Restoring Joy in Work and Preventing Burnout: An IHI Framework for Joy

29th Annual National Forum on Quality Improvement in Health Care Workshop A/B Restoring Joy in Work and Preventing Burnout: An IHI Framework for Joy Stephen J. Swensen, M.D. and Jessica Perlo, M.P.H. December 12, 2017 The presenters have nothing to disclose

Objectives 2 Share IHI s experience making Joy in Work a strategic priority Identify the key changes in the system for joy in work and to assure staff experience meaning, choice, camaraderie, and equity Describe key leadership behaviors that raise staff engagement and restore joy

Deming and Joy Management s overall aim should be to create a system in which everybody may take joy in his work. Dr. W. Edwards Deming

Welcome to IHI

The Burning Platform 60% respondents of MD survey are considering leaving practice 70% knew at least one MD who left practice due to poor morale 37% of newly licensed RNs are thinking of leaving their job 13% vacancy rate for RNs Few CEOs have taken up the challenge to transform their organizations Health care work force injuries are 30x greater than other industries Lucian Leape Institute. 2013. Through the eyes of the workforce: creating joy, meaning and safer health care. Boston, MA: National Patient Safety Foundation.

Joy is more than absence of burnout

Joy as a Strategic Priority Innovation Cycle 1: Research Engagement, Burnout, Satisfaction, Joy, Wellness

Joy as a Strategic Priority Innovation Cycle 2: Expert Interviews How do you think about joy in your organization? Where does joy fit with mission, strategy or priorities? Do you measure joy? How and how often? Have you seen improvement or cost resulting in your joy in work improvement efforts?

Joy as a Strategic Priority 9 Innovation Cycle 3: Prototyping Outpatient Kaiser Permanente Erwin Street Medical Offices Charleston Area Medical Center Glen Cove Hospital, Northwell Health Organizations and Trusts Institute for Healthcare Improvement imatter NHS Scotland Imperial College Healthcare Trust NHS Highland Inpatient Mount Auburn Hospital Labor and Delivery Floor Nemours/Alfred l. DuPont Hospital for Children Pediatric Intensive Care University of Michigan Cardiac ICU Academic University of Virginia School of Nursing Penn State Altoona School of Nursing

How do you improve Joy in Work? 10

Swensen, Pugh, McMullan, Kabcenell. High-Impact Leadership. Institute for Healthcare Improvement; 2013.

Swensen Pugh McMullan Kabcenell High-Impact Leadership. Institute for Healthcare Improvement 2013.

Real Time Measurement Wellness Resilience Daily Improvement Camaraderie Teamwork Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Camaraderie & Teamwork Happy Healthy Productive People Participative Management Participative Management Physical & Psychological Safety Meaning & Purpose Recognition & Rewards Autonomy & Control Physical Psychological Safety Meaning Purpose Autonomy Control Recognition Rewards

Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press Shanafelt, et al. Changes in Burnout and Work-Life Balance in Physicians. Mayo Clinic Proceedings: 90 2016 (12) MFMER 1600-13 slide-14

exhausted detached callous cynical unsure Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press Shanafelt, et al. Changes in Burnout and Work-Life Balance in Physicians. Mayo Clinic Proceedings: 90 2013 (12) MFMER 1600-13 3239472-15

substance abuse medical errors car accidents depression divorce Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press Shanafelt, Noseworthy. Executive Leadership Physician Well-being. Mayo 2013 ClinMFMER Proc. 3239472-16 2016

Gonzales-Morales, et al. Perceived collective burnout. Anxiety Stress Coping 2012;25:43 Bakker et al. Burnout Contagion. J Advanc Nurs. 2005; 51:276

Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Education Counseling. 88(3).

