A primary skill that a new physician executive needs relates to working in teams: to effectively lead teams and to be an able team member. Lack of trust will kill the effectiveness of an executive team. If team members aren't comfortable with expressing their truths, the team will perform poorly.

The definition of trust that we used in our executive team followed the definition given by Peter Lencioni in The Five Dysfunctions of a Team: A Leadership Fable. It basically centered around developing a team in which each member trusted themselves and each other enough to allow for vulnerability. Our team spent over a year working on trust. Our CEO pushed us to create a team that could fully explore difficult issues and utilize the gifts of each team member.

Why Bother?

As Lencioni argues, trust is the foundation upon which an effective team is built. Without trust, deep conversations and confrontation cannot effectively occur. Without meaningful, often difficult, conversations team members will not feel heard and will not commit to organizational goals. Accountability will be shaky and results will not follow.

Signs of a Lack of Trust

There are generally some fairly obvious indications that trust is lacking. Take a moment to reflect on the following scenarios. Do any of them describe the way your team operates?

Here are some of the behaviors to look for:

1. Members of the team have not built personal relationships.

They are not familiar with the personal lives of other members: their backgrounds, where they grew up and attended school, and what their outside interests and hobbies are. It is difficult to build trust when you do not have a personal connection with other team members.

2. The team always seems to be in consensus on decisions.

This is a bit counter-intuitive at first. But members of a team never agree on everything. If there seems to be a culture of consensus, it means that team members are holding back. Highly effective teams can only achieve commitment to a shared goal after a thorough discussion in which participants feel that they have been heard. At that point, commitment may be possible but 100% consensus will almost never occur.


3. The executive team dreads meetings.

Executive meetings are seen as boring and unimportant, because there is little engagement. Attendees are zoning out or checking emails. When our team was functioning at a high level, I looked forward to our weekly strategy meetings. There would be lively conversations, challenges to each other, and strong opinions expressed. I would come prepared, ready to make my case for, or against, a proposed strategic decision. Nobody wants to miss those kinds of meetings.

4. Team members don't regularly challenge each other and the CEO.

With a culture of trust, the participants feel open to challenging each others' assumptions and conclusions. If the meeting room is filled with yes-men (and woman) always agreeing with the CEO's ideas, it is a sure sign of a lack of trust.


5. Lack of discomfort.

In the absence of trust, conversations tend to be superficial. There is an avoidance of the risk of being wrong, or revealing that a mistake has been made. In an environment of trust, intense probing will occur and there will be times when the questioning becomes uncomfortable. There may be “pregnant pauses” during discussion. More empathetic members may feel the urge to come to a colleague's defense. But this discomfort is a normal occurrence in an effective meeting and will dissipate once the discussion proceeds, as long as each participant can openly express themselves without fear of being attacked or belittled.

6. Participants rarely admit their mistakes.

In a team lacking trust, the usual reaction to being called out is to defend your position or blame someone else for your failure. But when vulnerability is encouraged, and team members trust that they will not be criticized or embarrassed, they will admit mistakes, learn from them and move on.

Next Steps

If you recognize 5 or 6 of the above observations in your team meetings, there is a lot of work to be done. Even if only 2 or 3 are true, there is probably weakness in your team that should be addressed.

If you are the leader of the team or the CEO of the organization, then it is up to you to begin to address these issues. I will provide a list of possible actions you can take to build trust in a future post.

Have you witnessed these behaviors in your team? Does the level of trust tend to shift over time? Let me know in the comments section below.

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