In September 2010, the Army Surgeon General authorized the creation of a task force to design and implement a strategic initiative to build a Culture of Trust throughout Army Medicine. Army Medicine has a rich and proud heritage of bringing value and inspiring trust with our patients. As the Surgeon General stated "the Culture of Trust Initiative will permeate all facets of Army Medicine."

What is Trust' Trust is unique for each person. Trust for some is relying on someone to "be there." For others it may be someone's character, competency, or the ability to consistently perform their duties. In a room of 30 people if asked for a definition of trust, there would be 30 different answers. In fact, in current, research there is no consensus on the notion or tenets of trust. Trust is a combination of relationship skills, behaviors, and choices that foster trust-based relationships between two or more people. Some of those behaviors are transparency, vulnerability, accountability, openness, and congruency. Trust is a combination of trusting, being trusted, and being trustworthy.

In health care, Trust plays a critical and important role. What is a Culture of Trust as it pertains to Army Medicine' It is a shared set of relationship skills, beliefs and behaviors that distinguish Army Medicine's commitment to our beneficiaries to provide the highest quality and access to health services. It is based on confidence - confidence that we are competent, capable, and committed; that we will tell the truth and keep our promises. Trust along with transparency creates the conditions in which our internal talent thrives, our patients receive the best care, and our stakeholders Trust that we, Army Medicine, deliver what we say we will deliver.

Through the Culture of Trust Initiative, Claudette Elliott, PhD, Trust Enhancement and Sustainment Task Force Director, hopes "to help create an organization where people are passionate about the organization they work for and the work they do. The trust level should be a seamless and outward extension of AMEDD personnel towards our patients, beneficiaries, stakeholders, co-workers and community."

Numerous articles are published every year about best workplaces in America. What are the attributes that make them the best workplace' One manager stated in a recent article about his 2011 top ten company "people stay in large part because they are happy, but to dig a little deeper, I would argue that people don't leave because they feel regarded - seen, attended to and cared for. I have stayed for that reason and love what I do for that reason". High performance workplace equals high levels of trust.

The single most tangible attribute that will guide Army Medicine into the coming decades is TRUST: As Elliott explains, "Trust is an emotion and the quality of all relationships is based on the level of trust that exists between people. Every year billions of dollars are lost from employee disengagement, which impacts mission accomplishment," she said. "We are creating an ambiance of excellence within Army Medicine."

Implementing the Culture of Trust initiative over the coming year will produce tangible and measurable results, such as improved customer service, better patient outcomes, increased employee satisfaction, higher retention, and greater efficiencies. Patient satisfaction scores, error reporting scores and patient safety scores will improve; productivity will increase and costs decrease; employee morale will increase while turnover rates, EO/EEO complaints and union complaints will decrease.

"What does it impact' What doesn't it impact' As the Surgeon General has said, Trust is the glue that holds an organization together," stated Elliott when asked about the Culture of Trust. The systematic implementation of the Culture of Trust is aimed at reducing variance; standardizing and improving our patients' healthcare experiences, outcomes and readiness; and improving the workplace environment. Trust is the critical element in Army Medicine's relationship to every one of our stakeholders, customers, patients, and employees. Trust underlies every initiative, job performance, job satisfaction and outcome as well as recruiting, retention and development of employees.

There is evidence to support that trust-rich organizations see great improvements of the bottom line through, open, transparent communication both external and internal. In a culture of trust, transparent communication forms a foundation for building relationships. A sense of safety and a comfort level with interpersonal interaction pervades a workplace that has developed a culture of trust. Recent research indicates that increasing trust exponentially improves organizational effectiveness - something Army Medicine intends to achieve through this initiative.

The initiative's key tasks are to: 1) develop comprehensive training curriculum for hands on trust-building in every MEDCOM organization worldwide with a resource investment of a cadre of full time consultants and facilitators; 2) establish a system for ongoing assessments and evaluations of the level of trust; 3) build, develop and educate current and future leaders to have an understanding of the impact of trust on Army Medicine and 4) evaluate policies, procedures, systems and structures and ensure they support and facilitate a trust-based organization. The desired end state is an Army Medicine organization that understands and appreciates the value of trust and the effect it has on the day-to-day operations and the overall success of Army Medicine.

Army Medicine is committed to building a Culture of Trust. The initiative is an enduring effort; it is an organizational change that will support Army Medicine well into the 21st Century and help achieve our vision of Bringing Value and Inspiring Trust. Trust is the foundation of Army Medicine. Trust is critical. Trust is about relationships. Army Medicine is committed to remaining relevant and trusted - the keys to Army Medicine's long heritage of service.