Trust Matters and Metaphors

Trust Matters and Organizations as Political Systems

Kathyrne L. Tiras

California State University San Bernardino

EDU.705

Trust Matters and Metaphors

Organizations may function like a government regulating division of labor,
treatment of the employees and how and where the actual power lies. The
organization I will be using is a University & the adjourning Medical Center which in
this paper I will refer to as The Healthy Person Institution. I will give an overview of
how the entire medical center functions using autocratic decision making and then
will focus on one particular unit. I will describe how using the five element s of trust
can repair a broken institution.
Political Systems Autocratic rule
In an organization using autocratic rule one person or group of persons have
absolute power and thereby control resources and wield power with absolute
authority. There are strict rules and policies and if you do not agree with these
policies you will be not so nicely asked to leave or be terminated. (Morgan, 2006).
The Healthy Person Institution administrative body consists of a President who is a
Physician and a CEO and a group of vice-presidents all of which have business
degrees (MBAS). They rule with an iron thumb. They Biannual company forums
are provided, part of which is the CEO giving a finance report and in placing blame
on employees for the institution finical problems. This is followed by a question
and answer session in which audience is asked if there are any suggestion that
would improve how the company functions and possible cost cutting measures to
improve the bottom line. Employees proceed to ask questions and make
suggestions however they are rarely enacted on. This has created an atmosphere of
distrust and betrayal throughout the institution. Due to this increase in
dissatisfaction administration tried to placate the employees with asking their for
their input on projects. A prime example of this was when new piece of equipment
(cardiac monitor) was needed in the Intensive care units, intensive care nurses were

Trust Matters and Metaphors

asked to evaluate this piece of equipment. They evaluated three cardiac monitors
from different companies and then reported to the administration which cardiac
monitor would best meet the needs of the patient and staff.

The nurses found one

cardiac monitor to be superior and voted to have it purchased. Little did they know
that this had just been a sham and a cheaper product had already been purchased
by the organization. Two other common practices of administration is to hire their
relatives into position in which they are not qualify and coming into work to find
your office packed up and being escorted off the premises if you disagree with
administration. This had led to long standing and loyal employees of The Healthy
Person Institution to leave and find employment else ware.
This philosophy has trickled down to the individual units where employee
dissatisfaction is at an all-time high. On one particular unit which had the lowest
attrition rate at the institution before the change in administrative policy, to one
with the highest rates. The manager states he has an open door policy but he is so
rude and condescending when you speak to him avoidance has become the new
norm on the unit. The new manager has his favorites which can do no wrong in his
eyes and the rest of the employee cannot speak up when problems arise especially
when it concerns his favorites. He has instituted many new rules to try and increase
performance and encourages the staff to report any breakage of the rules. This has
seriously damaged morale and change the climate of the unit from one of
cooperation, to fear of losing your job for even a minor infractions. This atmosphere
has caused a decrease in safe care and instead of enjoying work made many dread
coming to work. The previous manager had been well like and listened to the
employees. The staff felt she had their best interest at heart. If we needed new
equipment she would try and get it for us. We felt we could trust her and we have

Trust Matters and Metaphors

absolutely no trust in the new manager. His interest appears to be keeping his
position and advancing in the organization not matter how many people he must
hurt to do so .The former manager left the organization after twenty years due to
the change in the administration and their hard handed way of running the
institution.
Shared governance
A better option for this institution, which is one of higher learning and practice,
would be a shared governance model which is similar to the Representative
democracy model in the book Images of organization by Gareth Morgan .The
Representative democracy model is rule by elected office who are mandated to act
on behalf of those who elected them. They have a specific term of office or the
length of time they continue to support the electorate, it provides a form of
government where the worker and shareholder control the industry (Morgan, 2006).
Shared governance provides the stakeholders of the company (its employees) the
opportunity to help run the company and have their voices heard via committee
membership. The committee reports to administration with their suggestion which
is based on research. The majority of the institution employees are college
graduates who have knowledge that would help the institution grow and thrive. This
type of administration uses it greatest resource which is its staff. Empowerment of
nurses and other health care professional has been shown to improve quality health
care, contain cost and retain staff (Barden, Griffin, Donahue, and Fitzpatrick, 2011).
Shared governance produces an atmosphere that provides vital communication and
decision making (Barden, Griffin, Donahue, and Fitzpatrick, 2011). The current
cost cutting practice of The Healthy Person Institution is to decrease staff,
decrease the availability of supplies and turning health care into an assembly line

