READ THE CHAPTER AND DO CASE 15.2. READ THE SCENARIO. THEN ANSWER THE THREE QUESTIONS.

THE QUESTIONS YOU ARE ANSWERING IN THREE PARAGRAPH AT MOST.

1. What long-term effects does Ralph's behavior have on his team ,the employees at large, and the organization as a whole? Are these effects irreversible?

2. Ralph is clearly a financial wizard and has great business instincts. How should he leverage these competencies to (create) a better culture? To make himself even more powerful by being approachable and trustworthy?

3. What role does power play in Ralph's success?

*** ANSWER THREE PARAGRAPH EACH*****

Hughes, R. L., R. C. Ginnett, and G. J. Curphy. 2015. Leadership: Enhancing the Lessons of Experience, 8th ed. Burr Ridge, IL: McGraw-Hill Education. Northouse, P. G. 2016. Leadership: Theory and Practice, 7th ed. Los Angeles: SAGE Publications. CHAPTER 15 SUGGESTED READINGS Trust Cohn, K. H. 2008. "Collaborative Co-mentoring." Healthcare Collaboration. Published June 18. www.healthcarecollaboration.com/collaborative-co-mentoring When you are not present, people can tell. When you are, people respond. Homberg, F., and H. T. M. Bui. 2013. "Top Management Team Diversity: A Systematic Review." Group and Organization Management 38 (4): 455-79. -Amy Cuddy (2015) Hurt, K. J., and M. A. Abebe. 2015. "The Effect of Conflict Type and Organizational Crisis on Perceived Strategic Decision Effectiveness: An Empirical Investigation." Journal of Leadership and Organizational Studies 22 (3): 340-54. Shaeffner, M., H. Huettermann, D. Gebert, S. Boerner, E. Kearney, and L. J. Song. 2015. "Swim or Sink Together: The Potential of Collective Team Identification and MAJOR MICHELLE HARRIS, an Army Medical Service Corps officer, has just Team Member Alignment for Separating Task and Relationship Conflicts." Group Lreturned to the United States from a third deployment overseas. As a and Organization Management 40 (4): 467-99. healthcare executive, she is active in her professional association's local chapter. In one meeting, she and Chuck Hall, a fellow executive, discuss the concept of trust in Susskind, A. M., and P. R. Odom-Reed. 2016. "Team Members' Centrality, Cohesion, leadership Conflict, and Performance in Multi-University Geographically Distributed Project Teams." Communication Research. Published February 3 . CHUCK. Michelle, in your position, it must be great to simply give orders that your team won't question or distrust. I'd love to do the same in my hospital. But I have http://crx.sagepub.com/content/early/2016/01/28/0093650215626972.abstract. to sell every idea, earn my colleagues' trust every step of the way Weingart, L. R., K. J. Behfar, C. Bendersky, G. Todorova, and K. A. Jehn. 2015. "The Directness and Oppositional Intensity of Conflict Expression." Academy of MICHELLE. No, that's not how it works in the military. There's a book called Management Review 40 (2): 235-62. Leadership Lessons from West Point. It points out that in the military, trust is even more critical than in civilian situations. CHUCK. How so? MICHELLE. In the military, we ask-note that I say "ask," not "command"- people to put their lives on the line, so we work harder to earn their trust. We provide constant training to ensure high levels of competency and safety. We demonstrate that we care about our personnel, and a high degree of openness can be observed in our training. We have to be on the same page, especially in combat situations. Everyone has a deep understanding of our missions and the dangers and payoffs they present. Movies about the military don't accurately depict the high levels of trust that underlie everything we do. CHUCK. That's quite impressive. I'd like to invite you to speak to my senior management team next month, if you have time to spare. 210 211TRUST IS THE first value all team members must learn. Without trust, team members engage in fierce competition, backstabbing, and hypocrisy (see exhibit 15 1). Exhibit 15.1 Consequences of Lack ofTrust - Team members keep important and relevant information to themselves for fear that others Wlll steal or sabotage their ideas. The team leader or high-ranking team members undermine the suggestions or plans submitted by lowerelevel members. Competition for resources among team members is excessive. Side deals or negotiations constantly occur. Many team members are deliberately left out ofthe planning and decisionvmaking processes. Cliques have more inuence on and power over team members than does the leader. Political maneuvering is rampant and Viewed as a necessary practice. Merriam-Webster's Collegiate Dictionary, Eleventh Edition, defines trust as the \"assured reliance on the character, ability, strength, or truth of someone or something.