Milllion Dollar Smile
--Birju Pandya
2 minute read
Apr 5, 2014

From Shawn Achor's Beyond Happiness book (originally heard in this video):

Ritz-Carlton has franchised a method called the 10/5 Way. It involves just a few 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." It sounds simplistic but these small changes can have a huge impact.

Ochsner Health System decided to adopt the 10/5 Way. They formally trained more than 11 thousand physicians, nurses, managers, and administrators to smile anytime they were within ten feet and say hello anytime they were within five feet of another person -- patient or fellow employee.

As a researcher, though, my job is to 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 employees find a loophole and simply walk eleven feet away from everyone in the hospital?

At first, many of the doctors and 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 employees, 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 the 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. It completely transformed the shared reality in the hospital. Not only did this improve patient's 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, the hospital had a 5% increase on Press Ganey's "Likelihood to Recommend" score, a 2.1% increase in unique patient visits, and significant improvement in the medical practice provider scores. Ochsner Health System 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! That gives a whole new meaning to the phrase "million-dollar smile."

Posted by Birju Pandya on Apr 5, 2014

4 Past Reflections