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Building trust: The influence of mentoring behaviors on perceptions of health care managers’ trustworthiness

Fleig-Palmer, Michelle M.; Rathert, Cheryl; Porter, Tracy H.

doi: 10.1097/HMR.0000000000000130
Features

Background: In health care organizations, trust is critical for effective workplace relationships that ensure patient-centered outcomes. Although research has focused on trust in the relationship between patients and clinicians, less is known about what influences workers to trust their managers. An understanding is needed of the specific behaviors that influence health care workers’ evaluations of their managers’ trustworthiness. Mentoring research focuses on the developmental assistance that a more experienced worker provides to a less experienced worker. Building upon Kram’s (1988) seminal research on mentoring functions, we argue that health care managers can build trust by providing informational (career-related) and interpersonal (psychosocial) support.

Purpose: The aim of the study was to investigate the influence of health care managers’ informational and interpersonal mentoring behaviors on workers’ perceptions of their managers’ trustworthiness and the mediating role of trustworthiness on trust in the managers.

Methodology/Approach: Surveys were completed during work hours by 315 health care workers at an acute care hospital and associated clinics in the Midwest.

Findings: Results showed that managers’ mentoring behaviors influenced worker perceptions of their managers’ trustworthiness, in terms of ability, integrity, and benevolence. Ability partially mediated the relationship between informational mentoring and trust in managers, whereas integrity and benevolence partially mediated the relationship between interpersonal mentoring and trust in managers.

Practice Implications: Health care managers can actively build trust through mentoring behaviors that inspire positive assessments of managers’ ability, integrity, and benevolence.

Michelle M. Fleig-Palmer, PhD, is Associate Professor, University of Nebraska at Kearney. E-mail: fleigpalmerm@unk.edu.

Cheryl Rathert, PhD, is Associate Professor, Virginia Commonwealth University, Richmond.

Tracy H. Porter, PhD, is Assistant Professor, Cleveland State University, Ohio.

No conflicts of interest are declared for any of the authors. Each of the coauthors met the criteria for inclusion by having made significant contributions to this study. Each author has read and approved the final manuscript and has met the requirements for authorship. The coauthors believe that the manuscript represents the honest work of each individual.

“It would be the patients that would suffer in the long run, …([in] a climate of low trust).”

Community Nurse in McCabe & Sambrook (2014, p. 820)

Trusting relationships are considered crucial in ensuring the effective delivery of health care and quality patient outcomes (Brennan et al., 2013; Graham, Shahani, Grimes, Hartman, & Giordano, 2015; Hall, Dugan, Zheng, & Mishra, 2001; Mullarkey, Duffy, & Timmins, 2011). Although trust is a vital component of effective working relationships in health care, research has focused on trust between providers and patients as well as on trust in health care institutions (Brennan et al., 2013; Cook & Stepanikova, 2008; Gordon, Pugach, Berbaum, & Ford, 2014; Hall et al., 2001). An understanding of how health care managers (HCMs) build trust is lacking (Calnan & Rowe, 2008), yet needed so that health care workers are willing to seek information, to communicate effectively, and to cooperate in team-based care in order to provide quality patient care (Dinç & Gastmans, 2012; Marshall, West, & Aitken, 2013; Mullarkey et al., 2011).

The focus of this study is on the HCM as the trustee (the party being trusted) and how an HCM influences workers’ trust in him/her. Research in the area of trust suggests that trustors (the trusting party; in this study, the workers) will have more or less trust in a trustee after assessing the trustee’s ability, integrity, and benevolence (Mayer, Davis, & Schoorman, 1995; Rogers, 2005). Previous empirical research in other fields suggests that the three trustworthiness factors of ability, integrity, and benevolence are antecedents of trust in a manager (Colquitt, Scott, & LePine, 2007).

A limited number of studies in health care have explored strategies that HCMs can use to promote positive assessments of their trustworthiness (i.e., ability, integrity, and benevolence) and thereby build trust. Recommendations include showing goodwill toward workers; being competent, reliable, and agreeable; and demonstrating empathy and support (Dinç & Gastmans, 2012; Marshall et al., 2013; Mullarkey et al., 2011). One study used the Mayer et al. (1995) model of trust as a foundation for proposed actions that an HCM could use to build trust (Rogers, 2005). Strategies such as being honest and humble, as well as sharing decision-making and expressing appreciation, are suggested to increase positive perceptions of ability, integrity, and benevolence, leading to increased trust (Rogers, 2005). Although such strategies are helpful, they are not specific enough in providing guidance to HCMs on specific behaviors that can be used to build trust.

