Study explores how health care workers share appreciation, promote positive workplace culture

Health care organizations, in reviewing care delivery opportunities and providing feedback to staff, often focus on what went wrong, but a new study suggests that reversing this perspective may help organizations improve their work culture by understanding what went right. A team of Mass General Brigham researchers analyzed peer-to-peer positive feedback, systematically collected when caring for a dying patient as part of a mandatory mortality review process.

They found that standardized collection and sharing of positive feedback—what went right—is a feasible way to increase mutual appreciation among health care workers and to provide valuable information to leadership on the hospital's culture of teamwork, collegiality, and civility. The study is published in The Journal of General Internal Medicine.

Researchers analyzed survey responses from 388 physicians, 212 nurses, 64 advanced practice providers and 1 respiratory therapist at four Mass General Brigham hospitals. Health care workers provided positive feedback to their peers about 1) exceptional patient and family-centered care; 2) a provider's expertise and composure; and 3) empathic peer support and effective team collaboration.

Analysis of positive feedback shows clear patterns of feedback across specialties. The positive feedback in medicine, neurology, hospice/palliative care, and surgery focused on patient care while, within emergency medicine, the focus was on expertise and composure. Most positive feedback acknowledged specific individuals, and nurses provided the most feedback across roles compared to other clinician types.

Study limitations include limited generalizability since the study occurred at a single health system and not collecting outcome data on adverse events, operational efficiency, or clinician well-being or attrition— all of which need to be examined longitudinally in different clinical contexts.

"Our study provides rich, qualitative data that highlight the amazing work that our clinicians provide on a daily basis," said first author Isaac Chua, MD, MPH, a palliative care physician at Brigham and Women's Hospital.

"Systematic collection and sharing of positive feedback is a grassroots, low-cost intervention that can help health care leadership understand and improve workplace culture based on the value system of its employees. Receiving and sharing this feedback may also help health care workers feel more valued at work, which may protect them against burnout and attrition."

"Every day, we review and learn from safety reporting and mortality reviews on how to improve patient care as well as scale best practices," said Mallika L Mendu MD, MBA, vice president of Clinical Operations and Care Continuum at Brigham and Women's Hospital. "It is time for us to systematically learn from positive feedback provided by and about our frontline staff. Our study provides foundational knowledge of how to develop a systematic tool and share data with frontline staff as well as organizational leaders to foster improved culture."