Everyday Gratitude in Re-humanizing Work Environments

Everyday Gratitude in Re-humanizing Work Environments

Guest Blog by Sandy Carter, Ph.D.

As a nation, in the United States, we’ve recently come through a very bitter and divisive presidential election process. I was frequently keyed up as if in immediate danger. When I paused to reflect on what was going on I realized nothing in my environment had changed, but the collective dialogue was stimulating fear and uncertainty in me and almost everyone I knew. It was as if we were all locked into a negative reality show that we couldn’t escape no matter where we turned. Sadly, the election results haven’t done much to alleviate these feelings. Fear and uncertainty linger as our leaders send conflicting messages and their words and actions don’t align.

As 2016 nears completion we’ve entered into the holiday season bringing added demands and stretching stress levels even further. Now, more than ever, it is vital we define practices that promote calming and centering. It is critical we intentionally and courageously re-humanize our work environments creating spaces that are harmonious, joyful and support conditions for positive connection.    

Research suggests one aspect of the season that is a natural part of our tradition promotes wellbeing and lifts our spirits – expressing gratitude.

Gratitude is one of the virtues positive psychology researchers study. Positive psychology is a scientific study of human flourishing that emerged about 17 years ago. It evolved from traditional psychology moving beyond focusing exclusively on the study of distress and pathology. The study of positive psychology is geared towards what works and assists individuals, organizations, and communities to thrive. According to the research, gratitude is important because it strongly correlates with greater health, happiness, and wellbeing – emotions that support flourishing!

The Oxford English Dictionary defines gratitude as “the quality or condition of being thankful; the appreciation of an inclination to return the kindness.” The word gratitude is derived from the Latin gratia, meaning favor, and gratus, meaning pleasing. Gratitude is expressed worldwide and is a universal human quality.  

There are various expressions of gratitude and also a difference between expressing gratitude and being a grateful person. For example, most of us express gratitude at appropriate times as we’ve been socialized to have good manners, but to truly be a grateful person goes deeper. This occurs when we recognize we’ve received something positive from another. Research suggests reciprocal relationships have their basis in altruism and are rooted in our ability to be empathic with others. There is evidence grateful people are more likely to sacrifice individual gains for communal profit. Expressing gratitude at this level connects us to something larger than ourselves – such as other people, nature, or even a higher power. When we practice “everyday gratitude” we’re intentionally weaving thankfulness into the fabric of our lives, and the benefits are enormous.

Barbara Fredrickson Ph.D., a leading scholar in the positive psychology movement, developed the broaden-and-build theory. Fredrickson suggests positive emotions broaden our thought-action repertoires. This, in turn, builds our personal capacity at various levels (physical, intellectual, social and psychological), enhancing resources from within.  Fredrickson states “Gratitude opens your heart and carries the urge to give back – to do something good in return, either for the person who helped you or for someone else.”

Robert Emmons Ph.D., wrote the book Thanks! How the New Science of Gratitude Can Make You Happier, and is one of the world’s experts on the science of gratitude. Emmons indicates it would be easy to minimize the emotion of gratitude as common in everyday life and therefore see it as very simplistic, but Emmons stresses this is not the case. He says,  “[I] soon discovered that gratitude is a deeper, more complex phenomenon that plays a critical role in human happiness. Gratitude is literally one of the few things that can measurably change peoples’ lives.”

Emmons conducted research with his team asking participants to journal daily on three themes over a ten-week period. One group noted things they were grateful for; another group noted things that irritated them, and the third group wrote about things that affected them (not labeling them positive or negative). The results showed, after describing in a single sentence five things they were grateful for daily, the gratitude group had a 25% increase in happiness. It also helped people take more positive actions in their self-care.

Having a daily practice of gratitude enhances our happiness and wellbeing. According to the scientific literature, becoming happier brings us greater experiences of joy, contentment, love, pride, and awe. It also improves other aspects of our lives: higher income, stronger social support, more energy, more robust immune systems, higher engagement at work and in relationships, and our own physical and mental health. Happiness boosts feelings of self-confidence, creativity, and self-esteem as well.

However, regardless of the benefits, it turns out developing gratitude towards others is not necessarily easy to do. To recognize and express gratitude, one must be vulnerable. The literature explains expressing gratitude places a person in an inferior position related to their benefactor, as they are acknowledging the positive in their lives and recognizing that it is external coming from someone or something else. For this reason, Aristotle viewed gratitude as incompatible with magnanimity and did not include it in his list of virtues. According to Aristotle, magnanimous people insist on self-sufficiency and find it demeaning to be indebted and, consequently, grateful to others.

