​Trust is foundational to the success of any health care organization. Particularly in times of staffing shortages and other challenges, trust can help improve retention, teamwork, and outcomes. In a recent “Leadership Development to Build Trust and Achieve Better Outcomes” panel discussion, experts offered some insights, solutions, and innovative initiatives that can help boost and maintain trust among all stakeholders over time.

Survey Says…

David Gifford, MD, MPH, chief medical officer at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), cited results of a survey involving 37 buildings that showed staff trust family, health care providers, supervisors, administrators, directors of nursing, and their organization more than their coworkers. There is good news and bad news here. The good news is that trust in supervisors and other leaders is key to higher vaccination rates. However, Gifford said, “If you don’t trust your coworkers, you can’t work as a team; and how can you meet the needs of our resident the same time, facilities wither lower trust levels have higher turnover and lower vaccination rates.”

What builds trust? Courtney Bishnoi, vice president of quality and programs at AHCA/NCAL, identified three drivers of trust.

1. Empathy. Defined as the capacity to understand the feelings of another person from their frame of reference, this enables people to attempt to place themselves in another’s position. Bishnoi said, “An empathetic leader meets people where they are without applying their own judgement to the situation.” She noted that this can be challenging, but she said, “We need to experience what other people are experiencing. We need to invite people to describe their feelings for themselves.”

She added, “When we make someone feel we don’t care about them, we call these ‘empathy wobbles.” These wobbles include micromanaging, multitasking during conversations, failing to ask people for their opinions, jumping to provide solutions, taking credit for others ideas, having hidden agenda, and not investing in others’ learning and growth. While it is important to try and avoid these wobbles, it is important to realize that they happen occasionally. “We all have wobbles,” said Bishnoi.

2. Logic. This is experienced when one trusts another person’s judgement. Logic involves communicating effectively, explaining not just what to do or how to do it but why it matters, and acting in ways that are consistent with what we say or ask others to do. As with empathy, there are logic “wobbles.” These include saying one thing but doing another, exercising poor judgment, demonstrating an inability to deliver, and/or failing to communicate consistently, effectively, and regularly.

3. Authenticity. This is when someone shows up as their true self. People demonstrate authenticity when they’re transparent, share how they feel, acknowledge different perspectives, accept and act on feedback from others, and make sure others understand and see them act on their values.  Jerald Cosey, BA, HFA, CNA, operational leadership development director at American Senior Communities, said, “Authenticity is a group activity. We need safety to disagree and express ourselves.” 

Authenticity wobbles include lack of transparency or withholding information, lying or manipulating others, and not being open to feedback. Sometimes, unfortunately, people find themselves behaving in inauthentic ways. This is due to factors such as existing norms within the organization or society at large, fears to push the envelope regarding our ideas about professional expectations, and common gender, cultural, or racial stereotypes.

Using Drives to Build Trust

Everyday interactions can present chances to build trust. For instance, said Cosey, “If someone comes in your office to talk about something that is important to them, this is an opportunity to build trust.” This can be done by communicating clearly that you believe in their abilities, reasoning, and judgment and that you care about their success. However, he noted that when leaders have so many things happening at one time, it can be easy to wobble. So, he suggested, “Ask questions and really listen.” Do what is necessary to make this happen, such as shutting your laptop or putting your phone in a drawer. He further offered, “Asking questions and listening to understand allows leaders to build trust and talk about change ideas.”

Change ideas, Cosey said, are learned from what is going well but also what is not going well. “Observe your system and what you can see when you are quiet,” he said, adding, “Talk to everyone, including people outside of your system. Ask a lot of questions and listen for themes. Thank about where you have seen solutions.”

You’re not going to find change ideas, Cosey said, when you jump to a solution, believe there is just one solutions, fail to recognize the depth of the problem, frame your ideas for change as solutions not change ideas, believe you experience is the same as the experiences of those around you, and/or believe that all the actors in the system have the same understanding of the problem or that there is a problem. At the end of the day, Cosey said, “It’s not rocket science. You just look for opportunities for improvement. We do this all the time.”

There are six steps to scaling up trust:

1. Set a clear aim.
2. Identify stakeholders and build your strategy around your people.
3. Recruit peer influencers and co-design relational tactics.
4. Test and measure the efficacy of your tactics.
5. Apply learning to improve your approach.
6. Use trust (as you build it) to advance other system-level strategies.

Start by knowing what you want to accomplish, then build a strategy with stakeholders, Cosey concluded. 

Checklist: Are You Committed to Building Trust?

If you can’t honestly answer “yes” to all of these questions, it may impact your ability to fully build trust. Go back and look at areas where you may have organizational weaknesses and see how you can strengthen your skills, strategies, and culture:

• Are you ready to make the commitment that trust takes?
• Are you ready to build trust over time?
• Are you willing to focus on the person, not the outcome?
• Are you patient and willing to listen?
• Do you use time to build trust now?
• Do you have sources of emotional support?

Need More Help? Training Program Can Help

Through a grant from the Centers for Disease Prevention and Control (CDC), AHCA/NCAL is offering an online course, “Building Trust: A Strategy to Improve Patient Safety, Staff Wellbeing & Vaccine Uptake in Long Term Care.” This free, four-lesson virtual program is for long term care leaders and offers numerous tools and resources to equip participants with skills and practices they need to build trust with staff to improve outcomes.

Learn more at www.ahcancal.org/buildingtrust.