If you’re digging deep right now to deliver the best care you can in tough circumstances, take heart. There’s a tried-and-tested scientific approach that can increase the joy we get from our work, even in hard times.

This approach is the “Joy in Work” framework and was developed to address burnout in human health care. It focuses on strengthening human connections within teams to solve system problems and it has had remarkable effects on how people feel at work, as well as on performance, engagement, team turnover and patients’ experience.

It’s the brainchild of the Institute of Healthcare Improvement (IHI) – a US-based 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. The framework’s emphasis on relationships at work is likely to resonate with UK veterinary professionals, given that the top reason UK vets and veterinary nurses stay in their job is their team^1,2.

The framework places importance on practice culture, and this speaks to the fact that work-life balance and management are two of the top three reasons why UK vets and veterinary nurses plan to leave their jobs^1,2.

Crucially, the framework is workable and relevant despite current challenges, as something can always be done to improve how we work, regardless of pressures on the sector.

A two-part approach to increasing joy

The framework comes in two parts: the first provides a structure for how to foster joy. This is founded on truly getting to know our colleagues – their values and motivations, as well as the bugbears in everyday practice that dampen their spirits. The latter are important, as they can deplete our energy over time and affect how we perform.

According to the IHI, this deep understanding of our colleagues is vital to establish a culture of joy – that is, a workplace where satisfaction, pride, confidence, safety and hope are the hallmarks (see parts one; VT51.49 and two; VT52.11 in this series). The second part of the framework is about what to work on. This involves categorising the workplace irritations that emerged during part one and tackling them as a team.

Drawing on extensive work in human health, the IHI has identified nine broad components of workplace joy (Figure 1). Of these, three can make the most difference to lifting a team’s spirits quickly: physical and psychological safety, meaning and purpose, and choice and autonomy – all supported by a bedrock of teamwork and camaraderie.

Physical and psychological safety

Physical safety is self-explanatory: are we in danger of getting stuck by a sharp, or being harmed by the animals we’re caring for? Does everyone, as far as possible, have the protective equipment they need to keep themselves and their patients safe?

Psychological safety is about feeling able to ask questions, voice concerns or raise ideas for improvement without negative consequences. It also enables us to speak up about potential or past errors without fear of retribution.

Do we have a learning environment that allows us to reflect on why an error happened and consider measures that can be put in place to prevent it from recurring? Most of the time, it’s our systems and how they work together that create the opportunity for errors.

Creating a just culture – one that considers how systems, as well as individuals, contribute to errors – is a powerful way to increase feelings of psychological safety.

Mental wellness support is important here – not just the offer, but ensuring people know about it and feel able to access it without stigma. Further, does work need to be done to ensure all colleagues feel equally valued and welcome?

What about cognitive overload – do team members all fully understand their jobs and can they be accomplished in the time available?

Psychological PPE

Individuals and leaders can take some simple actions to shore up psychological safety – particularly when facing unprecedented pressures.

The IHI’s set of “psychological PPE” suggests we avoid excessive media coverage of troubling issues that are out of our control and seek mental health support when we need it. Showing gratitude to our colleagues for doing their jobs – especially under stressful conditions – can go a long way.

We can also pause to try to find the positive things that have happened in the past day or week – because, in the words of Barbara Fredrickson, distinguished professor of psychology at the University of North Carolina, “the negative often screams at you, while the positive only whispers”⁴.

The NHS’ “Going Home Checklist” is a simple tool that helps teams do just that. It can improve well-being, and helps create space between work and home (look out for a discussion of the checklist adapted for the veterinary sector in the next article in this series).

Setting clear boundaries between work and home is invaluable to our everyday well-being – especially when taking time off is particularly difficult.

Now that CPD and other work-related activities are frequently undertaken outside working hours, it’s more important than ever to think consciously about where to draw the line, and the division that works for us as individuals to stay on an even keel. This might mean learning to shut down for the day, even when we are inclined to continue – a common and tricky habit to shake.

The answer of how much is too much will be different for all of us. For leadership, it’s worth considering whether all team members are being managed effectively. Having clear roles and leaders who are accountable and visible can increase feelings of psychological protection among teams.

It’s beneficial to set up training and systems to ensure managers are aware of risk factors for signs of mental health issues, and can keep an eye on this. Then we have peer support systems, where colleagues are paired up with buddies to give everyone someone to confide in about any difficulties they might be experiencing.

