It’s About Time You Give Yourself 5:1 Positive Feedback!

“Once you replace negative thoughts with positive ones, you’ll start having positive results”-  Willie Nelson

Why should you start giving yourself a 5:1 ratio of positive to negative feedback?  Because it is proven it can make your relationships happier and also make your team safer!

This type of positive feedback is part of my own organization’s journey toward becoming a Highly Reliable Organization. (HRO)[i]  A Highly Reliable Organization as defined by Weick and Sutcliffe is “an organization that performs high risk work but without rare, catastrophic events.”  As I am in the healthcare field this journey toward being ultra-safe is especially important.

HROs are developed through education and through the practice of Universal Skills.  One such skill is “Being Accountable”.  Accountability in the workplace is all about setting expectations.[ii]  This means holding others as well as ourselves to common expectations based upon the mission and values of the company.

Being accountable for each other means recognizing positive, safe and productive behaviors, and more importantly letting someone know you noticed and appreciated that safe and productive behavior.  The purpose of the 5:1 ratio is to build a culture of coworkers and peers who encourage safe behaviors.  This is best accomplished through positive feedback and is shown to improve both personal and work relationships.

Obviously, a 5:1 ratio of positive to negative means there will still be some negative feedback.  It is still necessary on occasion to let someone know a certain behavior is not safe or acceptable.  However, this should be a minority of cases.  Making the attempt in your home environment and in your work environment to give significantly more positive praises than criticism improves relationships and productivity.

So where did this ratio come from?  It started with research by Dr. John Gottman and Dr. Robert Levenson[iii] concerning a study of couples and marriage success.  They simply asked the couples to spend 15 minutes solving a problem.  They found with 90% accuracy that those couples who gave each other at least a 5:1 ratio of positive comments over negative comments were still together years later.  This was the difference between happy couples and unhappy couples.  The gestures did not have to be grand.  Even simply things like a smile, a playful tease and laughing together all count in that positive category.

This data has been further supported in the business environment with similar results.  A study cited in the Harvard Business Review[iv], performed by behavioral scientists, looked at the effectiveness of 60 leadership teams.  They measured effectiveness by financial performance, customer satisfaction and feedback within the teams.  They also found the difference between the most successful teams and the least performing teams was again the number of positive comments compared to negative comments.  Their study also resulted in a nearly 5:1 ratio being most important.

So, the next question is why do we need so many positive comments to have a successful work or family environment?  It is because we naturally find negative interactions much more powerful and memorable than positive interactions and it takes 5 positive interactions to overcome the memory of the one negative interaction.  The reason we remember and are so impacted by negative interactions is we are hardwired to have a “Negativity Bias”.[v]  This is our tendency to not only pay more attention to negative stimuli and events, but also dwell upon these events.  From an evolutionary perspective, this is how our brains kept us safe.  Early on, those who paid more attention to bad and dangerous threats had a better chance of survival.

In our current stressful health care environment, having more positive interactions is particularly important.  How easy is it for us to remember our last “bad” case? It doesn’t have to be terrible, but all of us have had cases that were less than satisfactory or had a poor outcome for whatever reason. Those seem to be the easiest to remember and can seriously impact an entire team, but how easy is it for you to recall your last “great” case?

So, if giving positive comments is shown to help marriages and our own teams at work, how can we start helping ourselves to overcome this Negativity Bias?

First you must realize the importance of overcoming this naturally negative trait.  Negativity Bias can affect your relationships, can affect your mental health, and also makes it difficult to have a positive outlook on life.  Perseverating on the negative in Healthcare can also create Second Victims[vi] where providers can also become emotionally traumatized.

Consider the following tools to Overcome this Negativity Bias:

Stop Negative Talk: You can start by stopping the negative self-talk.  Instead of fixating on the mistake, try and tell yourself what you have learned and how you might use this information to improve action in the future.

Establish New Patterns: If you find yourself perseverating about the event or the interaction, try to find an uplifting activity to redirect your attention. Go for a walk, read a book, find something to take your mind off the event.

Savor Positive Moments: This is the biggest challenge. Since it is so easy to remember the negative, you need to challenge yourself to remember the positive. After I had a recent case that was less than satisfactory (the outcome was fine, but yes I felt I could have done a better job), I challenged myself to start keeping track of my successful cases and I challenge you to do the same. We all have everyday success with routine cases, but really start keeping track of your own “successes,” those cases with especially positive interactions, great saves, great examples where the patient felt your compassion, or great outcomes. You will suddenly realize how good you are at this job!

Dr. Dike Drummond has a great technique to remember positive moments, called “Treat yourself like a dog”.[vii]  In his video he illustrates how well we treat our dogs by praising them when they follow commands or do good things. So why not praise yourself and give yourself a“Pat on the Back” or your own version of a “High Five” when something goes well? I bet it improves your own outlook just as much as positive comments are shown to improve marriages and the work environment.

Our HRO Journey stresses the importance of positive feedback as part of accountability within the workplace.  I submit it is just as important to be accountable to yourself and give yourself the same positive feedback that you either give to others or expect from others.

Feel free to leave comments about how positive feedback is making a difference at home or at work.

-Mark Elliott, MD, MBA










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