Manager Practice
can hold each other) accountable for them. This type of development within teams makes achieving their goals much more realistic. To attain this it is important to have a foundation of trust. Within team meetings when difficult decisions have to be made around patient care, systems and use of resources, it is important that all critical points and views are up for discussion. Team members must trust that their points – particularly where they are different from those of the majority – will be listened to and respected and not ignored or ridiculed. Healthy conflict can then result in effective problem-solving and agreements that all individuals can own and buy into. Where this happens, individuals are less likely to violate agreed patient safety procedures or undermine decisions.
SYMPTOMS AND IMPACTS In team interactions where there is an absence of trust, it is likely that people will avoid conflict or challenging others. Telling symptoms of a lack of trust include:
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Critical and challenging points are not raised or incorporated into discussions.
Individuals are more likely to conceal mistakes from one another.
Individuals will hesitate to ask for help when they are struggling.
Individuals are likely to dread approaching others for help for fear of rejection, ridicule or lack of support.
Such behaviours have a direct impact on risk. Commonly a lack of trust will mean that:
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• • •
Teams and individuals won’t have full situational awareness when making decisions about patient safety.
Incident reports won’t be submitted and learning from mistakes will not occur.
Individuals will choose (or feel forced) to work outside their boundaries or expertise because it is too hard to challenge others if they do not immediately offer support.
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Patients will not receive safe levels of care because support is not being asked for or provided.
Trust makes the difference in achieving healthy conflict and challenge which can really improve the way teams work and support risk reduction. Trust can also reduce the likelihood of negative conflict which can increase risk and threaten patient safety.
BUILDING TRUST One of the simplest ways to build trust is to create opportunities for individuals to get to know each other better. If people can understand their own and other people’s strengths and weaknesses – particularly in relation to communication and working preferences – they are more likely to be toler- ant and understanding of their colleagues. Some organisations use formal behavioural profiling to do this – for example options such as DISC analysis or Myers-Briggs. These tools give team members an objective and reliable means for describing and understanding each other. In practical terms, this might mean a receptionist understands better how to ap- proach a GP and present information in a way
that is helpful to that individual’s preferences. This type of change in approach makes the communication process easier and more ef- fective for all. Other organisations arrange team building activities, create functional project groups across areas of work or support opportunities for social activities. In these activities, individuals can be encouraged to be more natural and equal with each other. Developing clarity around roles,
responsibilities and boundaries can also help build trust. This can be facilitated through teams examining shared systems through the different lenses associated with different roles. Highlighting the importance of each role serves to identify gaps or misinterpretations in a more objective way, this in itself working towards risk reduction. So to reduce the potential for unacceptable clinical risk, it is important for teams to openly explore the link between trust, healthy conflict and risk reduction – so they can agree comfortable ways of ensuring healthy conflict happens. This includes acceptance that conflict is natural and that building trust is beneficial to risk reduction.
Cherryl Adams is a risk adviser at MDDUS
For more on this topic MDDUS members can access our new video module on Trust and challenge which can be found in the Risk Management section of
mddus.com
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