Change your tone, change their tune

When I walked around the nursing home, I did what many administrators do. I pointed out the med cart left unlocked, the resident with a stain on her shirt and the bathroom with the unlabeled toiletries.

A certified nursing assistant (CNA) said something that has stuck with me for years. She said: "All you do is see the negative."

My immediate reaction was to defend myself, both in my head and to the person who had spoken these words I was finding hard to swallow. When I returned to my office, I couldn't stop thinking about her words. Was she right? As I reflected, I thought about how I pointed out a few positive things but not nearly as many as the negative. I realized her words hurt so badly because they were the truth.

Scientists call this the negativity bias. As humans, we are hardwired to notice bad things instead of good ones. That's helpful if you are a caveman who always has to be on the lookout for danger. It’s not so helpful if you are a leader trying to inspire better employee performance.

As an administrator, I followed the advice we've all heard: praise someone, deliver a criticism and then praise them again. I assumed my walking around was morale building and uplifting, but the CNA opened my eyes to how staff really interpreted my feedback, as mostly negative. I knew staff members were motivated by genuine compliments not criticisms, but at the time I wasn’t aware of how much it actually mattered.

Research from the University of Michigan's Ross School of Business shows leaders and managers should use positive comments a lot more than negative if they want the best outcomes from their teams. The study found that the positive should be shared about six times more than the negative. Teams that did this were the best performing in the study as measured by profitability; customer satisfaction; and assessments by superiors, peers and subordinates. Comparatively, the worst-performing teams, those that performed poorly on all three measures, used three negative comments for each positive one.

When the focus is only on the negative, the message is, "Nothing you do is good enough." Criticism lessens the enthusiasm and commitment of staff members. Tellingly, lack of praise ranks at or near the top of employee issues in almost every employee engagement study. The Gallup Q12, a 12-item employee engagement assessment, asks if the employee has received praise in the last seven days. Variations in responses are found to be responsible for a 10 to 20 percent difference in revenue and productivity. Employees who regularly receive praise and recognition are found to have better safety records, fewer accidents on the job and are more likely to stay with the organization. Positive feedback isn’t just good for employees. Customers served by those employees reported increased loyalty and satisfaction, too.

The option of not sharing any feedback and assuming people instinctively know they are doing a good job doesn't work, either. In fact, the U.S. Department of Labor states the No. 1 reason people leave their jobs isn’t pay or benefits. It's that they don't feel appreciated.

I knew from all of my reading that I needed to change. I made it a priority to look for anything and everything going right and immediately praising the person who made it possible. More importantly, I usually held my tongue when I witnessed things done differently from how I would have done them. My line in the sand was drawn if the offending problem could injure or harm a person.

As a consultant, I often get asked if it's possible to give too much recognition. Leaders sometimes voice the fear that copious amounts of accolades would be seen as insincere. The fact is, specific feedback that highlights exactly how the person made a difference can't be shared too often. However, if it's delivered in a way that seems like an obligation, it will be viewed as disingenuous. But, by emphasizing specifically what employees did and their impact, they are encouraged to do more of it.

What’s the best way to praise employees? The answer isn't an employee of the month or annual banquet. These don’t normally let people know exactly what is being honored. Worse, programs where staff members see the same faces on the wall or just wonder who's up next encourage bitterness, not pride. This is especially true for the people who work behind the scenes. The nursing assistant who works in the rehab area might have plenty of thank you letters from discharged patients, but chances are the business office manager isn't getting too many expressions of gratitude penned by those receiving a bill in the mail.

Instead, frequent, specific and—most importantly—genuine praise is what works. For praise to be meaningful, it must depend on the person. Some people love public recognition while others just need a quiet word of praise in the office. What you like for praise might not be what the receiver likes.


How can you determine what works for each individual? Ask! Some questions might include:

  • What is the greatest recognition you recall receiving?

  • What form of thank you do you find the most motivating?

  • Do you prefer to be recognized in private or in public?

In addition to individual positive recognition, remember to praise teams for their efforts and outcomes. To help break down the barriers that so often exist among departments, recognize people who work together in a certain area or on a certain project as a group. It will connect the group even more and support teamwork throughout the organization.

Based on all the research, it might seem that negative feedback should be avoided at all costs for fear of disengaging employees. But critical feedback is also vitally important. People need to know what they can do better and letting bad habits or missteps "die from neglect" rather than addressing them head-on is a recipe for mediocrity. Unlike positive feedback, however, correcting a behavior or mistake normally doesn’t inspire people to put forth their best efforts.

When clients tell me they want to improve their customer service, I suggest they fight the negativity bias and challenge them to make praise part of their daily routine. Everyone wants to know their work matters and that someone cares. Seek out any and every reason to praise and use correction judiciously. Notice more of the good than the bad and share specific positive feedback about it. As employees feel recognized and appreciated for their efforts, their positive state of mind will impact the overall culture of the organization. Chances are you won’t only change your employees’ outlook, but your own as well.

Denise Boudreau-Scott is Principal of Denise B. Scott, LLC, a consultancy that helps healthcare organizations improve the resident and staff experience. She is also a former nursing home and assisted living administrator. She can be reached at

Topics: Articles , Executive Leadership , Facility management , Leadership , Staffing