The surprising competitive advantage healthcare leaders need to know

Shawn Achor

Founder and CEO of Goodthink Inc.

The surprising competitive advantage healthcare leaders need to know

27 May 2019 | 19min

Quick Takes

  • Happiness leads to success and not the other way around

  • Creating a narrative around positive change that is role-modeled by leaders is crucial for creating long-term cultural change

  • Happiness is not a self-help movement, it requires individuals in an organization to connect socially with the ecosystem of potential that surrounds them

Shawn Achor is a leading positive psychology expert. His TED talk on positive psychology is one of the most popular of all time with over 19 million views.

This is part one of a three part interview series. Don’t forget to sign up to our newsletter to make sure you don’t miss the next segments highlighting his compelling work.

THE HAPPINESS FACTOR: A key competitive advantage – PART 1

HT: Shawn, you are the New York Times best-selling author of The Happiness Advantage and Big Potential. How do you define happiness?

Shawn Achor: I got started back at Harvard Divinity school. I was studying Christian and Buddhist ethics and one of the things I learned was that the ancient Greeks didn’t define happiness as pleasure. They defined happiness as the joy you feel moving towards your potential, which is extraordinarily different than the way we’ve been measuring happiness. We were thinking about pleasure like, “Is life always fun? Do you always have a smile on your face at work? Is life always easy?”. What we were finding was that type of pleasure was so short lived, it wasn’t worth us researching for very long.

There are two reasons why I adopted this definition of happiness as the joy you feel moving towards your potential. First of all, that type of joy is something you can experience even when life is not pleasurable – in the midst of changes in a political or economic landscape that make work more difficult, or in the midst of childbirth for example. It’s not high levels of pleasure all the time, but moments of joy can correspond with some of the highest levels of fear and pain we can experience. This gave us something that we could study even in the midst of difficult work and challenges people are experiencing.

Happiness turns on the brain to its highest possible level and improves every single business and educational outcome we know how to test for.

The other side of it is that I think people are afraid of happiness. As a society, we’ve become afraid of happiness because we think if I’m too happy I won’t work so hard, or I won’t be so serious. Medical errors could happen if I’m just focusing on pleasure all the time. But what we are interested in is something very different. We are interested in how do we find a way of improving the outcomes that people have.

We find that pleasure might lead to some negative outcomes, but happiness, the joy you feel moving towards your potential, turns on the brain to its highest possible level. It triples your creativity, dramatically improves your problem solving abilities, and improves every single business and educational outcome we know how to test for. So if we have big problems facing our society, we need to bring the best brain possible to bare upon that, which is why we changed the definition of happiness for this work.

HT: The healthcare industry faces a lot of pressure to do more with less resources. In such a high stress environment where time is critical and stakes are high, can people really learn to bring happiness into their workplace?

Shawn Achor: I think it’s such a great question because we are good at controlling happiness in a psychology lab for a college freshmen that we’re grading and where we can control most of the variables. What we’re interested in is how do we study happiness in the midst of the messiness of life, for example, trying to provide high levels of patient care while at the same time caring for aging parents ourselves or being awake at two, three, four o’clock in the morning with our own children. How do we create happiness in the midst of life where we don’t get to control all the variables?

So what I’ve done is intentionally taken this research out of the lab to battle test it in the midst of difficult circumstances. We’ve worked with hospitals post Hurricane Katrina, UBS bank in the middle of the banking crisis, farmers in Zimbabwe who lost their lands. We’ve worked on the one year anniversary of a school shooting. What we’re looking for is how do we create happiness when life is difficult because what we’re finding is happiness is a luxury item when things are great. When life gets difficult, that’s when we need our best brain possible to bare upon the situations.

This is why, for example, we’re doing some of the work with all the schools in Flint, Michigan. We’re not necessarily going into the schools that have everything. We’re going into places that are dealing with a water crisis and cyclical poverty because we believe that this research oftentimes works best when the challenges are the highest.

The power of a narrative 

Happiness, optimism and resilience get us through challenging times  

HT: You have been doing new research at the Genesis Health System in Iowa. Could you walk us through how you start a program to create change? What was their starting challenge they wanted to focus on?

Shawn Achor: The Genesis Health System is one of my favorite studies right now and it’s the newest of the research we have. Jordan Voigt is the president of the Genesis Health System in Iowa and I’ve learned so much about the medical profession in the midst of the challenges that they’ve been experiencing. He knew that they were about to go through a challenging period of time. They were going to have to go through two massive cost reductions, which actually included having to let some key and cherished people inside the organization go. Instead of just hunkering down and hoping that they could get through it by closing their eyes and in five years from now everything would be better, they decided this was actually the time they wanted to invest in happiness, optimism and resilience.