Trust Matters and Metaphors

instead of a caring profession. It needs to change from the attitude we do it this
way to how can we do this (Morgan, 2006).
Codetermination
Codetermination would be a viable option for how to run the institution.
However it would not be as valuable as shared governance. Codetermination is
where the rule is done by opposing parties combine in the joint management to
maintain mutual interest. It is based on coalition or corporatism, in which each
party draws on a specific power base (Morgan, 2006). The mutual interest would be
quality patient care and maintaining the financial stability of the institution.
Everyone would have employment and the stakeholders (employees and patients)
would receive the care and respect they deserve. The problem with this sort of
governance is it sounds like having a union which could become corrupt and make
things worse.
Trust Matters
The five principle of trust are: benevolence, honesty, openness, reliability
and competence (Tschannen-Moran, 2004). In the remaining section of this paper I
will incorporate the five elements of trust to turn the university and medical center
administration into an institution that would promote an environment that provides
quality care, remains financially solvent and respects everyone that enters its doors.
Benevolence is the confidence that another person has your best interest at
heart, doing good, not harm and that you will be protected by a trusted party
(Tschannen-Moran, 2004). The administration of the Healthy Persons Institute has
not shown benevolence: not supporting the staff ideas and recommendation, hiring

Trust Matters and Metaphors

relatives instead of qualified employees and tricking them with lies concerning
equipment. When there is lack of benevolence by the administrators it moves
down to all levels of the institution. The staff feels as if they can trust no one.
They do not trust their managers or their co-workers. It becomes and atmosphere
or betrayal and protecting your own interest. Morale suffers as do the patients
receiving their care and the students learning how to become health care workers.
This is not an effective learning environment for students. Can they believe what
they are being told? Should they try and think critically or will that just get them in
trouble with the staff preceptors and their instructors. Teamwork is one of the
founding principles of health care and in this environment teamwork does not exist,
since you feel no one has your back. The institution could change this by changing
their attitudes and practices. They would listen to the employees and embrace
their ideas for improvement. They would hire those who are qualified for the
positions instead of showing favoritism to family members. Fairness in how
everyone is treated from the janitor to the CEO. Treat everyone with respect and
have a true open door policy. Reward those who do a good job. Providing fair and
impartial discipline, not favoritism and by using education to correct mistakes
instead of retaliation. A person is more apt to report a mistake if they feel
supported instead of threaten by making a simple mistake. Mistakes are often
cause by faulty processes and these will be corrected if people actually report them
instead of hiding mistakes. It is important to make an effort to correct the processes
that are harmful or time consuming, instead of constantly replacing employees who
are unable to fix the problem. Realizing that is the process or the problem that
needs to be changed not the person trying to solve it. The expertise of the health
care professional regarding their work and equipment needs. The nurses knew

Trust Matters and Metaphors

what would be the best monitor, someone who only knows numbers does not
realize the importance of quality over price. You get what you pay for and cheap is
what it is, monitors that break frequently are hard to use and have to be replaced.
Its like putting a round peg in a square hole. You break it trying to get it to fit and it
ends up costing more in the long run with repairs then the quality model would have
cost. If the administration just we apologize, realize their mistakes and change their
behavior to one of benevolence trust would increase as would the learning and
working environment.
Openness is a process of showing your vulnerability to others. Having the
ability to share information regarding both your successes and failures in life with
others. Knowing that the people you work with are reliable and that you can count
on them, embracing differences of opinions, none of us are right 100% of the time.
With knowledge comes the power to grow, to mature and to thrive (TschannenMoran, 2004). There was no openness at The Healthy Person Institution the forums
were just a front, important meetings and decisions all happen behind closed doors.
You would be called into your managers office or get a not so nice e-mail regarding
a mistake you made regarding a new policy that you didnt even know about. It
seemed that the policies changed every other day and finding them was a very
difficult process. Administrators would never admit they were wrong as in the
example of the equipment. If you by chance told the manager how you felt or were
concerned about something it never stayed private, soon the whole unit would
know.

