A culture of trust: Staff development's role in enhancing organizational culture

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A culture of trust: Staff development’s role in enhancing organizational culture

After reading this article, you will be able to:

  • Discuss the steps to building a culture of trust
  • Identify the benefits of building a culture of trust

by Jo-Ann C. Byrne, RN, BS, MHSA

Author’s note: I have been involved in healthcare education since the late ’70s when I pirouetted from my nursing role in the ED and became a critical care educator. It was a journey full of challenges and excitement. I have worn, and continue to wear, many hats: educator, consultant, manager, and director. Currently, I’m the system director for education and organizational development at St. Vincent’s Healthcare in Jacksonville, FL.

As an educator, how many times have you been asked to participate in changing a culture? The question is often asked as though it were something you could plan today and implement at change of shift tomorrow. Sound familiar? 

Organizational culture is basically the personality of an organization. Cultural change strategies are not to be taken lightly and should not be oversimplified. For the purpose of this article, I will talk about one facet of culture—the culture of trust—and the significant role we as staff development professionals play in the process of helping that culture thrive. 

How do you know whether trust is an issue at your organization? Non-trusting behavior exhibits itself in many ways. Pollyanna Pixton (2008), an international leadership expert, identified eight characteristics of a non-trusting team:

  • Fear 
  • Secretive, territorial, and out for themselves 
  • Lack of engagement 
  • Defensive and negative 
  • Judgmental and condescending 
  • Passive-aggressive behavior and lack of integrity
  • Impatient; people are easily agitated
  • Gossip runs rampant, as does complaining

Trust is about confidence and belief. A positive culture must be demonstrated at the top levels of an organization, and it must be lived and encouraged for it to become pervasive across the entire system. We know it can erode quickly when aberrant behavior begins to take root and is ignored.

The following red flags should alert you that your organization has some lapses in trust: 

  • A nurse manager talks with you about inappropriate outbursts by staff
  • A department manager wants sensitivity training for his or her staff
  • Human resources calls for a consultation on the best approach for behavioral issues in a department
  • You are informed that referrals regarding anger or abuse issues to the Employee Assistance Program are on the rise

Lapses in trust must be addressed. We need to talk about trust, or the lack of it, and how to foster it.

Recently, my organization pulled together a group of future leaders to talk about trust. Several of our more senior positions were held by interim employees, and our most recent staff engagement survey revealed that confidence in leadership was a concern. Our chief operating officer felt that the management team might benefit from a discussion of the importance of trust and the ways in which we could bolster it in the organization. 

Our session started with the “Leadership traits exercise” (see the tool on p. 11). Participants were asked to complete the exercise, noting which leadership skills they felt were more soft than hard and vice versa. They indicated in the last column whether they felt the trait could be measured. We defined “measured” as something we could quantify. Our real goal was to get leadership to realize that trust could be measured. 

In the discussion that followed, most agreed that compassion, empathy, and the ability to inspire, listen, and trust were soft skills. Surprisingly, as if hedging their bets, many suggested that almost all of the skills could be measured. But they were hard-pressed to provide quantifiable evidence of the softer skills, which was exactly our point. Although stories and anecdotal information are affirming, numbers are what help drive change. From there it was an easy transition to a roundtable discussion about how to instill and measure trust. 

As facilitators, we first introduced Covey’s (2006) formula: “Trust always affects two outcomes—speed and cost. When trust goes down, speed will go down and cost will go up. When trust goes up, speed will also go up and cost will go down.”

Using that information, participants were able to identify examples of how to measure trust, such as:

  • Number of repeat customers
  • Patient experience data
  • Physician referrals

Next, the group identified specific ways they might foster a trusting environment, such as:

  • Allowing failure (i.e., not always being successful), followed by an analysis of what went wrong and action plans to ensure that the same mistakes don’t happen again. Examples of acceptable failure include:
    • A project goes over budget, but with great results
    • A good idea is presented, a new venture is funded, but it doesn’t work out; however, the effort was Herculean
  • Rewarding teams and measuring team results. Encouraging teamwork implies that everyone works together for a common goal and thus tighter bonds are formed, fostering trust. Team results should be measured by outcomes or performance, not by one person’s contributions versus another’s. Rewards could range from thank-you notes to a day off with pay.

During the session, it became evident that people think about trust in different ways. Each person agreed that trust is earned, but the areas they were interested in measuring were very different. Some of their trust issues involved addressing questions such as: 

  • Can I trust the biomedical department to fix a piece of broken equipment in a timely fashion and return it to me quickly? 
  • Can I trust that managers will distribute time off equally?
  • Can I trust that work will be distributed equally among team members and that one person won’t get all the worst cases?
  • Can I trust that lab work will be completed in a timely way regardless of what unit it came from?

The group was asked to identify two ways in which trust could be measured in their department. They needed to learn to quantify the issue of trust. 

Members approached this task as they would a performance improvement project. In order to earn trust,  areas of weakness had to be identified, fixed, and consistently monitored, and performance had to be either maintained or improved.

The way the group approached the problem of our community’s lack of trust in our ED is insightful. The ED had very long waits for noncritical patients. Patients were leaving without being seen, and those who were seen were disgruntled. Word quickly spread in the community that it was not a good place to go. A team was assembled to answer the question of how we could regain the community’s trust. After gathering data, the team:

  • Recommended the creation of a fast-track unit for noncritical patients. The costs for services in the fast-track unit would be appropriate for the level of care required. 
  • Facilitated the opening of the unit. Although it had few patients initially, word quickly spread throughout the community of the new initiative. Patient numbers increased and wait times in the ED decreased. 

The new unit helped ED staff see critical and noncritical patients with no delays. We were also able to measure the trust regained by:

  • Decreased cost for services
  • Less congestion in the ED
  • Increased patient satisfaction
  • Increased sense of trust on the part of the staff that patients would be appropriately referred to the right level of care

The techniques we used will be familiar to many. Our challenge was to look at trust as a competency that can be measured. As a result of our work, we were able to demonstrate that trust can be a quantifiable trait. 

Try the exercise with your group, substituting characteristics that might be more appropriate for your setting. If I can be of any assistance, I can be reached at


Covey, S.M.R. (2006) The Speed of Trust: The One Thing That Changes Everything. New York: Free Press.

Pixton, P. (2008) “Creating a culture of trust.” Retrieved March 15, 2010, from


Adapted from Briefings on Evidence-Based Staff Development (formerly The Staff Educator), May 2010, HCPro, Inc.