Recent reports have shown that the high degree of caregiver burnout, toxic work environments, and a chronically disengaged workforce create significant problems for healthcare organizations.
Additionally, the human brain’s built-in negativity bias naturally inhibits positive emotions, including gratitude. Without a deliberate effort to focus on what’s positive and working well in your practice environment, you succumb to this bias, tolerating negativity and an unhealthy work culture at a significant loss of productivity and revenue. Today, growing research on positive psychology, gratitude, and contemporary neuroscience provides a greater understanding of the positive impact of gratitude in the workplace, on employee engagement, and the overall success of the practice environment.
The Science for Creating a More Positive and Healthy Workplace
Imagine a medical practice of clinicians, licensed caregivers, and administrative staff able to bring their best selves to work every day, fully engaged and able to recognize the meaningful contributions they make to their patients, families, and each other. Knowledge and know-how on building and sustaining this type of positive work environment through behavioral incentives has been a chronic challenge for practice leadership . . . until now.
Reports on the high degree of caregiver burnout, toxic work environments, and a chronically disengaged workforce indicate significant problems for healthcare organizations. Recent Gallup research found that 53% of American workers are not engaged, showing up without cognitive and emotional connection to their work and workplace, with 13% actively disengaged.1 One report found the cost of toxic work cultures to be a staggering $223 billion in turnover alone.2 Without making a deliberate effort to focus on what’s positive and working well in your practice environment, you succumb to this bias and tolerate negativity and an unhealthy work culture at a significant loss of productivity and revenue.
Before exploring the science of gratitude and defining gratitude, we need to first consider the science of positive psychology. The current and researched definition of positive psychology is “the scientific study of the strengths that enable individuals, communities, and institutions to thrive.”
Just as good health is not just the absence of disease, or being fearless is not the absence of fear, positive psychology is not the absence of pain and suffering. It does, however, call our attention to our strengths in order to maximize our potential and create greater happiness and life satisfaction.
Central to this existing research, the science of gratitude is proving essential in improving health, predicting happiness, and enhancing individual and organizational well-being. Once considered a simple emotion, the research now shows gratitude to be more complex than we thought.
What is Gratitude?
Gratitude can be categorized in several ways:
- Being in a state of gratitude—the emotion we feel when someone has helped us; and
- “Trait gratitude”—the frequency and ease with which we experience gratitude.
In Gratitude Works!, Robert A. Emmons, PhD,3 defines gratitude as an affirmation of goodness and a recognition of goodness outside of ourselves. Emmons further recognizes that gratitude engages three aspects of our mind:
- We intellectually recognize a benefit;
- We willingly acknowledge the benefit; and
- We emotionally appreciate the benefit and the giver.4
Ongoing research reveals that numerous health and well-being benefits are derived from practicing gratitude. These benefits are becoming more recognized and mainstream in our personal lives, and in our homes, schools, communities, and institutions. According to Alex Korb, PhD,5 “. . . there’s a gratitude circuit in your brain, badly in need of a workout. Strengthening that circuit brings the power to elevate your physical and mental health, boost happiness, improve sleep, and help you feel more connected to other people.”
Individual Health and Well-Being Benefits of Gratitude
The latest research on gratitude is compelling. A study by the American Psychological Association found cardiac patients who kept gratitude journals for eight weeks showed reductions in levels of several inflammatory biomarkers while they wrote.6 This was found to be true for both high-risk patients and those who had recently experienced an acute coronary event.
A study of Vietnam war veterans found those with high levels of gratitude experienced lower rates of post-traumatic stress disorder.7 Improvements in emotional well-being were found in a study on the relation between gratitude and well-being, leading to lower levels of stress and depression and higher levels of social support.8
Additional research found participants who kept gratitude journals reported fewer health complaints, more time exercising, and fewer symptoms of physical illness,9 and another study showed improved quality of sleep and longer sleep hours.10
Growing evidence points to the role gratitude plays in having more resilience when dealing with difficult and challenging life experiences. Psychologists define resilience as a commitment to finding purpose in whatever is happening, to believing in your ability to create a positive outcome, and to being better prepared for the inevitable setbacks that occur.
