Enjoying Work
Since 2017, ELFT have run 5 cohorts of Enjoying Work. Their goal was to enhance the experience of their staff at work, so that they can better serve our communities. This work was pioneered in 2017 with a prototype learning system containing 5 teams.
We use quality improvement learning systems as opportunities to bring together teams from across the organization for a period of time around a common subject. They then meet at regular events called learning sets which give teams opportunities to explore potential solutions and share experiences so as to accelerate their testing and learning around the topic.
How we have done it
Through the five cohorts of the Enjoying Work learning system, individuals, leaders, teams and the organisation have continued to learn how to foster joyful places to work using quality improvement methods, leadership models, team building exercises and other tools and methods. We have been testing, on a larger scale, what we have learnt about measurement of staff experience, leadership behaviours for change, how to engage teams, change ideas from the IHI Framework Improving Joy in Work and how to do quality improvement (QI) using the ELFT QI Method and the Model for Improvement.
Here you can find learning materials from previous cohorts:
This is only one of many ways ELFT is trying to improve staff experience, which is at the heart of our new strategy. The evidence suggests that there is a correlation between improved staff experience and improved service user experience and outcomes. [1] Like most other things in life, ‘you cannot give what you do not have’. Here’s a short video about how we support teams to do this work:
What has been the impact?
More than 500 staff in some 70 teams have already been involved in this work. Feel free to look through some of the stories from teams that have been doing this work. As you read through, look out for some of these themes (i) How teams come together to create their own solutions, (ii) How teams learn together and from each other, and (iii) How challenging, impactful, rewarding and fun the journey is. Behind the numbers are stories of teams and individuals who are making real progress towards creating great places to work.
Click here to access these stories >>
Figure 1- What staff have said about the impact of doing this work
How to get involved
We hope this inspires you to explore different approaches to work in your own teams. Why not share your own top tips for enjoying work on Twitter with the hashtag #EnjoyingWork and tag us at @ELFT_QI.
Follow how the work is progressing via this Twitter feed.
[1] Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. Harris F, ed. PLoS ONE. 2016;11(7):e0159015. doi:10.1371/journal.pone.0159015.
Using Quality Improvement to deliver a systematic organisational approach to enjoying work in healthcare
Abstract
Staff wellbeing is increasingly linked to good outcomes for service users in healthcare.
Therefore, it is important for organisations to find ways to focus on wellbeing and staff
experience at work. This article shares learning from 5 years of using the Institute for
Healthcare Improvement’s joy in work framework, coupled with quality improvement
methods to enhance staff experience and wellbeing. This demonstrates how teams were
brought together in a collaborative learning system to apply quality improvement to
enhance joy in work. Key steps are shared for other organisations wanting to undertake
this work, including the application of improvement methods to empower teams locally to
develop, design and test change ideas, and measure their impact. The design of systems
and structures required to meaningfully bring teams together and the type of leadership
that enhances this work are also considered. Key learning points for other organisations
include the need for improvement principles to iterate the organisational approach, make
measurement simple, encourage a bias to action and make the work fun.
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Quality improvement in practice—part two: applying the joy in work framework to healthcare
As healthcare systems emerge from the COVID-19 pandemic and begin the process of recovery and rebuilding, it is more important than ever to find systematic ways to ensure that all healthcare staff are focusing on their wellbeing, are able to reflect on new ways of working and find methods to improve their experience at work.
This article, the second in a three-part series on the practical application of quality improvement in healthcare, presents four case studies that demonstrate the learning from four healthcare systems that have been applying both quality improvement and the Institute for Healthcare Improvement’s ‘joy in work’ framework to enhance staff wellbeing and experience. These case studies demonstrate the benefits of involving staff deeply in the process of understanding factors that impact on experience at work, developing and testing creative ideas that can make a difference. The ideas that emerged were diverse and highly contextualised to the local service. Ideas related most strongly to four areas: wellness and resilience, daily improvement, camaraderie and teamwork, and recognition and reward. The systematic approach that quality improvement brings is potentially replicable across all healthcare settings, and can provide a way for all teams to have greater ownership and control over their wellbeing and experience at work.
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Enjoying Work Cohort 4
Congratulations to Forensics Admin, Quality Compliance and Performance and Newham CAMHS for successfully completing Enjoying Work.
In this collection you can find learning materials, project posters and stories from the teams during their participation between September 20120 and June 2021.
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Enjoying Work Cohort 3
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Enjoying Work Cohort 2
Here are some useful resources used as part of the Learning Sets in Cohort 2 of the Enjoying Work Learning System.
Please click on the link below to see the contents of this collection >>
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Enjoying Work – Luton IAPTS
Please learn more about this completed ELFT QI project from the adjacent poster.
ELFT staff, service users and carers can access full details of this project on Life QI .The project code is 103865 please log onto your Life QI account before clicking the logo below.
