As children’s hospitals grapple with unprecedented workforce turnover, many have turned to a holistic framework developed to bring joy back to the health care profession.
Informed by experts and organizations both in and outside health care, the IHI Framework for Improving Joy in Work outlines nine critical components of a system for ensuring a joyful, engaged workforce and the steps leaders and teams can take to get there. It also provides assessment tools to set hospitals up for success.
Here’s how two children’s hospitals have found success using the framework to foster a happier and more productive workforce.
Making conversations count
Lehigh Valley Reilly Children’s Hospital was among 18 organizations to pilot the Joy in Work framework as part of an IHI collaborative. After the pandemic and the overwhelming surge of respiratory viruses, the need for joy in work had never been more crucial.
“Burnout was at an all-time high. Our teams were extremely stressed,” says Karen Clark, vice president of patient care services. “We were short staffed and saw a tremendous amount of turnover. There was a very low sense of fulfillment among all our colleagues, whether they be clinicians or those supporting clinicians.”
Implementing the framework
To get started, the team created a 13-step process to guide implementation that included having “what matters to you” conversations, prioritizing key drivers, and performing plan-do-study-act (PDSA) cycles. The process not only guided planning and execution but also helped garner leadership buy-in for the initiative during a stressful season.
“What it all boils down to is the fact that joy in work and the well-being of the health care workforce is not so much individual responsibility,” says Helen Julia, project manager. “It’s a systemic and organizational responsibility.”
They chose two departments to pilot the framework: the children’s emergency department and the pediatric pulmonary practice, which were the hardest hit by the RSV surge. Eventually they added inpatient pediatrics and pediatric gastroenterology.
The most important step, Julia says, was the “what matters to you” conversations. “Those are the one common theme that remains consistent. You must have them, and you must go to the people doing the work and listen—not to solve, not to act, just to hear and collect data.
How each department chooses to have those conversations varies. For example, the emergency department built the questions into their professional evaluation survey. The pulmonary department used a comment box. Inpatient pediatrics integrated them into regular staff meetings. And the GI unit started the conversations with the question: “If you could break the rule in favor of patient experience, what would it be?”
Making a difference
To measure progress, the team used a survey before implementation and six months after. They found while stress levels remained similar, staff reported less burnout and more joy at work. In the emergency department, turnover dropped to less than half the national average, and they went from a 41% vacancy rate to being over-hired.
Of all the results, the most significant improvement can’t be reduced to numbers. “Engagement has really moved forward as well as their ability to work as a team,” Clark says. “We couldn't have driven this work on our own. We needed the team to become engaged and start to drive these changes.”
Kathy English does not believe the answer to workforce woes is increasing pay and benefits, important as they are. As executive vice president and chief operating officer at Children’s Nebraska, she’s prioritizing one thing above all else.
“We differentiate ourselves by creating a culture that puts people first,” English says. “And I'm here to tell you that it's paying off.”
Since embarking on its People First strategy, the hospital has seen a reduction in a turnover, saving millions of dollars. Engagement has risen, improving not only staffing but clinical effectiveness.
“We’re investing in the people who are in our organization because we see them as the pipeline for the future,” she says. “As a result of our work, we're prioritizing the team's purpose, joy and well-being—and all of that leads to engagement.”
More than a program
The People First culture was created using the IHI Joy in Work Framework and includes holistic well-being, continuous learning, and recognition for individuals and the team. Recognition was the first component the team addressed, creating an electronic platform where any employee or patient can leave a note of recognition for someone else. Since launching in February, 60,000 recognitions have been submitted.
Other initiatives included:
- An on-site ESL class to address employee social determinants of health.
- Well-being programming aimed physical, financial and community needs.
- Therapy dog, Howie, nicknamed the “Chief Morale Officer.”
- Paid volunteer programming for staff to get involved in the community.
The team used an extensive internal communications plan to impress the value of this culture on staff. Effective communications ensure staff can maximize their benefits and builds a strong Employer Value Proposition both internally and externally.
English emphasizes this is not a program but a framework influencing every hospital decision from benefits and policies to executive strategy and organizational leadership.
As much as English and Janel Allen, executive vice president and chief people officer, have driven this culture, successfully enacting the Joy in Work Framework takes more than a couple of motivated individuals. “You build organizational capacity through your leaders. That's foundational for us,” says Allen. “Every leader in the organization is an owner of our culture. It’s asking for their involvement and accountability.”
Moving the needle
Since implementing Joy in Work, Children’s Nebraska has seen measurable results:
- Employee retention rate rose 5%.
- First year RN retention rose 20%.
- At or above Agency for Healthcare Research and Quality (AHRQ) benchmark in 10 of 12 categories.
- Employee engagement score of 89%.
“Those measurements are telling us we're moving in the right direction,” Allen says. “We’re fostering an environment that allows individuals to in the organization to thrive.”
These stories were presented as a joint session, “Retaining Talent with Well-being and Joy,” at CHA’s 2023 Annual Leadership Conference. Experience transformative sessions like this at CHA’s 2024 Transforming Quality Conference where children’s hospitals will learn to improve children’s health through advancements in data analytics, evolving care systems, creative partnerships and practice improvement efforts.