How to improve patient experience in 15 minutes or less?

Shawn Achor

Founder and CEO of Goodthink Inc.

How to improve patient experience in 15 minutes or less?

5 August 2019 | 13min

Quick Takes

  • In the midst of challenging circumstances, training healthcare employees to carry out simple and effortless gestures such as making eye contact and smiling can significantly increase the number of unique patient visits and improve staff engagement levels

  • Similar to the social and emotional contagion humans experience in reaction to positivity; negativity, stress, uncertainty, and anxiety can also be spread through the mirroring response

  • Daily positive interventions can help protect oneself against stress, increase happiness levels and improve business and educational outcomes

Leading positive psychology expert, Shawn Achor, shares simple interventions and daily habits that can help improve patient experience and employee engagement.

This is the final segment of our three-part interview series. Read part one and part two to learn more fascinating insights to help improve healthcare delivery and services.

THE HAPPINESS FACTOR: A key competitive advantage – PART 3

Elevating patient satisfaction with a smile

The 10/5 way

HT: You have worked with Ochsner Health Systems and implemented the “10/5 way” there. Could you explain a bit about this method and what it set out to achieve?

Shawn Achor: We worked with Ochsner Health System down in Louisiana post Hurricane Katrina. What we were interested in is how do you improve somebody’s experience – in this case, patient experience – in the midst of walking into a building where you’re surrounded by people who are sick, or you’re sick, or you’re injured, or you don’t necessarily want to be there in the first place. So we went out to see who was amazing at customer service. One of the places we went out to was the Ritz Carlton hotel chain.

We learned that they would train their employees to make eye contact and smile at the person walking down the hallway if they were within 10 feet. Within five feet, they were trained to say hello. It’s called the 10/5 way and it’s actually really fun to walk in and out of those spheres with them, even if you’re not staying at the hotel. We took that research and brought it down to the hospitals and tried to train 11,000 doctors, nurses, and staff to do this simple 10/5 way experiment.

Whenever you try to create positive change, you get pushback. Some of the doctors at Ochsner Health System said, “You hired us to save people’s lives. We make you a ton of money. Don’t tell me how to walk up and down the hallway. I’m not doing this stupid smiling initiative from HR”. And we would say, “You don’t have to. This is an opt-in program coming from the CEO”. Nearly 11,000 people opted into it, but there were still stubborn resistors, which is fine because we are socialized to reciprocate.

Encouraging hospital employees to make eye contact, smile, and say hello can significantly increase the number of unique patient visits and improve staff engagement levels.

If you get into an elevator with someone and they smile and say hello to you, you don’t slam up against the side of the elevator, you usually say hello back and then pull out your cell phone. The same thing is true with how people were walking up and down the hallways. Even the stubborn resistors were at least reciprocating oftentimes.

None of this is interesting yet, because we haven’t gotten back to the patient – this is just the staff, doctors, and nurses doing this. What’s fascinating about this work at Ochsner is what was happening to the patient experience. Patients coming into the hospital never learned the 10/5 way. They weren’t trained on it. They weren’t socialized about it. It wasn’t a part of Ochsner’s mission statement. They had just walked into a hospital, but as they did, their brains unconsciously learned the social script: Within this space, I’m given license to make eye contact and smile and to treat people as if they are human beings.

As we observed these patients in the hallways as they would come into the hospital, they didn’t just reciprocate the 10/5 way, they’d actually initiate it – sometimes with the stubborn resistor doctors. None of that’s still interesting yet. That would be a cute story about how you can change a hospital hallway. The reason we got interested is because we wanted to see how this impacted their key performance indicators six months later.

Ochsner Health System results

We had two experimental groups of hospitals within the Ochsner Health System chain, which had the same geographic location and the same economics. The only difference between them was that one group adopted the 10/5 way and the other was a weighted control group. As it turns out, the group of hospitals that adopted it, had a significant rise in the number of unique patient visits to the hospital. The likelihood of patients to refer that hospital based on the quality of care that they received skyrocketed, and the doctor’s engagement levels were the highest in a decade.

