There may seem to be a chasm between healthcare work and the commonly understood meaning of “joy,” but the Institute of Healthcare Improvement (IHI) is dedicated to bringing the ambitious goal of “joy in work” into reality.

The idea stems from preventing burnout, which is reaching epidemic proportions in healthcare, said Jessica Perlo, director of IHI.

“Burnout is characterized by emotional exhaustion, depersonalization, cynicism, and a low sense of personal accomplishment,” she said in December at IHI’s 2019 National Forum on Quality Improvement in Health Care in Orlando. “Anywhere from 54% to 60% — depending on the study — of U.S. physicians are experiencing symptoms of burnout. Usually 40% to 50% of nurses. Around 30% of ancillary staff. This is not any one discipline.”

The bias in work assessments is to look at gaps and negatives, but healthcare “is one of the few professions that regularly provides the opportunity for its workforce to profoundly improve lives,” the IHI stated in a white paper on the issue.1 “Caring and healing should be naturally joyful activities. The compassion and dedication of healthcare staff are key assets that, if nurtured and not impeded, can lead to joy as well as to effective and empathetic care.”

The IHI framework is designed to reduce staff burnout while improving patient care and overall organizational performance. “Making a workplace joyful is the job of leaders,” the IHI report noted. “Nevertheless, everyone from senior executive leaders to clinical and administrative staff has a role to play. From creating effective systems to building teams to bolstering one’s own resilience and supporting a positive culture, each person contributes.”

Although the approach becomes more detailed and complicated in the report, the initial steps are straightforward.

“We found that working with thousands of organizations around the globe that these steps were what people were asking for,” Perlo said. “They wanted simple steps they could take to a complicated problem. They are not overly complicated, but they are really challenging to do.”

The four steps, with Perlo’s comments, are as follows:

• Ask staff what matters to them.

“How often have you stopped and asked someone whom you may have worked alongside for years what makes for a good day for them? Why did they get into this?” she said. “Or, reflect yourself on your values and communicate them to peers.”

• Identify unique impediments to joy in work in the local context.

“What are the pebbles in your shoes? What is getting in the way of more good days?” Perlo said. “Often, what we find with this step is that these things fall into innate human needs that aren’t being met, things like meaning, choice, camaraderie, and equity.”

• Commit to making joy in work a shared responsibility at all levels.

“We need to think differently about leadership with this [step] because that’s what it takes,” she said. “We need to think differently about power, and about inviting different voices to co-create solutions. The people with the problem can become authors of the solutions.”

• Use improvement science to test approaches to improving joy in your organization.

“We are not revamping the system all at once,” Perlo said. “We are using improvement science. We use some tests of change together. We are going to fail, and learn what works in one setting before we apply it to another. We are going to celebrate what works, and learn together.”


  1. Perlo J, Balik B, Swensen S, et al. IHI framework for improving joy in work. Cambridge, MA: Institute for Healthcare Improvement; 2017. Available at: