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Before Happiness by Shawn Achor

What Happens When You Turn a Hospital Into a 5-Star Hotel?

Read an excerpt from Before Happiness: The 5 Hidden Keys to Achieving Success, Spreading Happiness, and Sustaining Positive Change.

Choose Happiness with Shawn Achor's new two-part online course
272 pages; Crown Business
Available at Amazon| Barnes & Noble | Indiebound 

In a 2012 article for the Harvard Business Review, I wrote about the extraordinary steps the Louisiana-based company Ochsner Health System made after Katrina to raise positive genius among their eleven thousand health care providers, administrators, salespeople, and staff. I had been invited several times over the course of two years to help their leaders implement my Happiness Advantage research. But what I soon realized was that if we really wanted to help them transform their organization, it wasn't enough to just convince a few top leaders that the best way to improve the hospital's bottom line was to raise levels of happiness first. They had to plant the idea that "happiness is contagious and advantageous" in the brains of everyone in the organization.

The character Michael Scott from NBC's The Office is famous for needlessly and often hilariously pointing out the obvious. In one episode, he declares, "I do not like hospitals. In my mind, they are associated with sickness." This is funny (to me) because of course hospitals are associated with sickness. The problem is that, as research shows, when we think about something as being unhealthy, it has an unhealthy effect upon us. That's why people oft en start to manifest the symptoms of the diseases they most fixate upon, and it's the reason first-year medical students get the infamous "medical school syndrome" in which they start believing that they have each disease they are studying. But this poses a significant problem for hospitals: How can you make people feel healthier in a place associated with sickness and disease?

Simple. You turn your hospital into a Ritz-Carlton.

The Ritz-Carlton hotel brand has become synonymous with "five-star" customer service, and for good reason. Contrary to what you might think, it's not just because of their plush towels or large swimming pools or comfortable beds. It's because the Ritz does business according to a simple code of service: make the guest feel valued, and exceed expectations. I once stayed at a Ritz in D.C., paid for by a client, and when I asked to change rooms because mine smelled of smoke, the hotel immediately found me a better room, then paid for my dinner and drinks and even threw in a free massage to compensate me for the very minor inconvenience. But most people don't know the secret ingredient in Ritz's sensational service: they franchised a policy called the 10/5 Way, which turns out to be the perfect example of how to transform an organization through positive inception.

The 10/5 Way involves just a few simple behavioral rules that all staff are trained to follow. If a guest walks by a Ritz employee within ten feet, the employee should make eye contact and smile. If that guest walks by within five feet, the employee should say, "Hello." This is similar to the policy Sam Walton instituted for his greeters at Walmart, who were supposed to smile whenever they were within ten fee t of a customer (now sadly no longer required). It sounds simplistic, but research has shown that these small changes can have a huge impact on customer satisfaction, employee retention, and the bottom line.

After consulting the experts and reviewing the research, the folks at Ochsner Health System figured that if they wanted to improve the performance in the hospitals by creating a reality of happiness and comfort, who better to emulate than one of the best-known luxury franchises on the planet? So they adopted the 10/5 Way.

What Happens When You Turn a Hospital Into a 5-Star Hotel?

Before Happiness by Shawn Achor
Read an excerpt from Before Happiness: The 5 Hidden Keys to Achieving Success, Spreading Happiness, and Sustaining Positive Change.

Choose Happiness with Shawn Achor's new two-part online course
272 pages; Crown Business
Available at Amazon| Barnes & Noble | Indiebound 

In a 2012 article for the Harvard Business Review, I wrote about the extraordinary steps the Louisiana-based company Ochsner Health System made after Katrina to raise positive genius among their eleven thousand health care providers, administrators, salespeople, and staff. I had been invited several times over the course of two years to help their leaders implement my Happiness Advantage research. But what I soon realized was that if we really wanted to help them transform their organization, it wasn't enough to just convince a few top leaders that the best way to improve the hospital's bottom line was to raise levels of happiness first. They had to plant the idea that "happiness is contagious and advantageous" in the brains of everyone in the organization.

The character Michael Scott from NBC's The Office is famous for needlessly and often hilariously pointing out the obvious. In one episode, he declares, "I do not like hospitals. In my mind, they are associated with sickness." This is funny (to me) because of course hospitals are associated with sickness. The problem is that, as research shows, when we think about something as being unhealthy, it has an unhealthy effect upon us. That's why people oft en start to manifest the symptoms of the diseases they most fixate upon, and it's the reason first-year medical students get the infamous "medical school syndrome" in which they start believing that they have each disease they are studying. But this poses a significant problem for hospitals: How can you make people feel healthier in a place associated with sickness and disease?

