Trust – It Always Has to be Worked at

Pharmacy always appears in national polls measuring trust, and always in the first three, with results for pharmacists, nurses and doctors all highly ranked and all close together.
Trust is an elusive concept to quantify and when evaluating, only a subjective opinion can be formed as a measurement.
But in human beings it is something that is deeply embedded – perhaps even resident somewhere in our DNA.
From primitive times, power and leadership has always been controlled by the professional triad of medicine, law and theology.
In some societies, a leader was all three, but in more modern societies the roles are more shared roles.
From witch doctors to modern democracies, trust is developed intuitively and in commercial entities, trust has been able to be promoted by perception, forming products and services to be identified by a “brand image”, using the skills of advertising to communicate trust messages that progressively strengthen the brand or image.

In the message below Seth Godin ponders on how some trusted brands (like Coca Cola) have evolved when science is at odds with the vibrant and healthy images portrayed in advertising.
However, even Coca Cola has slipped in rankings of trust as the health message gets through and obesity is now exposed as being almost as harmful as tobacco.
Company turnover is dropping year on year which is causing Coca Cola to review all of its activities.
The problem for them is that because trust has dropped through a product deficiency and misinformation, can they replace that product to maintain existing consumers and how can they attract those consumers they have lost if their brand is too weak and trust levels have fallen too low.

Pharmacists need to be conscious as to those elements that reinforce the trust image for the entire profession.
One pharmacist being unprofessional will have an impact on the entire profession.
Brand pharmacy is still very strong, but I suspect that in Australia the brand has been weakened by disunity and a constant stream of adverse (but false) media reporting.

Pharmacy leader organisations have the responsibility of maintaining the pharmacy “brand” to the wider community, and you can see how fragile that image can be when various advocacies working as a network, can attack a pharmacy concept e.g. the recent attack on Chemmart and their genetic testing claims.

As pharmacy proceeds to develop its core business by creating services that promote care and responsibility for patient health care, there is a responsibility required by each individual pharmacist to ensure that any service, even if only adopted by a select number of pharmacists, is properly thought through so that “brand pharmacy” is not diminished in any way.
Some pharmacists believe that pharmacy messages such as “Australia’s cheapest chemist” fall into that category, because the message is not true.
They are not the cheapest source for every product they sell.
While the ACCC permits such statements as acceptable commercial “puffery” they are not ethical.
It gets back to whether you are a community pharmacy and desire to attract patients, or do you see yourself as a retailer and desire to attract only customers.
Whatever your vision, one impacts on the other and there is an ethical point where one side becomes deliberately predatory and may damage the pharmacy brand.

I believe that pharmacists should be the vision that they see for themselves – even a discount pharmacy if that is your ambition – provided your activity remains ethical and does not damage the pharmacy brand.

It is possible to be innovative and disruptive rather than be predatory and destructive to win market share.
Respect and brand integrity improves with innovation and is encouraged.
We also drew on the words of Seth Godin for his view of “trust” – he makes some good points.

The irrational thing about trust

The obvious and rational equation is that being trustworthy plus being transparent will lead you to be trusted. Verification of trustworthiness should lead to trust.

This makes sense. Being trustworthy (acting in a way that’s worthy of trust) plus being transparent so that people can see your trustworthiness—this should be sufficient.

How then, do we explain that brands like Coke and Google are trusted?
The recipe is secret, the algorithm is secret, and competitors like DuckDuckGo certainly act in a more trustworthy way.

In fact, trust often comes from something very different. It’s mostly about symbols, expectations and mystery.

Consider the relationship you might enter into if you need surgery. You trust this woman to cut you open, you’re putting your life in her hands… without the transparency of seeing all of her surgical statistics, interviewing all previous patients, evaluating her board scores.

Instead, we leap into surgery on the basis of the recommendation from one doctor, on how the office feels, on a few minutes of bedside manner. We walk away from surgery because of a surly receptionist, or a cold demeanor. 

The same is true for just about all the food we eat. Not only don’t we visit the slaughterhouse or the restaurant kitchen, we make an effort to avoid imagining that they even exist.

In most commercial and organizational engagements, trust is something we want and something we seek out, but we use the most basic semiotics and personal interactions to choose where to place our trust. And once the trust is broken, there’s almost no amount of transparency that will help us change our mind.

This is trust from ten thousand years ago, a hangover from a far less complex age when statistical data hadn’t been conceived of, when unearthing history was unheard of. But that’s now hard-wired into how we judge and are judged.

Quick test: Consider how much you trust Trump, or Clinton, Cruz or Sanders, Scalia or RBG. Is that trust based on transparency? On a rational analysis of public statements and private acts? Or is it more hunch-filled than that? What are the signals and tropes you rely on? Tone of voice? Posture? Appearance? Would more transparency change your mind about someone you trust? What about someone you don’t? (Here’s a fascinating story on that topic, reconstructed and revealed).

It turns out that we grab trust when we need it, and that rebuilding trust after it’s been torn is really quite difficult. Because our expectations (which weren’t based on actual data) were shown to be false.

Real trust (even in our modern culture) doesn’t always come from divulging, from providing more transparency, but from the actions that people take (or that we think they take) before our eyes. It comes from people who show up before they have to, who help us when they think no one is watching. It comes from people and organizations that play a role that we need them to play.

We trust people based on the hints they give us in their vocal tones, in the stands they take on irrelevant points of view and yes, on what others think.

Mostly, people like us trust people like us.

The mystery that exists in situations without full transparency actually amplifies those feelings.

I’m worried about two real problems, each worse than the other:

  1. The trustworthy person or organization that fails to understand or take action on the symbols and mysteries that actually lead to trust, and as a result, fails to make the impact they are capable of. 
  2. The immoral person or organization who realizes that it’s possible to be trusted without actually doing the hard work of being trustworthy.

We may very well be moving toward a world where data is the dominant way we choose to make decisions about trust. In the meantime, the symbols and signals that mesh with our irrational worldviews continue to drive our thinking.

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