The purpose of this case study is in response to a consideration of the following:
“Collecting positive feedback can increase nurses’ confidence, show improvements in performance and provide a baseline for measuring patient satisfaction” (Nursing Times 2011)
Currently the Patient Experience and Feedback Team, Torbay and South Devon Healthcare Foundation Trust, uses a database to log the variety of compliments. It is a simple process to capture the written compliments via; NHS Patient Choices, Real Time Patient Feedback, Friends and Family Test, National Survey and Social Media.
Staff often receive compliments from patients by written letter/card or verbally. They are often thanked for giving the treatment patients receive, care and support, or complimented on the environment, atmosphere or cleanliness of the wards/departments. However, these compliments are not easily accounted for and therefore do not provide a realistic reading of the overall positive feedback data received by the organisation. In order to resolve the absence of an effective data collection, a pilot was set up to record verbal and written compliments using a tick box weekly chart. The goal for this case study was to understand the volume and impact the compliments are having on the staff.
The chemistry of compliments:
What happens to us when we receive a compliment or we are praised? It is common knowledge that being praised often makes people feel good. Pride, pleasure and raised self-esteem are all common reactions to being paid a compliment or receiving positive feedback. Scientific evidence suggests that being praised triggers the release of dopamine, a neurotransmitter that helps control the reward and pleasure centres of the brain. As well as making us feel good, dopamine can also contribute to innovative thinking and creative problem-solving at work (Training Journal 2014).
Why do negative comments and conversations stick with us so much longer than positive ones? According to Glaser (2014), chemistry plays a big role in this phenomenon. He explains that when we face criticism, rejection or fear our bodies produce higher levels of cortisol (a hormone that shuts down the thinking centre of our brains) and we become more reactive and sensitive. Conversely, positive comments and conversations produce another chemical in addition to dopamine as mentioned earlier. This reaction spurs the production of oxytocin (a feel good hormone) that elevates our ability to communicate, collaborate and trust others. Interestingly, the negative effects of cortisol on the brain last three times longer than the positive effects of oxytocin. Thus making the impact of positive feedback more short lived, in comparison to the longer term effects of negative ones.
The Impact of Compliments/Praise:
In 2004, the Gallup Organisation conducted a worldwide research project, surveying more than four million employees, about the importance of praise and recognition. The conclusion revealed that employees who received regular praise were more productive, engaged and more likely to stay with their organisation. However, the Gallup Organisation emphasised that only genuine achievements should be praised as empty words have little or no value.
In 2008, consultancy firm Towers Watson published the results of their Global Recognition Study, which revealed a strong positive correlation between manager recognition and employee engagement. The study suggests that there is little doubt that praising and recognising the efforts and achievements of others can bring about some very positive results in the workplace, make the recipient feel good about themselves, which in turn can help to boost their performance. Tower Watson researchers also reflect on the significance of ‘uplifts’ – positive experiences that boost morale and motivation at work. Furthermore, they state that offering praise and recognition costs nothing.
For praise to have this kind of impact, world-renowned psychologist Carol Dweck suggests that managers should be specific about which aspects of their team members’ performance have particularly impressed them and why; sincere praise and compliments can have a powerful effect on people (Dweck 2014).
According to ‘Psychology Today’ compliments are one of the most extraordinary components of social life, but will only work if they are sincere reflections of what we think and if they are given freely and not coerced (Psychology Today 2015). People benefit from being the objects of compliments (knowing that we notice and learning that we value them), but we can also benefit from giving them.
Bringing in the patient:
A growing body of research shows that end users – customers, clients, patients who benefit from services are surprisingly effective in motivating people to work harder, smarter and more productively. Therefore, the experience implemented by radiographers in the Harvard Business Review, 2011, described the benefits of radiographers seeing photographs of their patients when reviewing their x-rays. This inspired them to read with increased attention to detail, resulting in a significant change in accuracy outcomes.
A high level of staff engagement is a strategic goal for a growing number of organisations, including healthcare. Evidence suggests that engaged employees are committed to their employer, satisfied with their work and are willing to go that extra mile in order to achieve the organisation’s goals. Evidence also suggests that engagement influences other major human resources goals, such as retention, job performance, absenteeism and recruitment (Gibbons and Schutt 2010; Macey and Schneider 2008). Conversely, after a study of health care workers, it was found that employees, who worked for a boss they disliked, had significantly higher blood pressure. According to British scientist George Fieldman, boss induced hypertension could increase the risk of coronary heart disease by one-sixth and the risk of stroke by one-third.
