Chuck Lauer: Trust

Trust plays an enormous role in our lives. We have to trust people in just about everything we do. There are simple, everyday situations, like trusting your mechanic to fix you car in time, so that you to drive it to work the next day. And there are more critical situations, like trusting the pharmacist to fill your prescription properly, or trusting the surgical team to make sure you don't get an infection.

We are constantly keeping our fingers crossed that everyone we trust will do what we expect them to do. This is particularly true for executives who depend on large numbers of people to get things done. In a recent survey of corporate executives by Partners in Leadership, 79 percent said teamwork and trust constituted a major organizational challenge. They agreed that when trust falls apart, it leads to mistakes that might not be fixable.

Trust in teamwork

Trust is a critical issue in healthcare right now, because we are putting much more emphasis on teamwork. This involves clinical caregivers, the rest of the hospital staff and a growing list of affiliated organizations outside the hospital, contracted through accountable care organizations and the like. All of these people have to work together closely and learn to trust each other.

At a recent meeting I attended, a panelist spoke on the critical role of trust in making a hospital function efficiently and effectively. When that trust erodes, patient care gets screwed up. He gave an example of a hospitalist and ER physician having a falling-out over a patient handoff.

The seeds of this conflict derive from the differing roles of these two specialties. The emergency physician is focusing on immediate needs and how to stabilize the patient, whereas the hospitalist is trying to provide a definitive diagnosis for the long term. But these differences should be augmenting each other, not creating conflicts where big egos get in the way of delivering quality care.

In this particular situation, the hospitalist doubted the ER physician's diagnosis. He told the emergency physician he was going to "think about it" and would get back to him about admitting the patient. The emergency physician smoldered over the hospitalist's lack of trust in his diagnosis, and all the while, care for the patient had to wait.

Trust is so critical that the amount you have in a person can trump all the skills and abilities that person has. On my high school football team in Buffalo, N.Y., there was a halfback who looked every inch the football player; he had plenty of natural ability, but he couldn't follow through on assignments. If the quarterback told him to run into a certain hole, he might run the wrong way. You could never be sure what he'd do. Even though he had great talents, no one could trust him, so he ended up sitting on the bench.

Trust is also impaired when promises are continually broken or a lot of obvious mistakes are made. When you no longer trust another person, you have to double check their work all the time, and you can't rely on what they say. This eats away at efficiency and endangers quality of care.

In organizations like the United States Marine Corps and all the other branches of the military, trust is indispensible. Soldiers are trained to support each other, no matter what. There can't be any room for large egos or selfishness.

When police officers are in a standoff with an armed and dangerous fugitive, they'll say to each other, "I've got your back." They'll be there if something goes wrong. "All for one, one for all" is how the Three Musketeers put it. That should be the motto of any organization that strives to be successful.

And yet hospitals have the persistent problem of "silos" — entrenched groups that don't work well with each other. Physicians may form silos against management, nurses against physicians and whole departments may feud with one another like the Hatfields and McCoys. There should be no allowance for turf and ego in any healthcare organization. A hospital needs to be a refuge of comfort and security, not a hotbed of conflicts and simmering rivalries.

Ultimately, these problems end up at the CEO's door. Chief executives set the tone for the hospital. If they let this behavior get out of hand, it will destroy the efficiency of the institution and completely jeopardize patient safety.

This all gets to the main mission of a healthcare organization, which is winning the trust of patients. The patient's opinion of the institution is becoming even more important with new requirements like the HCAHPS patient satisfaction surveys for Medicare. But winning patients' trust involves much more than just hitting all the right metrics. You have to have it in your blood.

Earning and maintaining the public's trust makes all the difference between a good organization and a great one, according to David A. Shore, founding director of the Trust Initiative at the Harvard School of Public Health. "A good organization produces excellent programs, products and services," he writes. "A great one — with a power brand — is trusted to consistently deliver excellent programs, products and services."

Unfortunately, the public's trust in hospitals and other medical institutions has declined in the past half century. According to Harris Polls, 73 percent of Americans expressed a "great deal of confidence" in medical institutions in 1966, but that number had dropped to 32 percent by 2004.

For the patient, trust is everything. Alice K. Jacobs, MD, a former president of the American Heart Association put it this way: "Trust has been shown to be essential to patients, in their willingness to seek care, their willingness to reveal sensitive information, their willingness to submit to treatment and their willingness to follow recommendations."

Winning back the public's trust has a lot to do with assuring a high level of trust among all the people within your organization. It's a tragedy every time a patient who needs care can't be admitted because of some feud between a hospitalist and an emergency physician. Patients should be assured that the people they go to for comfort and aid are focused on them, and not on some bureaucratic nonsense. We can do better than that!

Chuck Lauer ( was publisher of Modern Healthcare for 33 years. He is now an author, public speaker and career coach who is in demand for his motivational messages to top companies nationwide.

More Articles by Chuck Lauer:

Chuck Lauer: Keep it Simple
Chuck Lauer: The Shameful State of Our Hospitals
Chuck Lauer: What's Really Happening to Healthcare?

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