“It has long seemed a paradox to me that such depletion of joy in work can pervade as noble and meaningful an enterprise as health care. What we in the healing professions and its support roles get to do every day touches the highest aspirations of a compassionate civilization. We have chosen a calling that invites people who are worried and suffering to share their stories and allow us to help. If any work ought to give spiritual satisfaction to the workers, this is it. “Joy,” not “burnout,” ought to rule the day.” – Donald M Berwick, MD, President Emeritus , IHI
One of the critical aspects in creating a sustainable profession, is evolving to create a veterinary field that people continue to want to join and work in for a full career. As I mentioned last week, we are on the wrong track when 24% of veterinarians under 34 years of age would not recommend our profession.
Last week, I discussed one aspect of the problem: burnout. Occupational burnout is emotional and physical exhaustion secondary to prolonged frustration and stress at work. We are not alone in dealing with this issue. A 2015 study of physicians showed that more than 50% had signs of burnout. Burnout lowers productivity and increases turnover. One study showed that replacing a single departing physician with a new hire can cost a healthcare organization more than $1 million. In addition, burnout can lead to a higher incidence of medical mistakes which directly impacts quality for patients.
Last year, the Institute for Healthcare Improvement published a white paper entitled, “IHI Framework for improving Joy in Work.” The research project involved literature review, expert interviews and patient interviews. It was then followed by a test of prototype programs in 11 health care systems. Concrete steps were identified to help healthcare leaders combat burnout and replace it with joy and engagement. The key in this work is a re-framing. We should not just tolerate our jobs. We want to recapture the joy and enthusiasm that made us want to be veterinarians in the first place.
Although this research was done in human healthcare, I believe the findings are directly relevant to creating joy in veterinary work as well.
Joy in Work Step One: What Matters to You?
The first step in changing cultures is asking this simple question of not some, but ALL of your staff. Asking, “what matters to you?” is a way to show you care about your staff and also that you want their input.
Conversations can be one on one, in groups, or through a survey. These conversations only work, however, if you are ready and willing to LISTEN and LEARN. Your staff must trust that you are ready to hear them. In addition, you need to create some time to ACT on suggestions and be willing to make changes. This doesn’t mean you have to fix, or even can fix, everything at once. If you can be TRANSPARENT about the suggestions you receive and show small steady improvement, you will build momentum and engagement.
Starting these conversations may need an introduction to your goals and your desire to make it a better place to work.
Specific questions to ask might include:
1) When we are at our best, what does that look like?
2) What causes a bad day or gets in the way of us doing our best?
You need conversations with both the positive AND the negative members of your team. Lots of different perspective helps. As a side benefit, you’ll often learn about unexpected talents and strengths on your team.
Joy in Work Step Two: What impedes your ability to do your job?
Understanding, “the pebbles in your shoes,” is the next step in finding out what makes people frustrated. The amazing thing about this question is there are often some really fixable things that are easy.
At our hospital, we used to have the doctor morning shift start at 6:30am but the technician shift start at 7am. This meant the doctors did cage side rounds and then right when they wanted to start exams and morning treatments, the technicians started rounding. There was no reason for this set up – just bad initial planning. It caused a load of frustration for everyone. The fix, when someone finally brought it up, was simple. We lined up the schedules so everyone could round together. It increased camaraderie and teamwork, made the work day more efficient at no extra cost, and only took a small initial effort. Many things that frustrate your staff probably also frustrate your clients. Our clients often called around 7 am and with the new change, everyone was more ready and responsive to these calls.
Do you know what frustrates your staff at your hospital? Are there small nagging things that just need to be fixed? Working together with your staff to improve the way work flows is a great way to create a feeling of team.
Asking these questions on a regular basis creates a mindset of continuous improvement. In the research study, hospitals incorporated “bright spot” and “impediment” questions into daily huddles, regular team meetings, and also used sticky note comments on a white board for a visual conversation.
In my previous hospital, in our 3 month check in for new employees, we asked, “What do you think we do well?” and also, “What suggestions if any do you have for improvement?” This allowed us to get fresh perspectives and new ideas.
Joy in Work Step Three: Commit to a systems approach to solutions that involves everyone
The only thing worse than not listening to your staff is soliciting feedback, promising to act, and then not doing anything. However, you can not fix things alone. Engaging your staff to work WITH you to fix the fixable “pebbles” frees you up and helps empower them to continue to look for solutions.
Having a hospital project or improvement board is a great way to let everyone know the issues presented and keep track of progress. If you create a list of “pebbles,” you can have your team help prioritize those that are most important and maybe identify some easy wins. It is important to be upfront that you can’t fix all problems immediately or even over several months. However, working to solve doable small pieces consistently over time using team suggestions keeps people engaged and hopeful.
Joy in Work Step Four: Can you measure improvement?
When you try to fix processes in a veterinary hospital, some things will work and some will fail. However, you will learn from both wins and mistakes. Keeping track of accomplished projects and celebrating wins helps make people feel valued.
Can we really create joy by asking questions and fixing processes? I think we underestimate the stress caused by inefficiencies and roadblocks to quality care. I also believe that people are happier when they feel heard. Creating joy is about listening to your staff, hearing their concerns, and then working TOGETHER to fix problems. One way to show someone they are valued is to implement one of their suggestions and then to celebrate improvement it brings.
Next week, we will discuss 5 baseline needs to address during this process to create joy in work.
