Creating trust in relationships is widely seen as a crucial skill for healthcare executives—important in managing employees as well as in working with outside stakeholders. What may be surprising is that building trust is becoming a hot topic in management and leadership journals, books, educational seminars, and career development programs.

One never finds disagreement with the assertion that creating trust is an important leadership characteristic, so what is behind this sudden attention to the topic? One reason is increased focus on healthcare ethics. Publicly reported events related to Medicare fraud and abuse have heightened managers’ awareness of how the public views healthcare organizations and whether the healthcare management field is deemed trustworthy. It is no coincidence that one of the hot career opportunities for our field is compliance officer! Also, the role of trust building in leading successful organizational change has become broadly accepted, and executives and scholars have become sophisticated in considering how management trends and innovations affect levels of trust within organizations.

Successful managers no longer regard trust only as a trait that either exists or doesn’t. They realize that when trust does exist, it is not necessarily equal in all relationships or with people whom we deem trustworthy. When you realize that levels of trust in various relationships are not what they should be, you begin to view trust as something that can and should be managed, that is, viewing trust as a competency as well as a characteristic.

Today it is not beyond our capacity to conscientiously create conditions that will nurture higher levels of trust. Many factors that influence whether trust flourishes or founders are familiar, such as being open and communicative, displaying integrity, and being benevolent. Some are not as readily recognized as part of trust and trusting, such as taking risks and being willing to forgive and reconcile. Recognizing these behaviors or patterns of behaviors is what empowers us to increase trust in specific relationships.

It would be nice if everyone were able to trust everyone else completely, but our time resources limit the amount of trust building that we can do. A recent eye-opening contribution to our understanding of managing trust levels comes from the authors of “The Structure of Optimal Trust: Moral and Strategic Implications” (see recommended reading below). They offer three considerations we should take into account in deciding how much time, energy, or resources to invest in establishing trust in any given relationship. First is a rational, objective prediction of how the party to be trusted will behave. Second is an assessment of our feelings-based belief in the moral character of the party to be trusted. Third is an examination of the level of interdependence between the parties in the relationship. Is this relationship essential or optional? After considering these factors, managers should strive for an appropriate degree of fit between trust levels (low, medium, or high) and levels of interdependence in a given relationship.

Today in healthcare, leading is evolving from a command and control paradigm toward a more collaborative effort. Consequently, the trustworthiness of our partners and stakeholders, and their level of trust in us, grows in importance as they take on more decision-making roles. By applying the growing knowledge around trust building we can find a way to appropriately balance those challenges and stay personally at peace with our decisions.

Recommended Reading:
“The Structure of Optimal Trust: Moral and Strategic Implications,” by Andrew C. Wicks, Shawn L. Berman, Thomas M. Jones. Academy of Management Review, Vol. 24 No. 1, Jan. 1999.

Trust Matters: New Directions in Health Care Leadership, by Dan S. Wilford, FACHE, and Michael H. Annison. Jossey-Bass Publishers, Oct. 1998, ISBN 0787943894.

“Managing Oneself,” by Peter F. Drucker. Harvard Business Review, Vol. 77 No. 2, March/April 1999.

Other Resources
Healthcare Executive Career Resource Center’s Trust-Building Self-Assessment

1999 Congress on Healthcare Management seminar audiocassette “Trust and Distrust at Work: Strategies for Sustaining Relationships During Rapid Change,” presented by C. Ken Weidner II, Ph.D.