It takes courage to develop a practice of gratitude because the expression of gratitude stimulates an uncomfortable feeling of dependency. Suffice it to say – gratitude is a complex and multilayered concept that challenges our western values of independence, self-sufficiency, and self-interest. There was a time when I was so engaged in the daily struggle of surviving with my head to the grindstone that I did not often look up to see the gifts around me. The tricky part is that I framed this as striving towards success, as I rigidly defined the American dream. I often felt burdened and certainly had good manners, but was limited in my capacity to genuinely give and receive. I associated those experiences as weak or even insincere when expressed by others. My life was out of balance related to relying on myself and receiving support from others in authentic ways.

A number of things shifted my mindset, allowing me to embrace a spirit of gratitude. One critical incident was when my daughter, Kyrsten, gifted me with a “gratitude jar.” This eventually led to a daily gratitude practice I’ve sustained ever since. Each day, I reflected on the things I was grateful for, wrote them down, and placed them into the jar. Initially, I did it because it seemed like the right thing to do to be appreciative of my daughter’s gift. What I didn’t count on is how gratitude practiced daily became a superpower for me. Over time, I internalized the practice and now go to bed and wake up reflecting on what I’m grateful for. The more I embrace gratitude, the more it grows and spontaneously flows into my life in big and small ways – uplifting and energizing me.  

In 2013 the John Templeton Foundation surveyed 2,000 Americans asking them how likely it was for them to feel and express gratitude at work. Survey results ranked participants last (regarding work) in terms of the things they were grateful for. Many of the participants reported that expressing gratitude to colleagues makes them feel happier and more fulfilled, but only about 10% acted on the impulse. The other 60% said they do not express gratitude at work or do so about once a year. The results indicate we suppress being thankful at work, even if we would be happier doing so.

Cultivate gratitude at work

Intentionally cultivating gratitude on the job makes people feel better, and research indicates it improves the bottom line. Here are some ideas for re-humanizing your work environment through the practice of everyday gratitude.

• Express your gratitude clearly and consistently by saying “thank you” both privately and publically. If you’re in a position of power – incorporate gratitude into performance evaluations
• Thank the people who do the mundane tasks and rarely get thanked. Every organization has people who are not as high profile, yet, make a difference in the work place setting
• Expressions of gratitude must be authentic – it is not how much you express gratitude (quantity), but how sincerely you express gratitude (quality) that matters. It is also important to pay attention to individual preferences for receiving gratitude.  
• Be creative – Discover ways to deliver gratitude in unique ways. One example, build a gratitude wall. Gift giving also fosters gratitude.

Cultivating a culture of gratitude can support employees in mediating conflict, and dealing with the natural part of their work environment related to failures and change. There is scientific evidence indicating grateful people are more resilient to stress and in dealing with large and small-scale change efforts.

Gratitude plays an essential role in making the world we live in a better place. It evolves our collective humanity as it binds us together in community. Our differences are vast and significant right now, but these differences need not supersede what defines us at our core. We must unite around our common values and desire to live good lives. As the research (and common sense) indicates, a simple practice of gratitude can make us stronger individually, and it can make us more humane collectively. 

Remember, gratitude is a choice! Developing gratitude is like building any habit. It is a skill that can be enhanced with dedicated practice. Having a life orientation that focuses on noticing and appreciating the positive can help us to re-humanize our work environments. During times of heightened fear and uncertainty shifting our focus towards happiness and wellbeing becomes a necessity more than ever before.

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Sandy Carter, Ph.D. works as a physician coach and consultant. Sandy is a professional certified coach, holds a PhD in organizational management with a specialization in leadership, and Masters in Business Administration and Social Work. Her research is in the area of transformational leadership with physicians, and wellness and resiliency.

Update on the Humans Working to Create Human Work Environments

Gary and Dave started this blog as a place to put some of their work and conversations on the need for re-humanizing work environments. At the time, both were working in clinical psychiatric practice in New Zealand, although that is no longer the case. Despite meaning well and continuing to periodically chat about ways to move these concepts forward, a number of years have passed since we last posted on this site, November 10, 2012. Now, over three years later, Dave has moved back to the States, but is living in Seattle. Gary has transitioned out of clinical practice and is splitting his time between Wellington, New Zealand and Melbourne, Australia, where he has enrolled in Interior Design Interior Design at CATC / Billy Blue School of Design, Torrens University.

What remains the same is Gary and Dave’s friendship and shared passion for making the world a more “human” place and we would like to re-commit to periodically posting on this blog as we feel it is still a much needed perspective in an environment so often shaped by political, economic, and institutional needs that leaves out basic human needs.

