The key to joy and excellence at work

What makes for a good day at work – a day when you feel pride, confidence, satisfaction or accomplishment?

We all have our own recipe for what some call joy – a fantastic outcome, an opportunity to learn or a heartfelt thank you from a grateful client. However, a common ingredient keeps veterinary professionals coming back through the practice doors, day after day – their team^1,2.

A scientific framework actually exists for increasing how much joy we feel at work. It was developed by the Institute of Healthcare Improvement (IHI) – a US not-for-profit that aims to improve the lives of patients, the health of communities and the joy of the health care workforce around the world based on improvement science. You can find out more about the Joy in Work framework in part one of this series (VT51.49).

According to the IHI, nine components make for a joyful workplace. These include recognition and rewards, choice and autonomy, and wellness and resilience, among others, but the IHI has found teamwork and camaraderie is frequently cited as the most critical component when teams start to focus on fostering joy.

This matters because joy isn’t just a nice-to-have concept – the IHI’s research shows Joy in Work is instrumental to safe and effective patient care. When teams experience more joy, their motivation, engagement and productivity all grow, leading to improvements in patient experiences, outcomes and safety – and ultimately lower costs³. In short, a clear clinical and business case exists for taking joy in our work, and camaraderie is at the heart of it. This is good news, because team spirit comes without a price tag, it is potentially long-lasting and the whole team can do something about it.

Definition of team spirit

If we want to strengthen team spirit, that might seem rather abstract, so what exactly are we aiming for?

The IHI describes teamwork and camaraderie as “social cohesion generated through productive teams, shared understanding, and trusting relationships”⁴. Day to day, that means people experience mutual support and companionship at work, and feel part of a team that is working together towards something meaningful.

It means having a friend at work we can turn to for advice, and trusting our leaders. For leaders, it involves communicating transparently, and for the whole team it is about regularly expressing appreciation for one another’s work.

These characteristics are underpinned by good communication, civility, compassion and kindness – which are indicative more broadly of a positive and healthy practice culture⁵.

How camaraderie improves performance

Everyone in a team can have an impact on care, therefore effective teamwork is critically important to patient safety^6-10. To work as an effective veterinary team – especially under resource and time pressures – we need to be respectful and supportive of our colleagues. Great leadership and communication create the conditions for a shared understanding of the common goal, practice values and team members’ roles, as well as the specifics of individual cases^11,12.

When the whole team collectively examines an instance of outstanding care from their different perspectives, we can distil the elements of a success and give ourselves the best chance of reproducing it. Equally, working cooperatively helps to reduce the likelihood of errors recurring: when the whole team comes together and feels able to share ideas openly about the root causes of problems, we are more likely to identify strong, holistic and sustainable solutions¹³.

Involving the whole practice team in analysing and addressing both these types of significant event is critical to successful Quality Improvement – a systematic and coordinated approach to making changes to bring about measurable improvements using specific methods and tools¹⁴.

And in a practice with a strong team culture, there is likely to be more empathy and engagement – and, consequently, a desire to address events constructively as opposed to the dead-end of blame or a one-off case of exceptional care that the team doesn’t learn how to reproduce.

Moreover, mutual support and companionship oil the wheels of information flow around a practice – helping to create a network of excellence based on “distributed cognition”¹¹.

Good communication helps mitigate challenges posed by time pressures, handovers, and differences in how we work¹⁵. Contrast this with “stepping stones” of excellence, which can be precariously connected when individuals don’t work in an integrated way. Recent UK veterinary research found communication problems played a contributory role in 80% of settled cases of alleged professional negligence^9,16.

What’s more, when we enjoy mutual support and companionship, we want a good day, or “joy”, for our colleagues as well as ourselves. This makes a team-wide, sustained commitment to improving care much more likely. In fact, research suggests people who have a close friend in the workplace are seven times more likely to engage fully with their work¹⁷.

Additionally, supportive teamworking can have a positive effect on our well-being – while diminished well-being can have a detrimental effect on quality of care^4,18-20.

In brief, weak teamwork and poor, uncivil communication can compromise performance and patient care – and substantially contribute to medical error^{8, 21-25}. On the other hand, a strong team culture reduces the risk of errors and can act as a springboard for care improvement²⁶.

How to build teamwork and camaraderie

To nurture camaraderie, the IHI suggests we start with improving trust and understanding among the team.

For starters, managers can pair colleagues up, and change these pairs over time, so that all colleagues get to know one another well. These “buddy systems” are especially useful when introducing newcomers to a practice and its culture. Bringing different roles together for meetings and training can also bear fruit.

Interestingly, managers who have reviewed workflows with their team report increased camaraderie (see part two of this series; VT52.11). Supporting flexibility where possible helps, too²⁷. In these ways leaders avoid rigid hierarchies, and build democratic teams that feel able to speak up and share ideas^8,15,28,29.

Furthermore, managers can model the behaviour they expect by involving the whole team in decision-making wherever appropriate, and showing colleagues gratitude and compassion – behaviours that also improve team effectiveness, quality of care and client satisfaction^30,31. “Extracurricular” activities boost camaraderie, too – eating together, supporting a charity, social events or simply seeking laughter^27,32,33,34.

We don’t have to wait, however, for managers to take action. There are many things we can all do to nourish team spirit. Saying thank you is a simple, but effective way to bring out the best in one another.

We can make an effort to learn new things. We can pause to note successes – both formally as a learning opportunity, and with after-hours celebrations^{15, 35}. And we can all suggest a drink, bite or fund-raising activity to get to know our colleagues better, regardless of our role³³. When things don’t go so well, every one of us can show compassion, and do something to try to alleviate our colleagues’ distress³⁰.

Whatever kind of day we’re having, we can take a moment to check we’re treating others as we’d like to be treated ourselves. It may not sound like much, and you may sometimes feel like a small cog in a large wheel, but some simple actions can have a genuine effect on your team’s camaraderie, joy and performance.

Following an RCVS Knowledge webinar on “What matters to you?”, the leadership team adopted the Joy in Work framework to empower team members to identify workplace challenges, action solutions and rejoin decision-making. During a training day, the team identified four “pebbles in their shoes”, which were addressed with measures they suggested. “Before and after” surveys showed quick results: more than 95% of team members who took the survey felt their well-being was now considered, 100% would now recommend the practice as a place to work and 100% would strongly recommend the practice as a place for an animal to receive care.

To maintain momentum, a “joy-o-meter” using pink and blue balls was introduced to mark good and bad days. This showed bad days decreased after pebbles were addressed, and gave leadership a heads-up when sickness was affecting morale. The team has a fortnightly ”What matters to you” meeting, a Joy in Work board listing pebbles in progress, and a “pebbles pouch” for further suggestions.

Many team members now feel more engaged in helping set the practice direction (another aspect of the training day), and feel they have a productive way to address day-to-day niggles. The team has inspired local practices and other practices in its group to adopt Joy in Work.