Daily Editors' Notes

For happy residents, don't go the extra mile

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Tim Mullaney
Tim Mullaney

I have a welcome message to share with long-term care professionals: You should relax. Don't worry about going above and beyond for your residents and their families, because chances are, they're not really going to appreciate it. At least, this is what new research suggests.

The findings can be traced back to the exceptional performance of Internet retailer Amazon. A University of California at San Diego researcher, Ayelet Gneezy, Ph.D., realized that Amazon routinely was getting orders to her more quickly than promised — and that she didn't feel particularly grateful about that fact.

Gneezy began to study how consumers respond when companies exceed their promises. She conducted a series of experiments; in one, a participant was tasked with completing some puzzles, and a helper pledged to do a particular number of them to help reach the goal. In this and the other experiments, the participants valued those who kept their promise and those who exceeded it about equally.

"I was surprised that exceeding a promise produced so little meaningful increase in gratitude or appreciation,” said Gneezy's co-researcher Nicholas Epley, Ph.D., of the University of Chicago Booth School of Business. “I had anticipated a modest positive effect … what we actually found was almost no gain from exceeding a promise whatsoever."

As to why this is the case, the researchers could only conjecture. One possible explanation: Keeping a promise is so powerful that there's very little room to amplify the effects. Promise keeping is valued “so highly” because in doing so, a person or organization fulfills a social contract and proves “reliable and trustworthy,” Epley explained.

He summed up the lessons from the research: Organizations should “invest efforts into keeping promises, not exceeding them.”

I know I was being glib when I wrote that residents and family members wouldn't appreciate it when a nursing home goes the extra mile. I'm sure that a nursing home that exceeds expectations generates a lot more gratitude than an Internet shopping site that beats its delivery deadlines.  But I do think that it's worth thinking about the long-term care implications of what Epley said.

Nurses and other long-term care pros easily can find themselves going above and beyond for residents, and for as wonderful as this impulse is — and for as great as its benefits can be — this also can lead to trouble. For one thing, it can lead to caregiver burnout, as has been described by McKnight's “The World According to Dr. El” blogger, Eleanor Feldman Barbera, Ph.D.

Another potential pitfall: Expending extra time and energy on one resident can erode the care provided others. Last week, Jacqueline Vance, RN, wrote a moving "Real Nurse Jackie" blog about how she and her coworkers took a risk by giving a tub bath to a very sick and frail resident, fulfilling what ended up being the woman's last wish. This was a laudable act, but Nurse Jackie did note that it created some havoc:  “It never occurred to me … I was more than an hour behind in treatments for the other residents … the nursing assistants were behind in getting their assigned residents up and dressed and ready for rehab, etc.”

I think Nurse Jackie absolutely did the right thing in bathing this resident. But the chaos it caused underscores how unsustainable it is for a long-term care facility to operate on the principle of always exceeding expectations, always going the extra mile to meet special requests and perform extraordinary feats. As Eppley put it, "Behaving fairly toward others is the critical point.”

These new research findings might provide a valuable opportunity for long-term care operators to evaluate what promises are being made to residents and their families at the time of admission, to ensure that these promises accurately reflect what the facility provides (take heed if not), and to reinforce to staff how crucial it is to consistently fulfill these promises for each person in a bed.

Caregivers might be reassured that they are not falling short when they're not going beyond the call of duty — if they realize how much people value promise-keeping, and how people might not really be putting a premium on promise-exceeding.

In fact, “just” by providing the promised level of care, they are doing something very powerful: Creating a facility that is reliable, trustworthy and fair.

Tim Mullaney is McKnight's Senior Staff Writer. Follow him @TimMullaneyLTC.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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