Whether you are a healthcare professional seeking ways to enhance your well-being, a leader aiming to foster a supportive work environment, or simply someone interested in the power of gratitude and neuroscience, this episode promises to be both informative and inspiring.
This transcript of the discussion has been edited for clarity and length.
Mike Sacopulos: My guest today is Linda Roszak Burton. She is an author, researcher, and executive coach. Linda is the author of The Power of Gratitude to Heal the World. She incorporates neuroscience-based methodologies into her coaching. Linda Roszak Burton, welcome to SoundPractice.
Linda Roszak Burton: Thank you, Mike.
Sacopulos: How did you become interested in neuroscience and well-being?
Roszak Burton: The neuroscience came to me. I was adding credentials to my coaching repertoire, and I saw a NeuroLeadership program that really fascinated me. I’ve always been fascinated with the brain — to pull it apart and find out what’s going on, right? And so I thought it would be very, very helpful for me as a coach to understand what the brain looks like in the workplace, and how we use what we know from the neuroscience and some of the behavior change theories that we know come from neuroscience. And I added that to how I would be able to provide the best type of coaching service to my clients.
Sacopulos: You contributed an article in the winter of 2024 to the Wharton Healthcare Quarterly. The piece discusses virtuous practice. Can you tell me what this means?
Roszak Burton: We are not short of data on clinician burnout and lower job satisfaction and the levels of distress that we know impact both the health and well-being of clinicians, as well as the quality of the care they provide and the outcomes of their patients. What our research shows is that there is a segment within healthcare where clinicians are thriving, even in spite of the tremendous administrative burden, the electronic medical records. Practicing medicine almost feels like that has to come after I do all my charting and deal with some of the policies and regulations.
In response to that, we became interested in — how do people flourish, how do they thrive? The “virtuous circle,” the virtuous cycle is we know that when we can connect with the purpose of what we do — in the clinician’s world, the purpose of healing and helping individuals — that when they can reconnect with that purpose and they can identify the values that describe who they are and they understand the importance of the relationships that they have with all colleagues, including patients and families — that begins to create the opportunity for them to recognize that practicing medicine gets them back to the reason that they entered this profession, this noble profession, in the first place.
While it doesn’t eliminate the distractions, it doesn’t eliminate the difficulties in healthcare today, it provides more of a control. If I know my values, if I know the virtues that define who I am as a clinician, I’m going to be more in touch with my purpose, I’m going to be more engaged with my patients in a relationship as opposed to checking the box, filling out the chart, and it brings more patient satisfaction to the patient–physician relationship.
When we look at what patients describe as a good relationship with their physicians, it has less to do with their knowledge and their skills. It’s more to do with, do you see me, do you know who I am, do I feel this genuine concern for my well-being? That’s the cycle right there. If the patient feels cared for, the physician’s levels of burnout begin to diminish, and that’s reinforced every time that they recognize, this is why I’m here to provide good quality care, this is who I am based on my values and virtues. We bring into the picture virtues such as forgiveness and gratitude and compassion and empathy. We know that when we lead, when we administer care through those lenses, that the relationships that we have with our patients go beyond where they could ever be. And the same with the colleagues, with the team that any clinician is working with.
Sacopulos: Do you find it triggers reciprocity with the patient to the extent that the clinician is forgiving, that the patient is likewise forgiving?
Roszak Burton: 100%. There’s reciprocity that happens in the moment, and it can happen afterwards. There’s downstream, what we call downstream reciprocity. The psychological well-being is just something that we are looking at with more data all the time.
For instance, the research in gratitude has been going on now for about 20 years. The practice of gratitude is now done all over the world. It’s done with college students, it’s done with senior citizens, it’s done with healthcare, in academia. It is something that we now know we need to pay more attention to — these values or virtues — however we wish to describe them, for overall health and well-being.
Sacopulos: I should have identified the title of the article that we’re discussing terms from. The article is “Embracing and Affirming the ‘Good’ Doctor.” It states, in part, that patient gratitude is not dependent upon achieving positive clinical outcomes. I find that interesting. Is it dependent upon clinicians spending time with patients?
Roszak Burton: Yes, it is so dependent on that relationship. Even if there isn’t a good outcome or as good of an outcome as the patient desires — if they feel that there’s this genuine relationship, this sense of caring, I’m doing everything I can for you, they will feel that gratitude.
Dr. Robert Edmonds is a scientific advisor to Accordant Health. His most recent lecture that I attended now defines gratitude as a human touchpoint, or the touchpoint of human existence. When you think of gratitude described that way, as this touchpoint of human existence, then what you see exchanged between the physician and their patient really defines how that comes to the heart of care.
