Trust Starts With Trustworthy Leaders

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Jaime McClennen


This is the fourth Trust Practice Challenge to be featured in this letter. It was one of eight outstanding submissions we are showcasing at the annual Foundation Forum in August.

“More than anyone else, leaders are accountable for trust within communities, no matter how large or small. Leaders matter. The video must match the audio. And the video must include truthfulness, transparency, character, capability, partnership and respect.” This is the beginning of the Trust Practice Challenge entry describing The Leader Index employed at the Mayo Clinic. Its basic premise is that trust in an organization is fundamentally related to trust in its leaders. This trust in leadership is connected to the well-being, fulfillment and satisfaction of physicians.

The Leader Index is based on the belief that five behaviors engender trust in leaders and their organizations.

-Include: Nurture a culture where all are welcome and psychologically safe

-Inform: Transparently share what you know with the team

-Inquire: Consistently solicit input and ideas of associates

-Develop: Support professional development and career aspirations of staff

-Recognize: Express appreciation and gratitude in a meaningful way to colleagues

Mayo Clinic measures these five trust-generating leader behaviors annually with a confidential staff survey of their ~4,500 physicians and scientists. The physicians and scientists assess these five behaviors in the leader to whom they report. A senior leader then shares the results with, and provides feedback to, every physician leader. Each leader then develops a plan of opportunities for improvement. For example, the plan may include a workshop on leader behaviors or emotional intelligence, or it could include an executive coach. The index is used in the spirit of helping physicians become better leaders.

This approach to engendering trust is evidence-based and validated. The peer-reviewed published report of the authors’ research shows that for every point of improvement in the 60-point index scale, staff satisfaction improved by nine percent and burnout declined by 3.3 percent.

What are the lessons from The Leader Index?

  1. Focusing on leadership is a high-leverage strategy for building trust in all types of relationships in health care.
  2. This index’s focus on creating psychological safety is similar to other proven strategies for promoting supportive conversations.
  3. Leadership can be fostered and developed over time and is not solely a character trait.
  4. One key to a positive culture is showing appreciation and gratitude, which costs nothing but is often missing.
  5. If I can’t trust my leaders, then I probably will not develop authentic trusting relationships among colleagues and team members.

Leadership is so important but it is a scare commodity. The Leader Index offers a path to cultivate this most precious asset and help the people working in health care have great relationships with colleagues.




Daniel B. Wolfson
EVP & COO, ABIM Foundation