Whom Do You Trust?

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There is perhaps no greater indicator of an organization’s cultural health than the degree to which members of the group—really, a community—trust one another. It is the case in large as well as small groups. Indeed, with individual relationships between two people, if there is no trust, there truly is no relationship. When groups have trust, they flourish even in tough times. When they don’t, even good times are painful. I saw this illustrated this summer in a very meaningful way. I was part of a delegation of business executives within an organization that travels, under the invitation of the US Departments of State and Defense, to visit foreign countries to gain firsthand information about our national security and geopolitical relationships. In June, we traveled to South Korea and had the opportunity to learn about the longstanding alliance that our two governments have had since the outbreak of the Korean War. In the words of a South Korean general with whom we spent time, the relationship between our two countries is a “bond of trust born in blood.” We have each other’s backs covered in a way that, on a daily basis, can mean the difference between life and death. It is real. It is deep. It has been unbroken since 1950. That sentiment started me thinking about trust as a concept integral to relationships and alliances in business, and more specifically, within our imaging profession. When I have been asked to work with radiology groups and hospitals that are trying to work through deep and complex issues related to their strategies, plans, governance, or respective corporate cultures, I have found that I spend most of my time with them working through building or rekindling trust among the group’s stakeholders. Trust is the glue that can hold a group together when it exists—or the fragile and elusive piece of a puzzle that doesn’t quite seem to come together as a whole when it does not. Trust: People have given their lives for causes, over the centuries, that were rooted in a culture defined by it. Probably even more have given their lives to causes driven by an evaporated trust. Nurture it, and a group is more likely to succeed. Ignore it, and organizations are doomed to fail. If it’s all about me, then there really is no room for you or us, or for the focus on the other party that is the basic requirement for building a foundation of trust. Enter the many fragile relationships, all over the country, between hospitals and radiology groups. Are these alliances based on trust? Can the radiology group trust that the hospital administrator views the relationship on a coequal basis, or is the radiology group being used as a pawn in a larger game, unknown to the radiologists? Can the hospital administrator trust that the radiology group is looking out for the best interests of their mutual customer, the patient? Do these entities trust one another to focus on the greater good of the organization, not the egos or financial interests of each of the components? Here’s another huge question: Do partners within radiology groups really trust their colleagues? This is an especially important question in an age of declining reimbursements and fewer RVUs to sustain historically high personal-income levels. Do the partners work in collaboration for the benefit of the group, or does the group culture break down when workloads thin out and productivity levels fall? This is, perhaps, even more important when hospital-radiology relationships break down due to factions, on either side, working to nurture discord in order to gain an advantage over their alliance partners. Likewise, the essential transaction between customer and service provider is based on the fact that the customer trusts the quality, reliability, availability, speed, convenience, and predictability of the service. Referring physicians trust that the transaction to deliver these basic requirements is understood and embraced by the service provider. The service provider trusts that the referring physician means it when he or she says that these requirements alone will determine where patients are sent for imaging studies. If these are ignored because of some perverse financial incentive or expected quid pro quo for the referral, trust evaporates and market cynicism emerges. It is during times such as these that an organization’s culture either sustains a view of forward-thinking survival (based on a band of brothers and sisters leveraging their mutual trust to seek advantage in a competitive environment) or devolves into backbiting, grumbling, and finger pointing that make it vulnerable to stronger and more focused competitors. It is incumbent upon leaders within organizations to create an environment where trust can flourish, superegos are held in check, and the smartest one in the room is the person who has the best solution to offer, no matter what his or her rank or social status might be. Likewise, it is also the leader’s duty to seek out those who just don’t get it when it comes to building trust. Those within groups who couldn’t care less about such a touchy-feely concept as trust—and who seem to go out of their way to sow seeds of discontent—need to be shown the door. Nothing breaks down overall trust in a group more than a toxic person who thrives on the chaos created by an absence of trust. A breakdown in positive group culture is exacerbated by nonconfrontational leaders who allow such toxic people to operate unfettered within the group. As I saw in South Korea, though, when groups bond together in order to survive difficult situations, they emerge on the other side of the crisis stronger and better able to understand the role that trust played in their survival. We can learn valuable lessons from these big-picture examples, and when we apply them to our daily lives (especially to those roles that affect our groups or alliances), we become stronger pillars for these entities. The foundations of our organizations strengthen, and we are better able to fight the external forces that would love nothing more than to see it come undone. Trust me on this. Editor’s note: This article originally appeared in the August 2009 edition of imagingBiz.com. Curtis Kauffman-Pickelle is the publisher of Radiology Business Journal and the CEO of the Imaging Center Institute, Tustin, California. He welcomes your comments: ckp@imagingbiz.com