Joy and meaning are generative and allow the best to be contributed by each individual, and the teams they comprise…. 1
Burnout and lack of joy in work are a major problem in healthcare – 54% of US physicians are burned out, 37% of new nurses are thinking of leaving their positions1. Abundant evidence points to leadership behaviors that are an antidote to this dilemma. What leaders do makes a difference - in less burnout, better teamwork and patient experience, safer care, less turnover, and improved financial vitality. Attention to joy in work is now gaining more attention as a pressing need for leaders to address.
While many leaders are beginning to recognize this need, it is understandable when the reaction is: “One more thing to add to the list of leadership behaviors to pay attention to? Now we need to add creating joy in work to the list of leadership actions?” It seems that one more item on the list is the last thing over-burdened healthcare leaders need. A leadership literature scan shows an abundance of pithy advice on how to be better healthcare leaders – lists of leader behaviors for safety, population health, patient experience, working with new payment models, etc. While interesting, this advice rarely results in an integrated leadership approach to the range of vital healthcare outcomes required. What do leaders do when there are so many other demands on them and team members?
One answer is to look for leader behaviors that offer an integrated approach to achieving healthcare outcomes in joy in work, safety for patients and team members, excellent quality, patient experience, population health, and lower costs. Reviews of lessons from the field and relevant literature reinforce that integrated leadership actions exist. However, understanding the integrated behaviors is often clouded by different language and descriptions for similar behaviors. Lack of a common language leads to different lists – and confusion. For example, leadership actions for safe care – psychological safety, assuring civility, and a just culture – also are foundations for an environment that nurtures joy in work but different language muddies the understanding that it is one set of behaviors not two.
We recommend integrated behaviors in our description of Leadership and Personal Practices. The intent is to offer focus and a clear roadmap that encourages individuals to build on their strengths. Leaders are able to tailor behaviors to their unique personal needs and the culture building required to bring the organization’s mission to life. The Practices stem from a study of transformational healthcare leaders by Barbara and Jack Gilbert published in The Heart of Leadership2. The Practices are also grounded in more than 30 evidence-based resources, a previous blog, and a wide range of lessons gleaned from our work with the Institute for Healthcare Improvement and with leaders, physicians and healthcare teams on patient experience and joy in work.
The Personal Practices are those that are consistently found in The Heart of Leadership and other literature that provide the essential foundation for effective leadership. Embarking on leadership practices absent strong personal practices can lead to a lack of credibility and authenticity – going through the motions rather than a deep commitment that others seek in their leaders. The Leadership Practices described are Purpose – Eye on the Prize, Partners – Create a Common Fire, Systems – Make it Work, and Mastery – Grow Others.
Purpose – Eye on the Prize: effective leaders label and link – they offer an urgent and relentless commitment to a clear purpose based on the mission that is frequently communicated to everyone. They do not assume everyone understands why strategies exist. Through conversations, they help team members see how their role and daily actions contribute to the mission – offering a clear picture that they are part of something larger than themselves and how they add to community outcomes. These leaders intentionally use their words and actions to model high aspirations and to let others know what is important.
Partnerships – Create a Common Fire: effective leaders build and sustain healthy, trusting relationships with the healthcare team and community members across boundaries as part of their daily work. They show, through an emphasis on collaboration and teamwork, that the healthcare team and patients/families/community members are full partners. The commitment to “nothing about me without me” is evident in improvement and design where the team includes patients.
Systems – Make it Work: Don Berwick reportedly said, “We need to stop doing stupid stuff”. Effective leaders work to achieve that outcome through disciplined operating systems and infrastructure that enable innovation and reliability. No ones’ time, good will, or efforts are wasted. The use of best-known science – e.g. safety science, improvement methods, and evidence-based care – is expected. There is a commitment to learning fast, transparency, gaining knowledge from failures, and developing effective, innovative leaders.
Mastery – Grow Everyone: effective leaders assure that everyone improves, adds skills, and contributes every day. Skillful coaching is an expectation for every leader. Teamwork and compassionate communication are evident in all interactions among team members. Everyone has the opportunity to grow in his or her work.
In the next blog, we will talk about one of the Leadership Practices in more detail. We welcome your reflections and lessons from your work to add to the conversation.
1Institute for Healthcare Improvement, Joy in Work Bibliography; accessed 8/9/16; http://www.ihi.org/Topics/Joy-In-Work/Documents/IHIJoyInWorkBibliography.pdf
2Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ Qual Saf. 2015;24:608-610
3Balik, B., Gilbert, J. (2010). The Heart of Leadership: Inspiration and Practical Guidance for Transforming Your Health Care Organization. Chicago: AHA Press.