How can staff engagement be measured? From April 2014, NHS England introduced the Staff Friends and Family Test (FFT) in all NHS trusts providing acute, community, ambulance and mental health services in England. NHS England’s vision for Staff FFT is that all staff should have the opportunity to feedback their views on their organisation at least once per year. It is hoped that Staff FFT will help to promote a big cultural shift in the NHS, where staff have further opportunity and confidence to speak up, and where the views of staff are increasingly heard and are acted upon. Research has shown a relationship between staff engagement and individual and organisational outcome measures, such as staff absenteeism and turnover, patient satisfaction and mortality; and safety measures, including infection rates. The more engaged staff members are, the better the outcomes for patients and the organisation as a whole. It is therefore important that we strengthen the staff voice, as well as the patient voice (NHS England).
Roy Lilley (2015) discusses the possible reasons why we work – apart from the need to earn money:
“Maybe there is something in the idea that you go to work because you like the people you work with, you are good at the job and you like where you work. Behavioural psychologists refer to this as social reinforcement; the joy of a job well-done and a pat on the back for doing it.”
This influences us to consider – have you had a pat on the back or indeed given one lately? Lilley continues,
“Or maybe we get up and come to work because we are proud of what we do. You do it because you have the courage to take on the challenge and because, inside you there is a passion to get it right for the people you serve and the colleagues you work with. It’s OK to be proud of what you do.”
Finally, Lilley surmises that the secret reason people come to work is because they have a burning desire to have a great day doing good stuff and go home feeling they have done the right thing. Maybe, all we have to do as managers is to make sure they want to get up and come back and do it all again tomorrow.
How powerful is a thank you? Harvard researchers (2011) set up an experiment; an email, asking 50% of participants for more help in an on-going project. The other half, in the email, included the words ‘thank you so much for taking part in the project, I’m really grateful’. Sixty six per cent helped with the second letter, 32% help with the first. “Saying thank you is polite but it also works” (Roy Lilley 2015). This demonstrates that compliments are powerful in motivating continued efforts.
The findings from the NHS Staff Survey 2015 identified numerous areas in which the Trust is performing well. Interestingly, an area identified where further work needed to be done was: Recognition and helping staff understand how their roles make a real difference to patient care.
According to Rath and Clifton (2004), the concepts of “recognition” and “praise”…. are two critical components for creating positive emotions in organisations.
Therefore, if staff were able to regularly review and consider the written and verbal compliments they received, they could possibly help reinforce how the patients’ experiences were directly as a result of their practice and work, as emphasised by Lilley 2015.
In consideration of the context surrounding patient experiences and compliments by staff, a data collection was agreed to be the best starting point for this case study
Fig. 1 Tick box weekly chart:
Staff from two medical wards were invited to take part in collecting data by using a tick box chart during a period of 24-hour shift pattern, for 31 days.
The tick box chart shown above in Fig. 1 was developed to enable staff to capture data, written and verbal compliments. Staff were provided with the following instructions:
- A chart will be placed each day in the staff room for 31 days
- Each time you receive a compliment, verbal or written from patients, please tick the box
The outcome was that staff from the two wards were recording (ticking) the chart each time a verbal or written compliment was received. This was completed enthusiastically by staff to start with but waned as the month progressed. The results were encouraging with an average of 10 verbal compliments each day in total. The above method identified the challenges with the data collection using a tick box chart. Whilst it captured the quantitative data, the missing element was the narrative of the qualitative data. Therefore, it was decided to follow up with a questionnaire to a different staff group to survey the impact of their feelings and thoughts when they received patient written or verbal compliments.
The questionnaire as shown in Fig. 2 below was given to the staff attending clinical induction and they were requested to complete and hand back upon departure of the session. To complement this data collection, a second staff group (preceptees) were also requested to complete the questionnaire. This widening of the data collection enabled access to disparate staff members of the employer.
Patient Compliments – I am currently working on a project surrounding patient compliments. I would be really grateful if you could help me by forwarding your comments on how you felt after being paid a compliment. The following questions may be helpful but please feel free to make further comments:
- How did it make you feel when a patient/staff gave you a compliment?
- Do you think that being complimented helped to improve or change your practice/care of patients – if so, how?
- If the compliment gave you positive feelings – has this changed how you respond to your colleagues?
