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CIO Unplugged 10/16/13

October 16, 2013 Ed Marx 9 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Thankfulness in Action

During a leadership meeting, one of our chief nursing officers, never nominated for Miss Congeniality, came rushing towards me. Although smiling on the outside, I braced on the inside for the tornado I expected would hit. I extended my hand in greeting, but she went straight for a hug. Not knowing her intentions left me cautious and suspicious.

She released the impromptu embrace. “Ed, you sent me a thank you card for serving in nursing while acknowledging my top 100 nurse recognition, and I was like ho-hum. But what caught me off guard is when I walked into the nurses’ lounge on our med-surg unit. On our community board was another card you sent to one of our floor nurses for her recognition as well. I tracked her down and she was blown away that a non-nursing executive would take the time to acknowledge her contributions in this way. It means a bunch to her, to me, not to mention her peers who all see the card.” Then she chided me for being forced to change her password every six months (j/k).

I’m paperless and proud of it. I have no printer drivers. You’ll rarely find me with a notepad, and I judge people—particularly those in healthcare technology—who still rely on paper. But I have one major exception. I still pen handwritten thank you cards. I always carry blank thank you cards and I send out an average of eight per week.

Here’s why:

Thank you card sales have hit an all-time low. Digital convenience has displaced some of the need, but I think the reason goes deeper than that. I suspect it’s a combination of laziness and lack of training. Growing up in the Marx household, we could not enjoy any gifts received without first having written a thank you card. This became second nature to us kids, and we’ve since passed this tradition down to our kids. I suspect they will do the same with theirs. No thank you cards, no gifts.

It makes a difference. Since handwritten cards are rare, the impact they have is magnified tenfold. People still love to receive snail mail, especially personalized mail. You can open a card and hang it in your office or place it on a desk. You can touch it, smell it, hold it to your chest. As another benefit, thank you cards differentiate you. When interviewing candidates, darn right I pay attention to which interviewee sends a card and which one does not. That little bit of effort speaks volumes and differentiates candidates.

Handwritten thank you cards are a physical expression of the word “care.” Recipients not only see that care, but they feel the effort and time it cost the sender.

What’s the best virtue of handwritten notes? They don’t beg for a response as do email. You send an email thank you, and the person now feels obligated to reply—“Back at ya.” Doesn’t that defeat the purpose?


  1. Carry with you a stash of cards, and when you hear of a deserving act, whip one out. The five minutes you spend writing could bring a day’s worth of happiness to someone.
  2. Write cards with your leadership team. This is a standing agenda item at our weekly meetings. There is always someone deserving of praise. (Not to mention it’s leadership by example.)
  3. When you see or hear of someone who has received honor, send a card. For instance, whenever the top 100 nurse list is published, I target the nurses who work in my organization.
  4. After concluding a meeting during which someone went above and beyond, start writing.
  5. Each Friday, a task pops up on my schedule that says, “Give thanks.” I reflect on the week and decide who to thank.


  • A grumpy finance executive responded to a thank you card via email. “Thank you so much for the card. The timing was perfect. Had a real rough week. Made everything worthwhile.”
  • A physician sought me out. “I have never received a thank you card from administration. This has given me fresh perspective.”
  • I was rounding with nurses in one of our hospitals when one approached me during a break. “Oh, you’re Ed Marx? We’ve never met, but you sent me a card two years ago [emphasis mine] for working with your team on an order set. Thank you for noticing and sending the card.”
  • Employees routinely stop me in the halls to say thank you for the card, some with tears in their eyes.
  • My first platoon sergeant, a tough Vietnam vet, said, “Lt Marx, I was like what the shit, I am just doing my job … and then it hit me, leaders do the little extras. I just sent short notes to my squad leaders.”
  • I sent a note to a CEO thanking him for his leadership and for my privilege to serve with him. “…nobody ever sent me a thank you card for no specific reason other than to say thanks for leading.”

I have a confession to make. I do store some paper actually—a pile of thank you cards I’ve received over the years. I can’t toss them. They carry such meaning. I’d wager it’ll be the same for the people who would receive a card from you. It becomes an oasis in the dessert. A Starbucks red-eye during an all-nighter. It’s salve on a wound and the bridge over a chasm. It can make our toils all worthwhile.

For whom are you thankful? Staff, your boss, a peer? Take action. Grab a card now and share your thoughts with that person. If your handwriting sucks, don’t worry, mine does, too. But no one has ever complained about it, and I doubt they even care.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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Currently there are "9 comments" on this Article:

  1. I couldn’t agree with you more, Ed. I have always enjoyed sending thank you cards and people have always appreciated them so much. After my first year as Director of Interoperability at a healthcare IT company I sat at home and wrote 75 thank you cards, one to each person who reported up to me. We had a good year, we met our goals, and they were responsible for it. Everyone was blown away. Those cards were pinned up on cubicle walls for a year. I had no idea it would elicit such a positive response.

    Now in my role at HIStalk I send thank you cards to new and renewing sponsors. I thank them and let them know they can contact me if they need anything at all. I have been surprised by the responses I have received. People just love it. On Friday the President of a HIT company called me out of the blue to let me know he received my card and he wanted to chat about how I might help him.

    It only takes a few minutes to recognize someone and it will likely be the highlight of the recipients day. It is impressive to see someone in your position take the time to make people feel special. I hope your article inspires others.

  2. Good manners and thoughtfulness are always in style and appreciated. Interestingly, something that is almost quite unexpected these days. Funny how the class act of sending a very personal thank you note is so very different and a nice strategy for really getting someone’s attention. What the world needs now are more Ed Marx’s. Thank you, Ed for this nice story and suggestion.

  3. Ed,

    You made a “paperless impact’ on me several years ago. I participated in a meeting yesterday where a person stated they wanted printouts of the slide deck handed out previous to the presentation — even if they had softcopy. Change is difficult to some. Keep the faith.

  4. Ed, Thank you for sharing your thoughts on this important subject. A “Thank You” can be the simpliest of things which lifts another from a tough day. I, too, was raised in a home where that “Thank You” note was sent out immediately. I’ve raised my kids to do the same, although I do have to remind them. My pile of Thank You notes sits on my desk at home….thinking maybe I should take them to work, too! While I try to always say thank you for simple things in addition to the larger scale items, the hand-written note is a better idea than my email.

  5. Ed: I really enjoy reading your posts. I’ve always told my parents, particularly my mother, that I am so grateful that she instilled in each of us the importance of good social graces and manners. Maybe it’s time I send her a thank you note. Have a great day!

  6. This is great advice and jives with one of the greatest Healthcare Leaders philosophy in his Evidence Based Leadership model. If you are not familiar with Quint Studer, youshould be. This is right up his alley and would be surprised to find that Ed and Quint have not crossed paths several times. A great CEO leader introduced me to his concepts from Results That Last. Handwritten cards are right at the top of the list.

  7. Amen and amen! In the age of electronic communication the hand written note stands apart. It takes a little time, thought and effort making it an act of true gratitude. So let’s continue to put pen to paper while people can still read cursive.

  8. Hi Ed,

    Very timely article in a period where people do not even acknowledge a personalized note let alone respond. As you have said, there are many who treasure such acts but may not say it aloud.

    Thank you

  9. Hello Ed,
    I loved this post. I also feel that the handwritten thank you card is a dying breed and one that needs to be embraced/re-embraced. I don’t have any children of my own to pass this down to but I wish there was a way to instill the importance of writing handwritten “thank you’s” to my nephews, without coming across like a crabby aunt :-). Thank you for the inspiration!

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