What matters to you? And why that matters when caring for patients…

If a colleague asked you “what matters to you?”, what would you say? Would you have a quick answer ready on your lips, or would it stop you in your tracks?

It’s a simple question, but answers relating to our professional lives may be complex, unexpected and unique. That’s because this deceptively simple question goes to the heart of what drives us as individuals.

When we ask all members of a team what matters to them, we gain a comprehensive understanding of what lies beneath our combined commitment to the best possible care – and there has never been a better time to know what motivates our colleagues to come into work and give their utmost, day in, day out, in the face of the enormous present challenges.

This knowledge puts the root causes of well-being centre stage, helps us pull together as a team and has been shown to pave the way towards us experiencing joy in our work – that is, a deep sense of pride, satisfaction and, at times, even a buzz, when we know we are doing all we can and trying new approaches to deliver excellent care.

Joy may seem like a lofty goal, but it is a fitting aspiration given the kind of work we do – and the focus on well-being, solidarity and hope in striving for joy is hugely important to those seeking to nurture joy in others in the toughest of circumstances.

First step

The answers to “what matters to you?” can be so insightful that this question forms the first step in a framework for improving joy in work developed by the Institute for Healthcare Improvement (IHI). The IHI is a US-based not‑for‑profit organisation that aims to improve the lives of patients and the health of communities around the world, based on improvement science.

Experiencing joy in work may sound like the cherry on the cake – or, at worst, a pipe dream – but the IHI points to a business case for joy, including measures such as engagement, satisfaction, burnout and turnover rates, as well as patient experience. Success stories from human health and other industries show the IHI framework can have a tangible and powerful effect on engagement, productivity, motivation and contentment.

Asking colleagues “what matters to you?” creates an opportunity to listen properly, in order to understand their values and what gives them a sense of purpose in their work. It’s only by understanding what truly matters to our team that we can identify barriers that limit how much we enjoy our work – and then devise meaningful changes together to removing these barriers. It can be hard to find the time to do this, especially in the extremely challenging times we live in, but it’s an effective way to place your colleagues at the centre of thinking about workplace values and how to restore joy, as opposed to one-size-fits-all approaches to increasing resilience that are sometimes presented to teams.

It’s also a structured way to take stock and consider the kind of organisation we want to work for, particularly when we are giving our all each and every day, and skills are in such demand across the professions.

Healthy and successful

Furthermore, asking your colleagues what matters to them shows them your respect for them as individuals and that they have a vital part to play in growing your practice’s joy and success. Coming from a manager, it demonstrates an equitable culture that takes well-being seriously, and a commitment to improving the workplace in a way that is meaningful for each unique team.

In designing its approach to improving joy in work, the IHI drew from experts in improvement science and sociology. W Edwards Deming, the founding father of improvement science, said people are entitled to joy in their work, and that we – led by management – need to look to the culture, the system and the environment that foster that sense of joy or pride.

Aaron Antonovsky, an Israeli American sociologist, postulated that health is not just the absence of disease, but rather the process that allows individuals to maintain their enjoyment of a life that’s comprehensible, manageable and meaningful, and to function in the face of changes in themselves and their environment. Similarly to the relationship between health and disease, joy is more than just an absence of burnout.

So, if we set aside precious time to have these conversations, how do we get the best out of them? You could have one-to-one dialogues, brief huddles, dedicated informal meetings or incorporate the conversations into regular practice meetings. Regardless, preparation is paramount.

If you have team members who are skilled at facilitating conversations, you might want to approach them about leading this activity, with time allocated for preparation and write-up. In this case, it’s important the team understands that this person doesn’t hold sole responsibility for the activity – it is a shared effort. Securing the support of a senior champion can be valuable in reassuring colleagues that their participation will be worthwhile, and in driving through major changes further down the line that may be identified through the process.

It is likely most practice team members won’t have previously been asked to open up so personally or to participate in developing improvement strategies. The conversation leader therefore needs to be clear about what you are trying to achieve: that to work towards maximising everyone’s enjoyment of their work, we need to understand one another’s motivations and what’s important to us as individuals.

Effective process

Another key point is that the more colleagues who take part, the more effective the process is likely to be, as team members will come up with ideas together to overcome barriers. It is also vital for the team to appreciate that the overall journey to increasing joy at work will therefore be more meaningful and likely to succeed, but will take time.

When it comes to the conversations, some simple, but searching questions can be a good place to start. Different phrases will elicit different responses from colleagues, so the IHI conversation guide suggests several options to ask similar questions. Conversation leaders are encouraged to find and use language that resonates with them and their colleagues.

“What matters to you?” often helps open the conversations on “bright spots” – points of strength or aspects of the practice that work well for the team and shine through, even in these demanding times.

Starting with this kind of constructive question is helpful to remind people of all the good things about their work. Conversation leaders can get things going by sharing what matters to them, but it’s essential to ensure this activity is carried out with colleagues, not to or for them.

Don’t be thrown if the question is at first met by silence. It might be hard for people to draw back from current pressures and focus on something that might, at first, seem abstract or theoretical. It’s critical to take time for responses to emerge, then to listen actively and clarify responses, rather than second‑guessing people’s views or speaking for them.

Do invite others to comment – it’s likely team members will have different comfort levels with sharing personal feelings and different views.

The initial question can lead on to “why did you decide to work in this profession?” or “what makes you proud to work here?” You could also ask colleagues to share “I know I make a difference when…”, “when we are at our best, it looks/feels like…” or “what makes a good day is…”. The answers may be different or dialled down from those you would have heard before coronavirus and Brexit. However, when common themes are mentioned, pointing these out can help underscore team spirit and the sense that “we are all in this together”.

Capture feedback

It’s highly likely these conversations will start to touch on barriers to a good day, or aspects of work that hinder people from performing at their best – and that’s okay. At this initial stage, it’s just important to capture all feedback – positive and negative – and to place it somewhere visible to all team members, such as a whiteboard on a wall in a central location. This reinforces the value attributed to the activity and serves as a reminder of the practice’s commitment to the process.

Done well, asking “what matters to you?” strengthens relationships and builds a firm foundation for step two of the framework: identifying “the pebbles in your shoe”, the impediments to joy in your particular workplace, and starting to co-design strategies for overcoming them.