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What can individuals, organizations do to promote joy in pediatrics? :

February 11, 2020

I had the privilege of working in a hospital in Kampala, Uganda, during a sabbatical in 2002. It was a high-acuity setting, with many ill patients and limited resources. Often, two to three patients died each day.

Yet every day at 11 a.m., the staff stopped working and met for tea and biscuits for 15 minutes. I marveled at the laughter and joy shared during that brief time. I learned the importance of working hard to provide the best care possible as well as finding the joy in our work and with our colleagues. It is interesting that these seem to be foundational values shared across cultures.

I have numerous examples of finding joy from my work and moments for which I am grateful. Many involve relationships with patients, families and colleagues, and include: Performing a home visit for a newborn and attending her birthday party at the same home for the next 10 years. Examining a 6-year-old who had an oncologic diagnosis and was in terrible pain from a rectal abscess who saw a scar on my arm and asked, “Does it hurt?” A 23-year-old patient with Trisomy 21 whom I cared for since birth who ran up to me on the street and hugged me, despite his cognitive delay and not having seen me since his transition to an adult provider two years prior. The laughter created by trying to answer a riddle posted by a medical assistant on the clinic’s white board each day and seeing the right answer the following day.

As Daniel Sulmasy, M.D., Ph.D., states in “The Healer’s Calling,” “Joy is possible when we live in the present, we approach our work with gratitude and we acknowledge the privilege of serving others.”

The Dalai Lama and Desmond Tutu state in the “Book of Joy” that seeking and maintaining joy is a personal choice. And according to psychology professor Sonja Lyubomirsky, Ph.D., we must address the factors that have the greatest influence on increasing our happiness; reframe each situation more positively; experience gratitude in our lives and choose to be kind and generous. I find these suggestions empowering. The search for joy has been a lifelong journey for me, altering between occasions where I have encountered sadness and anxiety with days when I hit the mark and find joy.

While we can take individual approaches to enhance our personal joy, organizational approaches that perhaps are even more important to long-term fulfillment in our work ultimately are needed.

Stephen J. Swensen, M.D., M.M.M., and Tait Shanafelt, M.D., define joy in practice as “the aspirational state in which professionals are emotionally and behaviorally compassionately engaged in the care of patients and the mission of their organization” (Jt Comm J Qual Patient Saf. 2017;43:308-313). They have outlined organizational strategies that are important for joy in medicine. These include meeting patients’ and employees’ basic needs, including supporting their physical, mental and emotional health and safety without stigma; creating an environment where everyone feels safe; and creating a space where we can cultivate and appreciate the meaning in our work. Equally important are building a social community where we share in the joys and the suffering of our patients; promoting autonomy and functioning at the top of our respective fields; and removing sources of frustration and inefficiency.

The Institute for Healthcare Improvement Framework for Improving Joy in Work ( describes four steps that are particularly relevant to teams and organizations to consider:

  1. Ask staff “What matters to you?” and “When we are at our best, what does that look like?” These questions allow teams to identify similar values.
  2. “What is the pebble in your shoe?” This question identifies the frustrations and inefficiencies that make our work difficult.
  3. Commit to a systems approach to identify and resolve the problems of the pebbles and engage all staff in the process.
  4. Use a team-based model where front-line staff and leadership work together to identify what they want to change and use improvement science to do so.

How will you contribute to revitalizing work environments where all providers can thrive?

Dr. Serwint is a member of the AAP Wellness Advisory Group.

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