A one-second free behavioral change resulted in more money for the hospital, more people cared for, a better perception of care quality, and greater levels of happiness for caregivers.

What’s amazing is that was a one-second free behavioral change that resulted in not only more money for the hospital, but more people cared for, a better perception of quality of care, and greater levels of happiness by the people providing it. What we got interested in post Ochsner was what if we could get more than one second with someone? The hallway is such a short period of time. It was not even something that was happening in the operating rooms. This was something that was happening in a hallway before going into a waiting room. And yet, we were seeing these massive changes occurring in the patients’ perception of the quality of care that they were receiving.

Honestly, I was shocked to see this type of result. Smiling is the weakest intervention in positive psychology. It happens and then it goes away and there are so many other factors, especially the fact that you’re at a hospital in the first place. You might be scared, you might be confused, you might be nervous about what’s about to go on. Seeing smiles and eye contact in the hallway having an impact on the quality of care and the engagement scores from the people providing it gave us an opening to start to test deeper interventions. Finding out what would happen if you didn’t have just a smile in a hallway, but if you changed someone’s levels of optimism on a team. If you could deepen somebody’s resilience, such as a critical care nurse for example. That’s when we started getting really excited and spreading out the research from there.

A positive patient experience begins with positive employees

HT: What prompted the hospital to want to undergo this transformation in the first place?

Shawn Achor: It was the leadership. The leadership there realized that part of what was going to be predictive of their long-term outcomes was not just the happiness levels and satisfaction that patients were experiencing. They realized that you can’t create patient satisfaction if the employees are negative, or are experiencing stress and uncertainty.

Social and emotional contagion are strongly built into the human system. How we process the world is a reflection of our surroundings – whether positive or negative.

One of the experiments I do in my talks is I partner people up and I have one person go neutral. They think something bad is about to happen and then the other person just makes eye contact and smiles at them. I’ve done this experiment in 51 countries and 80 to 85% of people worldwide can’t stop themselves from smiling. They break down. They start laughing and smiling and then we switch it around. What it shows very quickly is the social and emotional contagion that is built into the human system and into the way that we process the world around us.

I use that in my talks when I’m going out talking to medical leaders, or going out and talking to CEO’s, or to tech companies. Because it’s not just smiles or yawns that spread through this mirroring response, it turns out that negativity, stress, uncertainty, and anxiety can also be picked up like secondhand smoke. You don’t have to be the one smoking near a hospital to have the negative health implications. The same thing is true with how other people’s brains process your experience of a hospital, or a working environment, or a school. So what we’re trying to do is find a way of being able to not only shield people against the negative, but how to create a positive ripple effect out as well.

That’s what the leaders at Ochsner were interested in. That if you’re going to create a positive change among the patient population, you actually have to start with the staff population. We were doing the same with Princess cruise lines. They came in and asked us to improve their guest experience. The very first thing we told them was in order to improve the guest experience, we need to work with the staff who would be on the cruise ships beneath the guests because that’s actually the bedrock of someone’s positive experience. The same thing we saw with teachers. It’s very difficult for a child to pick up on social and emotional learning when the teachers and the staff themselves don’t feel socially and emotionally supported.

HT: What are actionable strategies towards happiness that healthcare providers can implement to improve patient experience?

Shawn Achor: One of the things that I find fascinating is that people who have medical training – nurses and doctors, they know very well what causes people to become sick. They know how contagious things are. And yet, once they learn all that information they then inoculate themselves, they wash their hands and they try to meet with as many of those sick people as possible. What I find fascinating about this is oftentimes when I talk about happiness, as soon as you find out somebody’s negative, people are immediately trying to run away from that person or we isolate them, which exacerbates the problem. We need to be doing exactly what people with medical training are doing in terms of happiness levels.