We will each provide a blog entry as an update on what we have each been up to these past few years – then we will get back to work on posting some more of our thoughts and work on Creating Human Work Environments. Here is Dave’s update…

Dave left New Zealand at the time of the US government shut-down, late 2013. He ended up extending his time in New Zealand for a month, but in the end came back to the US without having a signed contract for a job. A few weeks later, he received the contract and started at the Seattle Division of the Puget Sound Veterans Affairs Health Care System. He works in Primary Care Mental Health Integration (PCMHI), doing same day walk-ins, follow-up appointments, and co-leading groups for veterans. The philosophy of PCMHI is to have easy access, brief treatments and triage, and to build collaborations with primary care providers.

Dave has developed, with his team, two different classes for veterans. The first was an adaptation of Joseph Campbell’s hero’s journey model for veterans. This is a 12 session class that uses ancient and modern mythology, story, narrative, mindfulness, poetry reading, and reflective writing in a 90 minute session. The focus is away from specific diagnoses and toward a recovery model of looking at strengths. We look at military service and return to the civilian world through the lens of cultural adjustment and nervous system re-training. Campbell also spoke of the hero’s journey as an initiation process, of moving through the phases of separation, initiation and return. We encourage the Vets to do a Hero’s Journey Project for the last class, putting together in a creative form their life story in a hero’s journey framework. Here is an example of my hero’s journey painting.

The other class is the Whole Health Class. This class adapts the Circle of Health and whole health concepts coming out of the innovative national VA Office of Patient Centered Care & Cultural Transformation. This is a drop-in class that veterans can attend as suits them. We have 9 sessions that continually rotate, including: physical body, surroundings, personal development, nutrition, sleep, relationships, spirit & soul, and the positive power of the mind. We do a 9^th session each round which is an integration session. We have found this class to be an excellent tool, not just to engage veterans in proactive, personalized, and patient centered care, but also as a way of engaging with other staff as we have run a version of the class for all the primary care nurses and are also preparing to run it for a LEAN change management program for administrative staff. 

Another component of my work at VA is that I started and coordinate a monthly Integrative Health Workgroup that brings together people working across disciplines and service lines who are passionate about integrative health & medicine.

Additionally, I have been continuing my writing. My first book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine was published in late 2014. That same year, I began collaborating with Native American visionary, Joseph Rael (Beautiful Painted Arrow). He and I have great fun together and he is a great teacher and friend. Our first book together is due out in July of 2016 through Millichap Books and is called, Walking the Medicine Wheel: Healing Trauma & PTSD. I am very excited about this work with Joseph and we are both artists as well, so the book should be beautiful as it will include both of our paintings. Here is a link to the pre-publication webpage and here is the working cover:

It has been a bit of the journey, moving back from New Zealand to the States, coming full circle to working back in the VA (my first job was at Omaha VA) and working with trauma and PTSD again a great deal. However, this time around I bring a deepened cultural awareness as well as deeper roots in integrative & holistic medicine. (Oh, and I also passed my third board certification, the newly formed American Board of Integrative Medicine!). I still miss New Zealand a lot – the people, the whenua (the land) and the moana (the ocean), but I have had a great number of professional opportunities here. 

Update on the Humans Working to Create Human Work Environments

Gary and Dave started this blog as a place to put some of their work and conversations on the need for re-humanizing work environments. At the time, both were working in clinical psychiatric practice in New Zealand, although that is no longer the case. Despite meaning well and continuing to periodically chat about ways to move these concepts forward, a number of years have passed since we last posted on this site, November 10, 2012. Now, over three years later, Dave has moved back to the States, but is living in Seattle. Gary has transitioned out of clinical practice and is splitting his time between Wellington, New Zealand and Melbourne, Australia, where he has enrolled in Interior Design Interior Design at CATC / Billy Blue School of Design, Torrens University.

What remains the same is Gary and Dave’s friendship and shared passion for making the world a more “human” place and we would like to re-commit to periodically posting on this blog as we feel it is still a much needed perspective in an environment so often shaped by political, economic, and institutional needs that leaves out basic human needs.

We will each provide a blog entry as an update on what we have each been up to these past few years – then we will get back to work on posting some more of our thoughts and work on Creating Human Work Environments. Here is Gary’s update…

Some ideas about design and the healing environment:

Over the last couple of years, Gary has become increasingly dissatisfied with the constraints of a profession that in his view, maintained a narrow and biased adherence to bio-medical models with a limited capacity to step beyond these. There are some regions of the world that are more amenable to working within an Integrative Medicine Paradigm, but living in a part of the world with a conservative professional approach, he felt that it was time to create a significant change professionally leading to a better work life balance, enhanced creative potential and the realization of a long held passion to pursue a career in design and the decorative arts.

