The authors reviewed 1,267 compliment letters received by hospitals to identify the types of practices being complimented and how the letters varied between front-line staff and management. About one-third of the compliments focused on voluntary non-routine behaviors, such as extra emotional support or staying late to run an extra test. Front-line staff were more likely to receive letters acknowledging behavior, while management were more likely to receive letters requesting acknowledgement of or rewarding individual staff.