Restoring joy in work

Gillian Kernaghan, MD


The headline in the Canadian Medical Association Journal, “Has suicide become an occupational hazard of practising medicine,”1 needs to be a call to action for all leaders in health care. When burnout rates are 50% for physicians and nurses, we need to ask serious questions about the system, not the individuals.


Since the introduction of continuous quality improvement into health care in the 1990s, we have been focused on looking for system factors that result in errors in care rather than looking to blame individuals. We appreciate that well-intentioned individuals do not come to work to harm patients. We have focused on making it easier to do the right thing, with process redesign, standardization, controls, and alerts that reduce the risk of harm.


Similarly, as we approach the rates of burnout and suicide in health care providers, we are challenged in the CMAJ article to look at system solutions rather than seeing individuals as weak or non-resilient.


In 2013, the Mental Health Commission of Canada published the National Standard of Canada for Psychological Health and Safety in the Workplace,2 the first of its kind in the world. It is a set of voluntary guidelines, tools, and resources intended to guide organizations in promoting mental health and preventing psychological harm at work. The standard is designed for all types of work environments and includes principles and implementation supports.


The For Health, By Health Collaborative is a group of health care leaders who, together, are committed to the application of this standard in health care organizations. The collaborative is providing leadership to develop implementation tools and processes that are sensitive to health care. Organizations will have components in place; however, the standard provides a framework with which to assess opportunities for improvement in a specific organization. Application of the standard takes a system approach that will benefit all who work in health care: staff, physicians, leaders, students, researches, and volunteers.


At St. Joseph’s Health Care London, the use of the standard was identified as a strategic priority in the 2016 strategic plan. A steering committee of leaders and front-line staff was established to facilitate this initiative. A gap analysis was undertaken to look at what was in place and to set priorities for the work ahead.


In 2017, the Institute for Healthcare Improvement published a white paper: IHI Framework for Improving Joy in Work.3 According to the authors, “Joy in work is more than just the absence of burnout or an issue of individual wellness; it is a system property. It is generated (or not) by the system and occurs (or not) organization-wide. Joy in work — or lack thereof — not only impacts individual staff engagement and satisfaction, but also patient experience, quality of care, patient safety, and organizational performance.”


These words speak to the importance of why, as leaders, we need to make this a system priority. If our ultimate goal is to provide exceptional patient experience and outcomes, this cannot be achieved in an environment where there is low staff and physician engagement.


The IHI Joy in Work framework, as with the Canadian standard, takes a systems approach, recognizing the responsibility of all in creating a work environment where people are valued and can contribute in meaningful ways.


The Mayo Clinic, when faced with physician burnout rates similar to the national average of close to 50%, took a systems approach to this challenge. Their framework4 speaks to the importance of individual, work unit, system, and national factors.


The alarming rate of suicide among physicians and medical trainees needs to be a burning platform for leaders in health care organizations and medical schools to take a systems approach, individually and collaboratively, to creating learning and work environments that promote psychological wellness and joy in work. Top




1.Vogel L. Has suicide become an occupational hazard of practising medicine? CMAJ 2018;190(24):E752-3. Available:

2.The national standard of Canada for psychological health and safety in the workplace. Ottawa: Mental Health Commission of Canada; 2013. Available:

3.Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI framework for improving joy in work. White paper. Cambridge, Mass.: Institute for Healthcare Improvement; 2017.

4.Shanfelt T, Noseworthy J. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Pro 2017:92(1):129-46. doi: 10.1016/j.mayocp.2016.10.004



Gillian Kernaghan, MD, is president and CEO of St. Joseph’s Health Care in London, Ontario. She has been an active and vocal leader in health care and a champion of system leadership for many years.


Correspondence to:


This article has been peer reviewed.