Research in mentoring could offer insight into specific managerial behaviors that could foster positive assessments of trustworthiness and trust. Kram’s (1988) typology of mentoring functions is particularly suited to this investigation because it describes the career-related informational and interpersonal behaviors that mentors engage in to support protégés’ professional and personal growth. Our focus is on mentoring behaviors versus mentoring because research has established that mentoring can be informal, whereby health care workers report receiving mentoring assistance yet do not consider themselves to formally have a mentor (Roemer, 2002). Prior research using Kram’s typology showed that workers reported observing HCMs engaged in mentoring behaviors (Koberg, Boss, Chappell, & Ringer, 1994; Koberg, Boss, & Goodman, 1998).

To address the question of how HCMs can build trust, we integrate Kram’s (1998) typology of mentoring behaviors with Mayer et al.’s (1995) trust model to propose that an HCM’s engagement in mentoring behaviors can influence workers’ perceptions of his/her trustworthiness, which should increase their trust. By investigating the relationship between mentoring behaviors and the trustworthiness factors of ability, integrity, and benevolence, this research offers insight into the process of inspiring trust.

This study is significant because it integrates research on trust and mentoring to shed light on the specific behaviors managers engage in to influence the three factors of trustworthiness and trust itself. By shedding light on the trust development process, this research makes several contributions. First, the integration of two research streams contributes to the growing interest in trust in health care research and the importance of trust (Gordon et al., 2014; Graham et al., 2015; McCabe & Sambrook, 2014). Second, it contributes to research on trust because it tests the assertion that trustors observe and assess the actions and behaviors of the trustee (Colquitt et al., 2007; Mayer et al., 1995). Third, it provides insight for HCMs as to the specific behaviors that can foster trust. Little research to date has explored how trust in managers is developed, specifically in health care work relationships.

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Trust

In research on trust, a shared theme is the aspect of risk and vulnerability: A trustor is vulnerable to a trustee and must take a risk in trusting the trustee (Edmondson, 2004; Hall et al., 2001; Mayer et al., 1995; Mullarkey et al., 2011). In a health care organization (HCO), a worker is vulnerable to a manager because the manager makes decisions that impact the worker (Mullarkey et al., 2011). Thus, for purposes of this study, trust is defined as the intention of a worker (the trustor) to be vulnerable to a manager (the trustee) when the worker must rely on the manager for resources and support (Mayer et al., 1995; Mullarkey et al., 2011).

Research on Mayer et al.’s (1995) theory of trust has received extensive empirical support, demonstrating that high levels of trust can produce beneficial outcomes in the workplace regarding task performance and extra-role behaviors (Colquitt et al. 2007; Schoorman, Mayer, & Davis, 2007). HCMs play an important role in fostering trust in health care environments, and higher levels of trust support effective teamwork resulting in quality patient care (Dinç & Gastmans, 2012; McCabe & Sambrook, 2014; Mullarkey et al., 2011). Given that trust is predictive of important organizational outcomes in health care facilities, research is needed to explore the types of mentoring behaviors HCMs may use to build trust.

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Mentoring

The purpose of mentoring is to provide career-related support so that a worker can perform more effectively in his/her job (Kram, 1988). Managers in health care who offer mentoring support are viewed by workers as engendering trust in relationships so learning can take place (Dye & Garman, 2015; Jones, 2013). Of the nine mentoring behaviors theorized by Kram (1988), four are categorized as informational and focus on providing specific, job-related guidance to a worker. Through coaching, a mentor provides advice and knowledge to assist the worker in performing his/her duties. Ensuring a worker can build connections with people outside his/her unit is called exposure and visibility. Giving a worker a difficult task to increase skill level is providing challenging assignments. Finally, sponsorship refers to facilitating the worker’s career moves within an organization. Informational mentoring behaviors enhance a worker’s mastery of the job-related skills needed for career advancement.

The remaining five mentoring behaviors (Kram, 1988) are categorized as interpersonal because a mentor’s emotional support can enhance a worker’s feelings of confidence and competence. When protecting the worker, the mentor shields the worker from blame for mistakes. A mentor acts a role model when his/her behavior serves as a good example for the worker. Acceptance and confirmation behaviors help a worker feel nurtured and validated. A mentor may offer friendship to a worker by extending the work relationship into the personal sphere. In counseling, the mentor offers advice to help the worker cope with problems. Through these interpersonal behaviors, a mentor can help a worker become more effective at work.