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Immunization Against Burnout
Clinician burnout is far from being eliminated at health care organizations, but leaders, frontline
physicians, and nurses are joining forces to get to the roots of the crisis. That’s the takeaway from
the NEJM Catalyst Insights Council survey, “Immunization Against Burnout.”
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Appreciative Enquiry
Please click on the image to view the Appreciative Inquiry PDF.
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Change Ideas From IHI
The IHI are our strategic partners in this Quality Improvement journey. Please click on the image to read their Change Ideas document.
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Enjoying Work – A Trust QI Priority
Several teams have been testing and helping refine a learning system which brings together methods, resources and peers to help teams work on improving the experience of staff and enable people to enjoy their work. We are now extending this learning system to bring in more teams from across the Trust.
Here are the details:
To view the infographic as a PDF file please click here.
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Enjoying Work – A Trust QI Priority
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Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review
This review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions
to improve patient safety.
Please click on the image to open the paper.
Related Resources
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Enjoying Work
‘Enjoying Work’ Workstream Update
In previous newsletters, we shared some of the Trust-wide priority areas that are being tackled collaboratively by several teams using QI (Quality Improvement) as the design framework. One such work-stream is “Enjoying Work”. Feedback from staff through different avenues, including the annual staff survey, has highlighted the need to improve the experience of staff working across the East London NHS Foundation Trust (ELFT). A handful of teams started to work at addressing the issue of staff satisfaction and morale by running improvement projects. There is a wave of interest internationally in bringing back joy in work1.
Why it’s Important:
In addition to running appreciative enquiries with some teams, a survey was sent to all staff in early 2017 to gauge what matters to them. What came out of that exercise was astonishing. There was a lot of emphasis on needing to rebuild meaning, teamwork, trust and embrace new ways of working. The responses received from eighty-five survey responders and three services were used to create the wordcloud that is now the symbol of this work.
Who is involved:
Five teams from a variety of the Trust’s services have volunteered to be prototype teams for the Enjoying Work workstream. These teams were either already working on this problem or volunteered to get involved. The five teams also represent some of the different type of work environments in ELFT, they are:
- Highly mobile staff: West Locality EPCT (Enhanced Primary Care Team)
- Geographically dispersed: Luton IAPT (Improving Access to Psychological Therapies)
- Geographically centralised: Isle of Dogs CMHT (Community Mental Health Team)
- Corporate: Quality Improvement Team
- Inpatient: Millhabour Ward
Each service has established a project team which consists of staff from that service. They also have a local sponsor from the directorate management team, a Quality Improvement Advisor to coach them and a named Business Partner from the Human Resources/Organisation Development team. Mason Fitzgerald, Director of Corporate Affairs, is the executive sponsor for the workstream from the Trust Board.
This work will also be linked to other work taking place across the organisation on leadership development and compassionate leadership. We are also keeping in contact with other organisations that are doing this type of work to collaborate and learn from each other. We have also adopted the change ideas and change concepts identified by the IHI (Institute for Healthcare Improvement) in their recently published framework for improving joy in work in healthcare organisations2. Some of these will be tested by the prototype teams together with their locally generated change ideas.
What they are doing:
In the preliminary stages of the work, the prototype teams have been testing how best to approach this work in terms of measurement, appreciative enquiry, defining the problem and testing change ideas.
Some of the prototype teams are still collecting baseline data which will help us set a global aim for this work. We expect that the learning that comes from the teams doing this work will be scaled up to the rest of the organisation as we build confidence in the approaches and changes being tested.
Colleagues from Human Resources and Organisation Development will also be working closely with these prototype teams to test out the new Business Partner model of supporting teams and leaders in tackling specific challenges when leading and delivering services. You can also read in this newsletter about the events that took place in September with more than 200 staff, with Professor Steve Swensen who has led much of the research and work internationally on understanding staff burnout, team engagement, joy in work and quality improvement.
What can you do?:
After the publication of the annual staff survey, many teams make an action plan to address some of the issues which come to light. This also tends to happen throughout the year following team away days and other occasions. At ELFT, improvement has always been part of our DNA and we know that most problems can, and are, being solved without necessarily starting a formal QI project. We would love to hear about what you have tried in your team and what you have learnt while trying to improve staff enjoyment of work. In addition, if you would like to test out some of the tools that the prototype teams have developed for carrying out an appreciative enquiry, or the simple measurement tools, please get in touch. Drop us an email at elft.qi@nhs.net with the subject line “Enjoying Work”.
1Feeley D, Swensen SJ. Restoring joy in work for the healthcare workforce. Healthcare Executive. 2016 Sept;31(5):70-71.
2Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.