Sacopulos: Recently we’ve seen a senior healthcare executive gunned down on the streets of New York. Social media exploded with people surprisingly praising the gunman and cheering on murderous actions. Why are people so angry with the healthcare system?
Roszak Burton: Well, I see an anger, I don’t know that it’s only healthcare. I think we can see that in many areas of our lives. I think that when people feel things are helpless or hopeless, that they don’t know how else to cope with that themselves. And that anger is demonstrated in many different ways, and that is a tragedy.
Another reason why we’re focused so much on well-being, when we take a look at the research, it’s not just physical well-being, it’s social well-being, it’s emotional, mental, for some, it’s very spiritual. I think there’s an imbalance of us as humans being at our best. When we’re able to recognize what allows us to be at our best, then we’re finding coping mechanisms to minimize the anger, minimize even the impact of negative events. We all have negative events, right? And that can create some sort of small trauma, big trauma. When we are able to find ways to cope with whatever the negative event is, we can begin to recognize that we’re not ruminating as long as we normally do when something bad happens, when somebody’s disrespectful, someone cuts us off in traffic.
It’s something that’s readily available for us to take a look at: “okay, this isn’t ideal, however, what do I have in my life that is going well, what do I have that I can be grateful for?” It begins to kind of balance things out to a bit where we’re able to recognize that there are more good things going on in our lives than negative. It’s not to deny the negative, it’s not to say you can’t think of any negative thoughts, because we have to, it’s healthy to really try to understand what we’re feeling.
This is where the neuroscience comes in. Because of the neuroplasticity of our brains, how are we able to reframe what we’re looking at, not to deny the negative, not to deny the experience, but how do we reframe that in a more healthy way, in a more genuine way? It’s not rose-colored glasses.
That’s where the neuroscience becomes fascinating to us. My personal experience is that even a really tough situation is something that can be improved. I mean, the title of the journal is Gratitude Heals, which is so true in medicine, but also true in life in general.
Sacopulos: Do you think that the medical system of education has done a poor job with this? I’m thinking of residency programs that have such long hours, and it seems to be the polar opposite of what we would want for personal well-being. Are we turning out physicians without preparing them to practice gratitude and well-being?
Roszak Burton: I agree with that. I believe that there’s a glimmer of research that’s being looked at. I saw a study of residents in eight different academic medical centers or schools, and part of what that research showed was that when the individual taps into who they are as a person, back to the values, to the virtues, why they got into medicine in the first place, how they define themselves, how they want the relationship with their patient to be the same as if it was their relative — when they are able to get into that way of thinking, they find that it is very helpful. It doesn’t improve the headaches that we have with EMRs, et cetera, but it sustains them. I’m hopeful for more research to be done on that because I think it’s vital to understand what’s the evidence, right? That’s medicine today. Well, what’s the evidence that we have for our own well-being and what’s meaningful and purposeful in our life?
Sacopulos: You’re a nationally known executive coach. I’m looking maybe for some tips for our audience. How do you help individual leaders incorporate fundamental elements of gratefulness into their leadership activities?
Roszak Burton: First, I actually try to find out, do they have a gratitude practice? Is that something that they already have? How are they defining gratitude? Some may feel, well, they’re on different ends of the spectrum, I’ll put it that way, right? We always do a values assessment. It’s very important in any coaching relationship to identify the values and the strengths of the individuals that we’re working with, that creates this foundation. From there, then we determine, with our dialogue, what it is that they really want to accomplish? And some goal setting starts with that. We explore how would they look different if they achieve these goals? How would they look different than they do today? What might be getting in their way, and what can they already celebrate that they are doing in terms of how they are accomplishing the goals that they’re looking at? So it is strongly grounded in assessments, and, again, helping them identify who they are and what’s really important to them.
Sacopulos: Does it matter if you are working with an individual physician leader or with a healthcare system on how you operate and what you look for? Because it seems to me that there may be a difference if I asked you that same question about how to incorporate elements of gratefulness into activities if we’re talking about a healthcare system as opposed to an individual.
Roszak Burton: It does depend on who we are engaging with. You may have a CEO who is looking at creating a more healthy work environment, and they identify gratitude as being one of the core values of that culture. If that is the goal of the CEO, then it requires a broadening of who we’re working with to identify, well, what does the culture of gratitude look like? We’ll bring in the evidence, we’ll bring in the science, we’ll bring in the tools to help them experience what they’re hoping their employees are experiencing.
Talking from a cultural perspective, one of the things that we find very helpful is what we call positive deviance, so we’re going to be looking for “deviant” people.
