Trust Between Physicians - Part 2

Is it possible to develop trust where there is none?

In my last post on whether trust between physicians is possible, or necessary, I talked about how having trust or lacking trust (both within interpersonal relationships and teams/organizations) changes everything.  It is indeed one of those "must haves" for anyone who desires to move up, be successful, or simply be fulfilled in their personal and professional lives.

After exhaustive research and experience with individuals and organizations, here are the "truths" about trust (from Stephen M.R. Covey's excellent book "The Speed of Trust") ... see what you think:

Truth #1:  Trust is Possible

Many people believe that trust is just one of those things - either you have it or you don't.  But this has been shown to be simply not true.  Trust is something that can be developed over time, and that has an element of contagion that will positively impact those around you.  Trust can be effectively taught and learned, and it can become your leverageable, strategic advantage.

Truth #2:  Trust Begins With You

Trust is not a "soft" nice-to-have.  It is hard, measurable and concrete.  It is one of the most powerful forms of motivation.  We know that people want to be trusted and that they respond to trust.  In your professional life as a physician, if you desire to enhance your interpersonal, communication, or leadership skills, it is your job to get good at the thing that underlies (and can potentially de-rail) all of those things:  being able to establish, extend and restore trust.  You do not do this as a manipulative technique to get what you want, but as the most effective way of relating to and working with others, and the most effective way of getting results.

Truth #3:  Trust = Character + Competence

The most important thing to remember when thinking about building your "trust quotient", is that trust is a function of two things:

• Your character - which includes your integrity, your  motive, and your "intent" with people
• Your competence - which includes your capabilities, your skills, your results and your track record 

Think of a physician colleague who has a good character - he is a likable guy, has the best of integrity, and authentic motives ... but if he doesn't have the clinical competence or track record of capability, will you trust him with your patients?  Or the converse - you have a colleague that is the most clinically competent physician around, but has always lacked personal integrity, doesn't seem on the "up and up" with certain elements of her cases, or has unclear motives and seems to try and undermine you at every turn... would you trust her?

Both character and competence are vital.  You cannot have trust without either one.  Think about how you may be perceived in either of those areas ... do others see you as "trustworthy"?

Case in point:  when one of my past physician clients ("Dr. A") moved to a new facility, he had trouble with a particular colleague (a fellow cardiothoracic surgeon - "Dr. B") who he saw as aggressive, territorial, and "not supportive of his success".  All of Dr. B's motives and actions were suspect, communication between the two of them was terrible, and it affected Dr. A's wellbeing on a daily basis.  Competence of this fellow physician was never a question - he was a fine clinician.  However, his character was the issue - Dr. A didn't trust that Dr. B was there in support, but instead felt that he was being watched by Dr. B, and "walking on eggshells" around this person who was just looking for a reason to validate his own question of Dr. A's character or competence.  Things quickly deteriorated between the two of them, and Dr. A wasn't sure whether he could stay in this new position.

Once Dr. A began to embrace the idea that this situation could be improved by analyzing his own responsibility in the situation, and began working to develop a trust partnership with Dr. B, things began to change.  He realized that some of his own actions had created suspicion around his motives (even though they were good), and that some of his ways of communicating with Dr. B (talking, not listening, not maintaining eye contact) made it appear that he himself was the aggressive one.  Slowly they found some common ground, and communication became more open.  Dr. A worked hard to bring up issues to Dr. B directly, versus going to his superior with whom he had a much better relationship.  He began to not only speak better of Dr. B with other staff members, but also began to go out of his way to interact with him more positively.  Intent started to feel more transparent and small successes were had.  Patient cases and handoffs went more smoothly.  Trust began to develop - albeit very slowly - which improved their ability to work together for the good of their patients and the clinical staff.  Recognizing the importance and outcome of enhanced trust became the "tipping point" for Dr. A to look at and change his own behavior.  He began to enjoy going to work again.

Truth #4:  Trust is a Process

Changing trust - even within physician groups or organizations that have terrible track records in this area - starts from the inside out.  It is important to recognize that trust is part of a continuum, a ripple effect that comes from what Covey calls the "5 Waves of Trust".  Let's focus on the first two - the key for physicians who want to build their trust competency is to understand and know how to navigate these:

The First Wave - Self Trust:  This is where we learn to have confidence in ourselves;  in our ability to set and achieve goals, keep commitments, to "walk our talk", and to inspire trust in others.  The key principle underlying this wave is credibility, which is made up of integrity (how congruent am I?), intent (what's my agenda?), capabilities (am I relevant?), and results (what's my track record?).  

The Second Wave - Relationship Trust:  This is about establishing and increasing the "trust accounts" we have with others in our lives.  The key principle underlying this wave is consistent behavior, reflected in things such as our ability to talk straight, demonstrate respect, create transparency, show loyalty, deliver results, and keep commitments.  The net result for physicians who build this wave is a significantly increased ability to generate trust and enhance relationships, build better teams, enhance true collegiality, and achieve better outcomes.  As the saying goes, "together we are stronger".

If you pick up Covey's book you can go on to read about the other three waves of trust - organizational, market, and societal, which all cumulatively build on each other.  Depending on your role/responsibilities as a physician or healthcare leader, you may more or less influence over these last three waves.