\" In leadership teams, trust is the members' confidence in each other's ability and resolve to uphold the team's principles and to work toward its goals. It is what allows one member to vote for another's untested, seemingly outlandish proposal. It is what makes members stand behind their leader in moments of failure or scrutiny. Exhibit 15 2 enumerates the essential bases of trust, and exhibit 15.3 is a behavior guideline for all team members to promote a culture of trust. Page 212 of 36? Exhibit 15.2 The Five Components ofTrust 1. Integrityhonesty and truthfulness Z. Competencetechnical and interpersonal knowledge and skills 3. Consistencyreliability, predictability. and good Judgment 4. LoyaltyWillingness to support, protect. and save someone else 5. OpennessWillingness to share ideas and information freely Source: Adapted from Robbins and ludge (2013). Exhibit 15.3 How Team Members Can Engender Trust Speak your mind. The truth could hurt, but it could also pave a path for improved and increased communication. Be calm while you express yourself. and be receptive to the responses. Maintain condentiality. A lot of leadership team matters are conden- tial, and for good reason. Such matters, including informal or casual conversations, must not be discussed or shared. Actively support the team. Do not refer to or speak about the team negatively, inside or outside the team setting. People's poor perception ofthe team extends to their poor perception ofyou. ifonly because you belong to the group. Embrace openness. Trust develops in an open and candid envrronment. Practice due process. In the team setting, due process means that all team members have the right to be heard fairly. Cuddy, Kohut, and Neffinger (2013) state that \"trust also facilitates the exchange and acceptance of ideasiit allows people to hear others' messageand boosts the quantity and quality of the ideas that are produced within an organization. Most important, trust provides the opportunity to change people's attitudes and beliefs, not just their outward behaviori\" 213 An exchange of tangible or intangible favors or goodwill is common practice among team members. This transaction is modeled after the economics of bartering or the social exchange theory. This theory posits that individuals decide the fairness of a relationship on the basis of a self- measured givetake ratio. If a person thinks he is giving more than he is receiving, he will perceive the exchange as unfair, and thus he may withdraw from giving. Conversely, if the person believes the things he gives and receives are of comparable value, he will continue the exchange relationship. The same idea is true of trust: It is a commodity that team members can exchange. Unlike other favors, however, trust is not easily earned. A team member must prove her trustworthiness to the rest of the group by showing and having faith and concern; being transparent and accountable; providing support, assistance, information, and resources; and aligning with the general consensus without sacrificing personal values. More important, the team member must display these behaviors consistently and over time. Once earned, trust must be maintained. When team members cease to trade trust, a \"depression\" occurs, prohibiting members from cooperating, sharing information, and collaborating. It harms the cohesiveness of the unit and ultimately leads to various dysfunctions. THE CONCEPT IN PRACTICE The following approaches can enhance trustworthiness and trust levels among team members. Acknowledge the Quid Pro Quo Practice Honesty engenders trust. By publicly recognizing and discussing the fact that favors are exchanged to help forward the team's initiatives, team members can use that fact to achieve the most optimal outcomes. The concept may be woven into trust-building exercises. Earn, Do Not Expect, Trust Trust does not develop overnight, especially in a field such as healthcare that is in a constant state of ux. A leader cannot order her team members to trust her, nor can she think that trust comes automatically with the position. She must first assess her true self and either improve or maintain her trustworthiness. Trust building is a multistep and multiyear journey that can be easily derailed by a small move in the wrong direction. People want to feel understood by their leaders. Trust comes before strength and it becomes a conduit of inuence. Your strength is a little bit threatening before people trust you. But when they trust you and you are their leader, it's a gift to them. Presence allows you to build that trust because you are saying, \"I'm here, I care about you. I'm listening and what I am telling you to do is not just based on my own personal opinion but what I'm observing and hearing from you. Alny Cuddy (quoted in Schawbel 2016) Display Consistent Behavior In some respects, trust is about predictability and consistency. Team members will be hard-pressed to have confidence in a leader who does not do what he says or is fickle, temperamental, indecisive, impulsive, or too spontaneous. Moreover, followers are discouraged when the leader's words and deeds are contradictory. For example, one CEO declares that he wants to create a culture of empowerment, but he insists on reviewing everyone's work all the time and giving the final approval on every single decision. An erratic or unpredictable leader is viewed as unreliable and hence not deserving of trust. An understanding of people and relationships requires an understanding of trust. Trust requires the coexistence of two converging beliefs. When I believe you are competent and that you care about me, I will trust you. Competency alone or caring by iself will not engender trust. Both are necessary. Peter R. Sdtoltes (1993) Drive Out Fear In his well-known book, The Five Dysfunctions of a Team, Patrick 215 Lencioni (2002, 43) presents a pyramid that shows his theory of the five types of dysfunction. Notably, he puts lack of trust at the bottom of the pyramid, indicating that it is the most serious of the five. Most readers would agree that when trust is absent in the