Joy and happiness

There is a lot of talk these days about creating ‘joy at work’.

Why this growing interest in the study of joy ? What is the difference between joy and happiness? What does it have to do with helping people work safely (patient safety)?

We all talk about happiness and mostly know it when we experience it, but we lack a coherent definition.  Searching the definition of joy the dictionary states ‘a feeling of great pleasure and happiness‘ but when searching for the definition of happiness the dictionary states ‘the state of being happy’.  In fact, the source of the word happiness is the Icelandic word ‘happ‘ which means luck or chance.  What I do know is that during my career I have been very lucky.  Training to be a nurse and the subsequent years working in the NHS has offered me multiple opportunities to experience fulfilment, joy and happiness.

To help us understand more the Institute for Healthcare Improvement (IHI) have created a Framework for improving joy in work (Perlo 2017).  The framework provides four steps for leaders:

  1. Ask staff what matters to them
  2. Identify unique impediments to joy in work in the local context
  3. Commit to a systems approach to making joy in work a shared responsibility at all levels of the organisation
  4. Use improvement science to test approaches to improving joy in work in your organisation

Our friends at Kaleidoscope held a day focusing on joy in the NHS earlier in the year (see earlier blog) and have just published their paper which builds on that event together with the associated excellent webinars.  These can be found at: .  The report is titled Beyond Burnout (Kaleidoscope 2018) and at the end it provides fives ways to bring joy right away:

  • Eat together – make dedicated time for colleagues even just five minutes to share a cup of tea or your lunch
  • Say thank you – create a culture of positivity at the workplace by normalising thank you and you will start to hear them back
  • Seek laughter – laughter brings joy, share jokes and allow yourself to have a laugh even during a tough day (it is ok to feel joy even when things are hard)
  • Learn new things – learn things about your work, your patients and each other, discovering something new is invigorating and joyful
  • Support flexibility – do your best not to micromanage your colleagues, let their creativity and joy flourish but be available for advice and direction if needed

Psychologists have found that happy people live secure in the knowledge that the activities that bring them enjoyment in the present will also lead to a fulfilling future, rather than enjoying something now that may make them unhappy later.  While we cant be happy all of the time, we can work on becoming happier.  For example, one of the exercises Emmons and McCullough suggest is to keep a ‘daily gratitude journal’, writing down at least five things for which you are grateful every day.  They suggest that doing this regularly can help you appreciate the positives in your life.

Joy comes from so many places; enjoying what you do, liking the team you work with, having pride in your job and your organisation, and your own health and wellbeing. Often joy comes from small moments in the day.  As with so many things at the heart of this are relationships.  Healthcare employees who experience joy in their work and other positive emotion such as contentment may well thrive and build better relationships.  These relationships can be enhanced by the way we talk to each other in a positive and respectful way, our own joy, even the way we smile and show kindness.

Things that get in the way of joy include bullying, racism, sexism, the blame culture and incivility.  There is a need to acknowledge the current problem with incivility, when people are short or rude, which is sadly common in healthcare.   Incivility impacts on people’s cognition, their happiness and quality of work (Riskin et al 2015, Porath et al 2013).  It takes its toll on productivity, morale and relationships. See –  To shift from incivility to a kinder culture everyone needs to counter the rudeness by role modelling the right behaviour, reward good behaviour and deal with bad behaviour (Porath et al 2013).

In order for a more positive approach to safety to flourish we have studied the psychology of positive emotions, drawing from Barbara Fredrickson’s Broaden and Build theory (Fredrickson 2013). The Broaden and Build theory of positive emotions suggests that positive emotions i.e. enjoyment, happiness and joy, all broaden one’s awareness and encourage new insights, thoughts and actions.

Over time, this broadened behavioural range builds personal skills and resources. This is in contrast to negative emotions, which prompt narrow, immediate survival ‘fight or flight’ behaviours (Fredrickson 2004). Frederickson stresses the importance of positive and authentic feedback to instil pride in the workforce, and the benefits to both the person giving and receiving of saying a simple thank you.

Positive emotions are therefore considered a key component in happiness and wellbeing and perhaps even prevent burnout.  It could also help to promote both a positive safety culture and improved patient safety which are both dependent upon good relationships and the ability for people to speak up, listen to each other and learn from each other.

In a positive safety culture workers are seen as the solution rather than the problem. If we change our approach in patient safety, to draw explicit attention to the positive rather than simply look for the negative or even at the absence of the negative, we may in turn help people feel happiness and joy and also develop new insights and ideas.

It is a joyful time that these emerging concepts and theories; positive emotions, positive deviance, appreciative inquiry, safety II, joy at work and learning from excellence are all starting to gain serious traction within the safety world.


Bushe, G R (2013) The appreciative inquiry model. In E.H. Kessler, (ed.) Encyclopedia of Management Theory, (Volume 1, pp. 41-44), Sage Publications, 2013

Cawsey, M.J, Ross, M, Ghafoor, A, Plunkett, A, Singh (2017) Implementation of Learning from Excellence initiative in a neonatal intensive care unit ADC Fetal & Neonatal

Emmons RA and McCullough ME (2004) The Psychology of Gratitude, Oxford University Press

Fredrickson, B (2013) Positive Emotions Broaden and Build. In Advances in Experimental Social Psychology, Vol 47 Elsevier

Hollnagel, E, Braithwaite, J, Wears, R L (2013) Resilient Health Care. Ashgate Publishing Limited

Kaleidoscope Healthcare (2018) Beyond Burnout found at:

Perlo, J, Balik B, Swensen S, Kabcenell A, Landsman J FD (2017) IHI Framework for Improving Joy in Work. Cambridge Massachusetts found at

Porath, C, Pearson, C (2013) The price of incivility. Harvard Business Review, Jan-Feb; 91 (1-2): 114-21, 146

Riskin, A, Erez A, Foulk, T A, Kugelman, A, Gover, A, Shoris, I, Riskin, K S, Bamberger, P A (2015) The impact of rudeness on medical team performance: a randomized trial. Pediatrics, Vol 136; issue 3