You cannot give. 2013 MFMER 3239472-19

Wound Healing Trust Anxiety Pain LOS Readmissions ( Burnout) Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Ed Counseling. 88(3). Cosley, J Experimental Social Psychology 46.5 (2010) 816-823. Hibbard, Greene, Overton. Health Affairs, Feb 2013: 32(2): 216. Barsade, et al.companionate Love. Admin Science Quarterly. 5.29.2014

Experience Outcomes Empathy Errors Tests Procedures Professionalism Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Ed Counseling. 88(3). Cosley, J Experimental Social Psychology 46.5 (2010) 816-823. Hibbard, Greene, Overton. Health Affairs, Feb 2013: 32(2): 216. Barsade, et al.companionate Love. Admin Science Quarterly. 5.29.2014 Bodenheimer, Sinsky. From the Triple to Quadruple Aim. Annals of Family Medicine, 2015 Shanafelt Noseworthy. Executive Leadership Physician Well-being.Mayo Clin Proc. 2016 2013 MFMER 3239472-22 Cimiotti, et al. Nurse staffing, burnout and infections. Am Journal of Infection Control. 2012;40

McHugh. Widespread job dissatisfaction, burnout, frustration. Health Aff. 2011 Feb;30(2):202-10. Compassion fatigue, Moral distress. Psychological safety, Hostile work environment, Practice inefficiency, Production, Erosion of meaning, Clerical work

10,000 per day x 19 years http://www.pewresearch.org/fact-tank/2010/12/29/baby-boomers-retire/

Swensen. Esprit de Corps and Quality: Making the Business Case for Eradicating Burnout. J Healthcare Mgmt. In Press. 2018

BUSINESS CASE pp. 3-7 Roughly 75 percent of penalty kicks at the elite level are successful. The goal is a mere 12 yards away; it is 8 yards across and 8 feet high. 80 miles per hour. If the keeper guesses wrong, your odds rise to about 90 percent. keepers jump left 57 percent of the time and right 41 percent which means they stay in the center only 2 times out of 100. A kick toward the center, as risky as it may appear, is seven percentage points more likely to succeed than a kick to the corner. While a penalty kick aimed at the center of the goal is significantly more likely to succeed, only 17 percent of kicks are aimed there. If you follow this selfish incentive protecting your own reputation by not doing something potentially foolish you are more likely to kick toward a corner. If you follow the communal incentive trying to win the game for your nation even though you risk looking personally foolish you will kick toward the center. IMAGINE YOU ARE A SOCCER PLAYER: The statistics in this section were drawn from: PierreAndré Chiappori, Steven D. Levitt, Timothy Groseclose, Testing Mixed-Strategy Equilibria When Players Are Heterogeneous: The Case of Penalty Kicks in Soccer, The American Economic Review 92, no. 4 (September 2002) Chiappori, et al. Testing Mixed-Strategy Equilibria The Case of Penalty Kicks in Soccer. The American Economic Review 92, no. 4 (9/2002)

Organization Citizenship Behavior Collaboration Productivity Accidents Turnover Stress Profit Harter. Relationship between employee satisfaction, employee engagement and business outcomes: a meta-analysis. J Appl Psychol 2002; 87:268-279 http://hbswk.hbs.edu/item/national-health-costs-could-decrease-if-managers-reduce-work-stress Swensen, Shanafelt.

2017 National Health Care Retention Report. NSI Nursing Solutions, Inc 2017 (14.6% - $7.86M)

The world is run by those who show up Eighty percent of success is showing up. Woody Allen Gallup: State of the Global Workplace Report 2013 (34/51/16)

Swensen, Shanafelt. Organizational Framework Joy in Practice. The Joint Commission Journal on Quality and Patient Safety 2017

http://www.gallup.com/poll/1720/work-work-place.aspx Shanafelt et al. Arch Intern Med. 2009: 25;169(10):990-5. (+/- 20% ½ BO) 2013 MFMER 3239472-35

IHI Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Happy Healthy Productive People Physical & Psychological Safety Meaning & Purpose Autonomy & Control Meaning & Purpose Camaraderie & Teamwork Recognition & Rewards Participative Management

True source of joy in work is a connection to purpose.

Grant. Impact and the Art of Motivation Maintenance: The Effects of Contact with Beneficiaries on Persistence Behavior, Organizational Behavior and Human Decision Processes. 05/2007; 103(1):53-67 (scholarships - $503.22, up from $185.94) 2011 MFMER 3085330-38

How we spend our days is

Hibbard, Greene, Overton. Health Affairs, Feb 2013: 32(2): 216-222 Roter, et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998 Aug;36(8):1138-61.