One thing I learned that I found fascinating was that none of the hospital systems in Iowa right now, if I’m correct, are profitable. Only a third of hospital systems across the country are profitable, which means that we’re dealing with extraordinarily high levels of stress and change without some of the benefits that we normally expect. People were having to do a lot more with a lot less, so how do you create happiness in the midst of it?

This is where I think a lot of leaders make a mistake. They think we’ll talk about happiness when things are going really well. Once we get this hospital turned around, once we’re profitable, once we’ve got burnout lower, then we can start talking about happiness and optimism. But until then, it seems like it’s not a good time to talk about happiness when you’re having to let people go and people are having to work significantly longer. Jordan Voigt decided to do the exact opposite and put into action some of this positive psychology research.

A powerful narrative that focuses on the positive development of an organization as a community – and not just on an individual level – is crucial for long-term cultural change.

The Orange Frog program

I created a partner organization called the “Orange Frog”, which took all of the research I was doing and tried to put it into a narrative form called the Orange Frog. In the Orange Frog program you go through the principles of positive psychology, but with the power of a narrative – which I’m now learning is actually crucial for creating long-term cultural change.

I wrote a story initially about this frog that was green and had these orange spots. Every time he did something positive it made him more orange, which he hated because it made him so different inside this island. But after a while, he started realizing that being orange was not only contagious but advantageous as well. He then goes about trying to change other ponds – the pleasure pond, the workaholic pond, the disengaged pond – before the storm comes in. This created a narrative form of what we were attempting to do in the midst of a cultural change inside the organization.

I was finding it wasn’t as powerful to go into an organization and tell them we can dramatically raise your level of optimism and improve your productivity by 31%. The reason for that is that 31% could be 38% or 19%. It doesn’t really matter to a person that’s going through high levels of stress. The science that we were doing behind this and the statistics weren’t as sticky as some of the narratives that were built upon the science.

Overview of the 2-day Orange Frog training program at the Genesis Health System

  1. Staff education:
    • Principles of positive psychology
    • Idea that mindset can be a choice
    • Advantages of happiness in raising business and educational outcomes
  2. Provision of specific habits to create positive change
  3. Roll out of training in groups so intact teams and leaders could go through them together
  4. Creating a culture of adopting positive change through a narrative, rather than focusing on the individual

We went into the Genesis Health System with a two-day training program. We got the staff to go through all the principles of positive psychology – the idea that mindset could be a choice. We gave them specific habits they could use in the midst of the challenges they were experiencing, and explained how happiness can be an advantage – raising every single business and educational outcome we know how to test for. But instead of just providing the material, the training was done in groups so that entire, intact teams and the leaders could go through it together. This way it is not individuals trying to create positive change, it’s a culture of trying to adopt these ideas with the shared language of a narrative.

What I find fascinating about this is I’ve had a shift in my research. Up to this point I thought if we can raise individual levels of happiness, every single one of your individual business and educational outcomes can improve. Therefore, we focused on individual habits to create that change. But now that we have big data, I realized I was missing out on the majority of potential.

Creativity, if you measure it individually, you miss out on the fact that we’re more creative when we’re around certain people in our lives. We’re funnier around certain people. If you’re an introvert, that’s something genetic that we can’t touch. But, if I put you in a room full of higher introverts, you act like a pseudo extrovert within that environment. We’re finding that if we ignore the ecosystem of potential around you at an organization, we’re missing out on what really creates happiness.

So on day two, the individuals are invited back to the organization for the training and they are invited to wear orange. This makes them feel different as they walk around the hospital for example, until they get into a room full of people that are also wearing orange.  And it starts these conversations about how do you change the social script at work.

This sounds like something that is simple. It’s a 10 minute story that’s read about a frog with colors and oranges and greens and a storm coming. What we’re seeing, in terms of the research on the backside of it is phenomenal. In fact, when I first got the research on Genesis Health System, I thought I had actually switched the pre and the post data because I knew the challenges they were facing during this roll out.

The happiness advantage – Results from the Genesis Health System

We did a rolling roll out with a couple of teams so that we could have the same economic circumstances, the same time period, and test people before and after the training. The testing was not just done immediately after the training, but also three to four weeks afterwards to see if there was a positive benefit that stuck with people. We compared the results of the people who had completed the training to those who had not yet completed it but were signed up for it from within the same organization and dealing with the same things. Some of the data we got back was just incredible.

