This article is all about the power of thank you in medicine along with something called the “Magic Ratio”. Want to know what the “magic ratio” is? Well read on…

I recently had the honour of presenting at the first-ever onthewards conference. I was given the opportunity to discuss the issue of positive leadership in medicine.

Be a good leader, remember the power of thank you in medicine

My presentation was about the management challenge that most doctors find in stepping up to the senior role. In short that most senior doctors feel poorly prepared for our role in leading and managing others.

The first part of my thesis was that senior doctors can positively impact medical culture by becoming better managers. The second part was that trainee doctors can learn to empathise with the management challenges of their senior doctor bosses. If trainees can understand why one’s boss may be driven to act and behave in a certain way; they can often see that it is not personal. And we may even be able to work with them. So that they can give us the sort of leader support we are craving.

But what about trainee doctors as leaders?

But what about trainee doctors as leaders was the question from the floor? Or more specifically when am I in the leader or manager role?

It’s quite true that there are lots of moments in the day of a trainee doctor where they are in a leader or manager role. Just like senior doctors who become Consultants, we don’t need the title of Manager or Chief or Director to be able or required to lead or manage.

The example offered was of the resident medical officer on an evening shift being called by a nurse from the wards.

“Am I leading or managing in this situation?” was the question.

My immediate response to this questions was. “Yes. Indeed you are.” But upon deeper reflection, it would be more correct to answer, “It depends on your behaviour.”

The informal leader and role model

You see there are simple things we can do in the workforce to demonstrate informal leadership on a regular, even hourly basis, even if we are “the junior doctor” on the team. Two of these behaviours are effective praise and role modelling.

Think about the last time you called a registrar or consultant for advice about the patient. What was their reaction? Hopefully, it wasn’t something like this. Hopefully, at the end of that phone call or perhaps after they reviewed the patient and wrote in the notes there was a thank you.

Now, think about how that made you feel. Calling a senior can be a daunting experience. We know it’s their job but we are not the experts so there is often that niggling doubt which we call Impostor Syndrome that makes us feel nervous about this interaction.

Now, think about the situation in reverse. Where you are the resident taking the call from a member of the nursing staff on the ward. This person too may have doubts. They may be truly concerned for their patient (that’s the one that has just become your patient as well). They are just doing their job.

Finally, think about how often we are thanked for doing our job versus how often we may be told that we have done our job wrong.

“When you think about it we work in a team and you are not just thanking someone for doing their job you are actually thanking someone for helping you do your job.”

The emotional impact of negative feedback

Most of us can relate to the emotional impact of being given negative feedback on our job performance. There are plenty of studies that show one piece of negative feedback can linger and affect work performance for days. At times junior doctors do need to know where they are going wrong. But how can we moderate the negative impact of this criticism?

What’s the right mix of positive to negative feedback?

So what’s the amount of positive praise we need to cope with the occasional negative feedback?

It turns out that there has been a fair amount of study put into this particular question and the rule of thumb is FIVE to ONE.  That’s five amounts of positive feedback to counter one piece of negative feedback.

In order to understand the difference between happy and unhappy couples, Drs John Gottman and Robert Levenson began a longitudinal study of couples in the 1970s. They looked for observable characteristics in couples who were asked to solve a conflict in a 15-minute session. At 9 years follow-up, Drs Gottman and Levenson were able to successfully predict which couples would stay together or divorce with a remarkable degree of accuracy based on a small number of predictive factors.

Chief amongst these was the concept of a “magic ratio” of positive to negative reactions.

From couples therapy to business

Now granted we are talking about couples and partners here. But similar results have been found in business. In fact, in business, the magic ratio for high performing teams is even higher at 5.6 to 1. So the actual ratio might differ in your workplace but these studies provide some empirical information to remind us about the power of negative interactions versus positive.

Positive feedback and the power of thank you in medicine

In my own personal career in medicine, I have never felt that I have overdone positive praise and thanks. When you think about it we work in a team and you are not just thanking someone for doing their job you are actually thanking someone for helping you do your job. It’s surprisingly easy to forget to do. So I often try to find spare moments to dedicate time to this practice.

That’s the power of thank you in medicine.

What about you? What’s your ratio of positive to negative feedback?

Want to hear more about leadership and management challenges in medicine? Then hop over to Anthony’s YouTube channel – career doctor online