Isen. Influence of Positive Affect on Decision Making. J CONSUMER PSYCHOLOGY, 2001,11(2)75 85 (2x speed, 20% accuracy)

25 years? Ann Rhoades. Built on Values: Creating an Enviable Culture that Outperforms Chief People Officer of most profitable organization for 25 years ending 2002

Gittell, et al. (2008). Impact of Relational Coordination on Job Satisfaction and Quality Outcomes.Human Resource Management Journal, 18(2). Gittell, Medical Care Volume 28, Number 8: 807-819. Gittell, Impact of relational coordination on quality of care. Medical Care, 2000;38(8):807-19.

Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20:534-37 Overtreatment Failures of care delivery Administrative complexity Failures of care coordination

Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20:534-37 Overtreatment Productivity Compensation Worklife Imbalance Values Dissonance Social Isolation

Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20:534-37 Failures of Care Compassion Fatigue Meaning & Purpose Moral distress Workload

Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20:534-37 Administrative Complexity Inefficient workflow Values Dissonance Loss of Control Workload

The purpose of quality improvement

James, Poulsen. Harvard Business Review Jul/Aug 2016(94) Swensen, Bolton, Dilling. Business Case for Quality Improvement. J Patient Saf, 2013. 9(1)44 $42m >$900m $688m

Casadevall, Fang. 2016. Rigorous science: a how-to guide. mbio 7(6):e01902-16. doi:10.1128/mbio.01902-16.

Perlo, Balik, Swensen, Kabcenell, Landsman, Feeley. IHI Framework for Improving Joy in Work. IHI White Paper. Institute for Healthcare Improvement; 2017

2.9013 Losada, (2004). The Role of Positivity and Connectivity in the Performance of Business Teams. American Behavioral Scientist, 47(6), 740-765. 2016 MFMER slide-56

IHI Joy in Work Framework Real Time Measurement Wellness & Resilience Daily Improvement Real Time Measurement Happy Healthy Productive People Physical & Psychological Safety Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Daily Improvement Participative Management

Linzer. Cluster Interventions to Improve Work Conditions + Burnout. J Gen Intern Med. 2015;30(8):1105 Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61:2 105-127 March/April 2016 2011 MFMER 3085330-59

Swensen, Dilling, Harper, Noseworthy. The Mayo Clinic Value Creation System. 2011 AJMQ Spheres of Influence Little or no control Influence Control

John McCracken, Naveen Jindal School of Management, 2011 UT-Dallas MFMER 3085330-61

Dr. Laurel Fedor Region Medical Director for Continuous Improvement 2011 MFMER 3085330-62

Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61:2 105-127 March/April 2016

Swensen, Dilling, Harper, Noseworthy. The Mayo Clinic Value Creation System. 2011 AJMQ

Swensen, Johnson. Mapping Value Into Radiology. JACR 2005;2:992

Swensen, Dilling, Harper, Noseworthy. Mayo Clinic Value Creation System. 2011 AJMQ Purpose not to work harder

7 minutes

Swensen. Reliably Better, Faster, and Cheaper Soufflés. JACR. August 2006 Standardize when it creates value for patients and time for professionals.

217 Units (~11,000 staff) Morale +17% Burnout -21% Teamwork +12% Swensen, Kabcenell, Shanafelt. J Healthcare Management. 61:2 105-127 April 2016

IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management Participative Management

Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

Nick Seybert Harvard Business Review June 29, 2013 Physician Leadership and Emotional Intelligence. J Grad Med Educ Mintz, Stoller

Five Leadership Behaviors (P<0.001) (P<0.001) Shanafelt Swensen. Mayo Clinic Proceedings. April 2015: 90(4); 432-440

Appreciation Shanafelt, Menaker, Buskirk, Gorringe, Swensen. 12 Leadership Dimensions. Mayo Clinic Proceedings. April 2015: 90(4); 432-440

Sood, Amit,, and Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013. Enhance wellbeing Increase optimism Improve mood Boost energy

Ideas Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

Listen to understand.

