The empowering force of gratitude

This is article nine in an RCVS Knowledge series of features on patient safety, clinical human factors, and the principles and associated themes of Quality Improvement (QI).

It was Friday 6:00 pm, only half an hour to go. Sophie checked the weather for the weekend and smiled to herself as her app showed nothing but sun. The weekend couldn’t get here any faster. The week felt longer than it actually had been, and she had spent every ounce of energy on saving a sweet yellow puppy named Garfunkel, from the clutches of parvovirus. But her expert team pulled him through and they all feasted on the elaborate thank you gift of chocolate and biscuits from his grateful owner. Her last consult was an easy vaccination with one of her favourite clients, who always requested her.  She breathed a sigh of both satisfaction and relief. Not long now and she’d be in her garden with a glass of wine.

Determined to make the most of the next few minutes, she checked her email for lab results.  Instead, she opened a message from the practice manager, Linda, who outlined a recent complaint, in minute detail, made by a client.  Linda reassured her there was nothing to worry about, but could she please drop by her office first thing on Monday morning. Sophie remembered the patient well, a complicated case that had required lengthy discussions about treatment options. She thought, ‘What did I do wrong now, I thought everything had gone so well?’ Her jaw tensed as she slumped against the consult table; she began to prepare mentally for the meeting on Monday.

Veterinary teams do extraordinary things every day.  We cure and prevent disease, relieve pain and suffering, improve quality of life and provide comfort during the most heartbreaking of times. More often than not, good outcomes are achieved when happy patients go home, or by giving the gift of relief, and clients express their gratitude in heartfelt cards and chocolate. But once in a while, things don’t go how we would have hoped or clients feel compelled to complain. In a profession rife with perfectionists, this can be hard for us to handle¹.

On balance, one would think that we would spend a lot of time taking joy in our work. What the healing professions and their support roles get to do every day touches the highest aspirations of a compassionate civilisation². But the opposite is often true. 

As perfectionists, we are more prone to look at what we haven’t achieved rather than what we have.  Our minds have been programmed to look for the negative, based on past experience, and what we look for, we find more of.  Professor Alison Ledgerwood, a behavioural scientist from the University of California at Davis, conducted research looking into negativity bias³.

Research results

Two groups of people were brought into the research lab. Group 1 was told that a surgical procedure had a 70% success rate, which was considered by the group to be a success. Group 2 was told the same procedure had a 30% failure rate, which was viewed negatively. Both groups were essentially given the same information, but with different emphasis on the positive and negative.

Then Group 1 was told that they could also view the procedure as failing 30% of the time. This caused Group 1 to change their mind and they now viewed the procedure as a failure. Group 2 was told that they could also think of the procedure as having a 70% success rate. However, Group 2 did not change their mind and still had a negative view of the procedure.

This research begins to demonstrate that our minds get programmed with a negative bias and it is hard for us to change and think positively. When we add perfectionism into this mix and our expectations are set too high, we beat ourselves up if we don’t meet them. Even if we do meet them, we don’t seem to be able to take the credit. So, this striving to be perfect hurts us, rather than helps us. Instead, what we can do, is do our best. 

Accentuate the positive

So how do we change the negative programming that isn’t serving us and focus on the positive?  The good news is that it’s possible, but we have to work at it as our minds won’t do it naturally.

This isn’t to say that we should just brush negative feelings aside or that we can’t feel sad, anxious or angry. These emotions are a part of life. But what will keep us swimming in the ocean of good and bad, is looking for what we can be grateful for, even at the worst times of our life.

Practising gratitude increases our mental strength, by taking a proactive approach to building a positive mindset, changing the negative narrative that is scrolling through our head. It develops resiliency and gives us the advantage when we are faced with a stressful event, by helping us bounce back quicker⁸. Gratitude is an empowering force, but it takes time and effort to change our brain patterns.

Practise Gratitude

The practice of gratitude is free to use and is available to us at all times. The benefits have been reported as helping people to^5,6,7,8:

• Improve psychological health by reducing counter-productive emotions, such as frustration, resentment and regret. Grateful people enjoy higher wellbeing and happiness and have increased access to positive memories.
• Improve physical health. People who exhibit gratitude report a general feeling of health, fewer aches and pains and get more exercise.
• Improve their sleep. Practising gratitude can help you sleep better and longer.
• Generate happiness from within rather than seeking external sources.
• Improve relationships with others and enhance empathy. Expressing gratitude to others can help you make friends. Grateful people are more likely to behave with sensitivity and empathy.
• Enhance self-esteem, by being able to appreciate other people’s accomplishments.

But the time to learn to swim isn’t when you are drowning. Regular practice will help to build those gratitude muscles and help them remain strong, and can prevent slipping back into negative fixations. You can make a start by creating your own gratitude practice, such as keeping a gratitude journal. 