Pre-intervention, only 23% of the individuals were very expressive of optimism at work. That’s a problem. We have found in a lot of organizations that about 31% of individuals at work are optimists but not expressive of it within the work environment. This means that nearly a third of people working for you are actually closet optimists that are wanting to be expressive of their optimism, but they don’t feel licensed by the culture that’s around them. Post-intervention, four weeks later, that jumped to 40%.

My favorite study right now is one done by two researchers in Virginia. They found that if you’re looking at a mountain in front of you that you need to climb by yourself, your brain perceives it as 10 to 20% steeper than it would if you were standing next to a mountain of the same height with a friend who’s going to climb it with you. This means that our perception of the world literally changes depending on whether we think we’re alone going through a difficult economic period or organizational change, or doing it with other people.

What we had done with the Orange Frog narrative was similar. People at the Genesis Health System weren’t going through it individually. As they were listening to the positive psychology research, they were doing it with one another and the hills in front of them dropped dramatically. What we saw in terms of the optimism score was great, but the other scores were even more impactful.

Despite difficult challenges and high levels of stress, positive change is possible

 Orange Frog program results at Genesis Health System show the power of positivity in the midst of massive cost and staff reductions. 

% respondents pre-intervention 
% respondents 4 weeks post-intervention

Individuals reporting the highest category of stress at work dropped by 30% post training!

There’s a communal and cultural response based upon the shared language of a narrative. We know that even in challenging times, we can have low level pessimists scan for three new things that they’re grateful for for 21 days in a row,  and by day 22, they’re testing as low level optimists on average. We can do that individually, but when you see that change occurring at a cultural level, that’s when things start to have huge impacts for the key performance indicators for that organization.

So I think it raises the question, “When is it appropriate and a good time to start talking about happiness, optimism and a positive culture?”, and I think it’s now. Regardless of whether everything’s going great within an organization or they face high levels of challenges and stress, what we’re finding is it actually helps inoculate people against the negativity that they’re experiencing by seeing that they’re not the only ones trying to create a positive change inside an organization.

Happiness can inspire organic and positive cultural change 

HT: What were some of the cultural changes that you have witnessed happen organically inside organizations following a positive psychology intervention?

Shawn Achor: I’ve done this same Orange Frog training at large insurance companies in the Midwest. One of the things we had people do is not only this intervention, but we pulled them off the phones for 10 minutes a day to do these huddles where they would connect with their team. They only make money on the phones, so we pulled them away from where they make money to connect as a team.

Each person in the group would go around and say one thing that they were grateful for, one success that they had over the past 24 hours and check in emotionally. Over the next 18 months their revenues increased by 50%. Their engagement scores went from one of the lowest inside the organization to one of the highest. It was actually the highest change in engagement scores they were experiencing.

They created all these organic changes on the backside of it as well that had nothing to do with what we had suggested. They started Ted talk Thursday mornings, for which before work they would get together in these groups and just watch a Ted talk together creating these professional learning communities.  That was not part of the training and it was not something I’ve tested at all.  We had no idea about the impact upon the individuals, but those organic changes came out of individuals trying to do this as a team instead of us trying to do this as individuals.

Leaders must role model change

HT: What would you say to leaders who want to adopt change that leads to a positive culture?

Shawn Achor: It’s been 12 years of going out to organizations trying to test this research and I think that the biggest factor is one that’s often missing. As a leader we’ll hear this information – they might hear me give a talk for instance – and be like, “Great! I want to do a positive psychology intervention”, or “I want to do the Orange Frog”, or “I want to do a resilience program”. They then pay for it for their employees hoping that they will see the results they want.

I think that’s the weaker response. What we saw, and I think part of the reason Genesis worked so well, is that there was positive role modeling from the senior leadership. For example Jordan Voigt, the president, made sure he was at the first 20 minutes of every single one of those workshops that were rolled out inside the organization. That’s a huge expenditure of time and resources to join each one of those. But what he was doing was indicating that this is something important. This isn’t a flavor of the month type of idea. This is something I care about in the midst of the challenges I’m experiencing.

What oftentimes happens is you see senior leaders wanting to see change, but not either role modeling it themselves by going through the training, or talking about the positive interventions that they’re doing. I worked with a chief operating officer of a large fortune 100 company who told me that part of the reason he had been so successful was because he would start each working day thinking of three new things he was grateful for.  I said, “That’s amazing. How many people have you told that to here at the organization?”, and he realized that in 20 years of working there he had never told anyone. Immediately he got on Yammer, their internal social media, and told people that this is what made him successful. That he believed that you can train gratitude and here’s one of the things he’s grateful for.

