Interview with Amanda Krantz about the Power of Gratitude

Generally, I do not break the fourth wall when creating these bios, but I am making the exception here because in the spirit of appreciation, I am grateful that my path crossed with Amanda Krantz. I had the pleasure of meeting Amanda at a 2013 Lean Startup Conference in San Francisco. At that point Amanda was just starting DohJe (for more on her story, see: Why I Left a Comfortable Corporate Gig to Bring More Gratitude to Healthcare), almost 5 years later DohJe is now an amazing health technology company doing incredible things. In addition to DohJe, her list of note-worthy accomplishments includes serving in the Air Force, receiving an M.B.A. from Harvard Business School, and co-founding Notify.Me.

1) DohJe (doe-jay), the name of your company, means ‘thank you’. What is the company’s origin story?

I came up with the idea DohJe because I really wanted to thank a nurse after the birth of my first child. It was a C-section and I did not find out all the things she had really done for me until after she had left her shift. She stayed after her night shift and waited because they had no post-partum rooms, so I was in an OR recovery area. She basically stood guard so that they would not try to take the baby off to the nursery— she just did because. When I went to try to track her down to thank her, there were all these various barriers to finding her.

Life gets in the way, and I never actually thanked her. Fast-forward three more years, I have my second child and this time I had another crazy situation where I had a nurse come in and went way above and beyond. This time, several months later, I thought, “I can’t let years go by and not thank her.” I ended up tracking her down, and at that point the conversation was, “I need to know how to thank you in the way that’s most meaningful to you. Please tell me what I can do.” I didn’t want to just leave cookies for the floor because she personally had done so much. I wanted her to know, and I wanted her supervisor to know.

That’s when I started learning about nurse burnout and how any form of appreciation is so helpful. Just a thank you was enough. Originally, it wasn’t going to be a business. It was just going to be an app that we were going to create for patients to thank nurses and other healthcare workers. In our first pilot, with UCSF, is when we learned that there’s been a change in healthcare where they were starting to really recognize the value of real-time peer to peer gratitude—creating cultures of gratitude and appreciation.

2) As you have developed DohJe over the years, what has surprised you and/or stuck out regarding the power of gratitude in the workplace?

First, just how powerful gratitude is, especially for a brand new nurse. We had a nurse that we had never met, send us an email thanking us for creating DohJe because she was getting ready to quit. Actually, I think she had not graduated yet. It was her nursing internship, or she was on the floor working and had really run into lateral violence and just was really disillusioned at how bad the working conditions were, and was looking at switching careers. Through DohJe she received one note from her patient, and that one thank you note was enough to remind her why she’s doing what she’s doing. Then she wrote us to tell us that she decided to stay a nurse after that one note. That was my aha moment, gratitude actually changed the course of her life.

Second, it surprised me how many people were like me that wanted to thank someone but never did. Whether it’s you don’t know what to say, or there is not an easy way to say it, you end up not doing it. But when it’s made easy, a ton more people will thank the person who helped them.  Spending so much time now seeing the effects of gratitude on the sender and the receiver, I will catch myself not expressing my gratitude and make more of an effort to actually thank someone and let their supervisor know, in everything from airlines to customer service calls. Research has now validated the two-way power of gratitude—but experiencing it myself, I have seen first hand how it affects my own well-being.

3) It is fairly well-established that burnout is a major problem in health care. Gratitude has been shown as a useful empathic tool to mitigate the effects of burnout among health care workers. However, you have uncovered that there are unique attributes about the nursing profession that make this difficult. Why are nurses a special case in this regard?

You have a very intimate experience with your nurse. Their name just isn’t front and center. With the doctor, it’s always like, “Dr. So-and-so will see you now…” and their name is all over your EMR and your paperwork. However, I’d argue you are much more intimate with your nurses. We will get inquiries from patients that say, “Hey, I’m trying to find this nurse. She’s from here. She’s got these many kids.” They’ve had all this time together. They know personal things about them, they’ve connected on a personal level, but because of the way things are currently set up may not know the name.

To have a public place that nurses can be found is becoming more critical because more and more patients are expecting to be able to find people on social media: LinkedIn, Facebook, Twitter. More nurses are now on these platforms than when we started. However, this is not the right platform for gratitude. Many nurses do not want patients to go find them and thank them in a public forum. That’s their personal space. Therefore, having a dedicated place that patients can go and find them directly is really helpful.

One final point, many hospitals think that the various existing feedback channels (e.g. patient satisfaction surveys, etc.) are enough. However, family members are sometimes also deeply affected during the process of medical treatment. None of those channels are effective for the family members to thank nurses. If you think about when someone who is in the ICU, a cardiac patient or oncology, the care that’s given to the family members— I mean some family members live in the hospital during these times of crisis. They are often very grateful for what the care of a family member—as well as for themselves—trying to get through a situation that they’ve never experienced before. They go through it with these people—none of their friends or family members outside of that have any idea, and they’re now more connected with these people than they are anyone else in their life. Those family members don’t have a way through any of the existing mechanisms to express their gratitude directly to any of the staff.

4) Like many digital health offerings, one of the obstacles you have had to face is the ability to integrate with other systems. What have been some of your other obstacles? And what does DohJe look like in 5 years when you successfully navigate around these?

This is a fascinating question because we’ve taken the approach to avoid having to integrate with anything. As we’ve been doing this now for four years, the landscape is changing. Before, there was an opportunity for innovation groups, and service excellence committees, and rogue health care departments to experiment. Now the CIOs and IT departments are demanding more integration regarding their technology partners. Before it was harder to get approval to integrate, so we chose not to. Now, it’s not uncommon for hospitals to have 200 digital health tools— and they want these things to be more integrated.

Fortunately, our system was built [in the beginning] as a web app with APIs that can plug into almost all systems. I would say over the next five years, DohJe in some form will be the front-end interface that connects with any health care system and all the pieces work together nicely. We are recognized as one of the most authentic and genuine ways to collect real gratitude, and then we plug this content into the system of record of the health care institution.

Lastly, we want to flip the ownership of this type of gratitude on its [current] head. The people that we work with, the nurses and health care workers that have a DohJe gratitude locker—this “locker” holds their thank you notes. In our experience, gratitude that’s delivered through survey systems generally relies on manual ad-hoc systems, sometimes the gratitude gets delivered but it is held hostage in the hospital’s HRIS system. It is not portable.  Giving ownership of the gratitude to those who earned it makes good business sense, too. Using DohJe has been shown to increase employee engagement and reduce sick time at hospitals like Delta County Memorial Hospital.

We say, “You have,” as a caregiver, “a digital thank you locker,” so that the gratitude is yours. You can plug the content into your employer’s HR system so that you can get recognized career-wise, but the control and ownership belongs to the caregiver. This way, when you leave, you get to take your thank you notes with you. They are not artifacts that belong with your previous employer.

5) Based on the wisdom you have earned up to this point in your journey with DohJe, what takeaway can you share that one can immediately put into practice using the gift of gratitude to improve the life of others?

I am going to improve your question… let’s answer: put into practice using the gift of gratitude to improve the life of others and their own life. When you feel grateful, express it! Take the step to let someone know. We often hear people ask, “Well, I don’t know what the perfect thing to say is?” The number one thing we have heard from those that get DohJe notes, any thank you helps. People can never hear thank you enough. Some people will write these really long heartfelt notes of gratitude, and others will just say, “Thank you for your compassion,” and both of those make a huge impact. After you express it, you feel better too, whether you can express it as a quick thank you or a long one. When you feel grateful, say it.

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