Thursday, January 11, 2018

How Gratitude Can Reduce Burnout in Health Care

Today, more and more health care organizations are finding that a culture of thankfulness is good for their staff—and their patients.




When we are sick, we look to medicine to heal us. But what does the medical profession do when it’s ailing from stress and overwork?
More than half of U.S. physicians say they are struggling with burnout—a complex state generally defined by exhaustion, cynicism, a callous attitude toward others, and a diminished ability to be effective in our jobs and relationships. Studies suggest that a similar proportion of nurses and other health care practitioners experience burnout and depression. Burnout among these caregivers not only harms their health; research suggests that it also has grave implications for the quality of care that they offer to their patients.
As the profession struggles to address this crisis of burnout, some health care systems have turned to an innovative remedy: gratitude.
Indeed, more and more research has been documenting the health benefits of counting your blessings, including recent studies that have found it improves cardiovascular health (even among people at higher risk for heart attack), boosts our mental health and resilience to stress, and might have particular benefits for health professionals.
“Gratitude helps us cope with stressful experiences by reminding us of what is positive in our lives in the midst of—or even as a result of—suffering,” says Joel Wong, who directs the counseling psychology program at Indiana University, Bloomington, and has studied the mental health benefits of gratitude. “That can be tremendously relevant and useful to health professionals who need help bouncing back from the stresses and suffering they encounter in their jobs.”
Inspired in part by these research findings, some health care systems have been exploring ways to foster more gratitude within their organizations for the benefit of their medical providers, staff, and patients. Their experiences not only attest to the benefits of gratitude in health care, but also offer some lessons for other organizations that want to encourage more gratitude among their staff and patients alike.

A campaign for gratitude

Sutter Health, a doctor and hospital network serving more than 100 communities throughout Northern California, embarked on a two-month, gratitude-themed campaign in the summer of 2016. The campaign, organized as a joint effort between the organization’s employee assistance program and its Health and Wellness Operations department, gave more than 55,000 employees the opportunity to learn more about the benefits of gratitude and to try different ways of practicing gratitude in their daily lives.
Activities included a webinar on the science of gratitude, “gratitude challenges” that encouraged expressions of gratitude through journaling and posting to gratitude boards in break rooms, videos that reported on the benefits of gratitude, a symposium for Sutter Health managers to raise awareness about the relevance of gratitude to their work, and even glow-in-the-dark gratitude bracelets that served as reminders of why to practice gratitude.
“I’m still wearing mine!” says Michael Streby, a wellness coordinator at Sutter Health who helped organize the campaign.
“People already had some exposure to wellness topics,” he says. “But gratitude was one of those things where people seemed to have an ‘a-ha’ moment, particularly when we’re talking about fatigue and burnout in the workplace. Educating people about gratitude in the workplace had real value.”
He adds that the gratitude campaign helped pave the way for additional work that Sutter Health’s leadership is doing to address burnout.
“We received a lot of positive feedback on our management symposium on gratitude,” says Streby. “There’s a system-wide group within Sutter Health that’s working on mitigating burnout among caregivers, and our leaders have recognized that gratitude is one important practice that can be used.”

Workplace wellness initiatives

Kaiser Permanente has also been fostering gratitude as a way to address burnout and strengthen workforce health. The health care provider currently serves about 11.8 million members with operations in eight regions across the United States, boasting a workforce of nearly 285,000 employees, nurses, and physicians.
Beginning with the run-up to Thanksgiving over the past few years, staff from Kaiser Permanente’s employee assistance program have joined forces with the organization’s Healthy Workforce teams to spread the practice of gratitude in a variety of ways.

One has been through the use of “gratitude trees”: Large paper trees are hung on the floors of hospitals and medical centers, encouraging people to add post-it notes (in the form of leaves or apples) about people or things for which they are thankful. Sometimes, people express gratitude for something a coworker or staff member did; other times, people thank their family or express gratitude for things they witnessed or encountered in their daily lives.
“We’ve gotten an incredible amount of enthusiasm and engagement from our workforce,” explains Kelvin Gobble, lead project manager for Kaiser Permanente’s employee assistance program (EAP). “People find it to be an easy and tangible way to experience the benefits of gratitude.”
Kaiser Permanente’s EAP has also distributed flyers and posters to staff that promote the benefits of practicing gratitude, along with post-it pads pre-inscribed with “I am grateful . . .” The goal is to make it as easy as possible for staff to reflect upon the importance of gratitude and express their gratitude to someone else.
For an online offering, Kaiser Permanente partnered with the Greater Good Science Center to spread gratitude through 21-day Gratitude Challenges, using the GGSC’s online gratitude journaling platform, Thnx4.org. Through Thnx4, participants were encouraged to notice people and things they were grateful for over a three-week span, then record and share their expressions of gratitude. Nearly 400 Kaiser Permanente staff participated, though the goal is to encourage even wider engagement.
According to Jerry O’Keefe, Kaiser Permanente’s national EAP director, the biggest challenge is in spreading the word about gratitude programs and getting leaders and managers to practice with their staff. “With the science now validating the practice of gratitude, the response is growing,” he says. “We want to build awareness around the benefits of practicing gratitude, and also mindfulness, kindness, compassion, and more. There are ways that these practices can all serve as tools to help with resiliency and burnout.”

