top of page

Reciprocal Gratitude in the Workplace


Why is a culture of gratitude important, especially in health care organizations? How does reciprocal gratitude impact our culture?


Webster defines gratitude as, “A warm and friendly feeling toward a benefactor; kindness awakened by a favor received; thankfulness.”¹ One of the most cited definitions of gratitude is that of Robert A. Emmons, Ph.D., Senior Science Advisor with Accordant: “The affirmation of goodness and the recognition of goodness outside ourselves.”² Reciprocal gratitude occurs when gratitude practices cause a multiplier effect on building quality relationships and promoting more prosocial behaviors. The giver and recipient often exchange places as gratitude is shared among themselves. This can occur between physicians and patients, between clinicians and patient families, between leadership and team members. The Law of Reciprocity implies being on the receiving end of gratitude creates a psychological need to reciprocate. Reciprocal gratitude can be:

  • Direct – in return for someone doing something helpful for you

  • Downstream – others helping you because you’ve helped someone else

  • Upstream – better known as “paying it forward” as you help others because you’ve been helped

Reciprocal gratitude is not about feeling obligated or indebted to someone. Misusing gratitude between peers or from manager to employee as a means to get something in return erodes trust and sets up a toxic work environment. Instead, frequent, nonjudgmental and genuine gratitude yields the greatest benefits overall.

Health care staffing shortages and clinician burnout are extreme. Now, possibly more than ever, leadership must create a healthier work environment with gratitude as the foundation. There is a direct correlation between staff appreciation and patient care. The benefits are numerous among all health care stakeholders.

Consider these recommendations. Which ones offer the greatest opportunities for direct and downstream reciprocity based on mutual benefits and impact on outcomes?

1. Familiarize yourself with the various types of gratitude interventions. Include your team in determining which ones will support a healthy work environment. Develop criteria based on interventions that meet your employees’ needs. For example, conduct an informal survey or use sticky notes at the next staff meeting asking questions such as:

  • Do you have a favorite gratitude practice?

  • Has anyone expressed gratitude to you at the workplace? How did it make you feel? How can we extend this practice and feeling?

  • Have you expressed gratitude to others in the workplace? How did it make you feel? How can we extend this practice and feeling?

  • How would you want to receive genuine expressions of gratitude (verbally in front of the team, one-on-one or in writing)?

Compile this feedback and have the team identify the top two or three ideas to further cultivate and sustain gratitude.

2. Offer gratitude programming that specifically targets your organization’s leadership development initiatives or as part of a culture change process. Leadership development programs can assess and identify areas where improvement strategies will have the greatest impact on the work environment and metrics. It’s important to choose programs that offer a strength-based approach, grounded through research in positive psychology, neuroscience and gratitude. As part of a culture change process, create a steering committee to establish a cultural baseline, identify associated outcomes and assess current metrics including engagement surveys, patient satisfaction, retention and more. Creating a culture of gratitude is a long value- and vision-focused process that requires continuous practice of newly formed (gratitude) habits that effectively change behaviors.

3. Survey employees and patients to identify top stressors and then determine where gratitude programming and interventions can serve as a coping mechanism, support mental health and strengthen employee-patient relationships. It can be as simple as adding a shared gratitude journal in your break room and encouraging staff members to participate. The same can be done in patient and family waiting rooms. Create a list of videos that impact well-being for work teams and individuals to access. Offer gratitude wellness programs to support healthy coping techniques, mental health and overall subjective well-being. The success of any gratitude-related programming is directly correlated to the commitment leadership gives to their own genuine gratitude practices and thus, leading by example. Leaders who do so gain the trust and respect of their employees and become the catalysts of reciprocal gratitude, expanding the benefits of this vital practice. A well-thought-out strategy can authentically initiate and multiply gratitude not only throughout the health care organization’s teams but also among their patients and families.



Asking Accordant_Gratitude in Workplace
Download PDF • 728KB

About the Author: Linda Roszak Burton BS, BBC, ACC, is a Principal Consultant and a certified executive coach with Accordant. She is author of Gratitude Heals ~ A Journal for Inspiration and Guidance. You can reach her at and through LinkedIn.


Our Blog


The Accordant Team has published a number of books to advance the efforts of health care philanthropy and help development leaders everywhere. 

trustee logo_1.png

Accordant is honored to collaborate with American Hospital Association Trustee Services to provide issue papers, templates and webinars to support the involvement of healthcare trustees and foundation board members in advancing philanthropy. These resources can also be found on the AHA Trustee website.

bottom of page