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IHI TOOL

Copyright © 2020 Institute for Healthcare Improvement. All rights reserved. Individuals may photocopy these materials for educational, not-for-profit uses, provided that the

contents are not altered in any way and that proper attribution is given to IHI as the source of the content. These materials may not be reproduced for commercial, for-profit use

in any form or by any means, or republished under any circumstances, without the written permission of the Institute for Healthcare Improvement.

Conversation and Action Guide

to Support Staff Well-Being and

Joy in Work

During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 2

Authors:

 Barbara Balik, EdD, MS, RN: Leadership Faculty, Institute for Healthcare Improvement;

Aefina Partners

 Kate Hilton, JD, MTS: Leadership Faculty, Institute for Healthcare Improvement;

Atlantic Fellows for Health Equity, George Washington University

 Kris White, MBA, RN: Aefina Partners

IHI TOOL: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 3

Purpose and Use of This Guide

During the coronavirus pandemic, health care organizations worldwide face unprecedented, high-

paced change. Health care leaders are working to support staff who are experiencing anxiety,

stress, and intense demands, especially with shortages of personal protective equipment (PPE),

concerns about personal and family risks from caregiving, delivering care that does not feel patient

centered, or loss of jobs. Leaders strive to address sources of staff anxiety and support well-being

and joy in work for the benefit of both staff and patient care.

The guide is intended to supplement and build on the IHI Framework for Improving Joy in Work1

and prompted by the April 2020 article, Understanding and Addressing Sources of Anxiety

among Health Care Professionals During the COVID-19 Pandemic.2 The guide includes actionable

ideas that leaders can quickly test during the coronavirus response, and which can build the

longer-term foundation to sustain joy in work for the health care workforce.

This resource is intended to help leaders guide conversations with colleagues to:

 Provide and elicit needed information and problem-solving to ensure staff well-being and the

best care possible

 Use this time during the COVID-19 pandemic to break unnecessary rules and build more

robust systems

 Tap into creative solutions identified by staff for both immediate needs and in an ongoing way

 Promote joy in work through healthy relationships and environments that support teams and

personal growth while diminishing, as much as possible, current and future stress

In using this guide, leaders are encouraged to use any opportunity to frequently communicate with

team members — using brief in-person huddles, electronic methods, or other approaches — to

promote staff well-being.1 Leaders are also encouraged to measure the impact of these

interventions on staff well-being and joy in work.3

Principles

The guide is designed to support health care leaders to:

 Work in partnership with all staff to contribute to the essential evidence-based needs for joy

in work (even in stressed times) that are required for healthy work environments:1

○ Physical and psychological safety

○ Meaning and purpose

○ Autonomy and control

 Address COVID-19 pandemic-related working conditions:4

○ Time pressure

○ Chaos and control

○ Culture, including trust in the organization, with an emphasis on communication and

information, cohesiveness, and values alignment with leadership

 Support staff with pandemic-related sources of anxiety1

IHI TOOL: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 4

Actionable Ideas to Test

This guide helps leaders get started quickly with conducting effective conversations, learning as

they go, and resolving issues that arise from such conversations. The tables that follow include

actionable ideas that leaders can quickly test during the COVID-19 pandemic and should support

sustained actions in alignment with a joy in work strategy after this pandemic subsides.

Physical and Psychological Safety

Hear Me: Listen and act on lived experience to understand and address concerns to the extent
organizations and leaders are able

Do Don’t Steps to Try Sustain Joy in Work

Conduct frequent, brief
well-being huddles (at the
beginning and end of work
shifts) to learn about
current pressing issues

Listen, do not interrupt

Learn what is going well,
not just problems

Acknowledge the complex
emotions of delivering care
in the face of uncertainty

Assume you know since
concerns may vary by
individual

Ignore the strengths and
bright spots

Underestimate the
learning required (and
time it takes) to care for
patients with COVID-19
in addition to other
patients

 Ask: “What concerns do you have for
patients, yourself, or the team?”

 Ensure you understand by confirming:
“Here’s what I hear you saying — do I
have that right?”

 Ask: “What do we still need to learn?”

 Ask: “What can we do together that
would help right now?”

Continue well-being huddles to
learn about current pressing
issues for staff and focus on
what matters most to care
teams

Try different small tests to
identify the huddle time,
agenda, and facilitation
structure that works for each
group

Recognize that frustration
and anger are part of the
upheaval, not a personal
attack

Promise to fix an issue
when you may not be
able

Make decisions that
affect staff without their
contribution

 Ask: “Are there steps we can take
right now, as a team?”

