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As a business consultant, speaker and trainer to hospitals, physician practices and others, I have been hearing a lot about trust recently.

Some might dismiss trust as a “touchy-feely” concept, but I have spoken to many hospital CEOs, CMOs and physician practice leaders who trace many of their challenges to a lack of trust.

This lack of trust can be between management and staff, between physicians and nurses, between physicians themselves, and even between members of management.

And we are not doing a very good job of hiding our lack of trust from our work forces and colleagues.

In fact, in one recent study by the American Nurses Association (ANA), about half of nurses say that they would not be comfortable having a loved one receive care where they work.

The study concludes that these nurses have lost trust in their employer—so much so that they wouldn’t want their child or parent to be cared for in their facilities. There’s a business case to be made for rebuilding this kind of trust, because word-of-mouth marketing, especially from employees, is the most valuable type of marketing for a healthcare facility.

Before we go any further, let’s define what trust means. Trust is the ability to be vulnerable and fully present and real in all interactions.

Trust is usually better defined by what it is not: politics, meetings after the meeting, defensiveness, and ego-driven decision-making. My experience in health care tells me we have a ways to go when it comes to driving these destructive traits out of our hospitals, practices and offices.

What can be done to retain or restore trust in a healthcare workplace? In our book, Ordinary Greatness, my co-author Pam Bilbrey and I examined this question, and here is what we found.

Tell the truth

Sounds simple, but most employees we interviewed as we researched Ordinary Greatness who had lost trust in their boss could tell some story about a time they felt they were lied to, spun, or were told less than the unvarnished truth.

The boss often has a different perspective when confronted about this disconnect, and blames “the script HR gave me,” the employee’s unrealistic expectations, or the economy.

Physicians who are not aware of some of their blind

spots will not be likely to inspire trust.


But is there ever a reason not to tell the whole truth? Our commitment to protect confidentialities aside, be sure you are telling the truth in every situation.

A friend of ours asks his young children every night when he tucks them in, “Did Daddy tell the truth to you today?” We asked him why he did this. He said, “Because I want to avoid situations where my kids think I lied to them when in reality we just had a misunderstanding. For example, if my kids ask me if I could take them to the park, I might say yes, thinking I will do it this weekend, when they were thinking of today. I want to catch that stuff as it happens.”

Physicians in a busy practice or working closely with staff in a hospital setting have many opportunities to build trust through truth-telling. Our hospitals will be more productive and culturally healthier if physicians feel they can tell the truth to one another and to administration. If a physician feels that the current culture of the practice or the hospital does not support truth-telling, fixing this is job one.

Stay visible

Schedule time each day to go around and visit staff where they work, and work alongside them.

In many of the hospitals mentioned in the ANA study, it is a safe guess that administrators and decision-makers have hidden in their offices and made staffing and equipment decisions based on spreadsheets, not on what they saw in the workplace with their own eyes. That causes trust on the front lines to erode.

Often, physicians develop a reputation in a hospital for being unapproachable. This is prevented and cured by constant visibility—not just showing up to criticize when something has gone wrong. Here are the benefits to you of getting out and rounding and being visible today:

  • You will identify and recognize ordinary greatness occurring during the course of the workday.
  • You will let staff know that you care about the work that is being done and appreciate its importance in achieving organizational goals.
  • You will encourage staff to make suggestions and offer opinions to improve the organization, creating a stronger sense of ownership.
  • You will provide the context for identifying opportunities for improvement and understanding the dynamics of decision choices.
  • You will recognize obstacles or barriers that need to be removed to achieve better outcomes.

Be vulnerable about your own blinders

Physicians who are not aware of some of their blind spots will not be likely to inspire trust. In our research for Ordinary Greatness, we identified five blinders that keep leaders from spotting greatness in those they lead and building trusting relationships.

These are:
1. Compartmentalization: The belief that everyone and everything can be put in its own box.
2. Preconceived notions: Making premature cognitive commitments without getting the whole story.
3. Personal bias: Your own experiences and judgments that can cloud your vision.
4. External focus: Falling for the trappings of success or making judgments based on how something looks.
5. Busyness: Over-scheduling to the point that important things, such as employee engagement, are missed.

Which of these blinders might you struggle with? Know your limitations and which blinders might be traps for you. Then discuss these with your staff, administration or fellow physicians.

To take a free blinders assessment, visit

Conduct “aspirational conversations”

Do you know the aspirations of each of the staff you work with, or even fellow physicians? Do you know where they want their careers to go in the next five years?

Aspirational conversations are ongoing dialogue focused on personal development actions to support the expansion of responsibilities, upward mobility or new career paths.

I have been stunned by how few leaders actually do this simple, free activity that will reap benefits forever.

Check your ego

Our weaknesses are rooted in our strengths. When our egos get in the way, we see the traits that make us most effective (assertiveness, confidence, critical thinking) become our weaknesses (pushiness, arrogance, quarrelsomeness).

Trust is usually better defined by what it is not: politics, meetings

after the meeting, defensiveness, and ego-driven decision-making.


Once I was coaching a leader about his desire to constantly play politics in his organization, and he kept repeating to me that he was merely being diplomatic and seeking compromise wherever he could find it.

Somewhere, his lack of telling others what he was really thinking for fear of being rejected had become more important than the company’s results, which were suffering from his two-faced communication style. Eventually his inability to check his ego, trust his colleagues, and tell the unvarnished truth in kindness meant his untimely exit from the company.

One thing is certain: It can never be all about you (or me). In a survey we conduct with hospital teams, we have found that there is a particular question that bears a high correlation to performance: “We’re willing to live with problems if the organization’s money can be better used somewhere else. In fact, that is very cool with us.”

When a hospital contains individuals and teams that can answer “yes” to this statement, that hospital has a tremendous opportunity for high performance. The administration, physicians, management and staff have checked their egos.

If the hospitals with the untrusting nurses had expected the above behaviors from leaders, trust would not be as much of an issue there.

These principles work. Trust matters. Are you working hard each day to build trust by spotting ordinary greatness where you work and live?


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