I was working with an outpatient center in New Jersey several years ago, and we were looking at which were the high-functioning clinics, what was the median in terms of scores, high-functioning, middle-of-the-road, and low-functioning? When we think about positive deviance, we want to understand what is a high-functioning department, what does a high-functioning division look like? Why are they functioning so well, and what can we learn from that? Then we can begin applying those learnings to the other areas.
When we’re talking culture change, let’s assess the employee well-being, let’s assess the engagement, the physician satisfaction. Where do we see high scores, and what can we learn from an appreciative inquiry perspective as to why those scores are so high? What are the elements, the values, the strengths? You see the similarity at that point that allows these individuals to function very, very well. Then from there, we look at what are the techniques, what are the practices, what are the approaches for broadening what’s already working well in one area throughout the hospital or the system?
Sacopulos: This may be an odd question, but are the benefits from a practice of gratitude and well-being the same for individuals of different generations? Are the benefits universal in nature, or are there some benefits that maybe millennials get that are different from the benefits that generation X folks get?
Roszak Burton: Yes, the research shows the benefits are the same. When we look at college students, their outcomes are going to be the same as someone in our generation, or the study done in Hong Kong years ago with senior citizens that improved their depression scores. The benefits are the same. The approaches are going to be different. Layered on top of that, let’s consider the culture of the individuals. So, when we express gratitude, when we incorporate different gratitude practices within an organization, there are individuals who are going to respond well to certain approaches and some not so much.
For instance, some individuals are perfectly comfortable with someone acknowledging their work, expressing gratitude to them in a public place, in a public forum, such as at the beginning of staff meeting. There are some cultures, however, where that individual attention is dishonorable, it’s embarrassing — to that individual, it’s more about what we did as a team. When we see that in Japanese baseball, it’s not just about the pitcher, it’s not just about the outfielders, it’s the team that allows the work to be so successful.
I think we have to take a look at the cultures of the individuals that are in our environment. I also think we have to offer a variety of ways to practice it. Most of the time when I talk about journaling, many people — probably 50% of the room — will say, “I don’t like journaling. I tried it. I couldn’t do it. I’m not successful with it.” Okay, well, there are other ways of practicing. You don’t have to have a leather journal to do it.
I talk a lot about visual journaling. For those people that are on the more creative side, let’s go through a short gratitude activity where we start with a visual, just doodling, and we go through a gratitude intervention such as three good things. What are three good things that you’re grateful for, and why are you grateful, and why was that meaningful? Who is the individual that perhaps went out of their way to support you? And then we go back to the visual — and the two pictures are drastically different.
When I did this for myself the first time under a coaching guide, the first one was jagged and dark and shades of gray. After I went through the activity — and I wish I could show it to you — the lines were smooth and circular, and I started grabbing different colors to add to it. It was this shift in my mind of thinking about what I was grateful for, and then what is it that I created on my paper that was so drastically different from where there was no intervention. Again, that’s tied to the neuroscience. I started using different neural pathways after the gratitude intervention.
Sacopulos: As our time together is coming to an end, could you give our audience maybe one recommendation that could make their daily life just a little better?
Roszak Burton: Daily life — it would be to schedule a practice, because when we talk about the practice of gratitude, we’re talking about creating a new mental habit, and habits take some time to form. I would ask the individual to identify, is morning a good time?
There was one study at Duke Medical Center, where a group of ICU employees would practice three good things two hours before bedtime. They slept better, they slept longer, their emotional exhaustion levels were decreased, as well as some depression scores. It has to feel like it’s something that you can practice long enough to where it becomes a habit. It could be as simple as if you’re a walker or a runner, use that opportunity to what I call environmental gratitude, right? So, if you are out walking, actually be very in tuned with the colors, the textures, the sounds, the sights.
I did this for a group of students at Virginia Tech, which is my alma mater. They went out, and they practiced this “all walk” or this environmental gratitude walk, and they came back after that and talked about things that they noticed for the first time, and they had been on campus for two to three years already. So, incorporate it into any activity that you already have so it doesn’t feel like it’s another thing you have to do.
Sacopulos: Linda, for those listening today who would like to learn more about this topic and even potentially work with you, what do you suggest as next steps, and can you tell people how to find you?
Roszak Burton: They can find me at Linda Roszak Burton on LinkedIn.
Sacopulos: This has been phenomenally interesting, and I think it has the real potential to change clinicians’ daily lives. So, thank you. My guest today has been Linda Roszak Burton. Thank you so much for being on SoundPractice.
Roszak Burton: Thank you, Mike. Delighted to be together today.