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UW Health,Ambulatory Education,Educational Opportunities,Grand Rounds,Nursing Grand Round Presentation Video Archive 2012,Leading and Managing in a Clinical Practice Discipline 2012,08/08/2012 - Transforming and Transcending Through Trust,Resources

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Presentation - UW Health, Ambulatory Education, Educational Opportunities, Grand Rounds, Nursing Grand Round Presentation Video Archive 2012, Leading and Managing in a Clinical Practice Discipline 2012, 08/08/2012 - Transforming and Transcending Through Trust, Resources


Transforming and Transcending
Through Trust
Beth Houlahan, MSN, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer

Leading & Managing in a Clinical Practice Discipline Grand Rounds

August 8, 2012

Objectives
1. Describe what defines a trusting
relationship
2. Identify behaviors that signal trust
3. List the three conditions imperative for
trust
4. Identify individuals in the healthcare team
where trust is foundational to execution
Transforming & Transcending
Through Trust
1

• Who do you trust?
–Why do you trust this person?
• Who trusts you?
–What in you inspires the trust of others?
Transforming & Transcending
Through Trust
2

Trust: “You know it when you feel it.”

Jack Welch
Former CEO, GE
Transforming & Transcending
Through Trust
3

• When you trust people, you have
confidence in them – in their integrity and
in their abilities.
• When you distrust people, you are
suspicious of them – of their integrity, their
agenda, their capabilities or their track
record.
Transforming & Transcending
Through Trust
4

Nurses voted the most ethical and trusted
profession.

Gallup Poll
Forbes

Transforming & Transcending
Through Trust
5

Trust …
is a mental state that implies positive
expectations regarding the other party’s
intentions and behaviors.

Rousseau, Sitkin, Burt & Camerer (1998)

Transforming & Transcending
Through Trust
6

Definition:
Trust
• Verb: believe in, rely on, consign to
someone’s care, expect or hope
• Noun: confidence in trust, reliability,
obligation arising from responsibility
Transforming & Transcending
Through Trust
7

Calculus-based trust
that which builds over time if people are
predictable, reliable and consistent in their
behavior

Lawicki & Wiethoff (2000)
Transforming & Transcending
Through Trust
8

Identification-based trust
exists where people can develop and share
values and ideas, where they more fully
understand each other’s intentions, such that
they can “act for each other,” often without the
need for specific instruction.

Pullon (2008)
Transforming & Transcending
Through Trust
9

Three conditions of trust:
1. Vulnerability: which involves the uncertainty of
the future and the willingness of the parties to
take a risk.
2. Previous mutual interactions which are
perceived by the parties as positive and
reciprocal.
3. Expectation over time regarding reliable
conduct.
Dolan (2004)
Transforming & Transcending
Through Trust
10

Nursing literature defines attributes of trust
which includes:
• Expectation of competence
• Goodwill of others
• Fragility/vulnerability
• Element of risk
Chin & Kramer (1991)
Transforming & Transcending
Through Trust
11

Patients view the nurse patient relationship
as one that is inherently based on trust.

How does a nurse begin to build trust with
their patient?
Transforming & Transcending
Through Trust
12

Factors
• Personality of both the patient and the
nurse were key factors in developing a
trusting relationship
• Feeling comfortable with one another
• Being honest with one another

Jones (2009)
Transforming & Transcending
Through Trust
13

In addition:
• Communication
• Personality
• Experience of nurse
• Bedside manner
• Taking the time
Trust in turn is built through a process
Jones (2009)
Transforming & Transcending
Through Trust
14

Patient preferred Nurse Behaviors with Descriptors to Build Trust
Behaviors Descriptors
Caring Concern, compassion, considerate, genuine, kind
Warm/friendly Cordial, courteous, nice, personable, pleasant, rapport,
warm
Professional Business like, respectful, straightforward
Competent Efficient, knowledgeable, thorough
Empathy Understanding
Listens Attentive, interested
Honest/Sincere Truthful, authentic, real

Finch (2006)


