A Quality Improvement Project: Adapting the Joy-in-Work framework in a Neonatal Fellowship Program To Improve Burnout

Abstract Background Health systems are strained by workforce shortages, administrative burdens, rising patient acuity, and economic instability. Fellows/residents have higher burnout rates as they navigate a system, they cannot control which erodes psychological safety, retention and impairs learning. Fellowship/residency program directors are accountable for maintaining fellows/residents’ well-being and education while lacking the influence to improve clinical demands, posing a threat to accreditation. The Joy-in-Work Framework, developed by the Institute for Healthcare Improvement, is a quality improvement approach that shifts the paradigm by targeting system-level changes and engaging fellows/residents as “change makers” leading to improved psychological safety, well-being and agency. Joy-in-Work has been implemented successfully in clinical units but no evidence for implementation within a residency/fellowship training program. Our objective is to adapt the Joy-in-Work Framework into a fellowship training program, and report on its implementation and impact on physicians’ well-being. Methods In this quality improvement study, we implemented the 4 steps of Joy-in-Work Framework in a neonatal fellowship training program in an NICU. Fellows engaged in “what matters” conversations through surveys and focus groups, identified impediments to Joy-in-Work, co-created ideas to address impediments, and prioritized implementation of two interventions. We assessed well-being indicators through a questionnaire administered at baseline and post-implementation, process and contextual measures. Results Survey response rates were 18/23 (78%) and 8/16 (50%). There was significant improvement in sense of control over workload from 28% (95% CI = 10%-53%) to 88% (95% CI = 47%-100%), burnout (emotional exhaustion) from 78% (95% CI = 52%-94%) to 50% (95% CI = 16%-84%) and notable increase in psychological safety, from 39% (95% CI = 17%-64%) to 75% (95% CI = 35%-97%). Conclusion Joy-in-work implementation is feasible and engaging. Making small changes within the scope of a program director at a low cost that focus on what matters to fellows, could have a significant impact on their autonomy, burnout, and psychological safety. Joy-in-Work Framework could be an effective path for improving well-being and safety within post-graduate training programs while maintaining operational excellence. Future research is required to evaluate generalizability, effectiveness and sustainability.