Building, maintaining and recovering trust: a core leadership competency.

Health care has become a very dynamic, often chaotic business, filled with opposing stressors that threaten its very existence. Paul Van Riper, USMC Retired Lt. General opines that we need "decisive, rapid-fire decisions under conditions of high pressure and with limited information." (1)

Note that these same conditions are found in war, emergency rooms and the trading floors of Wall Street. Unfortunately, in the course of career advancement and education, most successful people learn to be competitive with their peers and protective of their reputations.

When faced with analogous crises, many managers and executives retrench to the command and control structure in which they are most comfortable. Stringent command and control systems substitute engagement, commitment, focus and innovation for compliance. In a rapidly changing world, this tradeoff could sound the death knell of an organization.

The root cause of most failed personal and business relationships is the inability to build, maintain and recover trust. A cohesive team working in an environment of reciprocal trust is paramount to success during times of extreme change. When people trust their leaders, they willingly get on board with a strategy, thereby harnessing tremendous speed and agility to help navigate times of great change.

In contrast, it takes immense time and effort to convince them with facts and figures. The level of commitment attained with trust is much greater than using facts and figures--the heart trouncing the head.

Choosing to trust

Trust is a product of choice: one chooses to entrust another with something important. Trust is visceral and is reinforced by shared experiences over time, kept promises and understanding of the motives underlying sacrifices. We must not confuse trust with credibility. Credibility is an intellectual attribute that is based on past performance. It is limited to a specific circumstance or subject.

Robert C. Solomon and Fernando Flores, in their seminal book Building Trust in Business, Politics, Relationships and Life, (2) advance the concept that "distrust is not so much the opposite, as it is 'the other side of trust.'" They go on to differentiate basic, simple, blind, and conditional trust from "authentic trust."

They describe authentic trust as "a form of self-overcoming and what must be overcome (but not therefore denied) is distrust." Thus authentic trust contemplates distrust and moves beyond it, sometimes in a steady march and at other times through leaps of faith.

Patrick M. Lencioni, in Five Dysfunctions of a Team: A Leadership Fable (3) opines that trust is the basis of the remaining four attributes of effective teams (engagement, commitment, accountability and focus). Trust leads to engagement, which he defines as "the productive ideological conflict that has as its only purpose the attainment of the best possible solutions in the shortest possible time."

Trust is the house in which we live out our relationships. It offers us shelter from the emotional storms outside and security that allows us to strip off our defenses. It provides sustenance to reinvigorate our soul. When you consider previous predicaments of great stress, you will most likely remember reaching out to your most trusted friend or colleague to both express your concerns and ask for advice. During that time, you were sheltered from new or mounting turmoil.

Building trust

One must be mindful that, as with a house, trust must be carefully built, lovingly maintained and steadfastly renovated as needed.

Lasting trust must incorporate three major elements. It must be:

1. Built on a strong foundation

2. Deliberately planned

3. Structurally reinforced

The foundation of trust is "self-trust." Keith Lehrer, in Self Trust: A Study of Reason, Knowledge, and Autonomy, (4) describes self-trust as the ability to trust oneself to trust wisely and authentically.

Self-trust should not be confused with self-deception or self-centeredness. It is not vain or unreasonable. It is trust that is continually examined and frequently refined. It is not critical or destructive. It is supportive and motivating and resolutely focused on improvement.

A house built in a week, even when built on a strong foundation, will likely succumb to the first sizable storm. Trust must be incrementally won and greedily compounded. The framework of the house is the ability to make and fulfill commitments that will benefit the collective over the individual.

Each supporting wall represents an individual sacrifice for the benefit of another. The glue or nails that hold the sacrifices together is communication; indeed, communication can be the tool that builds trust or the weapon that destroys it.

Maintaining trust

Once we have built trust, we must lovingly adhere to a maintenance program, lest it fall into a state of disrepair. In his recent book, The 8th Habit, (5) Dr. Stephen R. Covey advances a metaphor for trust called the emotional bank account. In the chapter titled "The Voice and Speed of Trust," he lists 10 key deposits and withdrawals to and from that account.

You can also distill the behaviors that bolster and maintain trust to 12 specific deeds that will fit easily on an index card. Frequently reminding yourself of these behaviors will help maintain trust.

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* Share important information, especially about yourself

* Admit weaknesses and mistakes

* Ask for help and tap into another's skills and experiences

* Accept questions and input about your areas of responsibility

* Give others the benefit of the doubt before arriving at a negative conclusion

* Be willing to be influenced

* Take risks in offering feedback and assistance

* Avoid abusing others' vulnerabilities

* Focus time and energy on what is to the collective benefit

* Offer and accept apologies without hesitation

* Act fairly and consistently

* Fulfill promises

Recovering trust

Authentic trust has a built-in reservoir that tolerates mistakes and setbacks without diminution of trust. Consequently, authentic trust will bounce back of its own accord, making it a precious insurance policy against loss of trust.

Nonetheless, there are things that erode trust. The ease with which we can recover from these insults is proportional to and inextricably linked to the structural integrity of the house of trust we have built. It is not difficult to identify the types of immense betrayals that annihilate trust. Many times, however, the breaches are less dramatic. They can be deceptiveness, disloyalty, callousness, arrogance, and failure to keep promises.

Recovering trust requires three separate actions that when combined act as a restorative intercession that can heal the relationship.

They are:

1. Sincere apologies

2. Permitting the affected person to influence you

3. Fulfilling the promise

Sometimes it is seductive to skip the apology and endeavor to repair the lapse. This will be viewed as confirmation of your unwillingness to be open, honest, vulnerable, sincere, courteous, and humble. Along with diminishing the magnitude of any further action, it instigates doubt regarding your underlying motives and actions.

