Why a “5-to-1 Mindset” Fosters a High-Performance Culture

In our work with major health systems across the country, we’ve advocated leaders adopt the golden 5-to-1 ratio in their interactions with colleagues and their teams.

This research-based strategy reveals the power of five positive comments for every one criticism in high-performing teams and organizations. This practice and the underlying research were cited in a 2013 Harvard Business Review article by Jack Zenger and Joseph Folkman, “The Ideal Praise-to-Criticism Ratio.”

But an insightful observation from Dr. Matthew Wayne, chief medical officer of Summa Health Medical Group and NewHealth Collaborative, in a leadership workshop last week helped me see a flaw in the way people think about the 5-to-1 ratio. By definition, this leadership principle focuses on quantity. Dr. Wayne wisely pointed out that the practice works best when leaders develop a mindset and bias toward recognition and appreciation. Paying attention to the numbers is beneficial only to the extent that it forces leaders to recognize how seldom they may offer positive feedback to their teams.

Qualitatively in our work with teams, we’ve watched and heard from frontline staff that more praise than criticism works for three major reasons.

High Performance Culture Medical Meeting


More praise reinforces positive contributions

Whether the carrot or the stick is more effective in changing behavior is a centuries-old debate. But there is no doubt that positive reinforcement encourages the practices and behaviors that we know improve a patient’s experience and the overall quality of care. But we’ve seen praise do more than that. Staff who feel appreciated and recognized so often go above-and-beyond to provide truly exceptional, compassionate care that differentiates great provider organizations from good ones.

More praise makes criticism more palatable and powerful

While it may seem counterintuitive, one of the most important reasons to provide more positive recognition is to make negative feedback more effective. Staff in organizations where leaders only point out the problems or shortcomings become more discouraged and less likely to go above-and-beyond. Providing balanced feedback usually means the constructive criticism is better received and embraced.

More praise builds a culture of strength-development rather than weakness-obsession

Marcus Buckingham and Curt Coffman’s 1999 best-seller First Break All the Rules: What Great Managers Do Differently is the leadership bible for those of us who believe developing staff member’s strengths rather than trying to fix their weaknesses is more effective – and makes work a lot more enjoyable. A culture of praise and appreciation is one of the ways managers emphasize employees’ strengths every day.
Changing the way we think about “5-to-1” from numeric ratio to transformative mindset can be one of the most important ways leaders improve employee engagement and a culture of high-performance. Both positive and constructive criticism play key roles in improving individual and team results – when they are delivered consistently and in the most genuine spirit.

Stamp & Chase offers up-to-date, effective strategies for healthcare organizations to improve staff engagement and develop high-performance teams. To learn more about our approaches based on team recognition and appreciation, send us a message.

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