Neonatal intensive care unit (NICU) medical staff who were exposed to maternal expressions of gratitude had higher scores in procedural and therapeutic planning and prosocial behaviors in response to neonatal medical emergency scenarios when compared to medical staff who were exposed to neutral maternal statements.
Evidence Rating: Level 1 (Excellent)
Study Rundown: Interactions in medicine impact medical team cognitive and communication processes. Rudeness, for example, has been associated with lower individual and team diagnostic performance. On the other hand, little is known about the effects of gratitude on medical team functioning. The purpose of this randomized controlled study was to evaluate how expressions of gratitude shape NICU medical staff diagnostic and therapeutic performance and prosocial behaviors. Medical staff reported high perceived levels of gratitude when expressed from mothers compared to the control group (same agent with neutral statement). There was no difference in medical staff perceptions of gratitude when expressed from expert physicians compared to the control group. Teams in the maternal gratitude group demonstrated higher scores for therapy plans, procedures, general therapeutic scores, information sharing, and workload sharing. There were no significant differences between the maternal gratitude and control group with regards to diagnostic scores and confidence in diagnosis. In mediation analysis models, information sharing was found to affect both team and diagnostic procedural performance. For providers, increased face-time with families may allow for exchanges in gratitude that may boost diagnostic/treatment outcomes and prosocial team behaviors.
Relevant Reading: The impact of rudeness on medical team performance: a randomized trial
Study Author, Dr. Arieh Riskin, MD, MHA, talks to 2 Minute Medicine: Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel:
“I think our article is important to read because our findings indicate that while patient/family-expressed gratitude may not necessarily boost the motivation of medical personnel to provide high quality care, it does boost their collective ability to do so. Accordingly, while the encouragement of gratitude and other small, positive interpersonal gestures may demand nothing short of culture change on the part of the medical community and those they serve, our findings suggest that the benefits may well be worth the effort. This reminds me of the Chinese proverb: “Every smile makes you a day younger” – small positive gestures, like expressions of gratitude from our patients and families, make a lot for us, and help us do our work better, providing better care to our patients (in my case our very tiny fragile preemie patients).”
In-Depth [randomized controlled trial]: Teams consisting of 2 physicians and 2 nurses were randomized into 4 video exposure conditions: maternal gratitude (N = 42), expert physician gratitude (N = 43), maternal/expert physician gratitude (N = 40), and control (same agents communicated neutral statements, N = 38). Teams were then directed to identify a diagnosis and establish a treatment plan in four neonatal medicine emergency scenarios. Two NICU staff (senior physician, senior nurse) who were blinded to the exposure condition, then observed and rated team performance on a 5-point Likert scale. Interrater agreement was deemed sufficient (RWG > 0.75). Teams were rated on diagnostic score, therapy plans, procedural score, general therapeutic score, confidence in diagnosis, information and workload sharing. For data analysis, the control data included the neutral group and expert group (N = 22 teams), and the gratitude group included maternal and maternal/expert physician gratitude (N = 21 teams).
Age and team experience did not differ significantly between groups. In validity analysis, medical staff in the maternal gratitude exposure had higher perceived scales of gratitude compared to control (4.8 ± 0.4 vs 4.5 ± 0.6 P < 0.001) – a finding that was not present for the expert physician gratitude group (P > 0.10). There was no significant difference between groups for diagnostic score and confidence in diagnosis. However, the gratitude exposure group in comparison to the control group had higher ratings for therapy plans (3.9 ± 0.9 vs 3.6 ± 1.0, P = 0.08), procedural scores (3.9 ± 0.9 vs 3.6 ± 1.0, P = 0.008), general therapeutic score (3.9 ± 0.9 vs 3.6 ± 1.0, P = 0.04), information sharing ( 4.3 ± 0.8 vs 4.0 ± 0.8, P = 0.03), and workload sharing (4.3 ± 0.8 vs 4.0 ± 0.9, P = 0.02). While the gratitude condition positively affected both information and workload sharing, in mediation analysis, it was primarily information sharing that explained the positive effects of gratitude on diagnostic and procedural performance.
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