Tufts, Intermountain CEOs on strategies to bridge the employee trust gap

Building trust with front-line employees is crucial for any hospital or health system CEO. Workers want assurance that the leader of their organization is honest and values their feedback. While efforts to build this trust must be intentional and require ongoing efforts, they also provide opportunities for meaningful changes, two CEOs told Becker's.

Most hospital and health system leaders spend time on the front lines with workers. However, hospitals may encounter an ivory tower problem when a leader — knowingly or not — is shielded from the pain points, dynamics and ideas across their organization.

A June 14 report from healthcare strategic communications consultancy Jarrard touched on the issue. The report, which is based on a May survey of 333 physicians, including 231 female physicians, found that barely half of survey respondents have a lot or a great deal of trust that their organization's leaders are honest and transparent.

Here, Michael Dandorph, president and CEO of Burlington, Mass.-based Tufts Medicine, and Rob Allen, president and CEO of Salt Lake City-based Intermountain Health, discuss how they build trust with front-line staff and share examples of times when they successfully addressed concerns or feedback from workers.

The importance of building trust 

Mr. Dandorph emphasized the importance of transparency in building trust.

It's important "to make sure [workers are] hearing all the great things that are going on within the organization, [as well as] the things that are not going as well or we're struggling with and that we're working on. Employees appreciate hearing both sides of that," he said.

For example, Tufts is making financial turnaround efforts amid industry pressures. This includes outsourcing its outreach laboratory business and some operating assets to Labcorp. Labcorp announced the agreement with Tufts Medicine on Aug. 3 as part of a larger strategic partnership. 

"We've been managing through our own financial recovery, which we continue to make progress on," said Mr. Dandorph. "I've heard a lot from our employees that they appreciate knowing where we stand and the fact that I've been very transparent about that and what we need to do to work through the financial turnaround."

Still, he acknowledged the challenges in communicating with staff in a way that resonates with them. Tufts has one-way electronic communications to staff and town halls that bring a large group of staff together. Mr. Dandorph said he has also had more roundtable discussions with workers "in a way that's really about listening and sharing information and answering questions." The discussions are more intimate, since they involve a smaller group. Front-line staff are randomly selected and invited to spend time with Mr. Dandorph as part of the roundtable, normally for an hour.

"It allows them to ask questions. I open it up, establishing a level of vulnerability for myself, and then I have a few things to say. But I really try to get what's on their mind and get them talking and asking questions," he said.

Mr. Allen, with Intermountain, has a similar viewpoint: "Trust comes from experience. Trust comes from engagement. Trust comes from feeling heard."

When he took the helm of Intermountain last December, he started to map out how he would connect to employees at an organization of Intermountain's size (64,000 employees and more than 30 hospitals).

"I determined that the first part of my journey would be focused internally," said Mr. Allen. "Although a CEO's job has a lot of external-facing things, it is really important that we connect with our people and that we understand where they are and what they're struggling with, what their worries are, what they're excited about, what they're proud about."

This prompted him to launch a multi-month journey across the seven states in which Intermountain operates. In the initial launch, he spent 138 hours of what he refers to as "eyeball to eyeball time" with staff.

"We talked about what was on their mind. And, for me, it was kind of remarkable because I had been cautioned when I took the CEO job that people are going to tell you what they think you want to hear, not what you need to hear," Mr. Allen said. 

"I was a bit taken back at how candid many of our caregivers were with me in my rounding. I was grateful for that. I think it indicated a desire at least to build a relationship of trust."

Addressing concerns and affecting trust within the organization

Mr. Dandorph and Mr. Allen have used these mindsets and approaches to tangibly address concerns or feedback from front-line employees.

As an example, Mr. Dandorph pointed to April 2022, when Tufts went live with converting 27 different EMRs to Epic. Amid this significant change, he spent significant time rounding and talking to front-line staff. He asked questions about the pain points staff were experiencing, among other topics.

While a lot of feedback came in, one larger insight that surfaced was that improvement was needed in terms of training, said Mr. Dandorph. This led to increasing the organization's investment in that area.

Another piece of feedback that surfaced: The onboarding process needs to improve.

"We're kicking off an end-to-end redesign of how we onboard staff in a way that ensures people who decide to come and work for us are truly appreciated," Mr. Dandorph said. "Let's kick off that relationship that we have with our employees in the best way. And we have some improvement opportunities in systematizing that in a way to do it flawlessly. And that came out of the conversation with the staff."

Overall, Mr. Dandorph subscribes to the lean management philosophy of leaders "going to the gemba," which involves direct observation to improve work processes. 

"You have to go to the front line and see things," he said. "You have to go into the operating rooms. What are workers really struggling with? You have to pay attention. Help walk me through what it's like to register a patient in Epic or do the charting. And just being present sometimes builds trust. Because I'm asking those questions."

At Intermountain, Mr. Allen identified 78 items that could be solved through the 138 hours he spent with staff. One of those items came from a meeting with physicians, during which he heard frustration about not being able to access patient test results through the portal. 

A physician who brought it up is "not on the inside of the firewall, and on the outside, he couldn't get in," Mr. Allen explained. The next day, people in the physician's office began working on the issue, and it was resolved within about a week.

Mr. Allen said it's one example of hearing what a caregiver was saying and taking action.

"A really important part of the process for leaders is that people feel connected, they feel that you're listening to them, and they see the actions that you understood" their feedback, he said.

Intermountain supplements those face-to-face times with regular town halls that employees may participate in. During the town halls, a polling tool is used, and people may ask questions and then others may vote on the questions they're most interested in addressing. 

"You actually spend your time answering and addressing the questions the majority of the people want to have you talk about," Mr. Allen said.

The town halls with caregivers occur regularly. However, if an employee is unable to attend a meeting, there is a recording of the meeting that they can access afterward.

In addition to town halls, Intermountain launched an initiative in 2017 that allows employees to offer ideas for improvement. Employees may submit ideas, and those may be addressed at the local team level. If the issue is not solvable at that level, the employee may also escalate the issue to broader groups to help solve. Since 2017, workers have generated and implemented 395,000 different solution ideas that address their challenges. 

Mr. Allen said the initiative aims to allow workers to be part of the decision-making journey instead of always being the recipient of other people's decisions and processes. 

"There are certain things the system has to do," said Mr. Allen. "You want a new EHR, you can't just decide that and change it. The system has to decide that. But there's a whole lot you can control. And I think when you create space for people to control what they can, that also creates a level of trust for them. It creates a level of engagement that enhances trust."

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