In a recently released article in Pediatrics, Dr. Arieh Riskin and colleagues (10.1542/peds.2018-2043) share a unique and intriguing study. Using simulation, the authors asked a simple but profound question: do expressions of gratitude impact the performance of neonatal intensive care unit (NICU) teams? Having previously demonstrated that incivility has a negative impact on medical care and teamwork, the authors reprised their simulation center protocol to examine the impact of kindness on these outcomes. Using four emergency neonatal scenarios that included mannequins with deteriorating vital signs, and parent actors, the NICU teams were observed by judges behind one-way mirrors. Half of the teams received a positive social interaction prior to the scenario (gratitude from the parent or a professional) and half received a neutral social interaction, such as an explanation. The main outcome was the medical performance of the team with respect to diagnosis and treatment, and an additional outcome was teamwork, specifically information and workload sharing. The thoughtful and elegant study design is not only prospective, with randomization of social interactions, but also protects human subjects by using simulation to mimic the stress and challenge of patient deterioration.
The analytic plan and the results are well explained, and walk the reader through the statistical methods used to explain how gratitude does its incredibly positive work. It’s one thing to conclude that gratitude is a good thing (spoiler alert- it is), and it’s another to understand how a word of thanks might create impact. In fact, the impact of gratitude, particularly from the parent, was huge, and I don’t want to spoil your journey through the Results and Discussion sections, that lay out the mechanism of the effect of gratitude on medical performance. This is a study that journal clubs throughout the hospital should seize upon and discuss. Although the study was conducted using NICU teams and scenarios, it likely can generalize to every corner of every office, clinic and hospital ward.
A parental thank-you validates us as individuals and physicians in a unique way that touches the heart. A simple spontaneous endorsement of the value of our daily work is the ultimate antidote to burnout, in my opinion. I recall a very angry mother of a 4 day old who verbally attacked me as I entered the room to apologize for her wait. Once I had sat down, and heard, understood, and directly addressed her misinformed worry about the baby (that his erythema toxicum rash was a herpetic outbreak), she began crying and thanked me. That event occurred literally months ago but remains very fresh in my mind and heart, and inspires me to try to do my best every day. I hope you will enjoy this excellent article by Dr. Arieh Riskin and colleagues too, and feel grateful that you read it!