Building Trust in a Changing Environment

November-December 2000


Gathering information and above all developing trust have become the source of sustainable competitive advantage.
—Warren Bennis1

At a recent professional meeting, a health care executive lamented the changing nature of work. "There used to be a great deal of trust in my hospital," he noted. "But with the advent of managed care, cost controls, and increased government regulation, trust has eroded. And, frankly, I don't know if it will ever fully return."

His view is accurate. Trust is in short supply in many organizations, often resulting in low morale. According to one survey of American hospitals, 81 percent reported morale problems among staff members—up from 59 percent in 1993—largely due to the changing health care environment.2 In another study, which focused on physicians, 36 percent of the respondents indicated that they would retire if they could; another 14 percent were "uncertain."3 Hospital work today seems to feature fewer rewards, an increasingly litigious environment, and diminished trust between administrators and staff members.

How do you restore trust and improve morale? How do you build a climate in which employees look forward to going to work and then, when the shift is over, feel a sense of accomplishment? Here are five practical strategies.

"Personalize" Leadership Styles
According to a Gallup survey, most workers say they rate having a caring boss higher than money or fringe benefits in terms of professional priorities. Moreover, the quality of employees' relationship with their immediate supervisors largely determines they length of time they remain in a job. "People join companies and leave managers," concluded Marcus Buckinham, the study's primary analyst.4

To start developing trust, managers must renew their commitment to developing strong, productive working relationships. According to a 1999 study by the Louis Harris Association, only 11 percent of employees who perceive their boss as competent, fair, and concerned are likely to look for work elsewhere. But 40 percent of those who rate the boss's job performance as poor will look for a new employer.5

To improve their relationship with employees, managers should "personalize" their leadership styles—that is, let employees know that their work is valued. One of the best ways to do this is through employee recognition programs. The Walt Disney Company has more than 180 recognition programs, the most important of which is called the "Spirit of FRED Award," after an employee who seemed to personify the company's values and vision. (The acronym stands for friendly, resourceful, enthusiastic, and dependable.)

Do employee recognition programs really build trust? Consider Jason Chestnut, a food-service worker employed at Walt Disney World's Dolphin Hotel in Orlando, FL. When a customer recently asked him, "What do you do here?" Chestnut replied, "I'll make your next hour the most fabulous one you'll have this week." Chestnut is neither in management nor highly paid. The longest job he ever held before coming to Disney was for 18 months. But he has now been working at the Dolphin for more than eight years. When someone asked Chestnut why he stayed at Disney, he said it was a "great" place for his career. How does he know? "They tell me every day," he said.6

Since Chestnut started at Disney World, he has been responsible for bringing 12 other people to work at the Dolphin. He is not just a food server but a recruiter, customer service department, and ambassador for the business.7 Every organization has Jason Chestnuts. But they need to be told daily that their work matters.

Do busy leaders have time to show appreciation for their employees' work? I know an executive who spends 30 minutes at the beginning of each day communicating his appreciation to employees. He spends the first 15 minutes writing notes of thanks to those who have accomplished noteworthy goals and the next 15 minutes telephoning employees who need extra encouragement. "These activities are the most important tasks of the day," he once told me. "They are fun to do and employees value them. Plus, it keeps us focused on what we are seeking to accomplish."

Most employees want to do a good job. The work ethic in America remains strong, and if employees are given appropriate rewards, they will leave no stone unturned in accomplishing their objectives. But when no one cares, trust diminishes and morale erodes.

Strengthen Communication Processes
Strengthening communication processes is especially important when change is occurring. Trust erodes when employees do not understand why change is necessary; morale erodes when they "don't know what is going on."

In fact, employees who have been informed about what is "going on" sometimes refuse to hear it. Even so, in many instances employees do not receive timely information and therefore cannot understand why their company has, for example, "flattened" its "hierarchy" or expanded or reduced its service lines. In a study of 1,400 employees, conducted by the consulting firm Kepner-Tregoe, 58 percent of the workers and 49 percent of the managers said they did not understand decisions made by top management.8

Managers in firms planning significant change can explain administrative actions by using two modes of communication:

  • Meet with employees to explain the changes and, if appropriate, ask for input
  • Communicate the reasons behind the changes in writing, to avoid misunderstandings

Employees may not agree that the administrative actions are needed, but they will respect managers for being forthright with them. The managers will have earned employees' respect. Trust, though bruised, can likely be restored.