If somebody is currently negative, they’re expressing suffering and if you isolate them you exacerbate it, but we’re all connected so you make the entire system cancerous. What we want people to do is to inoculate themselves against stress within their lives. That can take a lot of different forms. And in positive psychology there’s more than 30 different interventions that have rigorous study behind them. The ones I usually focus on are the ones that have been studied the most:


1. Start your working day thinking of 3 new things that you are grateful for. It doesn’t matter what you’re grateful for, what matters is training your brain to take resources to scan anew every 24 hours for three things you’re grateful for. When people do that, their levels of optimism rise dramatically and also their resilience against stress within their lives rises significantly as well. So if you’re going through a challenging environment – you have a difficult meeting coming up, or you could be meeting with people who are sick – inoculating yourself before by scanning for the positive helps protect you from picking up on the negativity that surrounds you, and you actually start to create a positive ripple effect back out to other people.
2. Exercise for 15 minutes everyday. We found that 15 minutes of fun, mindful cardio activity done every day, or three times a week for 30 minutes a day, is the equivalent in terms of outcomes as taking an antidepressant for the first six months.
3. Meditate for 2 minutes a day. Scan the world for two minutes, or stop every activity and just watch your breath go in and out for 2 minutes a day. At Google, where they have endless swimming machines and micro kitchens every 150 feet creating a positive environment around them, we found that the simple activity of just watching breath go in and out increased employees accuracy rates by 10%, improved their levels of happiness and dropped their stress levels.
4. For the first and last 30 minutes of you day, don’t check your email, go on social media, or read the news. Research shows that social media can have a negative effect upon people’s levels of long-term loneliness and depression rates. Therefore, if we’re going through extraordinarily challenging periods of time, the technology that’s around us might be having an exacerbated detrimental effect upon us. The weakest times for the brain are the first and last 30 minutes of the day. That is when your brain has the least amount of resources just because of the fatigue that you’re experiencing, or just waking up in the morning. So one of the things that I do is I’ve created a mental moat around my day. For the first and last 30 minutes of my day, I don’t expose my brain to those things. I can still see the negative in an email. I can still see the negative news. I just do it when my brain is actually in a stronger position.
5. Write a 2 minute positive email praising or thanking a different person every day. This is the most powerful 2 minute form of routine to create positive change and is my favorite. We got people, initially on Facebook, to write a 2 minute positive email praising or thanking a different person every day when they got into work for 21 days in a row. They could praise somebody at work, a family member, a friend, a coach, a teacher, or a peer. The reason why this was so effectual is because 21 days later their social connection score, which is their perception of social connection in their life, rose dramatically. Social connection is the greatest predictor of your long-term levels of happiness. It is the greatest predictor of the success rate of a team and the greatest predictor of our resilience to the challenges that we’re experiencing. So a 2 minute positive email could actually improve social connection.


In some of the literature, we found that social connection is as predictive of how long someone is going to live as obesity, high blood pressure, or smoking. We fight so hard against the negative, we forget sometimes to tell people how powerful all the positive can be within our lives. And oftentimes we’re so focused on the problems – with the symptoms for the patient or within an organization, that we forget to notice how powerful the meaning can be behind the positive actions we do.

Happiness as a global health initiative

Shawn Achor: I actually met up with the former US surgeon general to talk about happiness hygiene habits inside health organizations. One of the things that he was recognizing is that we get people to brush their teeth in terms of a global health habit, but aside from that – aside from vaccines – there’s pretty much not anything that we do as routine in somebody’s life to create global health. And yet, depression rates have increased by 30% to double, depending on who you’re talking to over the past decade.

So in the midst of what’s a global epidemic, how do you actually improve people’s lives? And one of the things that we’re studying was how these small little interventions; scanning the world for three new things you’re grateful for, writing a two minute positive email praising or thanking somebody in your life, exercising, meditating, doing a two minute journaling experience about a positive experience – those small happiness hygiene habits done akin to brushing your teeth, if we did them every day, not only improve people’s levels of optimism, but now we know also improves every single business and educational outcome we know how to test for. It improves everything we test for on the SAT and ACT. It improves everything from productivity to likelihood of promotion to energy levels, to sales, to patient satisfaction. So happiness is actually one of the greatest competitive advantages for an organization in the modern economy.

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.