In health care, mentoring is distinguished from precepting on two dimensions. First, a preceptor is formally assigned to a worker-in-training (Grossman, 2007), whereas some mentoring relationships are informal, possibly without any explicit acknowledgement (Roemer, 2002). Second, a preceptor is responsible for ensuring a worker learns the requisite clinical skills necessary; thus, there is an evaluative component (Gopee, 2011; Grossman, 2007). In a mentoring relationship, the informational guidance for professional development is balanced with interpersonal support (Kram 1988; Gopee, 2011; Grossman, 2007).

The distinctions between a mentor and a preceptor are applicable to an HCM. Many times, workers are assigned to work with managers who are responsible for ensuring the workers are properly trained. However, an HCM can choose to offer informational and interpersonal mentoring support to workers (Koberg et al., 1994, 1998). Interpersonal support is especially important in helping workers navigate professional and personal challenges, which may hinder the provision of quality patient care (Gopee, 2011; Grossman, 2007). Workers who feel protected will be more likely to speak up about medical errors and concerns in order to improve quality and safety (Edmondson, 2004; Nembhard, Yuan, Shabanova, & Cleary, 2015). Thus, Kram’s (1988) mentoring functions capture the multifaceted nature of support that managers may offer workers and are relevant to understanding the behaviors that influence trust in managers.

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Trustworthiness Factors and Hypotheses

According to Mayer et al.’s (1995) theory of trust, when trustors are in a risky situation, they will assess a trustee’s ability, integrity, and benevolence before deciding whether to be vulnerable, that is, to trust. The trustworthiness factors are considered to contribute to trust, yet are distinct from trust.

The first factor of ability is defined as the knowledge and competencies needed for effective job performance in a particular area (Mayer et al., 1995). Patients evaluate physicians’ competence in providing medical treatment when deciding whether to trust physicians (Cook & Stepanikova, 2008; Hall et al., 2002). The ability aspect of perceived trustworthiness implies a worker trusts an HCM because the HCM has shown skills in a particular area or specialty (Rogers, 2005).

Assessments of HCMs’ abilities may be influenced by the informational types of mentoring behaviors that they exhibit. The coaching behavior consists of providing knowledge to help a worker succeed on difficult tasks (Kram, 1988), implying that an HCM must have the requisite clinical knowledge prior to providing coaching to a worker. The introduction of a worker to key organizational members through exposure and visibility and his/her promotion through sponsorship (Kram, 1988) cannot happen unless an HCM has the networking abilities to establish and maintain contacts. Workers receiving technical training and performance feedback through challenging assignments (Kram, 1988) suggest that an HCM has the ability to accurately evaluate a worker. Thus, a worker may base an assessment of an HCM’s ability and perceived trustworthiness on informational mentoring behaviors and be more likely to trust the manager (see Figure 1). Therefore, we offer our first hypothesis:

Figure 1

Figure 1

Hypothesis 1. Ability will mediate the relationship between informational mentoring behaviors and trust.

A second trustworthiness factor is integrity, which is defined as the perception that the trustee adheres to values that are acceptable to the trustor (Mayer et al., 1995). Integrity may be assessed by a trustor who observes a trustee’s behavior such as whether the trustee’s actions align with what was communicated (Mayer et al., 1995). Workers who observe an HCM admitting mistakes are more likely to provide feedback because they trust that they will not be penalized for mistakes (Edmondson, 2004; Rogers, 2005).

The third trustworthiness factor is benevolence, which is the trustor’s belief that the trustee is willing to do something for the trustor without expecting anything in return (Mayer et al., 1995). Livnat (2004) suggests a benevolent person may act mildly irrational (in economic terms) because their care motivates them to do well. The empathy a physician shows a patient is a critical element of the healing relationship that engenders trust (Cook et al., 2004). A physician may demonstrate benevolence by engaging in behaviors that involve a sacrifice of time. For example, patients report trusting those physicians who were available outside of office hours, perhaps even providing a direct phone number for patients to call (Cook et al., 2004). The factor of benevolence encompasses the caring and concern for another person that is the foundation of the healing that takes place in HCOs.

