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Staff burnout, low morale, and high turnover are an increasing problem in most health care professions, and physical therapy is no exception. Good employees are not easy to find, develop, or keep in any environment, but it has been especially hard in the current economy and the wake of the Great Resignation of 2021.

Like most managers and supervisors, those at our facility felt we were doing a decent job of recognizing my employees. We even have an employee recognition program. But employee recognition has drawbacks: It primarily focuses on effective performance and does a poor job of helping employees feel valued as individuals. Additionally, most recognition is generic and impersonal – everyone gets the same certificate and gift card – and is often done in front of a large group, which makes some employees uncomfortable.

What we learned is that not everyone feels appreciated in the same ways. That is, not everyone values a verbal compliment or receiving a gift card. Some people feel valued when you spend time with them. Others appreciate working together on tasks, being asked to take on a higher challenge, or getting some practical help.

Five Keys for Communicating Authentic Appreciation

Looking into ways to show our employees more authentic appreciation, we found five core conditions that have been identified to help employees feel truly valued.

  • Communicate appreciation regularly. How "regularly" is defined varies by work setting, the frequency of interaction between co-workers, and the nature of the relationship. But it needs to happen more often than at a once-a-year performance review.

At our facility, the Center for Physical Rehabilitation, we have implemented different programs, including a peer-recognition program to encourage appreciation from all employees, not just leadership. At quarterly staff meetings, individuals are nominated to be recognized for their contributions. A winner is identified each quarter, and then an Employee of the Year is chosen from this group. Our most recent Employee of the Year felt most appreciated by thoughtful gifts, and so she received tickets to Hamilton and a night out "on the town" with the owners. She thoroughly enjoyed the experience and valued being highlighted for the quality of work she did to win the recognition (which also served as a tangible example to other employees of what management is looking for).

Another example at our facility was the unexpected outcome from appreciation being communicated consistently to an employee who wasn't performing to their potential. Even after investing a lot of time and energy trying to train them, we observed that the employee didn't seem to be "getting it." The employee said the right things in response to coaching about needed changes, claiming that they understood what they were supposed to do, but their work and behavior never improved. It wasn't until their supervisor shifted from focusing on their deficits to focusing on and calling attention to what they were doing right (using the employee's preferred appreciation language) that a significant change in their behavior was observed. The employee even began to lead others in ways that weren't expected.

  • Use the language and actions most important to the recipient. Most people tend to show appreciation to others in the ways they prefer being appreciated. If you like getting face-to-face compliments and praise, that is usually how you will end up expressing appreciation to others. But it is critical to "speak the language" most important to the recipient.

In fact, using the wrong appreciation language can backfire. One leader at our company learned this the hard way. Since he valued words of affirmation, he assumed that everyone else did as well. To recognize a team member for the outstanding work she was doing, he frequently praised her in meetings with other team members. But, to avoid the public attention, she would actually shut down and seemingly try to do less. (A national study found that 30%-40% of employees don't want to be praised publicly.)

  • Personalize your recognition. Sending a generic blast email that congratulates everyone on the team for a job well done may not be as effective as letting each person know you value them individually for the specific work they did.

Well-intentioned recognition from our leadership fell flat for this exact reason. Using generic praise led most people to get a "glossed over" look because the message wasn't necessarily about them. Now, however, leadership has been deliberate to state exactly what we are praising employees for. This has gone extremely well and led other employees to emulate the behaviors being singled out.  

  • Appreciation has to be perceived as genuine and authentic. Your team members can tell when you are "going through the motions." Your tone, voice, posture, and facial expression should match what you say, or it will sound insincere. Your employees also will question your sincerity if you act one way in public and differently in private, and if you only give praise when you want something.

Unfortunately, we've seen this in action – managers who were obviously not being authentic in their praise – and a very negative reaction resulted. The office manager even had to step in to help correct the problem. When less than real authenticity in communication occurs, employees lose trust, often immediately – and damaged trust can take an extremely long time and significant energy to restore. Trusting relationships are foundational to a healthy physical therapy practice  and help build a delightful culture.

  • Showing appreciation is not just a "top down" effort. Anyone in a physical therapy practice can communicate appreciation to anyone else at any level, from front desk employees to therapists to managers. Employees often report they want to know how to encourage one another, not just to recognize an employee or be recognized by a supervisor. Every team member, regardless of their position, can positively impact the workplace culture.

To support this practically, our practice has every employee take an online assessment to identify the specific ways each prefers to be shown appreciation. The results are shared with all coworkers. Encouraging colleagues to show appreciation to one another spreads the responsibility and empowers every team member to be involved.


Brian Gilbert, PT, MSPT, is a board-certified orthopaedic clinical specialist, certified in the McKenzie Method of medical diagnosis and therapy, and dry-needling certified. He is a partner and COO of The Center for Physical Rehabilitation in Grand Rapids, Michigan. Paul White, PhD, is a psychologist and co-author of "The 5 Languages of Appreciation in the Workplace."

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