Update Employees' Skills
Employees need to learn new skills continually, partly because of technological change and partly because of changes in the social contract between employer and employees.

Under the old social contract, the employer essentially said to the employee, "If you do a good job and get along with your bosses and coworkers, you can have this job for the remainder of your career." Nowadays, however, the employer is more likely to tell the employee, "You will be rewarded if (a) you keep your skills current and if (b) you help your employer reach certain quantifiable goals."

The new social contract is threatening to some employees—particularly those who feel entitled to their positions—but most realize that the work world has dramatically changed. For example, about one out of four U.S. workers has lost a job since 1985, four of 20 spend less than three years in their jobs, and one of four is looking for a new job while performing the old one.9

Such statistics may dishearten workers trained to believe that all they need do is show up and complete whatever task is assigned to them. But workers who have been given an opportunity to strengthen their skills—and hence become more marketable—will welcome opportunities to learn. In fact, organizations that make a commitment to upgrade employees' knowledge base report higher productivity, higher morale, and a more loyal workforce.

Managers who want the new social contract embraced should provide employees with the educational opportunities that enable them to succeed. In addition, managers should make certain that employees understand the importance of their roles. The manager might, for example, ask workers to visualize a great orchestra in which every member must contribute his or her talents if great music is to be played. In this analogy, the piccolo player is no more important than the clarinetist. The lighting director, stagehands, and others also contribute to a successful concert.

"Piccolo players" and "stagehands" exist in every organization. A good manager values their work and makes certain that they understand that, no matter what it is, their role it is critical to the organization's success. A manager who does this will dispel the feeling that "nobody cares" and begin to blend many voices into a magnificent ensemble.

To accomplish this, managers must understand the issues facing employees. It may help to manage by "walking around," seeing the organization through employees' eyes. This "walking around" means visiting with the nurses as well as x-ray technicians, talking with the dietary manager as well as the emergency department physician. It means, in short, looking at work-related issues from the perspective of employees. Taking such actions rekindles trust.

Increase Employees' Control of Their Work
Employees often feel overwhelmed with the demands at work as well as their responsibilities at home. In a five-year study sponsored by the New York-based Families and Work Institute, 42 percent of 3,400 randomly selected workers said they felt "used up" by the end of the workday.10 In another survey, 50 percent of the respondents said they had more work to do than they had had two or three years previously, and 42 percent said they were spending less time with their spouses.11 As Carol Sladek of Time and Work/Life Consulting Group, Hewitt Associates, LLC, put it: "There has been a tremendous blurring between employees' lives at home and their lives at work. Life has become complex, with higher work expectations, longer hours at the office and at home, high stress, and burnout."12

How do employees cope when the demands get too high and they feel they cannot escape job pressures? Some quit. Others look for a different career. But most simply skip work to tend to family responsibilities—or get caught up on sleep. In 1998 absenteeism soared by 25 percent, costing millions in employee-related expenses.13

Fortunately, many organizations realize that to retain outstanding employees and regain trust between employer and employee, they must implement strategies to reduce stress. One important strategy is to review the total number of hours employees are working and, where appropriate, reduce them. The number of hours Americans work continues to inch upward. Today we are working 108 more hours a year than we did two decades ago. Compared to their European counterparts, American employees are putting in the equivalent of eight more weeks per year on the job.14

The trend in American organizations to reduce workloads is small but growing. The managers of North Carolina-based SAS Institute, the world's largest privately held software firm, sends 3,400 workers home each day at 5 p.m. Then they close the gates and shut the phone systems down. A study of the firm found that its flexible 35-hour workweek had saved tens of millions of dollars a year. The biggest savings occurred in keeping turnover extremely low. The fact that employees were more alert and made fewer mistakes was an added benefit.15

Of course, health care organizations cannot shut down at 5 p.m. Nevertheless, in an era in which employees are stressed to the limit, health care organizations need to examine the workload issue. If those workloads are out of balance, managers need to do something about them. Health care managers may not be able to make dramatic reductions in hours worked. But by building personal holidays into work contracts, extending vacation time, and permitting staff to attend professional conferences, they will establish "safety valves." And employees will have tangible proof that their employer values their work and is sensitive to the issues they face.

