Trust Starts at the Company Level
Team building is an important facet for an organizational environment. In a previous article I mentioned the importance of trust for team development. It was also mentioned that the facility administrator has to lead this effort toward establishing a sense of trust within an organizational environment. When trust fails to exist, workers look for other alternatives to assist with their perceived lack of trust in an organization, and one of these consequences may be worker unionization to compensate for a perceived lack of trust.
However, trust must not only be fostered within a particular organization, but it must also come for outside of that organization's environment as well. In today's world, many long-term care facilities are part of larger health care organizations or companies, which own and run dozens to hundreds of facilities in our country. For sound organizational development to exist, organizational trust must not only exist at the facility level, but also on the company level as well.
Frequently, I have noticed that many companies feel that they need to manage all facets of existence. In a previous post, Empowering Nursing Home Staff is the Key to Success, I mentioned that micromanaging leads to the disempowerment of workers. However, it also foments an organizational lack of trust. When the larger company acts as "Big Brother" to constantly oversee every facet of the health care environment, it instills in workers a level of uncertainty and apprehension.
Workers need to feel that they have the ability to be trusted in their duties. When companies lead by micromanagement, it is actually stating that workers cannot be trusted and a paternalistic influence at the company level needs to exist. This is very similar to what Douglas McGregor referred to as his theory X and Y workers. Although under theory Y the company often viewed workers more positively, those that adopted the theory X view of workers felt that they needed constant oversight because they were lazy and irresponsible. Micromanaging views the need for constant oversight of all its workers since it takes on a theory X view of workers. This inevitably instills a compromised level of trust built into the organizational environment.
So the problem that exists for many administrators is that at a time when they need to build trust within their management team and let that trust foster within the facility that they oversee, the larger mindset of the company itself may actually impede the development of trust. The organizational culture has to encourage trust, starting with those at the top, which in turn leads to a distillation of trust to the facility level, flowing subsequently downward to all the facilities and all their workers. However, if the facility attempts to develop a trusting culture and is impeded by the larger company's micromanagement landscape, a true development of cultural trust cannot and will not happen.
What comes to exist and what is created through micromanagement is what I termed the paternalistic organization. The facility actually becomes dependent upon leadership external to its boundaries. However, in doing this one must ask the question, "Who is the leader of the facility"? Paternalistic organizations, which many long-term care facilities exist as, frequently are pervaded with a lack of trust. And in asking why is this the case, the answer that comes forth is that without establishing trusting and accountable leadership within the facility itself, many individuals working in the facility come to wonder who is in charge and who will determine what direction that facility should move toward in achieving their goals.
Since the invisible hand of the company is guiding their many facilities, often in a generic manner, the administration in the facility itself often becomes a titular feature, disempowered with an inability to establish a trusting network among its workers. The workers look at the work environment in askance, viewing it as questionable territory if the leader is disempowered and controlled by forces outside of their control
The trouble that comes to exist is that trust needs to be established in an accountable source, which is typically the administrator. If administrators hold themselves to a standard of accountability, others come to view the organizational environment with greater stability. Enhanced organizational stability due to understanding that there is an individual that is leading with a solid standard of accountability helps to create a culture of trust within a long-term care facility. However, in paternalistic organizations the question of who is truly accountable is found outside the facility walls.
In addition to the problems mentioned above, paternalistic organizations are often immature organizations. Similar to individuals, organizational environments have a developmental or maturational level. When organizational environments are continuously dependent on others making decisions for them, organizational growth is thwarted and the autonomous nature of the facility fails to flourish, which in turn creates an environment that fails to have confidence or trust in their staff to make important health care related decisions.
Just as children have to eventually emancipate themselves and gradually move forth and establish a level of autonomy for healthy psychological development, organizations have to follow the same path for healthy organizational maturation. Yet, stifling organizational development through paternalistic oversight and micromanagement creates and infantilized organizational environment that is not conducive toward healthy work patterns.
If this type of dysfunction exists in paternalistic organizations, why do companies continue to create this type of organizational climate? Often it is due to their attempts to standardize the organizational climate. One can see that standardization is often an honorable attempt by many companies to provide the necessary structure and control over daily operations. However, this one size fits all strategy, along with the often anonymous outside control, breeds mistrust. If the foci of power and control fail to exist within the confines of the facility, workers will often question the legitimacy of the facility's administration.
It becomes obvious that an important element for a cohesive organizational structure comes from the establishment of a trusting work environment. Trusting work environments aid in organizational productivity in long-term care environments. Therefore it becomes imperative to establish a culture of trust, which helps to nurture a cohesion that is important for successful team building. However, trust needs to be established not just within the facility, but outside of the facility as well. With so many facilities being part of larger companies, the distillation of trust starting at the company level and moving downward has to be established.
I hope it has become evident that a company's cultural mentality to control all their facilities through paternalistic oversight in the long run actually creates an environment that is dysfunctional. As Gordon Allport has stated, trust is an important element of a mature and stable personality.
Organizationally speaking, the same holds true. Thwarting long-term care environments by establishing a micromanaged cultural climate in the organization actually creates a neurotic organizational climate in which trust is muffled and workers interact with anxiety and suspicion of the true motives of the organization. Since growth and empowerment fail to develop, both on an individual and organizational level trust will also fail to develop, perpetuating paternalism and reducing productivity.
Allport, G. W. (1961). Pattern and growth in personality. New York, Holt, Rinehart & Winston.
McGregor, D. (1960). The human side of enterprise. New York, McGraw-Hill.