As a relatively new player in the health field, the medical clown profession was established to help ease the suffering, pain, and anxiety of hospital patients [1, 2]. Medical clowns use humor in a very challenging health setting and must adjust and cope with a wide array of emotions and difficult situations [3]. To accomplish their goals, medical clowns are required to elicit smiles and laughter when interacting with patients, families, and medical staff [3, 1]. Whereas recent studies have focused on the therapeutic benefits associated with the use of medical clowns [2], very few studies have investigated the clowns’ personal characteristics and behavior [4, 5].
The current study aims to expand on previous work by focusing on adaptive humorous styles as specific dispositions in medical clowning. From a more traditional organizational perspective, the literature supports the potential benefits that employees can derive from humor and laughter. Specifically, a meta-analysis of the effects of adaptive humor styles showed that performance, job satisfaction, and employees' health outcomes were improved [6]. As only scant research has been reported regarding medical clowns, the present research focuses on the effects of medical clowns’ humor styles on turnover and their potential moderators and mediators. Finally, since there is reason to believe that these unique personal qualities may have a greater influence on turnover early in the medical clowning experience, the current study followed medical clowns from the beginning of their training until the end of their internship period.
Humor Styles
In the current study, we focused on the adaptive humorous style. Thus, we adopted a two-dimensional conceptualization: humor appreciation (i.e., the ability to understand and enjoy messages containing humor) and humor creation (i.e., the ability to perceive relationships between people, objects, or ideas incongruously, as well as the ability to communicate this perception to others) [7]. Indeed, studies have shown that humor appreciation and humor creation comprise distinctive factors [8].
Adaptive Humorous Dispositions and Turnover
Turnover is one of the critical outcome measures in organizations, as substantial financial costs are associated with recruiting and training new employees [9]. Medical staff turnover has been identified as a global concern having potentially negative implications for patient treatment effectiveness and health outcomes [10]. As the job of a medical clown is accompanied by work challenges and difficulties [5], it seems critical to examine turnover among medical clowns and whether their use of humor contributes to decreasing the negative effects of turnover. Research in medical contexts indicates that the intention to remain in a job is a function of the fit between personal characteristics and various work environments [11]. Finally, whereas there is some evidence to support the association between humor and lower turnover levels among nurses in Korea [12], little is known of the impact of humor styles on medical clowns early in their careers. Thus, we posit the following hypotheses:
H 1a. Higher humor appreciation is associated with lower turnover rates among medical clowns early in their careers.
H1b: higher humor creation and humor appreciation are associated with lower turnover rates among medical clowns early in their careers.
The Mediating Role of Job Satisfaction
Job satisfaction is one of the most prevalent explanations for employee turnover [9], as individuals who do not like their jobs tend to leave them, as indicated by the recently published meta-analysis on both general turnover and voluntary turnover [13]. As noted, medical clowns use humor as their primary tool for enhancing the positive affect of patients, their families, and the medical staff [2]. Humor appreciation has been found to facilitate positive affect, which, in turn, may enable better mechanisms for confronting challenges at the workplace. [14], whereas humor creation has been found to enhance workers’ general joy [6]. In addition, a previous meta-analysis indicated that job satisfaction mediates the association between personality dispositions and turnover behaviors [15]. Hence, we can suggest that adaptive humor would decrease medical clowning turnover under the mediation of increased job satisfaction.
H2a: Job satisfaction mediates the association between humor appreciation and turnover among medical clowns.
H2b: Job satisfaction mediates the association between humor creation and turnover among medical clowns.
The Moderating Role of Traumatic Stress
Research has indicated that the incidence of childhood trauma (e.g., abuse, alcoholic parents, death of a parent or sibling) is frequently observed among mental health professionals and psychological counselors along with their positive and negative consequences. It has been suggested that the development of a general feeling of self-efficacy and a sense of control over life’s adversities guide people to help others and thus aid in rectifying negative consequences from childhood [16].
In the current study, we will examine the effects of stressful events that may have preceded entry into the medical clowning volunteering experience to determine the extent to which their presence attenuates the association between humor and employee outcomes. The research literature supports a distinction between self-focused humor and humor focused on others, whereby the former would be relatively more effective as an aid in coping with traumatic events. Self-focused humor has been shown to be more effective under stressful experiences, as it can grant the individual an opportunity to reframe the negative stimulus [17]. Consistent with this argument, it was found that external stressors interacted with coping humor in decreasing burnout and PTSD symptoms among firefighters [17]. Moreover, the interaction between humor and stress in the Israeli army was found to significantly predict performance [18]. Hence, we argue here that previous trauma experiences interact with humor appreciation in predicting positive work outcomes. However, other-focused humor style, such as humor creation, may be more facilitative of an interpersonal and interactive environment and may be non-significant when a person is experiencing intrapersonal and prolonged stress [19]. As such, we posit the following hypothesis:
H3: The association between humor appreciation and turnover rates are stronger among medical clowns who have experienced traumatic life stressors compared to those who have not.