Simple. You turn your hospital into a Ritz-Carlton.

The Ritz-Carlton hotel brand has become synonymous with "five-star" customer service, and for good reason. Contrary to what you might think, it's not just because of their plush towels or large swimming pools or comfortable beds. It's because the Ritz does business according to a simple code of service: make the guest feel valued, and exceed expectations. I once stayed at a Ritz in D.C., paid for by a client, and when I asked to change rooms because mine smelled of smoke, the hotel immediately found me a better room, then paid for my dinner and drinks and even threw in a free massage to compensate me for the very minor inconvenience. But most people don't know the secret ingredient in Ritz's sensational service: they franchised a policy called the 10/5 Way, which turns out to be the perfect example of how to transform an organization through positive inception.

The 10/5 Way involves just a few simple behavioral rules that all staff are trained to follow. If a guest walks by a Ritz employee within ten feet, the employee should make eye contact and smile. If that guest walks by within five feet, the employee should say, "Hello." This is similar to the policy Sam Walton instituted for his greeters at Walmart, who were supposed to smile whenever they were within ten fee t of a customer (now sadly no longer required). It sounds simplistic, but research has shown that these small changes can have a huge impact on customer satisfaction, employee retention, and the bottom line.

After consulting the experts and reviewing the research, the folks at Ochsner Health System figured that if they wanted to improve the performance in the hospitals by creating a reality of happiness and comfort, who better to emulate than one of the best-known luxury franchises on the planet? So they adopted the 10/5 Way.
Some companies "adopt" ideas or policies by sending around a perfunctory e-mail, then forgetting about it. Ochsner really adopted the 10/5 Way. They formally trained more than eleven thousand physicians, nurses, managers, and administrators to smile anytime they were within ten feet and say hello anytime they were within five fee t of another person—patient or fellow employee —and even evaluated them on it as a component of their performance reviews. Of course, a hospital is never going to be as luxurious as the Ritz, but that wasn't the point. The point was to instill a more positive reality among the hospital staff and then franchise that positive mindset and perspective to the patients.

As a researcher, though, it's my job to be skeptical, so I naturally had a lot of questions about how this would work. Would people find the smiling to be inauthentic and forced? Would all this time spent saying hello to everyone distract doctors and nurses from all the other important things they were supposed to be doing? Would negative employee s find a loophole and simply walk eleven fee t away from everyone in the hospital?

At first, many of the doctors and hospital staff were equally skeptical. Some would say, "Aren't these just cosmetic changes? Smiling couldn't possibly affect the underlying performance of a hospital" or "I don't have time to waste on this silly HR initiative. I'm busy saving lives here." There were some stubborn individuals that were too hard to reach at first. But for the next six months, every time one of those resistant, negative doctors walked down the hallway, something was different. People were saying hello or smiling at them. Not just employee s, but patients as well. You've probably noticed how when someone says hello or smiles at you, your automatic reaction is to say hello or smile back. Well that's exactly what those doctors started doing. Eventually, they started adopting the 10/5 Way—even if they weren't fully aware they were doing it.

In short, the behavior became contagious. Kara Greer, vice president of organizational development and training at Ochsner, told me that soon the employee s who originally didn't follow the 10/5 Way became such anomalies that even they began unconsciously to adopt the new positive patterns, simply so they wouldn't stand out for being unkind.

The 10/5 Way completely transformed the shared reality at the hospital. Some of the doctors had originally had a hard time believing that something so seemingly trivial as saying hello or smiling could possibly have any real impact on health outcomes. But what those skeptics had momentarily forgotten was the scientific and direct correlation between patient satisfaction and successful health outcomes on everything ranging from cardiac recovery to orthodontics work.5 We sometimes think that the best doctors are the ones who have the most specialized knowledge or the fanciest degree s, but in fact, study upon study, including one published in the New England Journal of Medicine, show that the best doctors are the ones who also know how to connect with their patients. It's not just because they make the patient feel warm and fuzzy; patients who fee l connected to their doctors are more likely to follow the treatment regimen and return for vital checkups.
Not only did this initiative improve patients' satisfaction with care; it improved outcomes for the hospital. Moreover, patient satisfaction with care is one of the greatest predictors of profit for a hospital; and indeed, within one year, according to Ochsner, the hospitals that franchised the 10/5 Way had a 5 percent increase on Press Ganey's Likelihood to Recommend score (which evaluates whether patients would send their friends to that hospital), a 2.1 percent increase in unique patient visits, and significant improvement in the medical practice provider scores. Ochsner reported $1.8 billion in revenue in 2011. So if they experienced even a 0.1 percent increase in revenue, positive inception saved millions of dollars to help care for more sick people!8 That gives a whole new meaning to the phrase "million-dollar smile."