Workers may evaluate HCMs’ integrity and benevolence by observing their engagement in interpersonal types of mentoring behaviors. For example, as a role model, an HCM can demonstrate values (e.g., dedication to patient confidentiality) that are shared by workers. If a worker observes an HCM’s constancy between words and actions (e.g., the HCM promises patient confidentiality and role models the behaviors that support patient confidentiality), the worker may assess the HCM as having integrity and, thus, trust the HCM.

When an HCM protects a worker from undue blame, it is because the HCM is motivated to help the worker even when the HCM is not rewarded and may experience the negative consequences of shielding the worker from blame. A worker may evaluate an HCM as high on integrity and benevolence and, thus, trust the HCM more because the worker realizes that the HCM shares the value of protecting others from blame and does not expect anything in return from the worker.

An HCM may extend friendship to workers, counsel workers by listening to their concerns, and nurture them through acceptance and confirmation. By engaging in these mentoring behaviors, the HCM is focused on a worker’s personal and professional growth. Because mentoring behaviors such as friendship and counseling imply a personal concern for and attachment to another person, a worker may perceive an HCM as high on benevolence and be more likely to trust the manager (see Figure 2).

Figure 2

Figure 2

Hypothesis 2: Integrity and benevolence will mediate the relationship between interpersonal mentoring behaviors and trust.

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Methods

Study Design

This study was part of a larger study investigating mentoring relationships at an HCO in the Midwest United States. The HCO offered emergency care, intensive care, progressive care, oncology, maternity, surgery, skilled nursing, and inpatient rehabilitation with 130 beds for inpatient acute care and 36 beds for skilled nursing. Institutional review board approval was obtained from both the HCO and the primary investigator’s university before the study was implemented. Initially, the human resource director sent an email to employees notifying them of the study and assuring confidentiality if they chose to participate. Over a 2-week period during day and evening shifts, the first author was permitted to meet with workers and to extend an invitation to participate in a survey.

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Participants

Of the 1,085 workers at the HCO, 321 participated in the survey for a response rate of 30%. Missing data on six surveys reduced the number of surveys that could be analyzed to 315. Both clinical (e.g., registered nurses, certified nursing assistants, patient care assistants, respiratory therapists, pharmacists, phlebotomists, radiological technologists, drug/alcohol counselors) and nonclinical workers (e.g., dietary, housekeeping, security, laundry, financial, and managerial) participated in the survey. The respondents’ ages ranged from 19 to 74 years (M = 40.08, SD = 12.60), with women comprising a majority of respondents (88%). Tenure with the HCO was measured in years ranging from 0.08 (1 month) to 38 years (M = 9.68, SD = 8.55). For all workers at the HCO, the average age equaled 43 years, the percentage of women equaled 88%, and the average tenure equaled 9 years, which indicates that our sample was representative of the employees at the HCO.

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Measures

The survey began by providing a definition of a mentor as “…one or more persons whom you feel have taken an active interest in your career by providing developmental assistance” (Higgins & Kram, 2001; Higgins & Thomas, 2001). Then, respondents were asked, “Have you had a mentor(s) during the past year?” If yes, they were guided to think of the mentor who was most influential and complete the survey with that person in mind. If no, respondents were instructed to think of their manager as they completed the survey. In this way, mentoring behaviors, which are the focus of this study, could be captured regardless of whether a worker had a mentor. For all scale items on the survey, respondents indicated agreement with statements using a Likert scale with 1 = strongly disagree and 5 = strongly agree.

Mentoring functions. The Mentor Role Instrument (Ragins & McFarlin, 1990) has 27 items that are used to assess the nine mentoring functions first delineated by Kram (1988). Three items are used to assess each mentoring function.

Informational mentoring. To represent the mentoring behaviors that involve passing specific, job-related information from a mentor to a worker, the 12 items representing exposure and visibility, coaching, sponsorship, and challenging assignments were combined. The coefficient alpha for the informational mentoring composite variable was .95.

Interpersonal mentoring. A second composite variable was created to represent the mentoring functions whereby a mentor offers interpersonal assistance to a worker. Fifteen items from the counseling, role modeling, acceptance and confirmation, friendship, and protection subscales of the Mentor Role Instrument were combined and exhibited a coefficient alpha of .96.