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Steve Swensen – Report on Leadership development events
By Marco Aurelio and Auzewell Chitewe 
The 2016 NHS Staff Survey showed us that we have made significant progress as an organisation in terms of staff engagement. We are committed to making further progress in the areas we have improved in, such as recognition and value of staff by managers and the organisation. Additionally, we want to address the areas that our staff identified as needing further improvement.
One of the actions taken was to invite Professor Steve Swensen to run workshops with leaders from all levels of the organisation to help us building on our culture of caring for our patients and each other. Steve Swensen has led much of the research and work internationally on understanding staff burnout, team engagement, joy in work and quality improvement. He previously led on leadership and organization development at the Mayo Clinic, a large healthcare system in America with many similarities to ELFT. He is currently Medical Director for Professionalism and Peer support at Intermountain Healthcare.
Steve ran several masterclass sessions with the executive team and leaders from around the Trust on 14th and 15th September 2017. Over the course of two days Steve helped us think through how we can 
support leaders to create an environment that prevents staff burnout, empowers everyone to be part of the solution by embedding a model he called “esprit de corps” – taking care of each other for the benefit of our patients.
Over 200 members of staff from a range of professional backgrounds attended a variety of workshops and events to learn about building “esprit de corps”. The model encourages leaders to address four basic elements – trust, resilience, passion and camaraderie1, 2.
So, as leaders, how can you go about doing that? A big focus over the two days was understanding 6 actions of the organizational framework for improving “esprit de corps”3 and enjoyment at work:
- Leadership – Exhibit behaviours that are open, encourage staff to try out new ideas and show them appreciation
- Design – Design organisation systems that eliminate or mitigate structural and functional drivers of burnout
- Commensality – Encourage staff to come together and socialise. Be it a simple coffee morning or having team lunches
- Pebbles in shoes – Ask staff what matters to them, or what is getting on their nerves and try and fix it together
- Don’t let staff be second victims – Having a bad patient outcome or sentinel event can cause serious psychological impact on staff. Don’t let them become a victim of that by having a culture of blame. Focus on changing systems
- Develop resilience in staff – Encourage staff to take care of their own health and wellbeing.
Of course, that sort of change doesn’t happen overnight and Steve’s key take away point is to start an open and honest dialogue with staff by asking what matters to them, what gets in the way and work together to design solutions to problems.
1Baard, Deci, Ryan. Intrinsic Need Satisfaction. J Applied Social Psych, 2004. 34(10): 2045
2Swensen, S., A. Kabcenell, and T. Shanafelt, Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience. Journal of healthcare management / American College of Healthcare Executives, 2016. 61(2): p. 105-127.
3Swensen, Shanafelt. Organizational Framework to Reduce Professional Burnout. Joint Commission Journal on Quality and Patient Safety June 2017 43(6) 308
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Steve Swensen visiting the Trust
This week we are delighted to welcome Professor Steve Swensen to ELFT. Steve is Medical Director for Professionalism and Peer Support at Intermountain Healthcare, and was previously Medical Director for Leadership at the Mayo Clinic. He has written and researched extensively on clinical engagement, enjoying work and staff burnout and you can find some of his published work available on the microsite here>>
During the two day visit he will meet with close to 200 ELFT staff, service users and carers who are working together on these issues. We will share some of the outcomes from these learning groups and workshops with you over the coming weeks.
Watch Steve present alongside Derek Feeley, CEO & President IHI, and Jessica Perlo IHI, at the 2017 International Forum on Quality & Safety in Healthcare.
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IHI Framework for Improving Joy In Work
With burnout and staff turnover in health care continuing to rise at alarming rates, this white paper describes four steps leaders can take to improve joy in work; a framework with nine critical components for ensuring a joyful, engaged workforce; key change ideas; and measurement and assessment tools.
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An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice
The epidemic of physician burnout undermines quality of care, patient satisfaction, and access to care, making it a major threat to the US health care delivery system. Burnout is primarily a system issue—not a problem of individual resilience. Accordingly, meaningful progress will not be made until the drivers of burnout are addressed at the level of the organization and care delivery system.
Click on the image to read this paper.
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Restoring Joy in Work for the Healthcare Workforce
While burnout in the health professions is alarmingly high, restoring joy in work is more than just reducing burnout. So, what can leaders do to counteract this epidemic? This article describes four key steps that leaders can take to restore, foster, and nurture joy in the health care workforce.
Feeley D, Swensen SJ. Restoring joy in work for the healthcare workforce. Healthcare Executive. 2016 Sept;31(5):70-71.
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Restoring joy in work and preventing burnout: an IHI framework for joy
Restoring joy in work and preventing burnout: an IHI framework for joy
- Stephen Swensen, Medical Director, Leadership and Organization Development Mayo Clinic; USA
- Derek Feeley, President and CEO, Institute for Healthcare Improvement; USA
- Jessica Perlo, Network Director, IHI Open School; USA
International Forum on Quality & Safety in Healthcare – London 2017
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