When we look around at our companies or workplaces, it seems that the employee s are all unique individuals with different personalities, thought patterns, beliefs, values, and learning styles. And while this is technically true, it misses an important point. Our personalities may be distinct and unique, but our brains are highly interconnected; they are linked on a wireless mirror neuron network. Mirror neurons, as readers of The Happiness Advantage may remember, are those receptors in our brains that cause us to unconsciously mimic the actions of those around us. When we see someone perform an action, like a yawn or a smile, our mirror neurons light up and signal our bodies to perform that same motion. But mirror neurons are so key to positive inception because our thoughts and perceptions are what dictate our nonverbal actions. So when you nonverbally express excitement, for example, my mirror neurons pick up on and imitate your expression of excitement. This, in turn, makes my brain think I'm experiencing the same excitement you are experiencing. Researcher Paul Marsden at the University of Sussex wrote a great review of this research showing that not only yawns and smiles are contagious but also emotions like stress, anxiety, optimism, confidence, boredom, and engagement. Thanks to our mirror neuron network, in other words, we are hardwired for inception.

History offers some dramatic examples of how we are programmed for social contagion. In 1962, in what was known as the June Bug incident, sixty-two factory workers at a textile mill were "bitten" by an insect whose venom apparently caused terrible nausea, vomiting, and numbness of limbs. Many of the dressmakers were hospitalized. Yet after months of investigation, the Communicable Disease Center (CDC) found that the symptoms had been caused not by the venom of a mysterious insect but by sheer, communicable anxiety! As it turned out, the dressmakers had been bitt en by mass hysteria.

Perhaps my favorite example of social contagion on record is the Dancing Plague of 1518 (not quite as scary sounding as Ebola or the Black Death, but more interesting). According to reports, it began when a woman in Strasbourg, France, known as Frau Troffea, started dancing in the streets and could not stop. Eventually she collapsed from exhaustion. At first people thought she had had a psychotic episode and that was the end of it. But then she started dancing again. In the next few days, thirty other people also experienced this same uncontrollable need to spastically dance. By the end, the authorities had to get involved because four hundred villagers were compulsively dancing day and night ... and not out of joy either. This was manic, desperate dancing, resulting in heart attacks and, incredibly, deaths. Frau Troffea's bizarre behavior had become wildly contagious.
A solitary mental breakdown started months of mass hysteria. A single case of false illness created an imaginary epidemic. These stories show how easy it is for us to "catch" the mindset of even a single person. There are tons of stories like this in social psychology. But if you've read the research or taken a class on the subject, you'll know that people rarely talk about the positive contagions that have occurred throughout time: mass decisions to abolish slavery, global declines in smoking rates, or widespread nonviolence movements in India or Egypt. Positive outbreaks can also begin with a single dancer. If we can create negative franchises, we can equally make positive ones.

The main point I want to highlight here is that you have the power to franchise positive habits in your home or workplace. So try implementing the 10/5 Way in your office or household. Or, if that sounds like too big a task or commitment, try adopting a variation I used in the PBS lecture "The Happiness Advantage for Health" called Flex Your Smile. All you have to do is flex your most powerful muscle three extra times a day. But by this I don't mean smile three times a day. I mean give three extra smiles. For example, smile at a colleague you wouldn't normally smile at in the elevator, smile at the barista when you order your morning coffee (yes, I know it can be hard to smile before you've had your morning coffee , but try it anyway), and smile at a random stranger on your way home from work. Or smile three extra times during the course of a meeting or a sales pitch and watch how this simple behavior change can transform the environment almost immediately. It might sound silly or implausible, but as we just saw at Ochsner, I doubt that any other one-second behavioral change could create that high a return on investment.

