Barbara Balik, EdD, MS, RN
Burnout and lack of joy in work pose significant risks to health care organizations: 54% of US physicians are burned out and 33% of new nurses seek another job within one year. Burnout is a syndrome characterized by exhaustion, cynicism or depersonalization, and a sense of loss of personal effectiveness. This problem takes a personal toll on health care team members and also seriously impacts patient safety. The correlation between greater engagement and safer patient care is well documented. Reducing burnout results in improved quality, safety, and efficiency with lower turnover rates.
Joy in work occurs when all team members, no matter their role, find meaning and
purpose in what they do.
Abundant evidence points to leadership behaviors that are an antidote to this significant problem. What leaders do makes a difference in reduced burnout, enhanced teamwork, lower turnover and safer care. Health care leaders can reduce burnout and achieve safer care by focusing on selected cultural essentials. Through the same leadership actions, they can get a two-for-one outcome: just culture and joy in work. Leaders who ensure just culture behaviors will nurture environments for both safe care and enable colleagues to find joy and meaning in work.
Steps for leaders to integrate just culture and joy in work include:
- Definitions of what are they are so everyone has a common understanding
- Clear purpose statements of why they are important, which offers a clear focus
- Actions that describe how we make gains in both
It is an environment where:
- Consistent clarity exists between human error in unreliable systems and intentionally unsafe acts.
- Reporting and learning from system flaws and mistakes are the norm and are valued.
- Safety science is used to understand human fallibility with systems designed to mitigate that fallibility.
- Response to harm is not based on patient outcome.
- There is confidence that it is safe to report and learn from mistakes.
- Accountability is clear for all roles. (See Pichert et al. 2013.)
Joy in work: when all team members, no matter their role, find meaning and purpose in what they do. It results when colleagues have an intellectual, behavioral, and emotional connection to the organization’s mission (IHI in press). These environments are characterized by psychological safety. Psychological safety means an environment where all team members feel secure and capable of changing; they experience respectful interactions among all; are able to ask questions, seek feedback, admit mistakes, and propose ideas (Edmondson 2012).
The primary way leaders embed culture is what they pay attention to and how they react to critical incidents (Schein 2004). Leaders are responsible for paying attention to and developing organizational behaviors that promote psychological safety, which enables both engagement and safety.
For instance, of seven drivers of team engagement identified, three are greatly enhanced by psychological safety (Edmondson 2012):
- Organizational culture and values are evidenced in the behaviors that are consistent with a just and fair environment. How leaders react to critical incidents involving patient harm is a key behavior that reflects consistency –or lack of– with the intended organizational culture and values.
- Social support and community at work are illustrated by respectful interactions among all team members no matter their role. Members feel they can speak up without fear of retribution; are supported by colleagues and leaders to do their best; and experience a sense of camaraderie in their daily work.
- Workload and job demands show a balance between the work to be done and the time/resources available. Excessive workload is frequently due to ineffective systems that waste time, energy, and good will. These same ineffective systems lead to unsafe conditions.
- How well do we demonstrate just culture principles in every part of the organization?
- What happens when an error occurs? What are leaders’ responses? Do the responses vary depending on level of harm or by what role was involved?
- Are we as focused on much on system failures as we are on harm events?
- Do we act daily to show that respecting others and treating them fairly is essential?
- What fairness gaps do we have in our current actions?
- Do we promote psychological safety through the following:
o Acknowledge the limits of current knowledge; frame the work as highly complex requiring all to contribute for great outcomes.
o Be willing to show fallibility and humility; acknowledge that we do not have all the answers and are learning.
o Invite participation.
o View failures as learning opportunities.
o Use direct, clear language.
o Set boundaries about what is acceptable behavior and hold others accountable for boundary violation (Edmondson 2012).
This list of what, why, and how is a means of strengthening the leadership journey towards safer care and an environment where joy and meaning thrive.