Investing in People: Strategies for Building Social Capital in Healthcare
The practical tools and initiatives leaders can implement to nurture trust, align values, and foster strong relationships among healthcare professionals.
This blog was inspired by topics covered in Episode 7: Trust, Strategy, and Resilience with Dr Thomas H. Lee.
If you haven’t listened to it yet, check it out on Apple, Spotify, Substack or wherever you get your podcasts.
Introduction.
Healthcare leaders understand the importance of Financial capital as a tool for sustaining and growing their organisations.
Often overlooked, but equally crucial for success is Social capital. This is due to its association with improved care collaboration, staff satisfaction, patient outcomes and performance.1
This different kind of capital derives its benefits from the relationships of employees, their trust, shared values and reciprocal norms.2
When social capital is low, distrust can infiltrate the culture and be corrosive to the organisational performance. This may start innocuously, when there is a blow to an organisation’s fortunes, such as a change in leadership, government policy or management practices.
Now that the culture is shaken, cracks can form. Groups move to protect themselves through isolation, reducing communication and collaboration. This disconnection creates helplessness and passivity, resulting in a downward death spiral.3
Distrust can also create a second job for everyone.4 Individuals will then spend considerable effort to hide their true thoughts or concerns as a way to protect themselves from perceived threats. Ultimately this consumes energy, distracts from responsibilities and reduces discretionary effort.
Leaders can look to prevent this downward spiral and build resiliance organisations by investing in social capital.
Building and Sustaining Social Capital.
To build and sustain social capital, leaders must prioritise and nurture social capital with specific strategic objectives and tactical approaches.
Trust.
When unravelling the concept of social capital, trust is seen as the great enabler or disabler of relationships within the network.
Trust can be broken into three parts;5
Authenticity: Being open, honest and transparent.
Logic: Using high-quality rationale and clear communication.
Empathy: Showing genuine care and consideration of others’ perspectives.
This framework can be deployed as the cornerstone of developing trust at all levels.
Measuring trust is an important starting point. This starts with regular, multi-modal and omnichannel measuring tools, such as surveys, interviews and focus groups. This helps to challenge assumptions and validate (or invalidate) the success of any particular intervention.
Note that these measures are only proxies and require ongoing measurement and refinement.
A vital next step in the process is the sharing of results with the organisation. At first glance can appear risky - however, transparency is a form of authenticity and respect for employees. It helps to streamline strategic and tactical decision-making, as the logic of the choices is laid bare by the data collected.
Becoming a Deliberately Developmental Organisation is another strategic choice to build trust by recognising the growth of individuals and organisations is part of the same mission6. This is a use of empathy and creates the internal capability to deliver on social capital goals.
Training set the expectations for excellence and enhances the likelihood for modelling of these practices.
The right quality measures are another method to adhere to the trust framework of authenticity, logic and empathy. This appeals to healthcare professionals’ intrinsic motivations to do good work.
Patient-Reported Outcome Measures (PROMS), and Patient-Reported Experience Measures (PREMS) are such measures as they capture the outcomes and experience of receiving care.7 Both help patients and clinicians better understand the care that is being delivered, while also providing metrics to hold the organisation to account.
Shared Values and Norms.
Explicit values are prevalent in institutions, yet their application can be difficult. This takes time, discipline and concerted effort. For values to be impactful, they must resonate with individual motivations. Leaders can support this alignment by actively modelling and communicating those values and motivations, especially when they conflict with entrenched behaviours.
Norms, the internalised standards within a group, are equally important. One key feature of norms is that of reciprocity, or the mutual support of one another. For example; being willing to help out a colleague when a patient's health needs fall outside your designated responsibility. Supporting local leaders and managers with the resources to take ownership over team behavioural expectations and workplace practices can foster positive norms and reciprocity.
Relationships.
Understanding the composition of the organisational social networks helps identify ‘strong ties’ and ‘weak ties’. That is where networks mostly know each other, and where they do not. Strong are typically more harmonious, whereas weak can be more innovative. These can be mapped to identify areas for improvement and can be enhanced with champion boundary spanners.
Interdisciplinary meetings, seminars, town halls, and standups are all opportunities to encourage relationship creation and improve ties - if done well. This means they are not tick-box exercises but are diligently planned, executed and refined to deliver on the social capital goals.
Organisations can foster interdisciplinary relationship-building by providing amenities like gym access and childcare and via purposeful social opportunities. These offer low-stakes and serendipitous scenarios for multi-disciplinary professionals to mix outside of typical work environments and build deeper relationships.
Specialist roles like a Chief Wellness Officer can be key to delivering on these strategic and tactical approaches.
A Note.
A downside can be that some groups become so tight that they end up complacent and insulated.8 These groups can be resistant to new ideas, change in practice or innovation. To mitigate this risk, ensure diverse teams, social and professional opportunities for cross-pollination, and encourage career paths that span different parts of the organisation.
A Thriving Healthcare Environment.
The COVID-19 pandemic tested the resilience of our healthcare systems and underscored the chronic under-investment in social capital. Healthcare leaders, now more than ever, are well-positioned to reverse this trend. They can achieve this by recognizing, and measuring the current state of social capital, and then implementing strategic and tactical methods to enhance it.
To succeed, we need a collective humanist approach, grounded in nurturing trust, values, norms and relationships.
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Thank you,
Jono
Norrish A, Biller-Andorno N, Ryan P, Lee T. Building Social Captial as a Strategy to Improve Healthcare Performance. https://hbr.org/resources/pdfs/leading-health-care-innovation/Norrish-Biller-Ryan-Lee%20Social%20Capital%20PDF.pdf
Putnam, R. D.: Commentary: ‘Health by association’: some comments. International journal of epidemiology 2004, 33, 667-671.
Kanter RM. (June 2003) “Leadership and the psychology of turnarounds.” Harvard Business Review, 81(6):58-67, 136.
An Everyone Culture by Robert Kegan and Lisa Laskow Lahey. [Book]
How to build (and rebuild) trust by Frances Frei. TED Talk.
An Everyone Culture: Becoming a Deliberately Developmental Organization. By Robert Kegan and Lisa Laskow Lahey. https://ssir.org/books/excerpts/entry/becoming_a_deliberately_developmental_organization
Bull C, Teede H, Watson D, Callander EJ. Selecting and Implementing Patient-Reported Outcome and Experience Measures to Assess Health System Performance. JAMA Health Forum. 2022;3(4):e220326. doi:10.1001/jamahealthforum.2022.0326 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2790756
Florida R, Cushing R, Gates G. When Social Captial Stifles Innovation. HBR 2002. https://hbr.org/2002/08/when-social-capital-stifles-innovation