Plus there is scientific proof that you can also raise your social and emotional intelligence simply by smiling. When David Havas and colleagues at the University of Wisconsin had participants flex the facial muscles involved in smiling, he found that merely simulating a smile reduced their ability to get angry at another person. And on the flip side, when people used the muscles associated with frowning, they had a harder time being social. If I told you that you could increase your social intelligence by wearing glasses, you might consider getting some clear glasses for work, right? Well, putting a smile on your face is even easier (and less expensive) and can reap the same benefits. Moreover, researchers have found that when you smile, your brain releases the neurochemical dopamine, which improves your mood and your reality as well. Remember, positive realities are contagious in both directions.

The point of this research is not to highlight the value of smiling but to show the value of franchising small, simple changes. Another simple franchise adopted by Ochsner was the "no-venting rule." Employees were trained never to vent in the presence of a patient. They could continue to vent about lack of sleep, fatigue, obnoxious patients, and so on to one another, but never in the presence of a patient, even if the patient was not theirs. The no-venting rule applied not only within the confines of the examination room or the doctor's office but in the hallways, the cafeteria, and so on. These days office buildings have specific smoking areas where we cordon off smokers so their smoke doesn't bother others; perhaps we should start implementing "venting areas" to cordon off complainers so they don't poison others with their negativity at the office.
Before you accuse me of suggesting that people be forbidden to voice negative feedback or point out problems that need to be fixed, let me explain. I am not saying that a doctor should be silent if the nurse makes a careless error or if he's forced to work a twenty -four-hour shift. In both scenarios staying silent would be irresponsible and dangerous. What I am suggesting is that a doctor refrain from making comments that only spread negativity and lessen the likelihood of success. Here's the key difference between complaining and pointing out solvable problems. A complaint is an observation about some reality that your comment could not possibly ever change. If you plan on taking positive action, your comment is not a complaint.

Last week I heard a woman in a movie theater whisper loudly to her husband, "It is way too cold in here." I couldn't help but think, either get up and ask the management to turn down the air-conditioning or stop complaining! I don't mean that in a callous way; I'm saying it for her own good. Given what we've learned from positive psychology, we know that by commenting on the cold she's making her brain more conscious of the cold, which makes her fee l colder (again, what we focus on becomes our reality!). So, out of kindness to yourself, if you find yourself in a similar situation, go ask the manager to change the temperature, get your sweater out of the car, or focus your attention elsewhere, like on enjoying the movie.

Similarly, if you say, "I'm not getting paid enough," but you aren't going to request a raise, highlight your positive behavior in a novel way to your boss, find another job, or take some other action to change the situation (remember the first criterion of noise from the last chapter—if the information is not going to spur positive change, it is noise and should be canceled), then that comment is a complaint and has wasted cognitive energy.

You might try implementing the no-venting rule in your office or household—or at least exile complainers to a cordoned-off "venting area." This is a small, simple change, and that is exactly the point. The smaller the change, the easier it is to spread it to others. Try it. For the next twenty -four hours, smile at everyone who comes within ten fee t, and abstain from venting. You'll be amazed to see how quickly and powerfully this can change the tenor of all the interactions you have. And don't be surprised if pretty soon the people around you have picked up these same habits without even being aware of it. Such is the power of positive inception.

Finally, don't forget that positive realities can be contagious in your personal relationships as well. One of my freshmen at Harvard once confided in me that she had been fighting a lot with her parents, who she felt didn't trust her to make good decisions now that she had left the nest. Instead of telling her to write them off as obnoxious parents, which would probably result in the kind of behavior that would only confirm their worst expectations (again, what we focus on becomes our reality ), I had her watch for patterns. She came back with an unusual observation. Every time she called them after 9:00 p.m., she and they would fight, but this almost never happened when she called before 9:00. This was usually because she worked really hard on her pre-med studies, and by the time 9:00 p.m. rolled around, she was cognitively depleted and no longer had the mental reserves to be patient, to explain her thoughts clearly, or to let things go. A simple solution: she decided she would "call family before 9:00 p.m. and never after unless there was an emergency." But also observe how this tiny change created positive inception. Her parents soon noticed how much more positive their interactions with their daughter were because of her newfound patience and openness (though they probably didn't know the reason for it). In turn, they became more open and patient on the phone and soon, to her excitement, began to trust more in her decisions. As a result, she found herself wanting to share more about college with them, which created even more trust and goodwill. So you see how positive genius is a continual feedback loop if franchised correctly.

Reprinted from the book Before Happiness: The 5 Hidden Keys to Achieving Success, Spreading Happiness, and Sustaining Positive Change by Shawn Achor. Copyright 2013 by Shawn Achor. Published by Crown Business, an imprint of the Crown Publishing Group, a division of Random House LLC, a Penguin Random House Company.

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