In my coaching work with physicians I hear many anecdotes about the rivalry and distrust that exists between doctors and within healthcare teams. We all know these stories - that physicians have not been trained to trust others or delegate tasks (and in fact were often publicly reprimanded for doing so while in training), that doctors don’t trust nurses to do things right, nurses don’t trust doctors to “have their back”,physicians don’t trust each other’s intentions, credibility or even capabilities, clinical staff don’t trust hospital administration to be on their side or have their best interests (or the best interests of their patients) at heart … and the list goes on and on.
Have we ever stopped to think of what this “deficit of trust” that exists in healthcare teams does to the core functioning of the healthcare providers or how it affects the key issues of patient safety, quality and the hospital’s or practice's economic health?Simply stated, that there is a significant lack of trust in the healthcare environment is not new news. But what is new, is the understanding that trust is a critical component to both personal and organizational success - that it underlies and affects the quality of every communication, every patient case, and every team effort.But what is trust exactly? Well, simply put, trust means confidence. When you trust people, you have confidence in them, in their integrity and their abilities. When you distrust people, you are suspicious of them – of their intent, their agenda, their capabilities or their track record. It is that simple. We have all had experiences that validate the difference between relationships that are built on trust and those that are not. These experiences clearly tell us the difference is not small; it is dramatic. In a fantastic book written by Stephen M.R. Covey called “The Speed of Trust: The One Thing That Changes Everything”, these issues are explored and peeled away to their core. And wow, does it all begin to make sense. One of the biggest “ah-ha’s” that come from this book is about what trust – or a lack of trust– does to any organization’s bottom-line. It is the most simple concept, and as Covey puts it:
"Here is a simple formula that will enable you to take trust from an intangible and unquantifiable variable to an indispensable factor that is both tangible and quantifiable. This formula is based on this critical insight: Trust always affects two outcomes – speed and cost.When trust goes down, speed will also go down and costs will go up.When trust goes up, speed will also go up and costs will go down. It’s that simple, that real, that predictable."
Think about healthcare environments, organizations or teams that you’ve worked in that may have had non-existent or low trust – do any of these “typical” workings sound familiar?:
Dysfunctional cultures (i.e., “open warfare”, sabotage, grievances)
Militant stakeholders
Micromanagement and redundant hierarchies
Punishing systems and structures
Initiatives that drag
Many unhappy employees
Intense politics with clear camps and parties
Excessive time wasted defending positions and decisions
Common “CYA” (cover your ass) behaviors
What about the alternative? If any of you have had the luck to be part of healthcare organizations or groups that have a healthy- to high-trust environment, you may have experienced:
A healthy workplace with good communication
Aligned systems and structures
A focus on work (not politics / rumors / grievances!)
Effective collaboration and execution
Positive partnering relationships
Strong creativity and innovation
Positive, transparent relationships
Strong engagement, confidence and loyalty
The way Covey puts it, in organizations where trust is high, you see material improvements in things such as communication, collaboration, execution, innovation, strategy, engagement, partnering, and relationships with all stakeholders – and the “dividends” of increased speed and improved economics. Not bad outcomes! But it is not just organizations that suffer the results from a lack of trust – you personally can suffer too. Physicians are notorious for not trusting each other or other members of the healthcare team – if this is true, or even “rings a bell” for you, I want you to think about how this might be affecting your performance and overall happiness on a daily basis. Let’s make it real – from Covey:
"Think of a person with whom you have a high-trust relationship – could be a spouse, friend, child, sibling, or colleague – and describe this relationship. What’s it like? How does it feel? How well do you communicate? How quickly can you get things done? How much do you enjoy this relationship?Now think of a person with whom you have a low-trust relationship – could be a colleague, boss, family member – and describe this relationship. What’s it like? How does it feel? How is the communication? Does it flow freely and quickly … or do you feel like you’re constantly walking on land-mines and being misunderstood? Do you work together to get things done quickly, or does it take a disproportionate amount of time and energy to finally reach agreement and execution? Do you enjoy this relationship… or do you find ittedious, cumbersome and draining?The difference between a high- and low-trust relationship is palpable!Can you imagine the difference it would make if you were able to increase the amount of trust in the most important personal and professional relationships in your life?"
Said another way, what would developing your “trust quotient” do for you, for your patients, for your team, for your career growth, and for your overall happiness?
Next Time: How You Can Build Your Personal and Organizational Trust Competency
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