 Ask: “How can we do this together?”

 Ask: “What can we stop doing? What
makes no sense to continue?”

Empathize with staff when
they encounter change and
invite them to co-design it

Partner with staff in decisions
that affect them

Recognize that individuals
respond differently to
stress, and fear may be
expressed as concerns
(e.g., with regard to PPE:
“…not enough, wrong sort,
too flimsy…”)

Judge or deny  Acknowledge and support: “No one
has ever gone through what we’re
dealing with now. Together as a team
we will take steps that make sense for
us and we’ll learn from others.”

 Listen to the concerns and the
emotion — “It sounds like you are
very worried right now” — then
address the facts

Create a peer support and
coaching network

Promote psychological
safety

Be threatened by staff
speaking up

 Affirm: “Never worry alone — if you
have a question, so do others.”

 Ask: “What are you most worried
about right now?”

Develop conversation skills
that create a psychologically
safe space for team members
to share what matters and
what’s getting in the way of
more good days

Invite staff to share positive
stories with one another

Assume people have a
way to process their
unique experiences

Ask: “What good thing happened
today?”

Conduct both one-on-one and
team conversations about
“What Matters to You”

IHI TOOL: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 5

Physical and Psychological Safety

Protect Me: Reduce the risk of acquiring COVID-19 and/or being a transmitter to family

Do Don’t Steps to Try Sustain Joy in Work

Be fact-based Make things up just to
have an answer

Reassure and inform:

 “We have X days’ supply of PPEs on
hand.”

 “Here’s what we’ve learned from other
health systems (or states). Which of
these ideas do you think we could test?”

 “Testing is available for staff — here’s
how you get it.”

 “Steps to protect your family before you
go home are…”

Establish and support a
physically safe work
environment

Conduct hazard
assessments

Create simple, trusted
workplace injury and
violence reporting systems

Focus on what we can
control

Use quality improvement
methods and conduct
small tests of change

Assume everything is
chaos

 Ask: “What decisions can we make
together about how we manage the
volume of patients we expect (or have)
using the PPE available?”

 Ask: “What can we test this morning?”

Engage staff and
patients/families in co-
designing safe systems

Offer realistic hope Provide false
assurances: “We’ll be
through this in 2 weeks”

Inform: “We have PPE shipments arriving
tomorrow. Local companies are making
PPE shields for us that will be ready in X
days.”

Share all data transparently

Physical and Psychological Safety

Care for Me: Provide holistic support for team members and their families, if isolation is required (or other
sources of distress occur)

Do Don’t Steps to Try Sustain Joy in Work

Identify what support looks like
for staff and their families

Mobilize efforts to obtain
support: use volunteers, social
workers, community members

Ignore the personal and
family toll on staff

 Ask: “What would support look like
for you today?”

 Address the basics: Food,
medicine, safe housing, PPE, child
care

Assess effective support
systems for all

Recognize that mental illness
may increase during times of
intense stress

Ignore that staff may have
mental health needs

Offer assistance: “Our mental health
is vital for all of us and our patients.
Let me or your provider know if you
need help.”

Provide accommodations for
mental health needs

Create a peer support and
coaching network

Find ways for staff to support
colleagues who are (or have
family members who are) sick
or have died from COVID-19

Assume that stress will
not affect everyone’s well-
being

Provide support:

 “Here are resources to support one
another.”

 “Let’s take a minute to think of
Louis’ family.”

Build on learnings about
effective support in times of
great stress

Ensure staff know about
resources if they are
furloughed

Assume that staff know
how to navigate HR or
government agencies on
their own

Inform: “HR partners will provide the
information you need and make sure
you get all your questions answered.”

Develop more robust HR
systems based on learnings

IHI TOOL: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 6

Autonomy and Control

Prepare Me: Provide training and support for high-quality care in different settings

Do Don’t Steps to Try Sustain Joy in Work

Be honest Assume you know what
each person needs to be
competent in new roles
or work

Acknowledge:

 “I know this is scary to change roles
this quickly.”

 “We have training plans and want to
hear how it’s going for you every day.”

Provide training based on
lessons learned and in
relationship-centered
communication skills

Be clear

Provide information that
staff do not need or will
not use

Ask: “Here are the steps we have
planned to help you give quality ICU
care. What else do you think you’ll need
today?”