Transparency www.greatplacestowork Root of the tree is trust. Michael C. Bush

Shanafelt et al. Arch Intern Med. 2009: 25;169(10):990-5. (+/- 20% ½ BO)

The study by Cecilia Rouse, an associate professor in Princeton's Woodrow Wilson School of Public and International Affairs and the economics department, and Claudia Goldin, a professor of economics at Harvard University, seems to confirm the existence of sex-biased hiring by major symphony orchestras and illustrates the value of blind auditions, which have been adopted by most American symphonies. Their report was published in the September-November issue of the American Economic Review. "This country's top symphony orchestras have long been alleged to discriminate against women, and others, in hiring," Rouse said. "Our research suggests both that there has been differential treatment of women and that blind auditions go a long way toward resolving the problem." Florence Nelson, director of symphonic services at the American Federation of Musicians, described the research as a "very important statement, especially to those of us who have done auditions both ways -- behind a screen and without the screen." She has played flute and piccolo in major orchestras. Traditionally, new members of the great symphony orchestras were handpicked by the music director and principal player of each section. Most contenders were the male students of a select group of teachers. To overcome bias, most major U.S. orchestras began to broaden and democratize their hiring procedures in the 1970s and 1980s, advertising openings, allowing orchestra members to participate in hiring decisions and implementing blind auditions in which musicians audition behind a screen that conceals their identities but does not alter sound. Of the "Big Five" symphonies -- the Boston Symphony Orchestra, the Chicago Symphony Orchestra, the Cleveland Symphony Orchestra, the New York Philharmonic and the Philadelphia Orchestra -- only Cleveland still does not hold blind auditions. Use of the blind auditions varies among the other orchestras, with some holding them only in preliminary rounds. In their study, Rouse and Goldin examined lists of personnel from 11 major orchestras, including the Big Five, and actual accounts of the hiring process maintained by personnel managers in eight major orchestras. Among musicians who auditioned in both blind and non-blind auditions, about 28.6 percent of female musicians and 20.2 percent of male musicians advanced from the preliminary to the final round in blind auditions. When preliminary auditions were not blind, only 19.3 percent of the women advanced, along with 22.5 percent of the men. Using data from the audition records, the researchers found that blind auditions increased the probability that a woman would advance from preliminary rounds by 50 percent. The likelihood of a woman's ultimate selection is increased several fold, although the competition is extremely difficult and the chance of success still low. Inclusion As a result, blind auditions have had a significant impact on the face of symphony orchestras. About 10 percent of orchestra members were female around 1970, compared to about 35 percent in the mid-1990s. Rouse and Goldin attribute about 30 percent of this gain to the advent of blind auditions. "Screens have been a very important part of the whole audition process," Nelson said. "My sense is that blind auditions have made a tremendous difference in the amount of hiring discrimination women face." Chua. Costs of Ambient Cultural Disharmony. Academy of Management. 2013, 56(6)545. Nelson recalled how sensitive she was to the gender issue while auditioning. She remembers being told in the 1980s to remove her shoes while walking to center stage behind a screen, so the judges would not hear the "clickety-clack" of a woman's high heels. Rouse. Blind Auditions. September-November. American Economic 2013 MFMER Review. slide-83

subjected to differential treatment that often is demeaning and pointedly directed to their status as women David Wahlberg. November 6, 2017 http://host.madison.com/wsj/news

Coaching Mentor Culture Elephant and baby Engagement = Leading Indicator What is the best way to succeed at Mayo? 12 Dimensions Career Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development 2013 MFMER Vol. slide-85 35 (4) 2016

the best way to succeed

2013 MFMER 3239472-87

http://www.gallup.com/businessjournal/493/item-supervisor-cares-about.aspx

Signature Size Shanafelt, Menaker, Buskirk, Gorringe, Swensen. Leadership Dimensions. Mayo Clinic Proceedings. 4/2015 90(4) Shanafelt, Swensen. Using the Annual Review to Reduce Burnout and Promote Engagement. American J Medical Quality 2017

IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Autonomy & Control Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management

Intrinsic Motivation and Employee Attitudes: Public Personnel Admin Dec 2012 382-406

Paul Zak. Center for Neuroeconomics Studies Trust Factor the science of creating high-performance companies 20% pay cut

Journal of Applied Social Psychology 34 (2004).; Lancet Vol 337 (1991). J Pers Soc Psychol 1976;34(2):191-198. Baard, Deci, Ryan. Journal of Applied Psychology. 2004, 34, 10, pp. 2045-2068.