work culture (or any culture for that matter), uncertainty and ultimately fear can easily develop. Clearly, fear has no place on any team. Following are some strategies for driving fear away: I Establish and sustain a culture in which people can express opinions, concerns, suggestions, and even dissent without putting their jobs, reputation, undertaking, or team membership in jeopardy. Do not discuss or negotiate anything in secret. Confidentiality is markedly different from secrecy, and the latter breeds suspicions, gossip, and disloyalty. Secrets are always revealed, and when they are, team members feel left out and threatened. Everyone on the team must practice transparency. Persuade members to participate in team activities. One leader holds \"Think Out Loud" meetings, where the team brainstorms ideas. The goal of this session is to stimulate creative thinking and generate novel approaches to old challenges. Be accessible. The executive suite should not be a hiding spot; it should be one of the places a leader can be found, in addition to the hallways, patient care units, conference rooms, cafeterias, other people's work spaces, and so on. Presence at organizational events and community functions as well as the availability of contact information are two ways a leader can become more accessible. Avoid the Perception and Reality of Conict of Interest Many situations in healthcare present a conict-ofinterest challenge because healthcare delivery and management entail so many types of exchanges, some of which could work in the self-interest of those involved in the exchange. Full disclosure is one way to combat the perception of a conict of interest. For example, the Cleveland Clinic now publicizes the business dealings of its physicians and other clinicians with drug and medical device makers. In April 2009, the Institute of Medicine issued the report Conict of Interest in Medical, Research, Education and Practice (Office of News and Public Information 2009). The report discusses how 216 \"disclosure by physicians and researchers not only to their employers but also to other medical organizations of their financial links to pharmaceutical, biotechnology, and medical device firms is an essential first step in identifying and managing conicts of interest and needs to be improved." Many healthcare organizations, including professional associations and healthcare businesses, already have a conict-ofinterest policy in place. However, more needs to be done in this area to minimize (if not eliminate) the risk of conict of interest and its subsequent consequences to the reputation of the organization, its leaders, and its staff. Be Candid Candor is the sincerity and frankness of speech and behavior. It runs counter to lying, condescending, or exaggerating. Speaking candidly means - retaining eye contact and a steady voice, - stating facts and withholding opinions that could hurt, - focusing on the situation and not going off on a tangent, o inviting questions or comments, and I giving the other person a chance to respond. Retreats are optimal moments for candid discussions, as John Kotter (1996, 132) proposes in his book Leading Change: \"Most of the time must be spent encouraging honest discussion about how individuals think and feel with regard to the organization, its problems and opportunities. Communication channels between people are opened or strengthened. Mutual understanding is enlarged. Intellectual and social activities are designed to encourage the growth of trust.\" Unfortunately, many team members recoil from voicing their opinions and concerns in front of the whole team, as my experience with leading senior management retreats has shown. Although these members were willing to be candid with me in private, they preferred not to speak when faced by the other members. To combat this phenomenon, I started meeting individually with team members before the retreat. I emphasized the merits of being open and honest, and I recruited them to contribute to the group dialogue. Also, I occasionally brought a list of concerns, with permission from the team, to serve as a starting point for our candid 217 discussion. Trust in a relationship generally develops gradually over time through the course of personal interaction. Taking some kind of risk in relation to the other person and feeling you weren't injured (emotionally or physically) in the process is what moves trust to new levels. James M. Kouzes and Barry Z. Posner (2003) Use Finesse Finesse does not cost anything, but it is worth a small fortune. However, like a battery, finesse is negatively and positively charged. Dealing with someone with decorum and courtesy is a plus, but it can also be a minus: It can prohibit the confrontation needed to reveal underlying conicts. For example, a cohesive leadership team that has been together for many years and has rarely argued over issues does not take kindly to confrontation. As suggested in W, a cohesive team does not necessarily make a productive team because many of its members have grown complacent; thus, the team can use a little shake-up once in a while. Having tact, however, prevents boorish behavior. High-performance teams are characterized by high mutual trust among members. That is, members believe in the integrity, character, and ability of each other. But as you know from personal relationships, trust is fragile. It takes a long time to build, can be easily destroyed, and is hard to regain. Also, since trust begets trust and distrust begets distrust, maintaining trust requires careful attention by management Stephen P. Robbins and Timothy A. Judge (2013) Expect and Welcome Resistance The process of earning trustessentially, being openputs a person in a vulnerable position. The leader (or a team member) should be prepared for criticism, doubt, resistance, and reluctance but should not take these responses personally. One CEO puts this risk in perspective: \"If you want trust within your management group, you have to expect to get shot down sometimes. Then you get back up, thank the person who shot you, and 218 move on.