Thank you for your time
Fig 3 Question 1
|Made a difference||6||6%|
|Made me think||1||1%|
|Must be appropriate||1||1%|
Chart to clarify the number of comments and frequency
Fig 4 Question 2
|High standard of care||15||17%|
|Reinforces good practise||6||7%|
|Does not change care delivered||4||5%|
|Appreciate value of role||4||5%|
Chart to clarify the number of comments and frequency
Fig 5 Question 3
|Improves work environment||3||4%|
|Encourages to achieve more||2||3%|
|Acknowledge good practise||1||1%|
Chart to clarify the number of comments and frequency
Examples of Qualitative questionnaire data from Preceptees group May 2015:
Questions from Fig. 3, 4, 5: These are examples of the responses:
|Q1 Makes you feel that going the extra mile is worth itmade an important difference to someone’s experience – doing it rightmade an important difference to someone’s experience – doing it right
|Q1 People recognise that I am good at my job. Feel more like participating in my work because of the good feedbackHad proof that I was doing a good job
|Q2 Don’t think it changed my vision of nursing people I try to be more professional Obviously good feedback gives you a positive opinion of yourself and not a reason for change reallyI try to be more professional Obviously good feedback gives you a positive opinion of yourself and not a reason for change really
Obviously good feedback gives you a positive opinion of yourself and not a reason for change really
|Q2 Reminds me that it is important to take time as this could be the first visit in hospital where as it is my hundredth patient|
|Q3 Congratulate each other and learn tooI always try to praise my colleagues
Good to say thank you to them and show them they are appreciated
Puts me in a good mood which probably change my response
|Q3 Probably – I started asking colleagues to be stricter with hospital guidelines. I don’t think this influenced me a lot|
Themes from the questionnaire
Themes from Question1
Q1 How did it make you feel when a patient/staff gave you a compliment?
People provided narrative answers and used the words “happy”, “motivated” etc. influencing the understanding arriving from the theory as described in the introduction – Release of Dopamine – makes us feel good————–
Saying thank you is polite but it also works so compliments are powerful in motivating continued efforts – “job satisfaction”
Praise and recognition costs nothing – “worthwhile”, “encouraged”
Key Responses from Question 2
Q2 Do you think that being complimented helped to improve or change your practice/care of patients – if so how?
People described how receiving a compliment made them improve or change practice, referring to the theory as described in my introduction. Being appreciated increased confidence, improved moral, reinforced good practice and overall reduced anxiety. This aligns to Roy Lilley who emphasised – “people go to work to——-
Key Responses from Question 3
Q3 If the compliment gave you positive feelings – has this changed how you respond to your colleagues?
People highlighted the external influence to their work colleagues following them receiving a compliment. The overall increased positivity improved the work environment, reduced stressful feelings and encouraged all to achieve more thus linking to the results of the Towers Watson Recognition study.
|Compliments can be offset against complaints to provide a balanced view of the service. This helps staff positivity and enhances the work environment and job satisfaction||Therefore, taking this experience formed the following recommendations to be made:Regularly advertise the numbers of compliments versus complaints (ward/department poster, bulletin)
Understand what went well with the compliment – repeat the circumstances
|Using a robust system for collecting compliments to ensure positive feedback is accurate, has proven benefit if the data is shared with the workforce
|Adopt a simple method for capturing all types of compliments including verbal and advertise the success
|Data can be used to benchmark services and improve staff awareness of quality issues, with the added benefit of reduced absenteeism and staff turnover||Offer praise to make people feel good about themselves and to boost their performance where possible based on evident achievements|
|Managers should also pay the same attention to compliments as they do complaints and therefore staff have an equal balance which is in response to the chemical makeup of human responses and changes within the brain||Enhance the learning from the ‘effects of patient compliments’ by offering positive feedback awareness to managers to be disseminated to staff to ensure this positive feedback is sincere and genuinely given, with details of what made the difference and why|
In conclusion, the overall benefits of collecting compliments are; reduces staff stress levels and increases confidence, improves staff wellbeing, improves team working towards shared goals, increases motivation, allows patient and career satisfaction with staff and services measured and offers a counterpoint to any complaints received.
Mark Twain, “All humans need and want praise, recognition and acceptance.”
Ashton, S., (2011), Using compliments to measure quality, Nursing Times, (Vol.107, p.14)
Dawson J. (2014); Staff Experience and Patient Outcomes: What do we Know? NHS Employers on behalf of NHS England
Dweck C., (2014), The Power of Praise and Recognition, Training Journal, on line https://www.training journal.com/articles/feature/power-praise-and-recognition Accessed 20/04/2015
Gibbons and Schutt (2010); Healthcare Quarterly (Vol. 15 No.2, 2012)
Glaser J. E. and Glaser R. D., (2014) Communication, The Neurochemistry of Positive Conversations, Harvard Business Review
Grant A. (2001), How Customers can Rally Your Troops, Harvard Business Review
Lilley R. (2015), Live health news, nhsManagers.net
Macey and Schneider (2008); Healthcare Quarterly (Vol. 15 No.2, 2012)
Rath D. and Clifton D., (2004) The Power of Praise and Recognition, Gallup Business Journal, online http://businessjournal.gallup.com/content/12157/power-praise-recognition Accessed11/03/2014
The Art of the Compliment, (2015), Psychology Today, online https:www.psychologytoday.com/articles/200403/the-art-the-compliment Accessed 05/05/2015
Towers Watson (2008), The Power of Praise and Recognition, Training Journal 2014, online https://www.trainingjournal.com/articles/feature/power-praise-and-recognition Accessed 20/04/2015
Zenger J. and Folkman J. (2011), Harvard Business Review