But we all  have extraordinary influence on the first two waves ... which is where the work begins for anyone who wants to increase this critical competency for themselves.

Bottom-line:  Trust is achievable.  It is a win-win-win-win-win (you, your colleagues, your patients, your hospitals, your community).

How can you make it happen in your life?

Trust Between Physicians?

Is trust between physicians possible? Is it necessary? (The simple answer: Yes!)

In my coaching work with physicians I hear many anecdotes about the rivalry and distrust that exists between doctors and within healthcare teams. We all know these stories - that physicians have not been trained to trust others or delegate tasks (and in fact were often publicly reprimanded for doing so while in training), that they don’t trust nurses to do things right, that nurses don’t trust doctors to “have their back”, that physicians don’t trust each other’s intentions, credibility or capabilities, that clinical staff don’t trust hospital administration to be on their side or have the best interests of their patients at heart … and the list goes on and on.

Have we ever stopped to think of what this “deficit of trust” that exists in healthcare teams does to the core functioning of the healthcare providers or how it affects the key issues of patient safety, quality and the hospital’s or practice's economic health?

Simply stated, that there is a significant lack of trust in the healthcare environment is not new news. But what is new, is the understanding that trust is a critical component to both personal and organizational success – and that it underlies and affects the quality of every communication, every patient case, and every team effort.

But what is trust exactly? Well, simply put, trust means confidence. When you trust people, you have confidence in them, in their integrity and their abilities. When you distrust people, you are suspicious of them – of their integrity, their agenda, their capabilities or their track record. It is that simple. We have all had experiences that validate the difference between relationships that are built on trust and those that are not. These experiences clearly tell us the difference is not small; it is dramatic.

In a great book written by Stephen M.R. Covey (no, not that Covey, actually the author is the more famous Covey’s son) called “The Speed of Trust: The One Thing That Changes Everything”, these issues are explored and peeled away to their core. And wow, does it all begin to make sense.

The Economics of Trust 

One of the biggest “ah-ha’s” that come from this book is about what trust – or a lack of trust – does to any organization’s bottom-line. It is the most simple concept, and as Covey puts it:

"Here is a simple formula that will enable you to take trust from an intangible and unquantifiable variable to an indispensable factor that is both tangible and quantifiable. This formula is based on this critical insight: Trust always affects two outcomes – speed and cost:

• When trust goes DOWN, speed will also go down, and costs will go up
• When trust goes UP, speed will also go up, and costs will go down

 It’s that simple, that real, that predictable."

Think about healthcare environments, organizations or teams that you’ve worked in that may have had non-existent or low trust – do any of these “typical” workings sound familiar?:

• Militant stakeholders
• Micromanagement and redundant hierarchies
• Punishing systems and structures
• Initiatives that drag
• Many unhappy employees
• Intense politics with clear camps and parties
• Excessive time wasted defending positions and decisions
• Common “CYA” (cover your ass) behaviors

What about the alternative? If any of you have had the luck to be part of healthcare organizations or groups that have a healthy- to high-trust environment, you may have experienced:

• A healthy workplace with good communication
• Aligned systems and structures
• A focus on work (not politics / rumors / grievances!)
• Effective collaboration and execution
• Positive partnering relationships
• Strong creativity and innovation
• Positive, transparent relationships
• Strong engagement, confidence and loyalty

The way Covey puts it, in organizations where trust is high, you see material improvements in things such as communication, collaboration, execution, innovation, engagement, partnering, and relationships between stakeholders.  

You also see the “dividends” of increased speed, collaboration, and improved economics. This translates into improved patient safety, quality, and clinical outcomes - a win-win-win for the healthcare team, the organization,  and most importantly, the patients and their families.

Trust Changes Everything

But it is not just organizations that suffer the results from a lack of trust – you personally can suffer too. Physicians are well-known for generally not trusting each other or members of the healthcare team – if this is true, or even “rings a bell” for you, I want you to think about how this might be affecting your performance and overall happiness on a daily basis.  Let’s make it real – from Covey:

"Think of a person with whom you have a high-trust relationship – could be a spouse, friend, child, sibling, or colleague – and describe this relationship. What’s it like? How does it feel? How well do you communicate? How quickly can you get things done? How much do you enjoy this relationship?

… Now think of a person with whom you have a low-trust relationship – could be a colleague, boss, family member – and describe this relationship. What’s it like? How does it feel? How is the communication? Does it flow freely and quickly … or do you feel like you’re constantly walking on land-mines and being misunderstood? Do you work together to get things done quickly, or does it take a disproportionate amount of time and energy to finally reach agreement and execution? Do you enjoy this relationship… or do you find it tedious, cumbersome and draining?

The difference between a high- and low-trust relationship is palpable!

Can you imagine the difference it would make if you were able to increase the amount of trust in the most important personal and professional relationships in your life?"

Said another way, what would developing your “trust quotient” do for you, for your patients, for your team, for your career growth, and for your overall happiness?

There are excellent tools in Covey’s book for improving your own personal “trust competency” and enhancing the working relationships that affect your overall professional fulfillment.  Next time I will share what some of those tools are, and how some of my physician clients have embraced them to improve their success in both the clinical and non-clinical environments.

Until then, I highly recommend you go and pick up the book - it's a great read!