The two words you need to say more in your hospital

Two of the most powerful words you can say to a person are those we learned as toddlers: Thank you.

At a basic level, showing appreciation for others is expected. However, when gratitude is internalized — when it becomes a central element of who you are — it has extremely positive effects on individuals' personal and professional lives as well as workplace culture.

Appreciation is an especially relevant virtue in healthcare. Of all human attributes, gratitude has the strongest link to mental health. The effects of an authentic sense of appreciation include increased happiness and optimism, improved physical health and heightened productivity. Gratitude in the workplace may perhaps be one of the greatest predictors of corporate health, for the bottom line tends to benefit when employees feel valued and respected.

Yet true thankfulness is an endangered virtue in contemporary society, in which we are generally preoccupied with our wants and what we lack. Oftentimes, we base the value of people on their output.

"Unfortunately, I think way too many leaders don't understand how critical it is to create an engaged workforce to achieve incredibly difficult goals," says Nancy Schlichting CEO of Detroit-based Henry Ford Health System. "The best companies use gratitude to encourage everyone to give their best work."

Ms. Schlichting says it's the CEO's responsibility to create an environment where everyone can reach their full potential, and a culture of appreciation is essential to this.

"Gratitude is vital," she says. "Many leaders don't pay attention to the good things; they only focus on the bad. People need to be recognized both individually and collectively for the work they are doing."

The value of "thank you" in the workplace

The positive effects of gratitude are immense, and many traverse from an individual's personal life to his or her work ethic and performance at work, whether in the C-suite or on the hospital frontlines.

Numerous studies have linked gratitude to increased motivation and energy, better sleep, improved health and reduced stress and sadness, according to psychologist Neel Burton, MD, author of Heaven and Hell: The Psychology of the Emotions.

"Grateful people are much more engaged with their environment, leading to greater personal growth and self-acceptance, and stronger feelings of purpose, meaning and specialness," says Dr. Burton. "For the company, this can translate into a more creative and productive workforce."

According to Dr. Burton, showing appreciation for one another bonds people in a mutually supportive and sustaining network of social relationships. "It is the foundation of the type of society in which people can look after one another without coercion, incentives or interference, which, unlike gratitude, demean rather than exalt us," he says.

The type of society Dr. Burton describes is precisely the kind healthcare organizations should try to emulate in their culture — one in which collaboration, helpfulness and appreciation are the norm.

This is not to say that gratitude and healthy competition are fundamentally incompatible elements of workplace culture, according to Randy Kamen, EdD, a psychologist, educator and author of Behind the Therapy Door: Simple Strategies to Transform Your Life. However, the goal behind any kind of competition should be to inspire employees to give their personal best.

"It's not about stepping on someone's head to get to the top," says Dr. Kamen. "That's where your sense of self erodes. If you're hurting someone to get to the next level, there is no way you can feel better about yourself."

Employee morale touches every aspect of a company, from talent retention and recruiting to workplace stress, wellbeing, productivity and absenteeism, and showing employees how they are valued and appreciated is intimately bound to morale, according to Dr. Kamen, who also presents on positive psychology to senior executives of Fortune 500 and Fortune 100 companies.

"The biggest thing is feeling valued, seen and appreciated," she says. "We all have this deep need to feel valued and recognized for what we do and how we spend our days."

How to cultivate gratitude

In contemporary American culture, there is a greater propensity for negativity than positivity, which makes cultivating gratitude challenging. However, everyone can develop a true sense of thankfulness if they are willing to put in the effort, according to Dr. Kamen.

Individually, one common method is keeping a gratitude journal and recording experiences and memories you appreciate most. According to Dr. Kamen, these experiences can be anything from a great cup of coffee to an afternoon spent with a friend to observing something beautiful in nature.

Another method people use to heighten their sense of appreciation is gratitude mediation, in which one enters a relaxed state of mind, engages in deep breathing and concentrates on one thing he or she is thankful for 10-20 seconds. In doing so, the short-term experience becomes a long-term memory, effectively hardwiring appreciation into the brain.

Although it is more challenging to cultivate gratitude on a larger, companywide scale, "the way our society is moving now, it is becoming imperative," says Dr. Kamen.

The initiative to develop gratitude in an organization's culture must start from the top down, according to Dr. Kamen. This means the leadership must demonstrate it by making an effort to show appreciation to workers in private and public.

"The leadership needs to demonstrate it — to live it — rather than just say, 'Here's a bonus because you did well,'" says Dr. Kamen. "Besides working for a paycheck, peoples' jobs are their lives. People want to be seen, acknowledged and appreciated, and when they aren't, there is job dissatisfaction."

In fact, receiving explicit appreciation is often a more powerful motivator than financial incentives (as long as employees are paid fairly). In 2013, roughly 80 percent of 2,000 Americans responding to a survey said receiving gratitude made them work harder, according to the Wall Street Journal. In 2011, after analyzing 50 studies, researchers at the London School of Economics published a paper concluding people try their hardest at work if they are interested in the subject matter, if they feel it provides meaning and purpose, and if others show appreciation for what they're doing.

Kwabena "Bobo" Blankson, MD, a pediatrician with subspecialty training in adolescent medicine and a medical consultant with GoodThink, a positive psychology consulting firm, says this is no surprise.

"At some point, we seem to figure it out — that being more successful and making more money doesn't actually lead to happiness," says Dr. Blankson. "The opposite is true: Happiness leads to success. Being appreciated and valued by an employer turns out to be far more important to being a successful employee than being offered a bonus."

Ms. Schlichting says she's seen firsthand how much her colleagues and staff appreciate a call, note or email thanking them for their work. To give recognition for team achievements, a "thank you" might be delivered in the form of an ice cream party or social event. The health system also gives out individual and team awards — often during important annual meetings with the board of trustees — to ensure leadership sees and appreciates those who work hard.

"It's so important to show appreciation and gratitude to people in healthcare because these people are doing amazing and difficult work every day," says Ms. Schlichting. "Not everyone can do jobs in healthcare because of the physical, emotional and intellectual challenges involved. Each job is vitally important and nothing is easy."

Other ways organizations can show their employees how much they are appreciated include creating a blog or newsletter featuring employees' achievements and hard work, hosting social outings, catering meals or even giving balloons, Dr. Kamen suggests.

Cultivating genuine gratitude takes work. "It is not a technique or a stratagem, but a complex and refined moral disposition," Dr. Burton wrote in an article published by Psychology Today. While developing a true sense of thankfulness takes deliberate effort, anyone can do so, and it behooves all working people, especially leaders, to try.


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