply into this topic, we’ve discovered that lessons from the field of community organizing are readily applicable in health care. Community organizing is a set of collaborative leadership practices designed to enable a community of diverse actors to mobilize toward a common goal, according to longtime organizer and Harvard Kennedy School faculty member Marshall Ganz. In this view, community organizing is a tool for building the capacity of people to work together to create change.

Here are four lessons we’ve learned from community organizing to nurture joy in the health care workforce.

Know Why You Care

Motivating others to join in action requires answering (1) What will we do? and (2) Why should we do it? What we do is a matter of tactics; why we do it is a matter of heart. Together, they make for a successful strategy. As Marshall Ganz teaches, we need to convey our motivations to elicit them in others. Communicating why we care in the form of stories provides staying power that no strategy alone can achieve.

For example, staff from the Frankel Cardiovascular Center at Michigan Medicine who were involved in IHI’s prototype program aimed to engage colleagues in a discussion about joy in work to discover what matters to the team. To do this, they shared stories of what called them to this profession and what was getting in the way of experiencing joy. Small groups of nursing staff, cardiology fellows, and “scribes” then checked off echoed comments to identify top priorities for testing small changes. This process gave everyone a chance to explore shared values and concerns and to weigh in on what to tackle first.

Start with Your People, not Your Problem

Too often, we begin our efforts to enhance staff joy by looking at staff satisfaction survey results. The data is helpful, and we’ll need it for improvement, but it’s better to start with the same question we’ve been urging our care teams to ask patients: “What matters to you?” Only by understanding what truly matters to staff will leaders be able to identify and remove barriers to joy in the workplace. When we begin with asking “What matters?” we demonstrate that we value staff members’ feedback and ideas for improvement. We also tap into strengths or bright spots — what’s already working in the organization — that offer energy for change. As an example in the food industry, Starbucks encouraged employees to use a special postcard to report decisions that they feel don’t support the company’s mission.

Do “With” and not “For”

The biggest barrier for many in asking staff “What matters to you?” is what to do with the responses. There is a very real fear that the challenges that come up will feel more like boulders than pebbles in our shoes — such as cumbersome electronic health records or perceived inadequate staffing levels. We can’t ignore these issues, but we can also empower local teams to identify and address impediments they can change without having to wait for external resources. This process converts the conversation from “If only they would . . .” to “What can we do today?” It helps everyone see the organization as “us” and not “them.”

Share Power

The IHI Framework for Improving Joy in Work asks leaders to make joy in work a shared responsibility at all levels of the organization. Shepherding this work and moving to what IHI President Emeritus and Senior Fellow Donald M. Berwick envisions as a new era in medicine means we need to support leaders at all levels of the system, from frontline workers to the C-suite. This concept, called “distributed leadership” in organizing, is a social process by which many people across group boundaries and levels within a social system create the conditions for collaboration. In this definition, leadership is a set of social functions, not a position. It is shared among many people in a system and is exercised by sharing resources, expertise, and authority. When guiding change at the unit level in health care, creating a distributed leadership team means we can sustain the effort, even when our energy for the work wanes.

At IHI, the responsibility for nurturing staff joy in work is shared, not just with our executive team, but with supervisors and project teams collectively aimed at improving the staff experience. By moving from the traditional top-down approach of responding to staff satisfaction data, we were able to increase the percentage of staff who believe IHI is an excellent place to work from 87% to 92% in one year — with an added equity aim of closing the gap in satisfaction between white staff and staff of color.

By applying community organizing principles to improve joy in the workplace, and then testing our approaches to make sure they’re effective, we have the potential to empower our health care workforce to drive changes that it seeks and to deliver the quality care our patients deserve. What’s more, we might be able to start moving the needle to combat burnout and restore the joy that is at the core of our profession.

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