The manager had spies that would tell him anything and everything that

was going on even minor things like telling a joke to ease the tension. It would get
to the point that the work was performed but the camaraderie was gone. The
nurse manager would send e-mails that were very hurtful and he would send e-

Trust Matters and Metaphors

mails that contradicted previous e-mails. How could this lack of openness be fixed?
It is very simple: be professional in all of your dealing with others, if you do not
know all the facts wait until you do to disseminate the information. It is better to
get correct information later then wrong information quickly. If you truly want an
open door policy make it so that everyone feels welcome and that their ideas are
important even if they may sound stupid. Dont lie sooner or later you will be
caught, if there is not money in the budget for something just tells them. Do not
say you will do this or do that if you cannot. Do not spread rumors and do not be a
tattletale. If something unethical or dangerous happens of course that needs to
be reported to the manager. Telling a joke or leaving your work area a mess is not
necessarily something that needs to be reported to the manager. If a joke offends
you speak with that person, ask them to tidy up after themselves when you have to
share a work area.
Reliability is the sense that you to depend upon another. You have support
from that person when you need it. That the person does what he/she says they
will do. That this is a person you can count on (Tschannen-Moran, 2004). At the
Healthy Persons institute there was a lack of reliably in management. The manager
of the unit was not available at times of crisis. During the night he would call to find
out what was happening on the unit but only to criticize not help. It got to be where
people no longer wanted to be in charge on night shift because of these calls. If the
person in charge called the manager with problems he would never help with a
solution. The night shift felt abandoned by management. When things were bad
such as not enough staff night shift would do the best they could. There was
frustration and since administration didnt care the staff began to have the same
attitude. It became a unit where you could not count on anyone any more. Fixing

Trust Matters and Metaphors

the reliability problem needs to start at the top. The CEO was considered unreliable
and so it just kept penetrating down into a vicious cycle. The CEO may not change
but the units could change. Confront the manager with concerns about his not
following through. Do it as a group so that voices could be heard in unison.
Confront the co-worker who had betrayed you. Ask for apologies and accept them
so the unit could progress. Do not forgive less that betrayal continue but let it be
known that you would not just lie back and take it, be proactive. It could be that the
manager is just as frustrated as the rest of the staff. Give him the benefit of the
doubt and move on.
Competence is having the skill to fulfill an expectation, perform a task
according to appropriate standards (Tschannen-Moran, 2004). The staff did not feel
the administration including the manager of the unit were competent. Standards
would change from week to week as would the expectations from the staff. One of
the biggest problems was retention of staff. The nurse manager seemed to drive
good people away. His standard of care of patients was below what the experience
staff felt like it should be. He seemed to cut corners as did the institution. In order
to save money the institution decrease on hand supplies so by the time weekends
came you would be out of needed items for care. When the administration was
informed of this they stated the system was working at other hospitals we were just
being wasteful. They did not seem competent is the fact that patient censes was
twice as much as the hospitals so we required more supplies or they would buy
cheap products that would break and that would cause increase in the numbers
needed. Decisions that required medical knowledge was being made by person
without it. The manager was not keeping up to date with the requirement of the
unit.

Trust Matters and Metaphors

To maintain competence the manager needs to be more present and speak with the
staff to know what the needs of the unit are. He needs to go to administration and
let them know that certain things are not working. The staff would be willing to do
research and collect data to show supply needs. Show that certain products were
defective. Competence means having the right person for the right job. This could
be done by having a medical person ordering medical supplies rather than a MBA.
Cost is a factor but not the most important one. The staff is very knowledgeable
and would be able to give administration help with this. Once again using the
resources you have would show competence, knowing who has the knowledge
needed and using them.
competent.

Knowing when to say you need help is part of being

Trust Matters and Metaphors