Gratitude in the Workplace
Along with the growing research on the health and well-being benefits of gratitude, collective studies have been conducted on how gratitude positively affects employee engagement and overall organizational wellness.
According to the multinational company Globoforce, gratitude is part of the “secret sauce” for building a great culture. In The Power of Gratitude, Eric Mosley and Derek Irvine highlight the importance of gratitude as a prime mover of greater productivity and a factor that helps organizations thrive.11 Employees who feel valued and are recognized for their contributions are found to have a higher level of job satisfaction, engage in more productive relationships, be motivated to do their best, and work toward achieving the company’s goals.12
Another important study highlights the positive impact of gratitude on organizational wellness. Expressing gratitude was found to be a consistent predictor of several outcomes, including less exhaustion and less cynicism; more proactive behaviors; higher rating of the health and safety climate; higher job satisfaction; and fewer absences due to illness.13
In a gratitude intervention conducted by DRW Coaching, Inc., an eight-week pilot program using an adaptive interaction with the study design resulted in baseline and post-assessment survey results with statistically significant increases on the employee engagement survey (p <.001) and statistically significant improvement on the meaningfulness of work subscale of the Positive Practice Survey (p <.001), a survey used to identify positive practices in organizations that produce desired changes in organizational effectiveness.
Cue the Neuroscience
Exciting research on the neural correlates of gratitude is being done. Specifically, with advances in functional magnetic resonance imaging (fMRI), modern neuroscience can observe what brain activity “looks like” when the subject is experiencing gratitude. Understandably, the reward centers of the brain are activated. However, numerous studies using fMRI have shown that gratitude activates multiple regions of the brain, including those for moral reasoning, fairness, empathy, economic decision-making, taking the perspective of others, and psychological well-being.
You may have heard the phrase “neurons that fire together, wire together.” Neuroplasticity— the brain’s ability to form new neural connections—aids in discovering these reported benefits of gratitude. Because of the brain’s built-in negativity bias, it’s easier to notice only the negative, because those neural pathways are well traveled. The good news is that by shifting your brain’s focus through a sustained gratitude practice, you will begin to create new and strengthen existing neural connections. The stronger your gratitude circuitry becomes, the more hopeful you become, and the better equipped you are to cope, heal, and reenergize yourself.14
Because the human brain views the workplace as a social system, feeling disrespected or not valued activates the pain regions of the brain. These feelings are as powerful as a physical blow to the head, and the effects are strong and long lasting. Compound this with daily stress and feelings of being overwhelmed, and you’re caught in a downward spiral of negativity and pessimism with long-term, harmful impacts on your health and well-being and that of your staff. At some point, this type of workplace culture leads to turnover, loss of productivity, and diminished revenue, all of which affect the success of the practice.
The Role of Neurochemicals
Several good neurochemicals—dopamine, serotonin, and oxytocin—are released in your bloodstream when you write about, reflect on, or express gratitude:
- Dopamine (C8H11NO2): When expressing gratitude, dopamine is released in your bloodstream, and it feels good! It triggers positive emotions, you feel more optimistic, and it fosters camaraderie.
- Serotonin (C10H12N2O): When reflecting on or writing down the positives in life and at work, your brain releases serotonin. Serotonin enhances your mood (think antidepressant), your willpower, and motivation.
- Oxytocin (C43H66N12O12S2): Being grateful to those in your life releases oxytocin, which is important in building safe connections with others. Oxytocin facilitates trusting, prosocial behaviors while inhibiting the stress hormone cortisol.
A national gratitude survey found that although 90% of respondents consider themselves grateful, only 52% of the women and 44% of the men surveyed express gratitude on a regular basis. The same study discovered that people were less likely to express gratitude at work, yet eager for their boss to express gratitude for their work. The respondents indicated that, in response, they would feel better about themselves and work harder.15
A study of gratitude in the workplace found people are less likely to express gratitude at work than anyplace else, with 60% never or rarely expressing gratitude at work and 74% never or rarely express gratitude to their boss. The same study found, however, that 81% of employees say they would be motivated to work harder if they had a boss who expresses gratitude.16
The Practice of Gratitude
Achieving any of these benefits, whether personally or professionally, starts with you and your commitment to a gratitude practice. There are a variety of ways to practice gratitude, some of which are discussed in the following sections. There is, however, a “prescription” for achieving the greatest benefits from your practice of gratitude. When reflecting or writing, follow these three steps:
- Reflect on specific people, experiences, and behaviors that are meaningful in your life.