Transforming & Transcending
Through Trust
15

Reflect on your behaviors
Intent vs. Impact
• Smoker
• BMI
• Infection control
Transforming & Transcending
Through Trust
16

Trust among colleagues is foundational to
safe high quality patient care.
• Physicians
• Peers
• Ancillary Staff
Transforming & Transcending
Through Trust
17

“Collaborative Capital”
• Facilitates the growth of other kinds of
capital such as social and intellectual
capital
• Creates greater safety and less
defensiveness in workplace interactions
between colleagues
Beyerlein & Kennedy (2005)
Transforming & Transcending
Through Trust
18

Transforming & Transcending
Through Trust
Deposits
(Examples)
Telling the truth
Keeping promises
Kindness, courtesies
Loyalty to the absent
Apologizing
Withdrawals
(Examples)
Placing blame
Breaking promises
Unkindness
Violating expectations
Gossip, rumors
Arrogance
19
Trust Account

“Jenna said she’d help me out with this heavy
assignment. Well, it’s noon, and I haven’t seen her
once. It’s always this way.”
“You can tell Greg about the new medication form
if you want. I’m not telling him. He never told me
about the change in our discharge policy last
week.”
“I should never have trusted Brandi. She lied to the
manager about me.”
Transforming & Transcending
Through Trust
20

A physician rudely criticized Lesley when she
called about a patient’s low blood pressure. Until
then, Lesley thought she and the physician had a
good relationship, but after the phone call she felt
betrayed, angry, and embarrassed. The next
morning, she avoided him on rounds and missed
important information about her patients. Two
weeks later, when she needed to contact him
again, she hesitated too long – and the result was
a failure-to-rescue incident.
Transforming & Transcending
Through Trust
21

Tools to build trust
• SBAR
– Situation
– Background
– Assessment
– Recommendation
Transforming & Transcending
Through Trust
22

Competence underpins interprofessional respect
Trust is often discussed in association with
respect which in turn is related to an
understanding of professional competence.
A shared understanding of each others roles and
the interplay between them over time can lead
from respect to interprofessional trust.
Transforming & Transcending
Through Trust
23

Leaders – the lynch pin in building trust
Trust is earned – once it is gone – difficult to
get it back
Laskowski-Jones (2011)
Transforming & Transcending
Through Trust
24

Relationship between transformational
leadership and employee well being will be
mediated by employees trust in the leader.

Kelloway (2012)
Transforming & Transcending
Through Trust
25

By acting as ethical role models being
committed to employees needs,
empowering and encouraging employees to
think on their own and motivating their
followers to achieve more than what was
thought possible, transformational leaders
gain their followers’ trust.

Kelloway (2012)
Transforming & Transcending
Through Trust
26

What builds a culture of trust?
It starts with the personal decision to act in a
rational, consistent, kind and respectful
manner during interactions with others.

Laskowski-Jones (2011)
Transforming & Transcending
Through Trust
27

Good leaders …
Poor leaders …
I’ve learned from them all
What is the tipping point for distrust?
Transforming & Transcending
Through Trust
28

• Inconsistency
• Favoritism
• Lack of follow-through
• Hierarchy
• Others?
Transforming & Transcending
Through Trust
29

Trust – best intention – safety – quality
• Be vulnerable and transparent
• Use presence and voice
• Listen to understand
• Communicate openly and directly
• Do what you say
• Admit mistakes
• Be accountable
• Lead as an equal
Transforming & Transcending
Through Trust
30


Tools engendering consistency = trust
Transforming & Transcending
Through Trust
31

E & R = O
Transforming & Transcending
Through Trust
32

Transforming & Transcending
Through Trust
33
Algorithm for culpability

Transforming & Transcending
Through Trust
34
Using our values:

Transforming & Transcending
Through Trust
35
Using our values:

What if you’ve lost
someone’s trust?
Transforming & Transcending
Through Trust
36

What will you do
differently as a result
of our time together?
Transforming & Transcending
Through Trust
37