By Felix Ankel (@felixankel) and Leah Hanson (@lrbhanson)
“Trust is like the air we breathe. When it’s present, nobody really notices. But when it’s absent, everybody notices.” -Warren Buffett
You are a new #MedEd dean charged with modernizing and integrating a postgraduate education program into a recently merged health care delivery system. The new organizational structure is built on past structures that emphasize authority/accountability and resources/responsibilities gaps. How do you navigate this environment? How do you build the necessary trust networks to accelerate change?
Most health care and educational systems have organizational charts that describe formal structures and lines of authority. However, much of the work done in any system is influenced by informal “advice”, trust, and communication networks that operate independent of the “org chart”. An essential skill of a #MedEd leader is to build an effective trust network.
Theories behind trust networks.
We tend to do our work through trusted relationships. (Geek warning, this is because of our eusocial traits and oxytocin). Health care and medical education is moving away from a product-dominant logic that emphasizes the transaction to a service-dominant logic that emphasizes relationships and the trust required to get the results we want.
#MedEd benefits from large trust networks: Quality and speed of decisions are increased, experience of teachers and learners is improved, and the cost of service is decreased. This results in high-value adaptive #MedEd value creation.
Leah’s trust network
I lead a neuroscience research group of scientists and clinicians spanning multiple teams within a large learning healthcare organization. One of the challenges in bringing our group together was its loose organizational structure. Early in my leadership role, I was frustrated with a lack of progress. Why weren’t initiatives moving forward? The ideas were solid on paper and people agreed they were the right next steps. I knew something was missing, but it took me a while to identify the missing ingredient as trust.
I did two things that built and expanded my trust network. First, I circled back to my local team and confirmed their support of the initiatives. In doing so, I uncovered some fears about the change that weren’t previously voiced and was able to address those concerns. Second, my gut told me that in order to succeed, I needed to strengthen my relationships across the broader organization. I reached out to other leaders and key stakeholders who I didn’t know very well with a “meet and greet” request. I was surprised that everyone agreed to meet with me, and it was easy to increase my network.
It took longer than I expected, but I was able to bring the group together once we built trust . Now, I recognize the “secret ingredient” to any adaptive change management work is trust and I intentionally continue to develop my trust network – up, down, and all around.
Tips for building trust networks
When building your trust network, consider the following:
- Be courageous: We are hardwired to be suspicious. Take risks, move out of your comfort zone.
- Be trusting: We judge others on behaviors, yet we want to be judged ourselves on intent. Delay judgment. Assume good intent.
- Be trustworthy: Use transparent communication. Express intent. Make a difference rather than a point. Elevate a conversation rather than maximize a position. Communicate in context. Keep commitments. Follow through.
- Be deliberate: Building a large trust network takes time and discipline. Engage with others; carve out time for deliberate practice in network building.
- Be generous: Give as much as you receive, take the first step to repair relationships affected by distrust.
A situational awareness of how advice, trust, and communication networks overlay an organizational chart is essential in complex organizations. To optimize performance of a team, driving a person harder (epinephrine) will not be as effective in the long term as drawing people together (oxytocin).
- Batalden M, Batalden P, Margolis P, et al. Coproduction of Healthcare Service. BMJ Qual Saf. 2015. [Epub ahead of print]
- Covey, Stephen MR. The Speed of Trust: The One Thing that Changes Everything. Free Press, 2006.
- Holmboe ES, Batalden P. Achieving the Desired Transformation: Thoughts on Next Steps for Outcomes-Based Medical Education. Acad Med. 2015 Sep;90(9):1215-23
- Krackhardt D, Hanson J. Informal Networks: The Company Behind the Chart. Harvard Business Review, July-Aug 1993.
- Shamay-Tsoory SG, Abu-Akel A. The Social Science Hypothesis of Oxytocin. Biol Psychiatry 2015. [Epub ahead of print]