When we role model that positivity to other people, we give a signal that this is something that’s not valued just by that individual who’s thinking to themselves, “Great. I love that happiness leads to greater success outcomes”. What they are saying is this is part of our new culture.

On that point, I got the incredible opportunity to work with Orlando Health several years ago. We know that gratitude has a huge impact and we wanted to see what would happen if we did it in a cultural form, similar to what we were doing with the Orange Frog. So we tried the Orange Frog trainings there, but we also attempted to do an experiment.

We got the leaders of the staff meetings at Orlando Health to start the meetings by having each person in the room say one thing that they were grateful for. This is right before they do resource allocation of who lives and dies – literally a life or death situation.

Alongside the Orange Frog training program, leaders at Orlando Health would start their team meetings by having each person say one thing they were grateful for.

Two years later, the victims of the second largest shooting in US history were cared for by the same teams.

The social cohesion created by these work routines was responsible for the organization’s resilience in dealing with this traumatic event.

It sounds like something a kindergartner would do. It took incredible amounts of social capital by the senior leaders to get this off the ground. The senior leaders said, “I have to be invested in this. I am invested in this. I’m going to do this and I want us to continue to do this even though I know we’re doing very important things”.

I go into a lot of organizations, especially in the healthcare profession, and they say, “We are working with tens of millions of dollars, hundreds of millions of dollars a year, and we’re dealing with life or death situations. We don’t have time to sit around holding hands and singing Kumbaya”. So we went into a level one trauma hospital to try this out in Orlando. The senior leaders were on board with it and consistently did it even three weeks after I was there at the organization suggesting it.

Some of the people were like, “Why are we still doing this? That happiness guy’s gone”, but the leaders said, “No, this is a part of our culture now. Every meeting we have to do this. But we have important things we need to get done and so much work to do that we need to go fast. So before you come into the meeting, I want you to already have one thing that you’re grateful for”. That meant that before staff were coming into the meeting, they were already scanning their environment for something that they were grateful for. Priming their brain to be positive.

Nearly two years after we started this experiment at Orlando Health, the Pulse nightclub shooting occurred three blocks down from them. All of the victims from the second largest shooting in US history came to the teams that we had been working with for two years. Several hours after the most traumatic experience that their community had experienced, they started their staff meetings with gratitudes again.

Universally, they realized that for two years they weren’t just doing work with the people that they were working with. They weren’t just doing resource allocation. They were also hearing these points of positive social connection and these things that people were grateful for, and also, these things that connect us as human beings. What that meant in my language was that they were deepening social knowledge, which is the precursor to social connection and the greatest predictor of the long term success rates for a team.

Social cohesion is a strong predictor of success

At Harvard, I found that the correlation between social connection and happiness is 0.7, which is almost a direct correlation between happiness and success. It is significantly higher than the correlation between even smoking and cancer. Google, at the exact same time in a project called project Aristotle, found as they looked at teams worldwide that the individual traits of the members of the team were not predictive of the long term success rates of that team. The only thing predictive of that was the social cohesion on the team.

Social cohesion was the greatest predictor of success for Google and happiness at Harvard if the following three things happened

  • Feeling connected to and liking the people you work with
  • Having the psychological safety to voice your opinion
  • Being able to express a strength within that group

The social cohesion created by these work routines that were endorsed, encouraged and often role modeled by the senior leaders in Orlando Health was responsible for the resilience in the midst of one of the greatest challenges they experienced as a community.

Now they actually go out to other hospitals and teach them emergency preparedness for the unthinkable. And one of the things that they talk about is not just medical procedures, but also the work routines like gratitude that make an organization so much stronger as they try to deal with these difficult challenges.

Happiness is not a self-help movement

HT: Earlier you mentioned, how your research took a bit of a twist from focusing on the individual to focusing on the more social aspect. What was the data that helped precipitate this change?

Shawn Achor: There were two studies that sort of precipitated this. One from business school and one from a study on bugs. And actually project Aristotle too, so I’d say all three of those. The first one from business school looked at the interactions between teams and their leaders. There were two main types of leaders that were studied. The first was a leader who thinks that their team only works for the pay and because they are micromanaged. If the leader is not on his or her team all the time, then they are going to work less.

