Health Beyond Measure is Man’s Greatest Treasure: On Promoting Joy in the Health Workplace
December 29, 2022
By: Karl Gerard R. Crisostomo, UPCM Class 2023
The World Health Organization, in the year 1948, famously defined the concept of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Such a statement implies that health deals not only with the biological aspect of well-being, but also that of the psychosocial. While steps have been undertaken to better understand the unseen facets of health, these are not as well-documented and presented as biological conditions are.
Invaluable to the healthcare scene are healthcare workers; they are human, too. Inasmuch as their pursuit is to provide holistic health to their patients, they are just as vulnerable to the loss of physical, mental and social well-being. Hence, further discussion and discourse must be initiated for us to determine ways to ensure better health for our healthcare workers. Beyond the physical needs, we must also ascertain their needs that are not seen, but rather felt. Conversation on this important issue was trailblazed by Prof. Nina T. Castillo-Carandang, MA, MSc, PhD through her talk, “Promoting Joy in the Health Workplace”.
Prof. Carandang started her forum with a poll asking the attendees if they considered themselves a “joyful” person, defining such as a fulfilled person who is constantly growing and evolving into the best version of themselves. A majority (68%) of the attendees answered in the affirmative, a small portion (11%) were unsure, and the rest (21%) answered in the negative. Prof. Carandang then proceeded to ask the participants to remember their response as she continued with her talk.
She noted that it had been 894 days since the start of the COVID-19 lockdown. Prof. Carandang made an active point to express her gratitude towards the frontline workers, both those in healthcare and those who constantly worked in economic and security sectors throughout the most difficult days of the pandemic. She also proceeded to offer her prayers to those who were sick and in need of blessing, as well as the souls who have passed on.
Prof. Carandang then highlighted the fact that the Philippines was in the middle of the longest lockdown in the world. Most countries had already relaxed their respective measures at the time, whereas our country was still in the middle of stringent measures imposed by the government. But despite this difference, there remain experiences that are universal to the COVID-19 pandemic. Two primary emotions were felt throughout the course of the lockdowns: Hunger — not only for food — but also for clear policies and assistance through these trying times. Confusion, during the many policy changes enacted as COVID numbers fluctuated in response to new rules. Many opportunities were lost, from spending time outdoors with our families, interacting in a face-to-face environment, to saying goodbye to our loved ones who had gone ahead. These feelings are further exacerbated by various factors, such as undiagnosed diseases prevalent in the country, delay in treatment that led to poorer prognosis — all results of the lack of an adequate and timely response to this pandemic.
She goes on to cite Nick Routley’s study titled “The Relationship Between Wealth & Happiness”, highlighting how the pursuit of happiness has long been a preoccupation of humankind. In our modern day, happiness is not only measured relative to our own life experiences, but also in relation to the people around us — not only in our immediate vicinity, but also cognizant of people around the world. Prof. Carandang then defines the way in which the World Happiness 2022 report, of which 146 countries participated, measures the concept of Happiness, focusing on three key indicators. The first is Life Assessments, which is measured through the use of the Cantril Ladder. This defines each country’s happiness as a function of six factors: per capita GDP, social assistance, healthy life expectancy at birth, freedom to make life decisions, generosity, as well as views of corruption. Next comes Positive Emotions, which were measured as the average of “yes” or “no” answers about emotions experienced in the previous day, these being laughter, enjoyment, as well as learning or doing something interesting. Lastly, Negative Emotions were measured similarly as the previous indicator, with the emotions highlighted being worry, sadness, and anger. With the results of the Happiness Report, it was reported that the Philippines ranked 60th among 146 countries, with an average life evaluation score of 5.904. Among Southeast Asians, the Philippines ranked 2nd among all Southeast Asian countries, trailing behind Singapore. A point highlighted by Prof. Carandang was how starkly different both of these countries achieved happiness: while Singaporeans mainly derive their happiness from their high GDP as a nation, Filipinos’ happiness is often rooted in high social support.
