By Read G. Pierce, MD – Faculty Member, the Institute for Healthcare Excellence
The grandfather of the healthcare quality movement, Avedis Donnabedian (BMJ), is reported to have said famously that “the secret to quality is love.”
On the surface, this thought seems patently naïve. In our experience leading quality, patient safety, and experience initiatives across a collective 30+ years in multiple health systems, we have yet to see love, or anything remotely like it, included on a quality scorecard. While starting meetings with a patient story is now commonplace in hospitals and clinics around the country, those stories tend to stay on safer emotional ground: encapsulating patient or family gratitude for care, or reminding us about purpose—that there really is a mission that accompanies the profit margin focus of our organizations. Amidst the extraordinary social and technical complexity of modern healthcare, the numerous pressures for change, the ongoing disruption induced by digital technologies, diversifying payment models, and millennials’ expectations about work, who has time for love?
It turns out that emotional experience at work is one of the most powerful drivers of performance across the metrics that keep healthcare leaders and members of the care team up at night: harm, cost, turnover, safety culture, every quality metric on those scorecards, and even organizational reputation on national rankings. It’s also the key to engagement from people doing the work, and it may have a bigger impact on organizational performance than technical skills, training, a top-notch strategic plan, tightly cascaded goals, or recruiting the best talent (See Nine Lies About Work, Buckingham). More negative emotions in the workplace lead to a toxic contagion of burnout, falling performance and turnover. More positive emotions in the workplace lead to the opposite—thriving, creativity, and sustainable performance.
What emotions, precisely, are these powerful catalysts for good? According to researchers like Martin Seligman, Barbara Fredrickson, and Bryan Sexton (2), love, hope, joy, amusement, inspiration, interest, gratitude, awe, serenity, and pride are a series of tiny engines in the brain. These engines do two powerful things, when activated. The first is recharge us, inside the work we are doing—they literally put energy back into us, as individuals and teams. Experience pride in your work, and you bounce back faster from stress, even while you are still working. Experience gratitude—whether you give it or receive it—and your sense of thriving and flow increases, while you are working. The second benefit is a rewiring of the brain, known as the undoing effect. As we experience positive emotions, we activate a different part of the brain, and enhance it. The result is a heightened ability to bounce back and to see and experience more of the positive in our work, while the negative is, naturally, still present.
What does this mean for quality performance in healthcare? Having the right technology matters—the best diagnostic tools, drugs, and devices. So does access to care, and a way to afford it. Hiring caring, highly competent, and well-trained people is also essential. However, these things don’t guarantee the best performance. Caring for other people, many of whom are experiencing their own negative emotions and are not at their best, is challenging. So is navigating the extraordinary complexity that comes with tremendous progress witnessed in medical science over the past 100 years.
What brings out the very best in our healers, and our healthcare organizations, is adding a large dose of positive emotions to daily work. Love, for example. While this approach may seem foreign to healthcare’s scientists and physicians, our executives and nurses, our policy experts, marketers, engineers, and lawyers, there are practical approaches to hardwire cultivation of positive emotion into the daily work of healthcare. Enlightened healthcare systems and leaders are starting to explore how this hidden leverage can come to life, through different approaches to meetings, teamwork, coaching, rounding, and even presentation of data. By heeding Donabedian’s wisdom, they are, indeed, putting love back into clinical quality, and, as he postulated, performance reliably follows.