The Reciprocity of Gratitude

Contributor: Linda Roszak Burton, ACC, BBC, BS
To learn more about Linda, click here.

 


Photo by Maxime Lebrun on Unsplash

In keeping with our 2021 Feature Article series on gratitude, we continue to look at the current state of the healthcare workforce, clinicians and non-clinical staff, to uncover current findings on the science of gratitude and the reciprocal benefits for individuals, organizations, and patients.

According to a search on PubMed, queries on gratitude have almost doubled (195/372) between 2019 and 2021. Related studies range from:

  • Health and well-being outcomes, including lower levels of clinician burnout, are improved.
  • Gratitude as an organizational value predicts engagement, job performance, and job satisfaction
  • Patient gratitude, influenced by a high-level relationship quality, translates to increased patient loyalty.

SO, WHAT IS GRATITUDE?

As described in the Wharton Healthcare Quarterly Winter 2021 issue, gratitude comes from the Latin root of gratus or gratia — "thankful, by favor." It’s considered a state of mind, a spontaneous feeling, an emotion, and a strength. Roman philosopher Cicero once said, “Gratitude is not only the greatest of virtues but the parent of all others.” One of the most cited definitions of gratitude is that of Robert A. Emmons, Ph.D. - “the affirmation of goodness and the recognition of goodness outside ourselves.”

RECIPROCAL GRATITUDE

Current research has established the cultivation and sustainability of gratitude practices have a multiplier effect on building quality relationships and promoting more pro-social behaviors, often called the “social glue.” Foundational to much of the research is the finding that gratitude triggers several forms of reciprocal gratitude. The Law of Reciprocity implies being on the receiving end of gratitude creates a psychological need to reciprocate. Reciprocal gratitude can be:

  • Direct – in return for someone doing something helpful for you
  • Downstream – others helping you because you’ve helped someone else
  • Upstream – better known as “pay it forward,” you help others because you’ve been helped

It’s important to note reciprocal gratitude is not about feeling obligated or indebted to someone. Misusing gratitude between peers or from manager to employee as a means to get something in return erodes trust and sets up a toxic work environment. Instead, frequent, nonjudgmental, and genuine gratitude yields the greatest benefits overall.

THE CURRENT DISRUPTIVE STATE OF THE HEALTHCARE WORKFORCE

Here’s what we do know about the current state of the healthcare workforce. Clinician burnout and moral injury (perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations) are at an all-time high. Staffing shortages are impacting every job function and the ability to get the job done well and safely. Healthcare entities are more aware of the critical need to support employees’ overall health and well-being. Recent publications note competition and margin pressures are driving many hospitals to consider strategic merger opportunities — putting further stress on an already overwhelmed and exhausted employee population.

A silver lining? The burgeoning research on the science of gratitude continues to confirm the significant and positive impact on individuals, communities, and healthcare institutions. In our coaching and team-building work, leveraging these findings and developing corresponding resources can fully support the current state by creating a more healthy work environment (HWE), especially when influenced by top leadership and further leveraged throughout the organization. 

CAREGIVER AND PATIENT GRATITUDE

Several recent studies have sought to understand the relationship between caregiver and patient gratitude, including the reciprocity between employees’ health and patients’ quality of care. In light of the growing competition fueling strategic hospital mergers, loyalty to caregivers is of key importance.

One study looked at the role patient gratitude plays in relationship quality and patient loyalty. Patient perception of the quality of the relationship (determined by trust, commitment, and satisfaction) translates to an increase in physician loyalty via patient gratitude. Gratitude is a driver of a successful relationship between physician and patient. “Gratitude represents the emotional core of reciprocity and plays a key force in the building of a mutually beneficial relationship.”

Results from another study confirmed expectations about patients’ support and gratitude as factors in reducing nurse burnout, including a decrease in emotional exhaustion and an increase in the sense of personal accomplishment. This and other studies acknowledge the significance of reciprocity between employees’ health and patients’ quality of care.   

EMPLOYEE AND ORGANIZATIONAL GRATITUDE

A 2019 study confirmed three types of gratitude as predictors of job satisfaction and job performance:

  1. dispositional gratitude - a personal tendency to notice and appreciate the positive
  2. collective gratitude - experienced by employees toward the organization
  3. relational gratitude - one received from customers, such as clients or patients

The study highlighted the importance of relational gratitude and reciprocity between organizations and clients or patients and the adverse impact a complaint can have on worker satisfaction and performance.

Additionally, a September 2021 study indicated having the perception of being appreciated by others at work showed a significant association with work engagement. This association was independent of job demands and job resources. Social norms of reciprocity indicate positive actions lead to positive outcomes, whether in personal or organizational relationships.

RECOMMENDATIONS

Knowing the strong association between gratitude and its impact on the workforce, here are several recommendations. When considering these recommendations, identify which ones offer the greatest opportunities for direct and downstream reciprocity based on mutual benefits as they seem to offer the greatest impact on outcomes.

  • Familiarize yourself with the various types of gratitude interventions. Include your team in determining which ones will support a healthy work environment. Develop criteria based on interventions that meet your employees’ and patients’ needs.
  • Offer gratitude programming that specifically supports your organization’s current wellness activities, leadership development initiatives, or as part of a culture change process to promote greater reciprocity.
  • Survey employees and patients for top stressors and identify gratitude programming and interventions to serve as a coping mechanism, support mental health, and strengthen employee-patient relationships.

Becoming more aware of and leveraging the science of gratitude, the ongoing research, and real-time applications will enable organizations to more successfully retain top talent and engage teams to be more open, creative, and innovative. These are true differentiators of the work environment, one that is thriving, positive, and healthy.

Want to learn more?


Contact Linda at:
[email protected] or 410.707.3118