What exactly is “joy in work,” and how can leaders elicit it? To create the optimal conditions it really helps if an improvement leader knows joy, can model it, shares the experience, and designs for joy. Four leaders of large-scale change in health care have identified seven design principles to help leaders become better facilitators of joy in work. One of the central ideas is that while joy is a lived experience at personal and interpersonal levels, and often seems spontaneous, it is possible to create the sustained conditions for joy in the workplace if approached as a system responsibility.