Share what you know and
what you don’t know

Share good and news

Encourage rapid tests of
change and learning

Blame when failure
happens

Ask: “These are the three tests we have
going right now — any ideas on them?”

Highlight learning gained to
decrease fear of failure

Communicate via real-
time methods: instant
messaging, huddles,
video conference

Ensure that staff can
easily communicate to
leadership

Rely on email

Assume people have all
the information they need
if they are not asking
questions

 Inform: “We have huddles two times
each day; regular COVID-19 updates
are available online.”

 Ask: “What questions do you have?”

Harvest lessons learned about
effective communication to a
range of staff

Develop “safety nets” for
staff

Expect people in new
roles to function quickly
with limited support

Offer assistance:

 “This shift Diana is your support
person. You can ask her anything.”

 “Team members are here to help one
another. Never worry alone.”

Harvest lessons learned about
effective staffing, new
workflows, and successful
tests; see change package for
specific examples

IHI TOOL: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 7

Meaning and Purpose

Support Me: Acknowledge demands and human limitations in times of great patient needs

Do Don’t Steps to Try Sustain Joy in Work

Be positive and present in
as many ways as possible
(including virtually)

Avoid staff  Ask: “How are you?” — then listen

 Ask: “What do you need right now?”

 Ask: “What is a source of joy for you
right now?”

Ask team members “What
matters to you?” to connect
their sense of meaning and
purpose to the team and the
organization

Use consistent value
statements to connect
staff to core needs: 1)
purpose and meaning, 2)
control, and 3) physical
and psychological safety

Be silent

Assume staff know what
you’re thinking

Give confusing
messages

Provide assurance and support:

 “As a team, we will figure out how to
best care for this patient.”

 “This is when we are at our best —
working together for patients.”

 “Never worry alone.”

 “This is all new ground, so no one has
the all the answers. We’ll figure this out
together.”

Model the way: Leaders
develop narratives about the
meaning of their own work and
share widely

Focus on who is being served
by the daily work, and link that
work to the organization’s
mission

Endorse self-care

Provide emotional and
psychological support

Ignore self-care

Assume stress reduction
is an individual
responsibility alone

Provide gentle reminders:

 “We work together to keep each other
safe.”

 “Food, fluid, bathroom breaks.”

 “Silence is our enemy — if you have
questions or ideas, please speak up.”

 “Take 5 minutes for a well-being
break.”

 “Take 10 deep breaths and picture a
calm place.”

 “The employee assistance program
(EAP) services are available to all
staff. EAP can identify online apps to
reduce stress.”

Build on lessons learned about
self-care among teams

Express gratitude

Link appreciation to
meaning and purpose

Promote and praise
teamwork at every
opportunity

Link daily work to the
values of senior leaders
and the organization

Assume leaders do not
also express their thanks
to staff just because the
public is already
thanking them

Be silent about essential
requests and concerns
with senior leaders

Say “thank you” and be specific:

 “The support you provided to Ms.
Jones to communicate with her family
showed the best of who we are as a
care team.”

 “This is what we are called to do, and
the community is seeing that by
thanking us.”

 “What we’ve done the past X hours is
exactly how great teams work! Thank
you!”

 “The senior team is very receptive to
hearing the concerns you have.”

Express gratitude

Link appreciation to meaning
and purpose

Link appreciation to shared
identities

Promote and praise teamwork,
testing, failing, and learning
and at every opportunity

Ensure support systems
are in place to ease
burdens (e.g., prompt IT
response to EHR needs)

Expect usual problem-
solving by overburdened
or anxious staff

Inform: “Our IT partner is available to
address issues that come up. The best
way to contact them is…”

Harvest lessons learned about
support systems that do and
do not work

IHI TOOL: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic

Institute for Healthcare Improvement • ihi.org 8

References

1 Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving

Joy in Work. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2017.

http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx

2 Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health

care professionals during the COVID-19 pandemic. JAMA. 2020 Apr 7. [Epub ahead of print]

3 See the “Measuring Joy in Work” section and Appendix C in the IHI Framework for Improving

Joy in Work white paper.

4 Linzer M, Poplau S, Grossman E, et al. A cluster randomized trial of interventions to improve

work conditions and clinician burnout in primary care: Results from the Healthy Work Place

(HWP) study. Journal of General Internal Medicine. 2015 Aug;30(8):1105-1111.

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