Nursing home staff’s trust in their leaders and federal health care agencies eroded during the worst of the pandemic – and the rebuild will be slow going.
Industry executives and advocacy leaders, who said that the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) have been unable to gain back staff confidence, also discussed strategies for renewing trust between staff, leaders and government agencies.
“Scaling up trust,” and building “trust equity,” so to speak, will take a lot of introspection and work from leadership, according to Jerald Cosey, health care speaker and operational leadership development director with American Senior Communities in Indiana.
“When coaching leaders, we always talk about self awareness – it’s the start for self development,” said Cosey. “I quickly learned that in this industry, we do a whole lot. We carry a whole lot. Sometimes everything that we carry doesn’t allow us to be the best leaders that we possibly can be.”
On the other hand, it doesn’t take much to lose trust, he said. It doesn’t take much to gain it back either, but it still needs to be a little bit at a time, and half the battle is self awareness.
Cosey, along with representatives from the American Health Care Association (AHCA) discussed methods for building trust between nursing home staff and building leaders when it comes to vaccine campaigns, on top of day-to-day operations during the association’s annual conference this week.
“When we developed this course, we were thinking about building trust as it applies to vaccine uptake. What we really found is that this is a skill set that our leaders can develop; it will allow them to be more effective in our communities,” said Cosey.
Dr. David Gifford, chief medical officer with AHCA/NCAL, said a breakdown of communication during the height of the pandemic also broke down trust in such agencies, exacerbated by the vaccine mandate and rollout. He was joined by Courtney Bishnoi, vice president of quality and regulatory programs for the association, and Kayla Drew-Ann Stocks, AHCA/NCAL federal grants manager.
“CDC’s communication throughout the pandemic undermined their trust. We have pointed that out to a number CDC staff,” said Gifford. “We saw distrust go up during the pandemic, across the board, often unintentionally … both by CDC, by AHCA, all of us trying to do the right thing.”
Even as early as last week, Gifford spoke with CDC members about actions the agency has done to create distrust again in the new vaccine. CDC and AHCA are working on tackling messaging around the 2023-2024 vaccine, but Gifford admits it’s going to be a slow process.
Gifford is thinking about this time as an opportunity to “reset,” and make sure the right information is available for leaders, staff and residents to make knowledgeable decisions.
“When you’re asking somebody to do something, and they don’t want to do it, you’re not going to convince them with one dialogue,” Gifford said. “It’s all about building trust over time so that when you have these difficult conversations, there’s more of a trusting relationship.”
The three drivers of trust
Authenticity, logic and empathy are the three drivers of trust, presenters said. No easy feat in a fast-paced, high stress environment.
Presenters shared various ways in which leaders may fail to build trust through one of these drivers. One example highlighted lack of communication on why staff needs to do something in a certain way. Timing sometimes doesn’t allow for leaders to explain the “why” behind decision making.
“We’re in a high paced industry, we don’t really have a lot of time to give all the background,” said Cosey. “However, if we’re making logical decisions, doesn’t it make sense to take credit for our logic? Isn’t that what we do when the state comes in?”
The mindset of nursing home staff has changed as well considering the ongoing workforce shortage – people know their power, Cosey said.
In terms of authenticity, Cosey said it’s more of a group action, to create an environment where it’s safe for people to disagree and to safely express themselves.
Improving empathy, he said, can be as simple as putting the phone away during group huddles, or giving someone your full attention without feeling the need to multitask.
“It’s a busy day and community. I just found that nurse’s note that just made me have a stroke. I got drama going on between culinary and CNAs … but then I have someone that comes in, and they want to talk about something that’s very important to them. This is a chance for me to build some trust equity, if you will, with somebody,” said Cosey.
Finding and implementing change ideas
AHCA’s Leadership Academy – which is accepting members for 2024 – is one way to facilitate “change ideas” in the industry. A change idea is a way to use trust building with a specific, strategic goal for a community.
Team members from long-term care communities across the country were part of the Academy, and over 18 weeks were taught how to build trust within their buildings, Cosey said. Some of their goals through the program included reducing falls and injuries, while others focused on wound care.
“I’ve learned with the change idea to start small … it’s important that we start with the smallest possible area where we can test out our change idea,” said Cosey. “Then we learn from what’s going well, and we learn from what’s not going well.”
Cosey encouraged listeners to “observe the system” too. Note what you see when you’re just quietly observing the day-to-day.
“Look for ways to find out what’s working, and look for ways to scale it up,” he added.
Jumping to conclusions, or believing there’s just one solution to a problem are sure fire ways to not find or fully implement change ideas. Failing to recognize the depth of a problem can be another pitfall, Cosey said.
“The landscape is changing, and trust is powerful,” siad Cosey. “If we can develop trust within our communities, it’s also going to help us with relationships outside of our work, and help us professionally as we continue leading and influencing.”
Companies featured in this article:
