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Leading the Way

Building trust in your leadership

Steve recently accepted an emergency department (ED) director position in a busy safety-net hospital. He knew the role would be challenging; the hospital had been through four ED directors in the past 5 years. A new chief nursing officer had recruited him to turn the troubled unit around.

When Steve met with ED staff, he found they had little trust or confidence in him. Previous leaders had made the same pledges he was now making to rebuild the work environment—and then they’d quickly left. Steve knows building trust with his staff will prove key to his leadership success.

Steve is wise to realize that trust is the currency of leadership. The ability to establish, grow, extend, and restore trust is a key competency for leaders. Nurses deeply value leaders who are authentic and trustworthy. High-trust environments correlate positively withchigh degrees of staff engagement, commitment, and organizational success. Gallup researchers consistently have found that honesty in leadership is the top-ranked characteristic that employees seek in leaders. In contrast, loss of trust can lead to environmental toxicity.

In The Trust Edge: How Top Leaders Gain Faster Results, Deeper Relationships, and a Stronger Bottom Line, author David Horsager observes that trust flows from individuals, not organizations. Credible leaders inspire loyalty and commitment. Without trust, leaders lose their influence and ability to retain team members. Horsager views trust as a competitive edge shared by great leaders and great organizations. (See Eight pillars of trust.)

The degree of trust in a leader can either accelerate or destroy an organization, business, or relationship. Trust is like a forest that grows over time but can easily be burned down by careless acts. And regaining trust once lost can be challenging.

When trust is broken

When trust is broken, leaders must take immediate responsibility for what has happened and then let go of the shame and guilt so they can move on. Although Steve didn’t violate the trust of staff, he needs to acknowledge that he understands their reluctance to trust him, given the history with their previous leaders. Until he can regain their trust, he must accept the discomfort that comes when trust has been violated. Staff may question his every comment, email, and action.


Trust can be rebuilt, but it may take a long time. In a fascinating article on betrayed trust in a hospital setting (“Betrayed trust: Healing a broken hospital through servant leadership”), former hospital chief executive officer Deborah Yancer reported on her 7-year journey to rebuild trust. Discussing the need to meet people where they are, she explains that although staff may feel broken when their trust is violated, they also have the capacity for resilience. Yancer describes transparency and modeling trust as antidotes for betrayal. Far more than words, trusting-building serve as the ultimate weapon for damage control.

Rebuilding trust

In his book Seven Habits of Highly Successful People: Powerful Lessons of Personal Change, the late Stephen Covey used a metaphor for trust that Steve might find helpful in moving forward. He described trust as an emotional piggyback. If as a leader, I make deposits with you in this emotional bank account through courtesy, kindness, honesty, and keeping my commitments, I build a reserve. Your trust in me grows and I can call on that trust when I need it. When trust is high, communication is easier and more effective. If instead, as a leader, I show a lack of truthfulness, concern, or respect, or if I overreact in situations, my emotional bank account is overdrawn and you distrust me. Trust requires constant deposits. When I make mistakes as a leader but I have large deposits in the emotional bank account, you’ll be more likely to forgive me.

In Steve’s situation, the emotional piggybank with his staff is overdrawn based on their experiences with previous ED directors. They may be jaded about his ability to change the situation and reluctant to risk trusting another director. Rebuilding trust through many deposits in the emotional piggybank will be a key strategy moving forward. To make such deposits, Steve can take the steps below.

Be open and transparent

Most leaders like to see themselves as truth-tellers, but sometimes they resort to spinning the facts or leaving out key evidence that doesn’t support their viewpoint. Staff notice this behavior. Steve will need to talk straight with his staff even when the truth is painful. His communications need to be clear and unambiguous. Staff will respect and trust him more if he’s willing to share the good, bad, and ugly.

Listen to understand

In situations marked by lack of trust, unresolved conflict may lead to uncomfortable and confrontational discussions. Steve needs to explore situations with his staff in an open manner, with the intent to do constructive problem solving. This will promote an environment that encourages the freedom to explore new ideas and alternative ways of doing things. Letting staff be heard and showing he’s listening to understand them will help Steve rebuild the trust that’s been lost.

Show vulnerability and admit mistakes

Steve needs to show compassion for what’s happened in the past and the impact it’s had on the staff and the work environment. He should demonstrate vulnerability as a new leader and ask staff directly to help him in his leadership. By openly acknowledging that the role is challenging for him, he can demonstrate honesty and humility. Undoubtedly, Steve will make mistakes on the journey to improve the unit and will need to accept responsibility for these. But when staff observe him taking personal accountability, they’ll be more willing to trust him.

Do what you say you’ll do

Keeping promises is the strongest behavioral evidence that a leader is trustworthy, and it leads to significant deposits in the emotional piggybank. Staff will watch to see if Steve’s actions match his words. If he can’t do something he committed to doing, he needs to proactively explain why and take the initiative to communicate. Staff will want to see results.

Be a giver, not a taker

Nothing builds trust faster than a willingness to give to others without expecting anything in return. Takers are self-serving in their interactions with staff; it’s all about what others can do for them. Givers are the opposite. A leader who’s a giver approaches most interactions with staff by asking, “What can I do for you?” If Steve does this, staff will know he’s not all about himself but instead has their best interests at heart.

Sustain hope

A leader’s credibility grows when he or she uplifts others’ spirits and restores a belief in the future. Keeping hope alive in situations like the one Steve faces is especially critical. Staff need to believe things will get better. They want a leader who’s positive, confident, and gritty despite obstacles and setbacks. To sustain hope, Steve needs to continually share and celebrate the team’s incremental improvements.

Trust: The currency of leadership and life

The best nurse leaders focus on creating trust as an explicit objective through authentically truthful interactions. They recognize that in healthcare environments, trust affects the quality of every relationship, communication, work project, and effort the nursing team engages in. When healthcare organizations and their staff are trusted brands, healthcare consumers choose them over competitors and tell others about their positive experiences. Ultimately, trust—not money—is the currency of leadership and life.

Rose O. Sherman is a professor of nursing and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing in Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com.

Selected references

Covey SR. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. 25th anniversary edition. New York: Simon & Schuster; 2013.

Gallup Press. First, Break all the Rules: What the World’s Greatest Managers Do Differently. New York: Author; 2016.

Horsager D. The Trust Edge: How Top Leaders Gain Faster Results, Deeper Relationships, and a Stronger Bottom Line. New York: Free Press; 2012.

Kouzes JM, Posner B. The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations. 5th ed. San Francisco; John Wiley & Sons: 2012.

Yancer DA. Betrayed trust: Healing a broken hospital through servant leadership. Nurs Adm Q. 2012;36(1):63-80.

 

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