Toward a more grateful organizational culture

In San Diego, California, Scripps Health has taken steps to generate widespread commitment to a culture of gratitude all year round.
The regional health system encompasses four hospitals across five campuses and a network of outpatient centers and clinics. While it is on the smaller side, with 3,000 affiliated physicians and 15,000 employees, Scripps has shown what it can look like to hardwire gratitude across the operations of a health care system.
The organization uses an online recognition platform for sharing expressions of gratitude between staff and leadership. The platform, called Excel Together, enables users to send notes of appreciation, makes it easy to recognize caregivers who do their jobs well through an electronic “wall of fame,” and incentivizes gratitude through a system of points that staff can redeem for gifts and benefits. While the platform is largely designed for the workforce, patients are also able to express gratitude for the care they receive in the form of handwritten cards that are inputted into the system.
Paul Randolph, the director of Scripps’s employee assistance program, says Scripps Health tries to capture gratitude in its online system even when it is expressed on the go.
“Our staff providing patient care may not get on a computer easily,” he says. “So there are cards on patient floors, and staff use these readily to hand-write their gratitude. These then become incorporated into staff huddles and meetings, and are fed into the electronic system.”
Scripps’s comprehensive approach to fostering a culture of gratitude also takes the form of professional development programs that teach the importance of building gratitude into leadership and management styles, as well as bulletin boards throughout its medical facilities where patients or staff can publicly post their gratitude to other Scripps employees.
“Part of the success in cultivating gratitude is making it routine for people to share their appreciation for each other’s efforts in real time so that it becomes part of the culture,” says Randolph.

Lessons for building gratitude in health care

As all of this work suggests, there is no one-size-fits-all approach to building a culture of gratitude in health care. Each of the health systems described here has had to work with the unique characteristics of its environment and operations to develop supports for gratitude.
Yet there are a few overarching takeaways they shared from their efforts that other health care organizations can keep in mind as they consider their own gratitude programs.
  • Try to “hardwire” gratitude. Efforts to foster gratitude are most effective when they are baked into organizational culture, supporting individual practice while working toward systemic change. When gratitude is practiced and encouraged by everyone from leadership all the way down to caregivers and patients, it creates a surround sound that makes gratitude part of the everyday experience across the organization. Paul Randolph from Scripps Health believes that his health care system’s comprehensive efforts to foster a culture of gratitude are part of the reason why Fortune magazine has repeatedly named Scripps as one of the 100 Best Companies to Work For.
  • Make it voluntary. Expressions of gratitude and gratitude programs as a whole should never be forced upon health care staff. Rather, gratitude needs to be fostered in a way that respects staff time. This is particularly true within health care, given the demands and urgency that many caregivers face daily. “Gratitude cannot be yet another thing that caregivers are obligated to do,” explains Kaiser Permanente’s Jerry O’Keefe. “It’s important to make it something they just want to do.”
  • Maintain authenticity. Similarly, gratitude should be a practice that is encouraged and allowed to grow organically. As such, people need room to express gratitude in thoughtful, personalized ways. It’s important to strike the right balance between hardwiring gratitude to the extent that it is part of the organizational routine, yet also allowing each expression of gratitude to be original and genuine.
  • Make gratitude a year-round activity. The most successful efforts to foster gratitude are ones that happen throughout the year, even though the Thanksgiving and end-of-year holidays are particularly suited to raising awareness about gratitude and its benefits. Moreover, gratitude will thrive when it’s not just done as part of discrete programs but is connected to other efforts to foster a positive, caring culture.
  • Build a resilience toolkit. Many health care organizations want to foster well-being among their staff and patients, and gratitude has been helpful in that regard. Yet gratitude is not the only path to wellness. Many organizations are using mindfulness techniques, training caregivers in the art of compassion, and engaging in campaigns to encourage kindness. These practices, together with gratitude, offer an array of tools that staff can use when facing challenges or simply to deepen their connections to colleagues and patients.

With health care at the fore of our nation’s consciousness these days, health care leaders have a lot to gain by recognizing the value of gratitude and other positive and relational practices. Best of all, practicing gratitude is free and available to anyone who wants to experience its benefits for the health of mind, body, and spirit. That’s something, indeed, to be grateful for.