Trust, an ingredient needed to innovate

Mònica Almiñana

"One, the citizenry will not forgive the president for hiding health information that can help save their lives. Two, in a crisis, people must feel like a soldier, not a victim. Three, telling the truth generates trust, silence generates fear. "

CJ Creck, The West Wing. Season 3, Episode 9 (2001-2002)

When Aaron Sorking wrote these sentences for his character, the White House press chief in the series The West Wing, in a chapter where a health problem was addressed, came up with some of the keys needed to manage the communication of this type of crisis. In a recent article in BMJ Leader, "Leadership during the COVID-19 pandemic: building and sustaining trust in times of uncertainty," Susannah Ahern and Erwin Loh also outline some of the keys to leadership in times of uncertainty. And one of those keys is trust. The authors themselves define it as "The expectation or belief of an individual, often in vulnerable circumstances, that another person's actions or motives will be honest, fair, and based on integrity (following sound ethical principles)." (1)

That is why we can delegate decisions to another without having all the information or all the capacities or skills necessary to understand the complexity of what is being done. Thanks to this trust, the framework has been built in which the majority of citizens have trusted professionals, scientists, epidemiologists, as well as the decisions taken by their rulers, in the face of the world's greatest health crisis in the last century.

The mentioned article details that leadership must plan, be based on data, be adaptive at different levels and be decentralized, but within a global strategy. The exercise of leadership requires assuming responsibilities, constant accountability and being permanently connected with those affected by decisions. The authors add that, ultimately, it’s this trust that requires leaders to offer hope, a credible vision for the future, and guidance on how to overcome the crisis.

There is a phrase in the article that I want to emphasize: "Confidence is necessary for transformative collective action, especially in times of uncertainty, such as a pandemic." Well, if it’s necessary to transform collectively, we should begin to trust that our health care organizations can be reformed. We all know that after the First and Second World Wars there were great scientific advances that transformed our organizations and improved the health of the population.

Ethnographer Linda Hill, at the TED talk “How to Manage Collective Creativity”, explains that if we want to build organizations that innovate, we must unlearn leadership as we understand it today. Innovation has to do with a collective genius and introduces the concept of "your slice of genius." She explains in this recommended talk that innovative organizations have three abilities in common: abrasion, agility and resolution. These abilities serve to solve problems collaboratively, know how to learn from discovery and know how to make integrated decisions. And that is the key used by companies like Pixar or Google to succeed. Many of these qualities have been present in health organizations during the COVID-19 pandemic.

Can hospitals or primary care work differently? Yes, they have shown it. Can they innovate organizationally? Yes, they have shown it. Can we improve leadership in our institutions? Yes, we can, we did it during the pandemic. As Linda Hill points out, leading innovation has nothing to do with creating a vision and inspiring others to implement it. It has to do with the role of the leader being to set the stage and not act on it, as defined by Ed Catmull, CEO and founder of Pixar. Leadership relies on trusting others, not just creating a framework of trust.

The Valencian Community, where I work, defines the current era as "improved normality" because we have learned from the pandemic and, therefore, the future demands better versions of ourselves. Don't you think so?

Bibliography

1. Anderson L. Leadership during crisis – navigating complexity and uncertainty, 2018: 49–54.