Pink, D. H. (2009). Drive: The surprising truth about what motivates us. New York, NY: Riverhead Books. (revenue 2016 centers) MFMER slide-94

Seifter. The Conductor-less Orchestra. Leader to Leader, No. 21 2016 Summer MFMER slide-95

Shanafelt, Sinsky, Dyrbye, West. Mayo Clin Proc. 2016;91(11):1667-8. (When Where BO)

Brookings Institute. Barrington L, Silvert H: CEO Challenge 2004. New York: The Conference Board, August 2004.

Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

Sinsky, et al. Ann Intern Med. 9/6 2016 Hill RG. Am J Emerg Med. 2013 Nov;31(11):1591 Shanafelt, et al. Mayo Clin Proc. 2016;91(11):1667-1668.

Clerical Work Hill RG. Am J Emerg Med. 2013 Nov;31(11):1591-4

Sinsky, et al. Ann Intern Med. 9/6 2016 Hill RG. Am J Emerg Med. 2013 Nov;31(11):1591 -Necessary? Efficiency. Right person. --- (Nights: Clicks, 2011 Workflow, MFMER Multi-Task) 3085330-101

Organization Design Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61:2 105-127 March/April 2016 Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Participative Management Recognition & Rewards Recognition & Rewards

Swensen. Esprit de Corps & Quality -Caring for each other for our patients the case for eradicating burnout. Journal of Healthcare Management. In Press. January 2018 (revenue centers)

Hess. Circ Cardiovasc Qual Outcomes. 2012;5:251-259

Swensen, Duncan, et al. Safe and Appropriate Imaging of Children J Patient Safety 10 (3) 2014

Daniel Kahneman, Angus Deaton. High income improves evaluation of life but not emotional well-being. Proceedings of the National Academy of Sciences. 2010 (107) 38:16489 16493

1. Camaraderie 2. Intrinsic desire 3. Recognition 4. Impact 5. Growth 6. Helping patients 7. Money Drzymalski, Gladstone, Troyani, Niu. TINYpulse Engagement Organizational Culture Report https://www.tinypulse.com/2014-employee-engagement-organizational-culture-report

Mellstrom, (2008) Crowding out in blood donation. Journal of the European Economic Association, 6(4):845. Pink. (2009). Drive: The surprising truth about what motivates us. New York, NY: Riverhead Books.

Grant. Psychological Science Hand hygiene prevents you/patients from catching diseases 22(12) 1494 99 2011

Kniffin. Workplace Commensality and Performance of Firefighters. Human Performance, 28:281 306, 2015 West, Dyrbye, Rabatin Shanafelt. Physician Well-being. JAMA Intern Med. 2014;174(4):527-533.

Bartolini et al. Decline in Social Connections. Social Indicators Research. Feb 2013, 110(3) 1033 1059

Holt-Lunstad (2010) Social Relationships and Mortality. https://doi.org/10.1371/journal.pmed.1000316

West, Dyrbye, Satele, Shanafelt. J Gen Intern Med. 2015;30:S89. Colleagues Meeting to Promote And Sustain Satisfaction

Meyer-Lindenbergh. December 7, 2005 Journal of Neuroscience

Hariri, Weinberger. NIMH. July 19, 2002 Science

Camaraderie Money

Companionate Love Empathy Satisfaction Engagement Commitment Productivity Exhaustion Burnout Barsade, O Neill. What s Love Got to Do with It? A Longitudinal Study of the Culture of Companionate Love. Administrative Science Quarterly. May 29, 2014

IHI Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Happy Healthy Productive People Physical & Psychological Safety Meaning & Purpose Autonomy & Control Physical & Psychological Safety Camaraderie & Teamwork Recognition & Rewards Participative Management

Swensen, Dilling, Harper, Noseworthy. The Mayo Clinic Value Creation System. 2011 AJMQ

Swensen, Dilling, Harper, Noseworthy. Mayo Clinic Value Creation System. 2011 AJMQ

Emily Jenny

Fair Faulty design or lack of system? Fix System and Human Error (lapse, slip, mistake) Console Learn Just Culture Accountability not determined by outcome Risky (choice increases risk where risk is unrecognized or mistakenly believed to be justified) Reckless (choice to consciously disregard a substantial and unjustifiable risk) Coach Learn Corrective Action Leonard, Frankel. Patient Education and Counseling. 80 (2010) 288-292 Reason J. Human error: models and management. BMJ. 2000 Mar 18; 320:768-770. Marx D. (2001) Patient Safety and the Just Culture : A Primer for Health Care Executives. Columbia University, New York, NY.

