Commentary

Do You Trust Your Employer?


 

References

Recently, I was talking with a colleague who works for a large hospital and health care system. While discussing his experiences over the past five years, he suddenly stopped and blurted out, “I don’t trust this organization. Nobody trusts this organization!”

Taken aback, I asked what made him say that.

First of all, he explained, there is a complete and pervasive lack of transparency as to both short- and long-term goals for the organization. Information is treated as proprietary thinking by nonclinical “corporate folks” and not released to the boots-on-the-ground clinician—which makes it difficult to work toward goals efficiently.

Furthermore, he related, there is consistent failure to provide accurate financial data or any plans to improve the organization’s financial position in the marketplace. This prevents providers from making a positive impact on cost containment. No one is invested. Provider compensation packages are neither universal nor simple. The financial folks devise complex formulas that do not account for the vagaries and complexities of health care. This health care organization views every patient as a Financial Information Number and makes no allowance for the fact that many have complex illnesses requiring significant time and attention.

Lastly, he described a systematic and insidious elimination of support staff at all levels—but particularly bedside nurses. The traditional “nursing safety net”—especially relevant in academic institutions—is in tatters, which threatens to undermine day-to-day success in patient care. Staffing of ancillary providers (those in physical, occupational, or speech-language therapy) has been cut back, which means patients wait longer to see these specialists and primary medical providers are frustrated by the lack of progress their patients make.

Stunned by his comments, I started thinking: How many of us recognize some or all of this description? How many trust the organization we work for? Realizing that a huge percentage of NPs, PAs, and physicians work for large entities, these are important questions.

Trust is central to human interaction on both personal and professional levels. Tschannen-Moran defines it as “one’s willingness to be vulnerable to another, based on the confidence that the other is ben­evolent, honest, open, reliable, and com­petent.”1

Continue to: A more focused definition of organizational trust

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