I cannot overemphasize this point: A manager who wants to build trust in the organization will remember that many employees yearn for a life that balances work and home. Such managers support workers when they need to attend a parent-teacher meeting at their child's school. They provide floating holidays so that employees can tend to their own health and well-being. An intelligent manager will demonstrate "family-friendly" values, as does Laurel Cutler, vice chairman, Foote, Cone & Belding, an advertising agency. "I wish I had known sooner that if you miss a child's play or performance or sporting event, you will have forgotten a year later the work emergency that caused you to miss it," she said. "But the child won't have forgotten that you weren't there. . . . I tell [young parents] working for me: 'It's more important to be there for your child.'"16

Project an Optimistic Attitude
I hesitate to advise managers, especially those in health care, to continually project optimism. It might be more practical to say: Do not allow yourself to become discouraged for more than 15 minutes a day.

In any case, whether the health care manager is a system CEO or a nurse supervisor, each day he or she is touching many lives and making decisions that will influence the organization's future. Put simply, health care managers cannot afford to wallow in pessimism because a negative attitude will inevitably have a negative effect on others.

A discouraged health care manager might consider the words of an acquaintance of mine, an associate vice president for nursing at a bustling city hospital for children. My friend told me:

I was very discouraged. Staffing was a problem. Personality conflicts drained my spirit. Plus, my supervisor wasn't very supportive. At the suggestion of a friend, I spent an hour every day visiting with patients and their families. And I made a point of having lunch each day with a staff member. These two strategies . . . changed my mood and put new energy into our department. The visits with patients helped me affirm why I went into nursing. The informal lunches with staff helped me understand their concerns. Staffing shortages persist and budget battles still rage. But reasons for optimism are starting to emerge.

My friend had "centered down," as the Amish put it. She had made a conscious decision to focus on those aspects of her work life that bring joy and hope to the people she serves. A discouraged manager might consider the words of Mother Theresa: "Our effort could be just a drop in the ocean, but the ocean would be poorer by a drop without it."

Trust Is "Emotional Glue"
None of these strategies takes large amounts of money to implement. All, however, can produce multiple rewards. As two leadership experts have put it: "Trust is the emotional glue that binds followers and leaders together. The accumulation of trust is a measure of the legitimacy of leadership. It cannot be mandated or purchased, it must be earned. Trust is the basic ingredient of all organizations, the lubrication that maintains the organization."17

Dr. Veninga is professor, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, St. Paul, MN.


1. Quoted in Thomas Steward, "Whom Can You Trust? It's Not Easy to Tell," Fortune, June 12, 2000, p. 332.

2. Doug Levy, "Managed Care Has Doctors Struggling to Manage Stress," USA Today, September 3, 1996, p. 6D.

3. Doug Levy.

4. Quoted in Amy Zipkin, "Attention Bosses: Nice Is Necessary to Keep Employees," Minneapolis Star Tribune, June 5, 2000, p. 1D.

5. Amy Zipkin.

6. Bob Nelson, "People Source," Sam's Club Source," June 1999, p. 12.

7. Bob Nelson.

8. Robert L. Veninga, "Stress in the Workplace," Vital Speeches, January 15, 1998, p. 195.

9. Warren Bennis, "The Future Has No Shelf Life," Executive Excellence, August 2000, p. 5.

10. Barbara Vobejda, "Workers in 1990s Less Willing to Make Sacrifices for Jobs," St. Paul [MN] Pioneer Press, September 3, 1993, p. 2B.

11. Barbara Parus, "Lives in the Balance," Workspan, June 6, 2000, p. 53.

12. Barbara Parus.

13. USA Today, January 15, 1999, p. 1D.

14. Mortimer Zuckerman, "Whistling While We Work," U.S. News and World Report, January 24, 2000, p. 72.

15. Ted Fishman, "Why Not Shorten the Workweek?" USA Today, June 27, 2000, p. 15A.

16. Quoted in Sue Shellenburger, "Executives Reflect on Past Choices Made for Family and Jobs," Wall Street Journal, December 31, 1997, p. B1.

17. Warren Bennis and Burt Nanus, Leaders: The Strategies for Taking Charge, Harper and Row, New York City, 1985, p. 153.


Copyright © 2000 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Building Trust in a Changing Environment

Copyright © 2000 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.