More broadly, leaders can work to instil a safety culture, where strong teamwork is integral. How about discussing quality and safety during management meetings? For this to work, it’s essential for leaders to get to know the people on the frontline of care and build trust with them. This includes making time to explore with colleagues how to improve when things don’t go to plan, and to celebrate successes when they do.

The overall aim is to create an environment where people don’t worry alone, but instead feel “in it together” and work out solutions as a team.

Meaning and purpose

Think back to why you wanted to work in the veterinary field. What meaning did the job hold for you? Do you still feel that meaning and purpose day to day?

It’s likely your colleagues will share some of your original motivations (you will find out more about this during part one of the framework). A strong sense of connection with patients and people is often at the heart of caring professionals’ motivations, so keeping these relationships at the forefront of how we work helps to build joy.

Do opportunities exist for colleagues to talk regularly about the meaning and purpose of what everyone does? Could you chat over coffee about how things that take place during the course of the day exemplify the practice’s values in action?

If the practice is planning to update its mission statement or set of values, you could even turn this into a team project, informed by these conversations.

This approach can strengthen connections between leaders and individuals, and empower team members to have a real say in the ethos of their workplace.

It might feel a bit artificial or cheesy at first, but actually articulating how the things we do embody a set of values has been shown to help unite teams, because it reinforces a common understanding of what a top-level mission means in practice, and how this relates to individuals’ own values.

Choice and autonomy

All team members in a practice can enjoy a degree of choice and autonomy, and this feeds into satisfaction, pride and other aspects of joy. Part of this is about having a job that’s comprehensible – do individuals’ roles make sense to them and others, and is it clear how each role fits into the bigger picture? Particularly relevant at present: are the remit and scale of everyone’s work in line with the time and resources available?

It can be helpful to review the make-up of the team, to capitalise on all the skills that team members can and would like to bring to their work. This process can also clarify whether recruitment – if realistic in current conditions – would enable team members to spend more time on work that makes the most of their skills and experience.

Coming from another angle, it’s a good idea to reflect whether any work is being done inefficiently, or whether people are undertaking tasks that actually contribute little value. Is time set aside to review this periodically?

Think about whether the work is controllable – do people have a say when work is done and how much work they’re able to do? Do team members have input into the definition of their roles and can flexibility be found in the way work is done, within reason?

Distributed leadership is a common theme underlying many of these ideas. This is where team members have a say in their practice’s values and decision-making.

To be successful, any changes brought in must be devised, implemented and measured by the whole team, using principles of quality improvement (QI) – a systematic and coordinated approach to solving problems using specific methods and tools to bring about measurable improvements. The aim is to make the change process itself empowering and, therefore, rewarding, as well as effective.

Scientific tools to build joy

Once you’re underway, any changes implemented need to be monitored. This ensures changes are worthwhile and helping the team progress towards greater joy. Checking the outcome of changes enables the team to see improvements clearly or to flex tactics if necessary, and stay committed to the framework.

It is powerful to draw on practice-derived data to show where certain areas might need addressing and then use a QI approach to do so.

Numerous ways exist to check and improve how your practice is doing in different areas – from audits and benchmarking to checklists and guidelines, and much more.

The key point is that the whole team is involved in testing changes on an ongoing basis, based on evidence of what’s working, and makes decisions together about which changes to adapt, adopt or spread more widely.

Start well to get results

If you’re keen to get going, remember to undertake part one of the framework as a team before plunging in to address specific issues (see aforementioned parts one and two).

Without this legwork, teams won’t necessarily have the trust, understanding, and commitment required to get full and lasting benefit from this approach. With these foundations in place, however, the gains can be greater than expected.

Mark Moreton, small animal GP vet and small animal veterinary director for CVS Group, said: “The more of these meetings you have in your practice, the more you’ll get out of them.

“The clinical teams feel that this work has been really worthwhile. They want to keep doing it, so they have a meeting once a week to talk about what problems annoy them and which ones they’re going to fix that week.

“A head RVN said: ‘This has given the team a sense of control and power; they are coming into work with a real sense of ownership’.

“Practice management told us this has been a real game changer, and feel like post-COVID, things for the team are starting to move in the right direction.”

Angela Rayner, RCVS Knowledge quality improvement advisor, summed up the strength of the approach: “The framework is energising – it’s about connecting with colleagues and solving problems, which together lead to happiness.”

Why not see where this practical approach to building joy can take you and your team?