Expressing Gratitude in Healthcare- Makes everyone better!

Gratitude–  “a recognition of the gifts that others give us, a recognition of the source of those gifts, and an appreciation of those gifts.”- Robert Emmons[i]

Every month one of our group leaders posts a very informative newsletter, and at the end is a list of positive patient comments.  After reading the list this past month I realized I felt bad (and perhaps a little jealous) that none of the positive comments were my patients.   Yes, I have had plenty of positive comments in the past, however those don’t seem to count for the present.  Am I not as pleasant to patients as I used to be?  Am I too rushed?  Am I not listening well enough?  Perhaps they just don’t know my name so maybe I should give them a name card to perhaps increase my chances of getting a positive comment!

Yes, I found myself with all these thoughts and it simply brought home the need for gratitude.  Gratitude interestingly is a 2 way street.  The benefits of gratitude are not just realized when received by patients, but the benefits are also present when we express our own form of gratitude both to patients and our peers.

A research study out of UC Berkeley[ii] took 3 groups of college students who were already seeking some counseling and split them into 3 groups.  One group was assigned to write one letter of gratitude weekly to another individual for 3 weeks,  another group was asked to write about their deepest feelings, and the 3rd group had no writing assignment.  At the end of 4 weeks with everyone receiving the same counseling, the gratitude group showed significantly improved mental health scores than the other 2 groups.  This positive influence of the gratitude letters continued to show an improved mental health also at 12 weeks, even though the assignment was only for 3 weeks.  Further positive effects included the natural use of more positive words in the gratitude letter writing group, continued benefit even if the letters were never sent, and even positive MRI changes at 12 weeks when compared to the other groups.

Bottom line, expressing gratitude has a positive lasting effect on your own mental health!

Now you are right- this does not solve my angst of waiting for positive patient comments, but perhaps I can keep focusing on expressing gratitude and not worry about my own patient comments.

Further studies point out that I can improve my health by writing nice notes!  Another study conducted in 5 public hospitals examined the effects of expressing gratitude in Healthcare workers and found similar positive results as the college students mentioned.[iii]  This study examined 3 groups of physicians- where one group was  simply asked to write a gratitude diary 2 times a week for 4 weeks.  Yes- the same results!   Those who wrote about work related gratitude events showed less depression and less stress scores at both 4 weeks and at 3 months.

A Pepperdine Business Review article points out when an employee believes his or her superiors are grateful for his or her work, the employee will benefit by having an improved sense of worth to the organization. This improved sense of worth can lead to performance improvement, thereby benefiting the organization.[iv]   The act of showing gratitude works in a 3 step fashion:

First- a person recognizes and experiences a sense of appreciation toward someone who performed a generous or kind act.

Second- as a result of this sense of appreciation, further appreciation is expressed toward the person performing the kind act.

Finally the person who received the recognition senses the goodwill and reacts positively to the person expressing the gratitude.  In other words it is a full circle- gratitude is first acknowledged,  expressed and then results in a positive response.

Showing gratitude should not be limited only to others.  You should also consider giving gratitude to yourself.  Dike Drummond points out the importance of giving yourself gratitude in this YouTube Video where he explains the concept of  “Treat Yourself like a Dog”.[v]   The concept is to try to encourage yourself and your peers the way you naturally encourage a puppy who did a cute trick.  When you finish a task take a deep breath, feel the moment and give yourself an “at a boy”.  You don’t have to wait for patients or coworkers to recognize your achievements, you can do it yourself!  This opens another entire area of behavior called Appreciative Inquiry[vi], which is the act of recognizing the best in people or the world around us; affirming past and present strengths, successes, and potentials.

So, expressing and receiving gratitude in all arenas seems to be a way to improve our health as well as become a defense against burnout.  One Forbes Article[vii] suggests keeping patient notes in a file as an individual way of preventing burnout.  This works great from a patient perspective- but anyone can set up similar burnout prevention within your own clinic or hospital setting.  Ideas include setting up a program of recognizing great saves,  starting meetings with gratitude to recognize staff, and even recognize “unsung heros” by pointing out folks who simply perform small heroic acts on a daily basis.

I challenge you to think about how expressing gratitude both at your work and at your home can improve your own health and resiliency. 

Feel free to offer comments about how gratitude can be expressed.

-Mark Elliott, MD, MBA









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