\" Do Not Take Advantage A leadership position offers many opportunities for inappropriate conduct. Sadly, in the past decade alone, high-level executives in and out of the healthcare field have exploited this truth. Taking advantage for the purpose of personal gain is wrong in any situation, as this act almost always has a victim. A leader could keep herself from taking advantage by obeying the golden rule of bartering: The exchange must be of equal value. Grant Authority Appropriately The power to bestow decision-making capabilities on team members falls on the leader, so he must exercise extreme care and judgment. Personal friendships, resentment or anger over past insults, and even lack of information can cloud the leader's ability to grant this authority. A poor choice can lead to infighting, charges of favoritism, and resistance. It could also erode the leader's trustworthiness. The best defense against such a scenario is always awareness and wisdom, which can come from being fully present physically, mentally, and emotionally. Understand the Links Between Trust and Mission and Action As this chapter's opening vignette indicates, military operations exemplify how trust is the basis of mission fulfillment. Trust essentially powers the actions that support the mission. Without trust, the action either does not occur or is performed haphazardly, causing grave harm. As retired Major General David Rubenstein, FACHE (2016), states: The first thing that comes to mind when talking about trust is the chain of events that occur in the Army from words to actions to tnrst to mission accomplishment. A soldier will hear his or her leader's words but waits to see the leader's actions. When action matches words, the soldier starts to build a tnrst that says, \"I'll go in harm's way to do my job because I trust you.\" When I hand my static line to the jumpmaster, 800 feet above the ground on a moonless night, I'm saying, \"I'm ready 219 to jump out of this plane because I trust you've ensured that my equipment and l are ready.\" CONCLUSION Trust is the assurance of goodwill between two people. It builds over time and must not be taken for granted. Trust among team members is a commodity that can be traded, facilitating ongoing relationships and improving the likelihood of collaboration, cooperation, and sharing of information. Lacking trust is like walking into a room full of complete strangers. You have a problem: You need to finish an important project, but you have no time to do so. Imagine asking these strangers in the room to help you. Imagine handing them the incomplete work. Imagine sharing with them valuable and confidential information about the project. Imagine encouraging them to collaborate and cooperate with each other. Imagine giving them a quick deadline. Imagine doing all of this without feeling paranoid, doubtful, desperate, exasperated, and doomed. Self-Evaluation Questions D How is trust displayed among my team members? Do we barter trust, and do we understand its function in the team? D Is my leadership style marked by openness and honesty? Do others easily approach me? D To what extent am I known as a good team player? D 15 my communication with the team candid and straightforward? To what extent do I encourage this communication style? Team Evaluation Questions To what extent do team members D believe in each other's abilities and competence? CI believe in each other's inclinations and intentions? D believe in each other's integrity? [I get along with each other? CI share the same goals? CI rely and depend on each other? :I have confidence in each other's motives and behaviors? Cases Case 15.1 New CEO Doug Wright has a problem. His leadership team displays dysfunctional behaviors. Infighting is rampant, and cooperation and sharing of information are nonexistent. At meetings, most team members do not participate in the discussion, resigned to sitting quietly after they give an update on their respective responsibilities. Recently, two chief executives suddenly quit, leaving the other team members gossiping about the reasons. Doug has spoken to the team (both as a group and individually) at length about the problem. He has touted the values of openness, honesty, and trust. He has encouraged the team members to speak their minds and has informed them of the no- recrimination policy he has just instituted. But still, the team seems removed, content with doing as it is told. Frustrated, Doug contacts Roxanne Samanski, an organizational development consultant. The first question he asks her is, \"Shall I fire all of them and start fresh?" Case 15.1 Questions I. If you were Roxanne, how would you respond to Doug? What suggestions would you offer? . What is the role that lack