Trust and organizational structure

Hierarchical organizational structures hardwire a command and control attitude in the organization. The structure is easy to develop and equally straightforward to monitor. The difficulty is in adjusting or fine-tuning the structure to meet the ever-changing needs of the organization.

The relationship, at its best, is based on respect and obedience of managers and employees. In The 8th Habit, Covey reports on results of the Execution Quotient Questionnaire of 23,000 full-time employees in the U.S.

Only 23 percent indicated that everyone precisely understands the organizational strategy and goals. Nine percent agreed that their teams have clear, measurable goals and only 15 percent felt that their organization fully enables them to execute key goals.

The hierarchical organization does not put decision-making authority close to the front lines but reserves that to the few top executives. Managers find it difficult to eliminate various forms of excess and waste because they require clearance from above to do so. Cooperation and exchange of information across departments is hindered, and collaboration is often futile.

Conversely, a flat structure reflects the trusting culture of the organization. It emphasizes a decentralized approach to management that encourages high employee involvement in decisions. It relies on each manager to promote the collective benefit over the individual gain. It values teamwork over individual accomplishments. It contemplates a reciprocal relationship that empowers employees to make decisions so as to react quickly to changing market conditions.

Employees, in turn, trust the leadership to set the global strategy, create a challenging and satisfying environment, and align rewards and accomplishments. In a trusting flat organization managers constantly strive to eliminate waste and excess; they share knowledge and credit easily, and they would rather collaborate than compete.

In an environment, often depicted as the "perfect storm," health care organizations and their leaders must learn from outside industries and leaders. We need to look to the great models of lasting success, most of whom are in banal industries with nearly as much government intervention and public scrutiny.

Trust offers us a framework to design, develop and lead our organizations and permits us to cultivate trust throughout our collective relationships.

Leadership, power and trust

In the U.S. we prize individualism and courage above conformity and teamwork. Power and strength are uniformly associated with leadership, but not trust. Leadership is power, not power in the autocratic sense but the power to choose.

Covey writes, "The power of choice means that we are not merely a product of our past or our genes; we are not a product of how other people treat us. They unquestionably influence us, but they do not determine us. We are self-determining through our choices. If we have given away our present to the past, do we need to give away our future also?"

Trust-based leadership earns its power based on its results. Trust permits managers and employees to take risks. Trust believes in the employees and managers affinity to achieve exceptional results collectively. Trust is a catalyst for the sharing of power. Power given is power amplified and power shared uniformly brings people together and strengthens their bond.

Also, authentic trust is wise trust. Authentic trust helps us to always look ahead and make progress. It wisely guides our organization and us out of harm's way.

Consider this. Who exhibits more power, the leader who fulfills promises, or the one who breaks them; the one who is open and honest or the one who is secretive and manipulative; the leader who apologizes or one who never acknowledges his mistakes; the leader who hordes power or the one who shares it; the leader who chooses to trust or the one who chooses to distrust; the leader who blindly trusts or the one who develops authentic trust?

Trust is the most basic and essential element of both personal and business success. It requires courage, determination and sacrifice. It is optimistic, full of promise, fair and supportive. It helps us negotiate troubled waters and beseeches us to build lasting relationships. It helps us to value each other as individual humans, not as components of a large machine.

As Solomon and Flores concluded, "to survive and thrive, we must count on each other and find leaders to follow. Like it or not, we are all in the process of creating a new way of life, and no one knows just what it will be. That is the domain of leadership, authentic trust, and history making." (2)

What are the real lessons that we can embrace? Our new emerging leaders should take heed from the past and forge a new model for building their organization and reputation on trust. Building, maintaining and recovering trust is a leadership competency that must be mastered in today's environment. Trust us.

Akram Boutros, MD, CHE, is executive vice president, chief operating officer and chief medical officer of South Nassau Communities Hospital in Oceanside, N.Y. He can be reached at 516-632-3480 or [e-mail]

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Claire B. Joseph, MS, MA, AHIP, is director of the medical library at South Nassau Communities Hospital in Oceanside, N.Y. She can be reached at 516-632-3452 or [e-mail]

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References

1. Gladwell, Malcolm. Blink: The Power of Thinking Without Thinking. New York: Little, Brown & CO., 2005.

2. Solomon, Robert C. and Fernando Flores. Building Trust in Business, Politics, Relationships, and Life. New York: Oxford University Press, 2001.

3. Lencioni, Patrick M. The Five Dysfunctions of a Team: A Leadership Fable. San Francisco: Jossey-Bass, 2002.

4. Lehrer, Keith. Self-Trust: A Study of Reason, Knowledge, and Autonomy. New York: Oxford University Press, 1997.

5. Covey, Stephen R. The 8th Habit: From Effectiveness to Greatness. New York: Free Press, 2004.

By Akram Boutros, MD, and Claire B. Joseph, MS, MA, AHIP

Table 1

DEPOSITS                     WITHDRAWALS

Seek first to understand     Seek first to be understood
Keeping promises             Breaking promises
Honesty, openness            Smooth manipulation
Kindnesses, courtesies       Unkindnesses, discourtesies
Win-Win or No Deal thinking  Win-Lose or Lose-Win thinking
Clarifying expectations      Violating expectations
Loyalty to the absent        Disloyalty, duplicity
Apologies                    Pride, conceit, arrogance
Receiving feedback and       Not receiving feedback and giving
giving "I" messages          "You" messages
Forgiveness                  Holding grudges