Milestone 24 Summary

Description: Practice has effective strategies in place to cultivate joy in work and can document results.

What does success look like?


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Practice has no proactive strategies aimed at creating joy in work. Practice has developed strategies to improve the experience of staff and create joy in work but implementation of these initiatives is limited. Practice has strategies in place to promote joy in work (e.g. reward and recognition programs, staff development, social activities) but has no mechanism for determining whether the programs initiated are successful. Practice has implemented strategies to support joy in work and can demonstrate the results through metrics such as staff survey results, high retention rates, or low turnover rates.

Note: numbers are PAT scores

Why is this important?

Practice transformation to deliver the best care possible often requires efforts to transform the internal culture to one that prioritizes staff morale and well-being. Healthcare professionals typically enter the field because they want to care for others. However, increasing demands and rapid changes in the delivery of healthcare often create new time constraints and a stressful environment, potentially diminishing joy and meaning found in the work while increasing risks of premature burnout. It is well documented that burnout contributes to lower productivity, greater risk of workplace accidents, and decreased empathic communication.1 Additionally, research from the National Patient Safety Foundation shows that healthcare workers endure bullying, harassment, disrespect, and physical injuries at much higher rates compared to other professions.2 This not only negatively impacts the worker, but research also shows that those stressors in the workplace may impact patient safety via increased risk of medical errors and failure to routinely follow safety guidelines.2 These and other risks can be mitigated or avoided all together by adopting strategies to restore  joy in the workplace, and hopefully, in turn improving staff retention, patient satisfaction, patient outcomes and operating an efficient and higher performing practice.1,3 While there are many strategies to bring more joy to work, the Institute for Healthcare Improvement recommends four steps that leaders should take to create a culture of a positive workplace: 1) identify what matters to employees, 2) identify barriers in the local context, 3) commit to a systems approach in which creating joy is a shared responsibility, and 4) use improvement science to test changes aimed at creating joy.1 As quoted by the National Patient Safety Foundation, “If we expect the health care workforce to care for patients, we need to care for the workforce.”2

Potential Tactics

  • Hold annual or biannual staff retreats to focus on team relationships, practice successes, and future planning.
  • Perform regular staff reviews which emphasize staff goals and professional development. Staff members also complete annual performance reviews for their respective managers.
  • Establish practice-wide conflict resolution procedures for when disputes arise between team members.
  • Create an incentive and/or recognition program for when staff members are given positive reviews from patients or other team members.
  • Establish system for obtaining staff input and an approval process for all operational and governance decisions or practice changes.
  • Promote open communication and transparency throughout the practice.
  • Staff members complete quarterly surveys addressing burnout, job satisfaction, leadership/managerial styles and professional development needs. Establish process for reviewing surveys and creating actions plan to address problems as needed.


Tools and Resources


What might this look like in practice?

A medium sized practice decided to form a temporary work group to establish a set of shared values and operating procedures for all team members. This group drafted a short document outlining expectations for creating mutual respect in the workplace, transparency in the workplace, safety for all workers and patients, and accountability and communication for staff at all levels. All staff members were given one week to provide feedback, and the finalized document is distributed to all new hires and revisited during staff evaluations as a framework for discussion. The practice holds monthly staff meetings which are started by sharing a positive patient story that is captured from patient surveys or anecdotal experiences. Staff are also encouraged to speak about openly about errors and concerns during staff meetings in order to identify room for improvement. Leadership and board meetings are open to all staff members, and regular practice performance data is made available. The practice hosts quarterly staff appreciation days (such as providing free lunch or supporting an out of work gathering), has an “appreciation wall” where positive stories and notes are publicly displayed, and all staff members receive paid time off on their birthday.



  1. Perlo J, Balik B, Swensen S, Kabcenell A, Landsmen J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambrige, Massachusetts: Institute for Healthcare Improvement. 2017
  2. Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. Boston, Massachusetts: National Patient Safety Foundation. 2013
  3. Issel M. Joy, work, and health care management. Health Care Manage Rev. 2007;32(2):91