First, a familial confession. I recall at sitting at my parents home in the waning hippy era of mid-1970s when a close friend of my elder siblings who had strong back-to-the-land inclinations faced a grilling about her life plans at our pressurized family table. Education? Employment? Contributions to community? The friend must have known she was thumbing her nose at her interrogators when she shared her counter-cultural goal: “I just want to be happy.”
I am not sure what I thought then about this radical response. I knew what it wasn’t. She’d made no reference to lawyering, doctoring, artistic, engineering or any professional, trade or commercial production. Neither did these seem to be in the picture. Her response was a conversation stopper. It was most definitely not an okay goal.
Jump forward 40+ years. It’s April 2018. The US culture has sped up and removed even further from natural rhythms. The scene is a National Academy of Medicine (NAM) workshop involving some 60 leaders of 18 different health and medicine professions – from the Association of American Medical Colleges to the Academic Collaborative for Integrative Health (ACIH). “Happiness” was directly in their sights. The participating CEOs, executive directors and board members hunkered down into small groups to experience the use of tee “Happinometer.” This applied survey device was developed in Thailand for measuring and advancing the experience in a nation, business or agency of that feeling that my family friend announced she was personally prioritizing. Use of the device is an implementation strategy for upping Gross National Happiness.
For the participants in the NAM Global Forum on Innovation in Health Professional Education workshop, the exercise explored whether the Happinometer might be used systemically in creating well-being and resilience. I was a participant in the planning team through past involvement with ACIH.
The draft report of the workshop was recently released by NAM as “Design Thinking, Systems Approach to Well-Being Within Education and Practice.” The second section of the report, “Creating a Culture of Well-being,” documents a presentation on the instrument by two professionals from Thailand’s Mahidol University, Sirinan Kittisuksathit and Charamporn Holumyong and the interactive session that followed.
Kittisuksathit, an associate professor at the university’s Institute for Population and Social Research, described how the Happinometer earned its appellation as an “evidence-based” tool. For its development, an international, multidisciplinary committee of experts in quality of life, well-being, happiness, and mental health was convened. These “drew on a breadth of theoretical constructs and research.” Among these, for instance, were Maslow’s hierarchy of needs. The group set 9 separate “dimensions of happy”: Body; Relax; Heart; Soul; Family; Society; Brain; Money; and Work-life.
Note that the economic dimensions that define the reductive goals of a nation’s Gross National Product have a role here. But they are embedded in a whole system of additional outcomes.
The questionnaire was tested for validity and reliability on all 9 dimensions. The questions for “Happy Relax” are shown below. The Happinometer results become “a thermometer for measuring happiness.” After an entity’s happiness is measured, “unhappy dimensions can be identified, and activities can be developed and implemented to reduce unhappiness.”
We participants sat at our separate tables in rounds, strategizing methods that might be implemented to leverage more happiness in the one of the 9 areas to which we were assigned. The inclusion of this unusual Thai presentation and interactivity at the NAM workshop was invited by an early, paradigmatic choice of the workshop’s planning committee. The committee, co-led by integrative health leader Mary Jo Kreitzer, RN, PhD, FAAN, chose to shift the framing from an initial focus on stress, suicide and burnout. We set our sights instead on how to systemically advance “well-being and resilience.” Happiness might take root in such a terrain.
In the NAM proceedings, this shift is captured via comments of Kreitzer. Instead of asking why people are stressed and burned out, why not focus on “what brings them joy.” Might happiness be an outcome toward which individuals, schools, businesses and government agencies routinely organize their activities? Kreitzer argued that such a path will lead to decisions that are ultimately more positive, fruitful and sustainable.
This pursuit of happiness at the highest levels of organized medicine didn’t arise out of nowhere. In the past half-decade, a context for considering happiness as an outcome, has quietly dawned. The Quadruple Aim foci on patient and practitioner experience were steps, if tepid, in the right direction. Another opening comes through conventional medical leaders learning to separate the firmaments between “disease management” from “health creation” – the very re-frame we’d engaged in the workshop’s focus. Harvard Medical School’s recent move to shift its mission from “relieving suffering” to fostering “health and wellness for everyone” hoes the same garden. Happiness is the basically the bullseye in the Institute for Healthcare Improvement’s “Joy in Work” initiative.
I found sitting with this group and applying ourselves to strategies for expanding the field of happiness to be, in itself, happy-making. One felt exposed, innocent, amidst a suspension of disbelief. Might a happier hue to the medical industry’s singed and overworked minions be possible? For a moment, the exercise induced the possibility that a sustained, direct focus on happiness with a work-plan to accomplish it might change our universes.
Still, it was hard to not ridicule the instrument and its related pursuits, even as our family friend was greeted with silence when she announced her goal 40 years ago. Certainly this Happinometer, this Southeast Asian cultural import could not have been born here, in the USA – not in a land nominally organized by the guarantee of everyone’s right to a pursuit of happiness?
Philosophers, strategic planners, and futurists all agree that if an individual, an organization, or a nation doesn’t envision a future, and diligently seek it, that such a preferred future will be less likely to arrive. We must confess that our goals are not for happiness if we do not fix our sights explicitly and routinely on a desire to live lives that are full of it. The quaint Happinometer can be an asset in such a transition.