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IHI Forum: Leadership Pivotal in Implementing Joy in Work Initiatives

Analysis  |  By Christopher Cheney  
   December 06, 2022

Efforts to start joy in work initiatives at healthcare organizations require a commitment from leadership.

Health system and hospital leaders have a crucial role to play in advancing joy in work initiatives at their organizations, an Institute for Healthcare Improvement executive said yesterday at the IHI Forum.

The IHI Framework for Improving Joy in Work is designed to reduce healthcare worker burnout and increase healthcare worker well-being. Healthcare worker burnout has spiked dramatically during the coronavirus pandemic, with a recent research article finding that 62.8% of physicians reported at least one symptom of burnout in 2021 compared with 38.2% in 2020.

Healthcare organization leadership is foundational in implementing the IHI Framework for Improving Joy in Work, Jesse McCall, MBA, director and improvement advisor at the Institute for Healthcare Improvement, told HealthLeaders at the IHI Forum.

"There must be commitment from individual leaders and leadership teams—that is the first step. Even having a leader ask the question about what matters to you at work is a signal that the leadership team cares—they are interested. However, leaders must go beyond asking about what matters to staff to doing something about it. Leaders can put a team together to surface issues, amplify strengths, or address barriers. Leaders can deputize other leaders across the organization to do this work in individual units or services lines," he said.

Beyond commitment to joy in work, healthcare organization leaders need make joy in work a high-level concern, McCall said. "The first step is to commit to this work as a leader—to say staff satisfaction, staff engagement, wellness, and well-being is important. The next step is to get joy in work in the strategic plan and the organizational dashboard. In addition to asking staff what matters, leaders need to feed back the data that is collected, whether it is qualitative from conversations or quantitative from staff experience surveys. Leadership needs to be transparent about what they are seeing and what they are doing based on the data."

There are four phases to implementing the IHI Framework for Improving Joy in Work, he said.

  • The first phase is asking staff what matters to them. "We have a lot of resources in how to engage people in these conversations and how to theme that data and turn it into actionable changes for your organization," McCall said.
  • The second phase is to identify unique impediments to joy in your organization. "What gets in the way of joy? What is frustrating day after day? What are the pebbles in your shoe—the small annoyances? What are the boulders—what are the things that management really needs to get involved in and what needs to change to enable you to do your best work?" he said.
  • The third phase is for an organization to make joy in work a shared responsibility. "Leadership must set the context to make joy a priority. Then there are specific roles in each organization to create and reinforce systems that foster joy in work," McCall said.
  • The fourth phase is focused on taking actions. "You use improvement science to test ways to remove impediments and test ways to improve your processes," he said.

Successful adoption of joy in work framework

There are three primary elements to adopting the IHI Framework for Improving Joy in Work, McCall said.

  • "The first key is making the case for the framework in your organization. You need to understand what problem you are trying to solve—whether it is burnout in a specific unit or whether it is burnout among the entire staff. Then you need to dive deeper and understand what matters to people such as larger things like scheduling, pay, or benefits. It also can be relatively small things such as supply availability. You need to understand the problem you are trying to solve first," he said.
  • "The second key is leadership support. You need to find the right leaders—finding an executive leader and a clinical champion. These leaders are someone who can say, 'Here is what I am doing. Here are the changes that I am making,'" McCall said.
  • "The third key is having a methodology. You need to have a model for improvement. It makes joy in work more than a fluffy concept. Having a model for improvement brings some rigor to the process—you are using a scientific method to test process changes and to bring about better outcomes for the staff," he said.

Primary barriers to joy in work initiatives

Healthcare organizations face a daunting hurdle in promoting joy in work, McCall said. "The biggest barrier is time and resources, which go hand in hand. When you think of resources, human capital comes to mind. You also need the time to engage in this work because it does take considerable effort to engage leadership and frontline staff. You must have conversations, develop a theory, and coach people. This takes time."

Organizational perspectives on devoting time and resources to boosting joy in work can also be problematic, he said. "In a progressive organization, you can realize the return on investment from devoting time and resources. But if you are looking at this work from a strictly bottom-line standpoint, it becomes more difficult to make the connections between expending resources and dedicating staff time and affecting the bottom line."

Related: Purpose and Meaning Essential to Creating Joy in Healthcare Workplaces

Christopher Cheney is the CMO editor at HealthLeaders.


The IHI Framework for Improving Joy in Work is a solution to the healthcare burnout crisis.

The first phase of implementing the framework involves asking healthcare workers what matters to them.

The primary barrier for joy in work initiatives is securing time and resources for the efforts.

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