The other type of leader that they were looking at in this study actually feel like people work out of intrinsic values. The more time employees are given to do their work organically and on their own and empowered, the better they work. Employees are not just working for pay, but also for the praise and recognition. When they looked at the people on the teams of each of these types of leaders, there was no surprise that the leaders thought that way because almost all the people on their team believed the same philosophy. This made it very hard for us to disentangle.

When they started looking at data for the organization – and not just an individual team or leader but the entire big picture for a company when they were restructuring – they looked to see what happened when those leaders who thought people work only through micromanagement moved to teams that had previously believed they worked for intrinsic values and not just for pay. Within a six month period of time the culture of the team would shift to the new leader’s mindset. What we started realizing was that it wasn’t individuals that have this certain type of mindset, there was an interaction at play between the leadership and the beliefs of the people that were on that team occurring as well. It’s called the skipper effect.

For project Aristotle at Google, they studied more than 110,000 employees worldwide and found with that big data set that the individual traits of the team were not predictive of the long term success rates for the team as a whole. Looking at group outcome and trying to predict it based upon individual traits was not possible and one of the head researchers there said that there was no pattern in the data. Google is amazing at finding patterns and there was no pattern. The only thing that was predictive was the social cohesion of the team.

In summary, what was going to happen on a team was not predicted by individual traits, it was predicted by the group or the larger picture. I’m working now with the NBA and the NFL and we are seeing the same thing. You get a superstar on the team and they can dramatically and vastly underperform in their abilities if they don’t have the right social cohesion with the team that they’re on. Injury rates can actually rise as well.

The other study that was related and actually kind of started this process for me was done back in 1935. There was a biologist who claimed in southeast Indonesia to have seen a group of lightening bugs that didn’t light up individually and randomly, but actually lit up timing their pulses as a community. Therefore, all the lightning bugs would light up and go dark at the exact same time. He went back to the US and wrote up a scientific paper about this miracle in the mangroves in southeast Indonesia. No one believed him and he lost his job. The reason for that is, it’s crazy.

Evolutionary biology tells us that the whole point of being a lightning bug is to light up in the dark so that you can increase your chances of sexual reproduction. Why would you light up when your competition is lit up? That doesn’t make any sense at all and a mathematician said that it is impossible for order to come out of chaos without somebody leading it. So, who is the one lightning bug that’s the metronome for the rest of the group, timing their pulses? It’s physically, it’s mathematically, it’s biologically impossible.

Three years ago, two researchers at MIT found that when lightning bugs light up individually and randomly their success rate of reproduction per night is 3%. That’s what happens when you study individuals lighting up randomly, alone and in isolation, which is just what we assumed. You have to be the fastest, smartest, brightest light shining, so that’s how we study people in a competitive environment. But in two places in the globe, one in southeastern Asia and one in the smokey mountains of Tennessee, the species of lightning bugs there have figured out how to time their pulses using neurotransmitters. They actually light up as an entire community instead of small potential trying to be garnered by individuals lighting up in competition.

When they do this, their success rates go from 3% to 82% per bug. So, it’s not like one bug is doing really well with the system like, “keep going guys, best night of my life!”. The entire system was doing orders of magnitude better than we thought was possible because we assumed a survival of the fittest and an individual mindset when we were studying this in our research.

Now what we’re realizing as I took a big shift in terms of how I was studying happiness is that happiness is not a self-help movement – even though they put Big Potential in the self-help portion of Barnes and noble. They didn’t make it all the way through page one. What we were finding was that if you pursue happiness and potential alone in isolation, those mountains in front of you look 10 to 20% steeper. We find that people burn out faster and feel higher levels of stress. They lose some of the meaning of happiness as it’s a shared trait – just like creativity, energy and productivity are.

So if you are really trying to create cultural change, you can’t just focus at the individual level. You have to get individuals in that group to connect with the ecosystem of potential around them. Surrounding those individuals with positive people. Expanding power out to them. Enhancing the people around them with non-comparison based praise. Defending that system by creating those positive habits within their lives so they can inoculate themselves and sustaining those gains by creating celebration on the backside of it.

Shawn Achor is the New York Times best-selling author of The Happiness Advantage and Big Potential. Shawn has traveled to more than 50 countries, speaking to farmers in Zimbabwe, CEOs in China, doctors in Dubai and schoolchildren in South Africa. His research on happiness made the cover of Harvard Business Review, his TED talk is one of the most popular of all time with over 19 million views, and his lecture airing on PBS has been seen by millions.