A Culture of Kindness and Accountability

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The diabetic overweight patient was at the doctor’s office for a foot exam. After the exam was completed, the patient struggled to put his socks and shoes back on. The doctor knelt down on his knees and gently helped him put on one sock at a time, one shoe at a time. The patient was embarrassed, but he was so moved that a doctor would do that for him. Six months later, he came back to see the doctor. He had lost 60 pounds! He told the doctor: “Your act of kindness inspired me to change my lifestyle and lose the weight. Thank you!”

This is one many stories of acts of kindness that I heard last week while I was speaking to a group of physician leaders and administrators at Kaiser Permanente in California. The main focus of the discussion was how to make sure that kindness was not just practiced towards patients, but also part of the overall culture of the organization, and as importantly, how to balance kindness with accountability in dealing with other leaders and employees.

It is no secret that kindness has gotten a bad rap in society recently. Many people think that kindness is a virtue of losers. In the workplace, some are hesitant to be kind to each other because they fear that they will be taken advantage of or viewed as weak or non-confrontational. It is true that some overly kind bosses avoid having tough conversations with others or put off giving negative feedback for fear of hurting others’ feeling or not being liked. Therefore, as I argued to the audience at Kaiser, a clear way to high performance is to create a culture of kindness coupled with accountability.

There is ample research showing that kindness is not just a feel-good, new agey thing, but that it actually works in producing results. The American Management Association(AMA) conducted a survey of its members to examine how a boss’s character affects employee performance and retention rates. About 75% of the respondents characterized their boss as kind, whereas 14% described their boss as a bully. When asked whether they plan to work for their company for a long time, 84% of the employees reporting to a kind boss said yes, but only 47% of those who reported to a bully agreed. These results unmistakably show how the relationship between employees and their leaders affects performance, productivity and even bottom-line results. Similarly, a recent studyconducted in a long-term healthcare care facility examined the culture of caring and kindness among employees. In this type of culture, the employees are careful of each other’s feelings and show compassion when things aren’t going well. They demonstrate their caring through small acts such as bringing someone a cup of coffee when they go to get their own, or by just listening to another if she needs to talk. The findings showed that this type of culture had a positive effect on employees’ emotional and behavioral outcomes such as reduced absenteeism and burnout and improved teamwork and overall satisfaction. Interestingly, that culture rippled out from staff to influence patients and their families. When employees treated each other with kindness, patients’ quality of life measured in terms of comfort, dignity, satisfaction, and spiritual fulfillment also improved significantly, and many of them had fewer trips to the emergency room. 

However, it is important to note that kindness by itself is not enough. To produce high performance, accountability has to be built in the culture. In an HBR study of 160,000 employees working for 30,000 leaders at hundreds of companies around the world, Zenger and Folkman identified two types of bosses: tough and nice. They described tough bosses as adept at establishing high standards, getting their employees to stretch for goals that they didn’t think they could achieve, and keeping them focused on these goals. On the other hand, nice bosses focus on staying in touch with the issues and concerns of employees, giving them honest but helpful feedback, developing them and maintaining their trust. Employees in the study were asked to rate themselves on engagement. Then, they were asked to rate to what degree they felt their leaders fit the profiles for tough and nice. Only 8.9% of employees working for tough bosses and 6.7% of those working for nice ones rated themselves as highly engaged and committed. But 68% of the employees working for leaders they rated as both tough and nice scored in the top on overall engagement. The clear conclusion is that being accountable but not kind, or the other way round, is not enough in improving employee engagement. Leaders need to be both kind and accountable.

Putting it All Together

Leaders who are kind but also who demand a great deal from their employees can be highly effective in guiding them to high performance. Strong leaders who establish high standards should not be afraid of the “nice guy” label. And kind leaders should not think of setting demanding goals as incompatible with their leadership style. These two approaches are “like the oars of a boat.” They should be used with equal force to guide the organization on its journey to excellence.


Some of the ideas in this article are based on my book “Intangibles: The Unexpected Traits of High-Performing Healthcare Leaders,” recently published by Health Administration Press.

Please share your thoughts in the comments section below. If you are interested in Executive Coaching, please contact me at amer.kaissi@trinity.edu


Amer Kaissi is an Executive Coach, Author, and Professor at the Department of Healthcare Administration at Trinity University. For more information, please visit www.amerkaissi.com.