- Describe specifically why you’re grateful for the person, experience, or behavior.
- Describe how you have benefited and specifically characterize the intentions, actions, and possible sacrifices made on your behalf.
Using this level of specificity, consider the following recommendations for creating and sustaining a gratitude practice:
- Keep a gratitude journal. It’s one of the most meaningful ways to practice. Journal one to three times a week. Start a shared family or workplace journal to gain practice momentum. If you are not into journaling, paint, sketch or draw.
- List all the people in your life for whom you are grateful. Then write to them or tell them.
- Write a letter of gratitude to someone. Deliver it or call them and read it to them.
- Write down three good things that went well in your day and describe why;
- Find time to simply reflect on a positive emotion you felt in the last 24 hours and consider why you’re grateful for this emotion.
- Pilot a gratitude intervention in your practice or make the science of gratitude a component of employee wellness/training/coaching.
- Develop a gratitude ritual to start all huddles and office meetings.
- Observe days of appreciation;
- Ask someone to volunteer to be a gratitude ambassador for the practice.
- Create a gratitude board to visually remind each other of what gratitude looks like in your practice.
Choose practice techniques that feel most comfortable and are not just something to put on a to-do list. With the changes in healthcare and the demands on your practice, this work is of the utmost importance.
In closing, in today’s world of 24/7 distractions, workplace overwhelm, and often high negativity, there remains a human need, perhaps a demand, to count your blessings, show gratitude to others, and find meaningfulness in your daily life. What one action will you take today to begin to create a practice of gratitude in your office?
1. Employee engagement on the rise in the U.S. Gallup.com. https://news.gallup.com/poll/241649/employee-engagement-rise.aspx.
2. The high cost of a toxic workplace culture. SHRM.org. www.shrm.org/resourcesandtools/hr-topics/employee-relations/pages/toxic-workplace-culture-report.aspx.
3. Emmons RA. Gratitude Works! San Francisco: Jossey-Bass; 2013.
4. Emmons RA. The Little Book of Gratitude. London: Gaia Books; 2016.
5. Korb A. The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time. Oakland, CA: New Harbinger; 2015.
6. Mills P. The role of gratitude in spiritual well-being in asymptomatic heart failure patients. J Spirituality in Clinical Practice. 2015;2(1):5-17.
7. Kashdan T. Gratitude and hedonic and eudaimonic well-being in Vietnam War veterans. J Behav Res Ther. 2006;44:177-199.
8. Wood A. The role of gratitude in the development of social support, stress, and depression: two longitudinal studies. J Res Pers. 2008;42:854-887.
9. Emmons R. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84:377-389.
10. Gratitude influences sleep through the mechanism of pre-sleep cognitions. J Psychosom Res. 2009;66(1):43-48.
11. Roszak Burton L. The neuroscience of gratitude. Wharton Healthcare Quarterly. Winter 2017.
12. American Psychological Association. Psychologically Healthy Workplace Survey. www.apa.org/news/press/releases/phwa/workplace-survey.pdf.
13. Burke R, Ng E, Fiksenbaum L. Virtues, work satisfactions and psychological wellbeing among nurses. International Journal of Workplace Health Management. 2009;2:202-219.
14. Roszak Burton L. Gratitude Heals – A Journal for Inspiration and Guidance. Amazon; 2019:3.
15. Simon-Thomas ER, Smith JA. How grateful are Americans? Greater Good Magazine. January 10, 2013. http://greatergood.berkeley.edu/article/item/how_grateful_are_americans.
16. OpenIDEO. Gratitude in the workplace challenge. https://ggsc.berkeley.edu/what_we_do/major_initiatives/expanding_gratitude/gratitude_partnerships/openideo_challenge.
*Author of Gratitude Heals: A Journal for Inspiration and Guidance. (Amazon, 2019), and Founder of DRW Coaching
LinkedIn: Linda Roszak Burton
This article appeared in the January/February 2020 issue of The Journal of Medical Practice Management.