By David Quigley,MSW, PHR, Board-Certified Coach

How would you answer a physician who asked during new employee orientation, “Do you really expect us to smile all the time?” That question stimulated an interesting discussion in a group of newly-hired clinical and non-clinical hospital staff which resulted in clarifications and several key insights. I continue to reflect on it years later—more so recently, in light of my “deep dive” into patient experience with a loved one.

The physician who asked the question in orientation had not been born in the U.S. He went on to explain that, in his country of origin, if you walked around smiling all the time it might get you an all-expenses-paid full psychological assessment at the local mental health facility. In other words, smiling constantly could have been seen as unusual, concerning, and perhaps a sign of other issues.

What is the culture in your healthcare facility regarding smiling? And more to my point, does it make any difference? Is it simply a social pleasantry, or does smiling hold the potential to impact patients, families, other staff, and perhaps even the “smiling staff person” themselves? Farfetched? Perhaps; perhaps not.

For the past several years I have worked in the realm of patient experience. I have coached, taught, and observed delivery of care models in hospitals, medical clinics, hospices, home care agencies, and nursing homes across the country. Adding to the professional experience is my recent personal “deep dive,” spending 561 hours (and counting) witnessing care delivery to a loved one in hospitals and, now, a long-term care facility.

We, the patient and family, have benefited greatly and are deeply appreciative to have received some truly outstanding care from physicians, nurses, techs, food and nutrition staff, physical, occupational, and speech therapists, and housekeeping. Some has been subpar too, but for now I want to focus on two specific elements that have been present in every one of the individuals who delivered exceptional care to us. And I submit to you that these characteristics not only benefit the patient and family, but also the employee themselves.

  • First, many of the outstanding care providers that I’ve had conversations with possess a positive attitude about their role, the work they do, and how their work benefits others. They believe in what they do and are committed to it. Although this is a small sample, every one of the high-performing staff that I’ve had a chance to visit with over time exhibits this “positive role perspective.”
  • The next element is that they exuded a warmth, and nearly always presented with a smile. There was a felt sense of the unconditional positive human regard, a phrase developed by psychologist Carl Rogers.

These qualities could be considered essential engagement attributes that increase patient communication, patient compliance, and patient well-being. And they seem to be part of empathetic communication and a language of caring.

Of course, there are many other critical staff qualities such as competence and communication. Yet the care we receive that is delivered by staff who are intelligent and competent, but lack a smile and the accompanying warmth, empathy and compassion, feels like a lesser quality of care.

Now, what the potential benefits of positive attitude and smiles to the employees, themselves? Several years ago, Jim Collins in his book, Good to Great described a dynamic that is now being empirically demonstrated by neuroscience and positive psychology. At the “center of the flywheel” for all outstanding companies, he said, was the sense of meaning and purpose—doing worthwhile work and making a difference—embedded in the organizational culture and experienced by employees. This felt sense of meaning and purpose in and about one’s role can:

  • Increase engagement
  • Deepen fulfillment
  • Enhance creativity and innovation
  • Increase employee resilience and change hardiness
  • Reduce turnover
  • Propel the organization’s success

Given that healthcare is a complex, rapidly changing, and ambiguous environment these qualities might just be an excellent vaccine against burnout and compassion fatigue. So, go ahead…smile!