Scott, et al. Caring for Our Own: Deploying a Systemwide Second Victim Rapid Response Team. May 2010 Volume 36 Number 5. 233-240 Shanafelt. Ann Surg 2010 Jun;251(6):995-1000. Burnout and medical errors among American surgeons. Kimberly Hiatt

Am J Psychiatry. 2004 Dec;161(12):2295-302 2013 MFMER 3239472-129

IHI Joy in Work Framework Wellness & Resilience Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management

Hobfoll. Stress. Am Psychol. 1989;44:513. Maslach. Applied Psychol. 2008. Workload & Environment.

social, physical, mental Hobfoll. Conservation of Resources - Stress. Am Psychol. 1989;44:513 2016 MFMER slide-132

Romundstad. Sense of Humor and Causes of Mortality: The Nord-Trøndelag Health Study. Psychosomatic

Sánchez-Villegas. Mediterranean dietary pattern and depression: the PREDIMED randomized

Epstein, Krasner, Physician resilience: what it means, why it matters, and how to promote it. Acad Med, 2013. 88(3): p. 301-03. Sood. Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013.

Blomkvist: Occup Environ Med 2005;62e1; Psychosomatic Med 67: 2005Ulrich: Science 224: 1984

Fidler MacCarty Swensen, et al. Feasibility of Using a Walking Workstation During CT Image Interpretation. JACR. 2008;5(11):1130-1136 Laskowski, Walking Keeps Depression (and a Host of Other Health Problems) Away. Mayo Clin Proc. August 2016; 91(8): 981-983

Shanafelt, Sinsky, Dyrbye, West. Mayo Clin Proc. 2016;91(11):1667-8. ( hours BO)

Sood, Amit,, and Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013.

Oberg, Frank. Physicians health practices strongly influence patient health practices. Journal of the Royal College of Physicians of Edinburgh. 2009;39(4):290-291.

2.9013 Losada, (2004). The Role of Positivity and Connectivity in the Performance of Business Teams. American Behavioral Scientist, 47(6), 740-765. 2016 MFMER slide-144

pp. 3-7 Roughly 75 percent of penalty kicks at the elite level are successful. The goal is a mere 12 yards away; it is 8 yards across and 8 feet high. 80 miles per hour. If the keeper guesses wrong, your odds rise to about 90 percent. keepers jump left 57 percent of the time and right 41 percent which means they stay in the center only 2 times out of 100. A kick toward the center, as risky as it may appear, is seven percentage points more likely to succeed than a kick to the corner. While a penalty kick aimed at the center of the goal is significantly more likely to succeed, only 17 percent of kicks are aimed there. If you follow this selfish incentive protecting your own reputation by not doing something potentially foolish you are more likely to kick toward a corner. If you follow the communal incentive trying to win the game for your nation even though you risk looking personally foolish you will kick toward the center. IMAGINE YOU ARE A SOCCER PLAYER: The statistics in this section were drawn from: PierreAndré Chiappori, Steven D. Levitt, Timothy Groseclose, Testing Mixed-Strategy Equilibria When Players Are Heterogeneous: The Case of Penalty Kicks in Soccer, The American Economic Review 92, no. 4 (September 2002) Chiappori, et al. Testing Mixed-Strategy Equilibria The Case of Penalty Kicks in Soccer. The American Economic Review 92, no. 4 (9/2002)

Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20:534-37

2011 MFMER 3085330-147

Swensen Pugh McMullan Kabcenell High-Impact Leadership. Institute for Healthcare Improvement 2013.

What s Next?

What s Next What will you do by next Tuesday? Can you commit to: Starting one conversation around what matters to your colleagues / staff? Testing one change to remove impediments to joy, contribute to institutional learning by spring 2018? Reassessing opportunities for interventions at the system level Our commitment to disseminate learning: IHI Joy in Work Whitepaper free download on www.ihi.org IHI Joy in Work virtual learning system

Upcoming Program Begins March 1, 2018 12 week virtual training with video content, group calls, and options for added coaching Learn more and enroll: www.ihi.org/joyinwork

Thank You! Please let us know if you have any questions or feedback following today s session. Stephen Swensen Stephen.Swensen@imail.org Jessica Perlo jperlo@ihi.org

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