Gary was always inspired by trying to improve the difficult situations that we all as fellow human beings find ourselves in. It was this desire that initially led him into medical practice as opposed to pursing a career in the creative arts. Even though he has tried to create shifts in service design, and look for novel methods of improving service delivery and access, he has often found himself working against a series of bureaucratic processes that prefer to maintain the status quo – a malady of many of the systems that we all find ourselves in.

Gary then set about developing the creative and artistic elements of his skill set by studying Interior Design at CATC / Billy Blue School of Design, Torrens University in Melbourne Australia. Gary sets out to explore the nature of our relationships and dynamics in relation to the spaces that we occupy as human beings - believing that we all need a space to feel welcome, safe and serene. This sense of space and well-being can be sensed in the recently built Melbourne Children’s Hospital, which clearly demonstrates a superb sense of space, light, harmony and transparency in a health care provider setting.

Ref: http://blogs.rch.org.au/news/files/2013/08/Untitled_Panorama1-copy_01.jpg

A photograph of the foyer of the hospital shows a wonderful, bright, cheerful and life enhancing setting with access to clearly defined spaces, a human scale of the elements in the building, bold and fun use of colour, all bringing together a well designed space that is delightful for patients, their parents and caregivers, as well as a pleasant, and uplifting space for staff and health care workers.

The clever use of design in our work and built environments is a fantastic investment in both the clients and staff that use such spaces. Ideas of design and the impact that the designed space has on human behavior and interaction is an area of research for academic psychologists, architects and academic interior designers. Academics working within these collaborative domains have shown many positive benefits to improving the spaces that we all use.

Academic researchers have demonstrated that access to nature and views of nature have improved recovery rates for surgical patients (1) who also used less painkilling medication, when compared to a group of people whose recovery space looked out onto a brick wall.

We would all likely agree that stress exerts significant effects on our health and wellbeing – some would argue that stress is the experience of feeling overwhelmed by external stimuli such as those experienced by adverse environmental, occupational and psychological pressures. Whilst we are not attempting to write a comprehensive review of the academic literature, a quick google search will reveal any number of scientific papers that indicate the positive benefits of environment on our health and well-being.

A paper of interest with respect to environmental effects showed the effects between two groups of healthy students exposed to stressful tasks which was subsequently followed by either listening to classical music or a 20-minute rest period. The group of students that listened to classical music showed positive benefit to the experience when they had a variety of measures of blood pressure take at the end of the experimental period. This allowed the researchers to suggest that classical music may stimulate a part of the nervous system involved in stress reduction and that listening to classical music can be of benefit as a tool for stress reduction (2).

The designed environment should include all aspects of our sensory experience and health care managers need to begin to address these issues, but sadly there are limitations in that so many of these ideas do not have well researched economic advantages in the scientific literature and as such get ignored. As a consequence, we then experience poor design and poorly thought out environments that add to both patient and health-care worker stress.

One of the more bizarre examples of poor design that has been personally experienced by the author, was the display of old surgical instruments located outside the main entrance way to a day surgical unit – just think of the impact that seeing crude old fashioned surgical instruments would have on someone who was walking into the unit for a day-case surgical procedure. This display is likely to be very well intentioned, but somewhat unfortunate in it’s locality – surely a wonderful photograph of the magnificent mountains, beaches and ocean of the locality would have been of much greater humanizing benefit to those entering the space.

Gary’s own experience of the arts and music in a health care setting stretches back to his early days of training as a psychiatrist where he had the great fortunate to work along side The Nightingale Project running through a variety of mental healthcare sites in central London (3). Recollections of being able to walk into the Outpatient Department waiting area as a clinician and witness different and changing art displays was an uplifting experience – indeed one that often served to break the ice when meeting with new people.

It is our view that the creation of a human working environment by both understanding the interaction that we have with each other and also the environment around, whilst complex and multi-dimensional is equally important and if the medical profession and health care economists ignore such ideas, then they do so at great loss to the patients and health care workers.

We hope that we have gathered some interest in our ideas, and that you will join us on our journey of interesting and different viewpoints of a truly integrated and holistic set of ideals linking health, well-being, spirituality and environmental ideas into a healing circle integrating our physical and spiritual domains. On this journey we would like you to join us in thinking about how we relate to the environment around us, our community, and society around and the spirituality that is within us all.

References:

(1)   Ulrich, R.S. 1984. "View through a Window May Influence Recovery from Surgery." Science 224(4647): 420–421.

(2)   Lee Kyoung Soon, Jeong Hyeon Cheol, Yim Jong Eun, and Jeon Mi Yang. The Journal of Alternative and Complementary Medicine. January 2016, 22(1): 59-65. doi:10.1089/acm.2015.0079.

(3)   http://www.nightingaleproject.org