of trust plays in this situation? . Do you think it's important to find out the history of this team to understand its current dysfunctions? Case 15.2 Ralph O'Riley is a dynamic CEO of a large for-profit system. He is well known in the community. He is a brilliant businessman, and he is highly rewarded for it, enjoying various perks such as a beautifully appointed office suite, a company car, and a parking spot right outside of the hospital entrance. He rarely attends employee-related functions, and he only occasionally visits the other facilities in the system, let alone the units on his own campus. He is a mythical figure among employees and intimidates his own leadership team. He shows up to meetings late, relies on his chief executives to \"fill him in on the agenda,\" and does not know all of his staff members' names or positions. He does not participate in operational discussions, but he gives orders that affect operations, something that confounds his team and angers the rank and file. Once during a reneat, Ralph was overheard by some of his team members boasting about his golf game and his power. \"This is a waste of my time,\" he 221 Page 222 of 369 complained over his cell phone. "It's not PC to say it, but I own these people. They Kotter, J. 1996. Leading Change. Boston: Harvard Business School Press. do what I tell them to do. I made a lot of money for this system. Now they should give me a break." Kouzes, J. M., and B. Z. Posner. 1993. Credibility: How Leaders Gain and Lose It, Why People Demand It. San Francisco: Jossey-Bass. Case 15.2 Questions Lencioni, P. 2002. The Five Dysfunctions of a Team: A Leadership Fable. San Obviously, everything Ralph is seems to run counter with the practices that build and Francisco: Jossey-Bass. enhance trust. Office of News and Public Information. 2009. "Voluntary and Regulatory Measures Are 1. What long-term effects does Ralph's behavior have on his team, the employees Needed to Reduce Conflicts of Interest in Medical Research, Education, and at large, and the organization as a whole? Are these effects irreversible? Practice." The National Academies. Published April 28. www8.nationalacademies.org/onpinewsewsitem.aspx?RecordID=12598. 2. Ralph is clearly a financial wizard and has great business instincts. How should he leverage these competencies to create a better culture? To make himself even Robbins, S. P., and T. A. Judge. 2013. Essentials of Organizational Behavior, 12th ed. more powerful by being approachable and trustworthy? Upper Saddle River, NJ: Prentice Hall. 3. What role does power play in Ralph's success? Rubenstein, D. 2016. Personal communication with author, May 15. Schawbel, D. 2016. "Amy Cuddy: How Leaders Can Be More Present in the Workplace." Forbes Published February 16. NOTE www.forbes.com/sites/danschawbel/2016/02/16/amy-cuddy-how-leaders-can-be- more-present-in-the-workplace/#4d39bef166ce 1. This vignette represents the contributions that military rs bring to healthcare Scholtes, P. R. 1998. The Leader's Handbook: Making Things Happen, Getting Things leadership and the healthcare field. It highlights the importance of trust in the military Done. New York: McGraw-Hill. and its applicability to civilian leadership. Attendees at American College of Healthcare Executives events (especially the annual Congress on Healthcare Leadership) see and learn from many of these military leaders. SUGGESTED READINGS The opening vignette in this chapter is based on a true story. Healthcare leaders in the armed forces do not work in a top-down, command-and-control environment. Obviously, a certain amount of discipline and authority exists in the military, but the Anderson, C., and S. Brion. 2014. "Perspectives on Power in Organizations." Annual dynamic is nothing like many believe. Military healthcare leaders have to cultivate a Review of Organizational Psychology and Organizational Behavior 1: 67-97. high trust level while developing the same competencies as civilian healthcare executives. My work with leaders in the Medical Service Corps, the Medical Corps, Avolio, B., and W. L. Gardner. 2005. "Authentic Leadership Development: Getting to and the Army Nurse Corps over the past 35 years tells me they are exceptional the Root of Positive Forms of Leadership." Leadership Quarterly 16 (3): 339-40. leaders. I thank them and applaud their service, sacrifice, and dedication. Bobbio, A., and A. M. Manganelli. 2015. "Antecedents of Hospital Nurses' Intention to Leave the Organization: A Cross Sectional Survey." International Journal of Nursing Studies 52 (7): 1180-92 REFERENCES Mccabe, T. J., and S. Sambrook. 2014. "The Antecedents, Attributes and Consequences of Trust Among Nurses and Nurse Managers: A Concept Analysis." International Crandall, D. (ed). 2006. Leadership Lessons from West Point. San Francisco: Jossey- Journal of Nursing Studies 51 (5): 815-27. Bass. Nair, S. M., and R. Salleh. 2015. "Linking Performance Appraisal Justice, Trust, and Cuddy, A. 2015. Presence: Bringing Your Boldest Self to Your Biggest Challenges. Employee Engagement: A Conceptual Framework." Procedia: Social and Behavioral New York: Little, Brown and Company Sciences 211: 1155-62. Cuddy, A. J. C., M. Kohut, and J. Neffinger. 2013. "Connect, Then Lead." Harvard Pfeffer, J. 1992. Managing with Power: Politics and Influence in Organizations. Business Review. Published July. https://hbr.org/2013/07/connect-then-lead. 222 223