10 Oct 2021
Do you love your job, every day? What about your team? Jesse McCall (Institute for Healthcare Improvement) and RCVS Knowledge set out a practical, evidence-based framework for overcoming burnout that puts teams in the best position to deliver top-quality care…
Image © Robert Kneschke / Adobe Stock
We are living through one of the most challenging times for veterinary professionals in recent history.
Increasing pressures on teams, compounded by the extraordinary demands of COVID-19, have led 75% of practices to report increased stress or impact on the mental health of teams working during the pandemic1, and 75% of vets to be concerned about stress and burnout in the profession2. These circumstances call for a fresh approach that strengthens existing efforts to improve the well-being of practice teams, including those at the top.
A proven scientific framework can help your team to thrive, not just survive, and put the practice on track for peak performance.
In human health care settings across the world, with their attendant resource pressures and ambitious organisational goals familiar to those in the veterinary sector, the most productive and engaged professionals enjoy a set of workplace characteristics that put them in the best frame of mind and position to strive for excellence every day.
The formula for what can be called “joy in work”, and a framework to help achieve this, has been developed by the Institute for Health Improvement (IHI), a US-based not-for-profit that aims to improve the lives of patients and the health of communities around the world.
The institute’s investigation of this area has uncovered, in an echo of improvement science founder W Edwards Deming, that effective ways of increasing team resilience or “wellness” focus on the operating systems that we all work in, as well as discrete well-being programmes.
Deming also said that it’s management’s job to create the culture, system and environment that fosters individuals’ sense of joy or pride in their work. But what does joy in work look like?
According to the psychologist Aaron Antonovsky, joy is more than the absence of burnout. Further, health is not just the absence of disease, but rather the process by which individuals maintain their sense of coherence; their enjoyment of a life that’s comprehensible, manageable and meaningful; and their ability to function in the face of changes.
Everyone experiences their work environment very differently, and different things can bring a feeling of workplace joy, whether that is happy and satisfied clients, the sense of satisfaction in a job well done or supporting your team to achieve your goals.
To combat the rising levels of burnout, we need to move away from the belief that individuals are responsible for their resilience and well-being, towards reframing the focus on analysing and improving systems.
If we have a great work recognition or wellness programme, for example, what elements are really working that we can build on, and what should we dispose of?
Historically, we have tended to think of human resources as responsible for this kind of area, but actually everyone in an organisation has a role to play to contribute to a joyful workforce, focusing on factors beyond resilience.
Of course, pay and traditional benefits are very important, but deeper reasons for pursuing a career throughout our lives include improved outcomes for patients, families and the practice; feelings of achievement or a job well done; team spirit; and equity.
Well-being is stymied when work demands are not matched to our knowledge, abilities or needs. When we only feel like a cog in a wheel, we are hampered from practising at the top of our licence and feel disconnected from why we entered our profession.
An extremely heavy workload over a long period of time, or working at an accelerated pace for long hours, unsurprisingly also precludes joy.
Particularly relevant to COVID-19, we cannot experience well-being in the face of repeated moral injury; that is, when we suffer an accumulation of negative effects as a result of continued exposure to morally distressing situations that challenge our professional integrity3.
One example would be having to take on the work of others on a protracted basis. Another would be seeing animals at an advanced stage of sickness because owners report they have had difficulty in obtaining an appointment given the reduced number of consults taking place.
To address the issue of burnout, the IHI developed a two-part framework, starting with a bottom-up approach.
The first step is asking your team: “What matters to you?” This is the springboard that enables senior leaders and core leaders to have meaningful and practical conversations with colleagues, and gain a true understanding of what is important to them in their daily work.
What helps make a good day? When are we at our best as a practice? What does that look like? What do we value as a workforce? And also, what gets in the way of having a good day? What are those “pebbles in your shoe” that bother you, and what can we do to remove those?
For this to be effective, leaders need to take care to be in a genuine listening mode, as well as manage expectations about the time it will take fully to grasp, prioritise and address the issues that surface in partnership with the team.
The next step is identifying unique impediments to joy or leading to burnout in the local context. What are the unique pebbles – or even boulders – that are getting in the way of a good day, or ultimately leading to burnout in our practice?
At this point, practice managers ask the team to commit to making wellness at work a shared responsibility at all levels of your practice. What’s important is to use improvement science to test your approaches: being rigorous in trying new things, in improving systems and in measuring the outcomes. Our experience shows this will lead to an improved client and patient experience, and improved organisational performance, as well as decreased burnout among the team.
Essentially, the first part of the framework is about how you try to establish that culture of joy in your practice. The second part of the framework involves delineating what you work on. You’ll find the unique impediments to joy in your workplace will fall into one or more broad categories (see panel).
While this list may be daunting, three domains tend to be the most influential in affecting joy in work, so provide a good place to start: autonomy and choice, meaning and purpose, and physical and psychological safety.
Feeling physically safe at work means we minimise the risk of being harmed by the animals that we’re caring for and the instruments we’re using, and that we have the necessary protective equipment (of particular relevance during COVID-19).
On the other hand, psychological safety relates to the ability to speak up without fear of retribution, especially when (potential) errors are spotted. A powerful and practical way to work on this domain is by creating a learning culture that balances a systems approach and individual accountability. In most cases, it is our systems and how they work together that create the opportunity for errors, rather than people.
As part of this, many human health organisations have found the concept of “psychological PPE” to be effective – particularly as they’ve worked through the coronavirus pandemic. Alongside actions individuals can take, leaders can show gratitude for great work done in challenging circumstances and create space to celebrate this, as well as find and share some positive elements within challenging experiences.
Practice managers can consider limiting shift times, and ensure roles and manager accountability are clear. We can introduce training in awareness of distress or mental health issues and systems to support this, such as buddy systems and a “rolling take five” or “going home checklist”.
The latter enables teams to acknowledge challenges that took place during the shift and identify ways to let go or handle these, and therefore release the psychological weight of what happened at work. The NHS has found it to be highly effective in helping to create space between work and home life, and thereby in reinforcing psychological safety.
Think back to why you became a vet or RVN. What meaning did that bring for you, and do you feel that you’re still pursuing that same meaning and purpose? Does your practice have systems that allow your team to connect to what that meaning and purpose is for them?
One way of doing this is to have a “value of the month” (an idea borrowed from US human health care) where team members take turns in practice “huddles” to share with colleagues how their work that day relates to a particular value – that is, what that value means in action for them.
Members of your team may well have their own ideas about how to connect personal values with practice values.
When people have autonomy and choice at work, they know what they’re doing and how their job fits into the broader picture of the practice’s strategy. They also have some say in their job’s definition and how it is accomplished, and the work is generally manageable given the time and resources available.
To steer change in this domain, it can be useful to consider team composition, whether all available skills are actually used, the processes in place to review whether any work exists that no longer brings value, and how team members contribute to practice decisions.
From this brief discussion, we can see the value in making joy or wellness at work a strategic priority. Teams that have genuinely adopted the IHI framework on improving joy in work or decreasing burnout have seen tangible results in their organisations, both anecdotally and in data regarding the number of team members who feel burnt out.
Some have found working on the project itself, with its focus on collaboration, has restored their joy in work. Others report that adopting the framework has improved the patient experience – as well as team spirit, enthusiasm and motivation.
Practice managers can do a huge amount, and materials are available to support you in helping to maximise team happiness, productivity and performance. It’s a good idea to start small, to be able to implement some concrete changes and in that way build confidence among the team in the approach. Why not simply suggest the idea of a focus on joy or wellness at your next team meeting, and see where it leads you?