While the aforementioned factors were key in ranking happiness, Prof. Carandang highlighted another point by Routley: that the factors that contribute to happiness, at their core, are as varied, specific, and subjective as the people in the world that they surely influence. However, some factors span the test of time, resonating with respondents from different years regardless of current events. These factors are Family, Love, Purpose, and Wealth. While the first three are subjectively felt, the fourth can be objectively measured. Upon exploring this concept further, Prof. Carandang noted that the data, while measurable, did not tell the whole story, as some middle-low income countries like the Philippines were noted to have a relatively high happiness index score, whereas high income countries had a relatively low happiness score. Prof. Carandang left the audience to ponder on this, as these differences were left unsaid in the study.
Prof. Carandang then proceeded to posit the question: Why is JOY important in the health workplace? Joy surrounds one of the most important assets of healthcare, the PEOPLE, that are so vital in ensuring that adequate care is dispensed to those in need. Effective workforce policy, or the health service provides for the needs of its workers such as training, pay, and support, is of utmost relevance in designing an effective healthcare system. Upon asking the audience regarding the status of such an important factor in the Philippine healthcare system, she then highlighted how the workforce is often considered an afterthought, a footnote, as most healthcare systems focus on clinical, operational, as well as financial factors in designing and implementing their respective plans. Currently, the country prioritizes the utilization of both contractual and financial incentives as a means to encourage productivity, but is noted to lack staff engagement, a balance between the stress and morale of their healthcare workers. To combat this, it is crucial to work on the intrinsic personal and professional motivation of the staff to deliver effective and more sustainable change.
An infographic presented by Prof. Carandang from the Women In Global Health emphasizes the call for a better workplace. This showed the need to end violence and harassment in the health and care sectors. There must be assurance that health workers, most especially women, are protected from workplace violence through the implementation of policies. Workplace violence is associated with lower staff retention; deterioration of not only physical, but also mental health of staff; increased healthcare costs; and a reduction in the quality of care provided. Enhancing the discussion, she also highlighted how, in a post-COVID healthcare setting, 5 key pillars were instrumental in improving the healthcare setting as it was: these were improving population health, enhancing the care experience, focusing on the well being of the care team, advancing health equity, and reducing costs. Aside from this, Prof. Carandang also cited a study by McGaffigan et al. (2020) highlighting how workforce safety is key to patient safety. A workforce that is physically and psychologically safe, joyful, and thriving can better provide adequate care to its patients.
Prof. Carandang then cites Perlo et al. (2017) in defining joy in the workplace. Joy in this context is not merely the absence of burnout or individual wellness. Rather, as stated by Berwick (2017) in the report “The gifts of hope, confidence, and safety that health care should offer patients & families can only come from a workforce that feels HOPEFUL, CONFIDENT, & SAFE”, it is an essential resource for the enterprise of healing. The lack of this joy — burnout — is a threat towards achieving true happiness in the workplace. It is classified not as a medical condition, but as an occupational phenomenon brought about by chronic workplace stress that has not been successfully managed. Individuals experiencing burnout would often feel energy depletion and exhaustion, mental distance from one’s job and cynicism, as well as reduced professional efficacy.
Prof. Carandang then provided a response unique to the context of our country, pulling inspiration from her own work on the concept of Kagalingan. Good Social Relations, Material Sufficiency, and Food Security are essential to a Filipino’s sense of well-being. The Institute for Healthcare Improvement also shared various points that would assist in creating a joyful workplace. The well-being of healthcare workers is at the forefront of this pursuit. The approach includes constantly checking on the staff and asking how they are doing, then identifying impediments to joy in the workplace, committing to a systems approach to ensuring joy is a shared responsibility, and testing approaches to improving joy in the respective organizations. For more concrete steps towards developing adequate mental health and well-being, Prof. Carandang suggested allowing a day off, facilitating opportunities for gratitude, reclaiming agency through reframing negative experiences as positive ones, limiting time on-site, designating clear roles and leadership, and making peer support services available to staff.
Prof. Carandang then ended her discussion by bringing forth ideas from her own esteemed mother, Dr. Gelia Tagumpay Castillo. She shares a mindset that would help one to grow “Gracefully, not Grudgingly” as she put it, putting an emphasis towards having a purpose, reframing bad experiences, appreciating the counting blessings, sharing these, and overall, practicing a life that takes into consideration the needs and well being of others as well as oneself. While further steps are still needed for our healthcare workers to feel true joy, Prof. Carandang’s forum has provided us with a blueprint that gives us hope that Joy, as well as a deluge of other positive emotions, can be felt in the workplace, even in our most trying times.