Writing down a few things that you are grateful for is one of the easiest exercises available.  The purpose is to reflect on the past day or week and remember 3-5 things that you are grateful for and why. Be specific. For example, ‘even though my patient died, I am grateful to my colleagues for treating me with compassion and support and that we have a process that has enabled us to put improvements in place. The whole team has learned from it, and we are better clinicians now because of it’.  The more you do it, the easier it will become⁸.

Strive for excellence, not perfection

In the veterinary profession, we work at saving lives and providing the best care, which we have translated into ‘we must be perfect’.  Perfection is a dead end, as there is no room to grow, so we must do the best we can.  Sometimes the situation does require more and we must learn from that. 

What we must realise is that our brain patterns guide us and create our reality.  If we look for the negative, we will find it.  If we look for the positive, we will find it.  What we must do is give ourselves the freedom to perform at our best.  In order to give our best, we can strengthen our mind by practising gratitude, reprogramming it with a positive frame, so that we are able to cope better and bounce back from stress, criticism or negativity and experience all of the benefits that showing gratitude can bring.

With deliberate intention and practice, gratitude is one of the simplest ways to transform our thinking and increase life satisfaction⁶. Empower yourself with gratitude. Try it for a month and see how your life improves. 

Checklist: What can you do next?

For those that want to do more to develop a positive mindset,

• The NHS has developed a tool to assist with positive reframing⁴.
• Adopt the NHS Going Home Checklist, which encourages gratitude and reflection.
• Visit PositivePsychology.com for more gratitude activities
• Listen to the podcast, The power of a growth mindset: why certain habits of mind matter in clinical improvement, by Bill Lucas.
• Download the Rolling take 5- Questions to discuss as a team to help improve communication and flag up required support for the team.

References

¹Perfectionism.  VetLife.  Available online: https://www.vetlife.org.uk/self-care/perfectionism/  Accessed on 19 May 2021

²Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. (2017). IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement.  Available at ihi.org

³Ledgerwood, A. (2013). Getting stuck in the negatives (and how to get unstuck). TEDxUCDavis. https://www.youtube.com/watch?v=7XFLTDQ4JMk 

⁴Suttie, J. (2020) How to Overcome Your Brain’s Fixation on Bad Things. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/how_to_overcome_your_brains_fixation_on_bad_things 

⁵NHS.  Positive Reframing, Gratitude and Managing Motivation.  Available online https://people.nhs.uk/execsuite/positive-reframing-gratitude-and-managing-motivation/  Accessed on 18 May 2021

⁶Ford, K. (2020) “The gratitude attitude”: growing evidence for medical and veterinary professionals, Veterinary Nursing Journal, 35:5, 130-132, DOI: 10.1080/17415349.2020.1742829

⁷Morin, A. (2014) Scientifically Proven Benefits Of Gratitude That Will Motivate You To Give Thanks Year-Round. Forbes.  https://www.forbes.com/sites/amymorin/2014/11/23/7-scientifically-proven-benefits-of-gratitude-that-will-motivate-you-to-give-thanks-year-round/?sh=d18648d183c0 

⁸Oppland, M. (2021)  13 Most Popular Gratitude Exercises and Activities.  PositivePsychology.com  Available online https://positivepsychology.com/gratitude-exercises/   Accessed on 19 May 2021

About the authors

Angela Rayner BVM&S PgDipPSHCF MRCVS

Angela is Quality Improvement Advisor for RCVS Knowledge, Director of Quality Improvement for CVS, and is an RCVS Knowledge Champion for her role in improving CVS’ systems for controlled drugs auditing.

In 2018, Angela began an MSc in Patient Safety and Clinical Human Factors at the University of Edinburgh. The programme supports healthcare professionals in using evidence-based tools and techniques to improve the reliability and safety of healthcare systems.

It includes how good teamwork influences patient outcomes, key concepts around learning from adverse events and teaching safety, understanding the speciality of clinical human factors, as well as the concept of implementing, observing and measuring change, monitoring for safety, and it focusses on quality improvement research and methodologies.   

Anisa Caine

Anisa Caine’s career path in training and education led from the forests – and classrooms – of Africa to the Middle East and on to Switzerland where she was consultant to multinationals and the UN.

She has a strong belief in human potential and its development, and to this end she has investigated the learning process, the transfer of knowledge and the development of thinking.  Anisa’s work focuses on breaking the barriers to human potential, and she champions excellence over perfection.

Through a series of on-going conversations, she is consolidating long-term interests: cross-cultural communication, inter-and intra-personal communication, multiple intelligences, and brain plasticity, with a special emphasis on self-knowledge.  Her multi-disciplinary approach, involving epistemology, humanistic psychology, philosophy and linguistics, enables her to bring an open questioning mind to her activities.

When she approached meditation and awareness, her enquiries combined global cosmologies with the scientific studies of Herbert Benson (Harvard Medical School) into the relaxation response and of Jon Kabat-Zinn (University of Massachusetts Medical School) into mind-body research.

She currently consults from the Scottish Highlands, with local clients and academics and other professionals from Switzerland and the US.