A second-order confirmatory factor analysis was conducted using MPlus to evaluate the level of fit for the loadings of three items on each of the nine mentoring functions and of the nine mentoring functions on the two composite variables of informational mentoring and interpersonal mentoring. An acceptable level of fit was indicated for the mentoring/informational and mentoring/interpersonal composite variables as second-order factors (X 2[288] = 666.37; CFI = .96; TLI = .95; RMSEA = .07; SRMR = .04). On the basis of the internal consistency measures and the fit of the confirmatory factor analysis, the composite variables of informational mentoring and interpersonal mentoring were used in subsequent statistical analyses.

Trustworthiness factors. The three trustworthiness factors were assessed using scales developed by Mayer and Davis (1999). In the three scales, the referent (trustee) was changed to “My mentor” where appropriate. Ability was measured with three items (e.g., My mentor has much knowledge about the work that needs done, α = .96).

Items from the Integrity and Benevolence scales were combined to form a composite variable representing the factors of trustworthiness that would relate to a worker’s (trustor’s) personal concerns. The five items of the integrity/benevolence composite variable assessed aspects of integrity (e.g., I never have to wonder whether my mentor will stick to his/her word) and benevolence (e.g., My mentor will go out of his/her way to help me). The coefficient alpha for the Integrity/Benevolence composite variable was .94.

Trust. The Schoorman and Ballinger (2006) adaptation of the Schoorman, Mayer, and Davis’ (1996) trust scale was used to measure trust. The referent (trustee) in this 7-item scale was changed to “mentor.” An example item is “If my mentor asked why a problem occurred, I would speak freely even if I were partly to blame.” In this measure, Item 5 had a low item-total correlation of −.018. Thus, this item was removed from the trust scale, and the coefficient alpha increased from .65 to .72.

Control variables. Higgins and Thomas (2001) suggest that greater work experience may influence an employee’s inclination toward and opportunities for mentoring relationships. This was controlled for in two ways. Educational level was indicated using a 5-point scale with 1 = high school degree and 5 = MD/PhD. Also, tenure with the organization was assessed by asking respondents how long (in years) they had been employed at the HCO.

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Common Method Variance Analysis

The single-survey method has been criticized as causing both method variance and common method variance. Despite the claim that such concerns are overstated (Podsakoff, MacKenzie, & Podsakoff, 2012), care was taken to avoid common method variance. Conway and Lance (2010) suggest single survey research should have the following: a rationale for the method’s appropriateness; evidence of construct validity; lack of overlap in items; and evidence that the authors took steps to minimize potential threats. The rationale for the single-survey method in this study was sound: Given the nature of the questions, it required self-reporting and anonymity for all respondents was guaranteed. We were confident of the construct validity for all chosen scales as the scales are commonly used and validated. Items did not conceptually overlap, and we carefully designed the survey. We took steps to minimize threats to construct validity, such as increasing the physical distance between predictor and criterion variables and including both positively and negatively worded items in the scales (cf. Podsakoff et al., 2012; Podsakoff, MacKenzie, Lee, & Podsakoff, 2003).

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Results

The descriptive statistics and correlations are presented in Table 1. To establish that multicollinearity is not a problem in our data set, we used SPSS to calculate the variance inflation factor (VIF) for both hypotheses. Regarding Hypothesis 1 in which the predictor variables are informational mentoring and ability, the VIF equals 1.74. For Hypothesis 2 in which the predictor variables are interpersonal mentoring and integrity/benevolence, the VIF equals 3.33. The VIF values are less than 4, indicating that multicollinearity should not be problematic in relation to the robustness of our results. For both hypotheses, the tests of mediation were conducted using Baron and Kenny’s (1986) recommendations.

Table 1

Table 1

Hypothesis 1 predicted that the informational mentoring behaviors of sponsorship, exposure and visibility, coaching, and challenging assignments would have an indirect effect on trust through the trustworthiness factor of ability (Table 2). First, the mediator of ability was regressed on the independent variable of informational mentoring, and this relationship was significant (β = 0.65, t = 14.87, p ≤ .01). In the second step, the dependent variable of trust was regressed on the independent variable of informational mentoring. This relationship was also significant (β = 0.66, t = 15.10, p ≤ .01).

Table 2

Table 2

Lastly, trust was regressed on the informational mentoring variable and the mediating variable of ability. The relationships between trust and informational mentoring (β = 0.44, t = 8.06, p ≤ .01) and trust and ability (β = 0.34, t = 6.31, p ≤ .01) were significant. Because all of the regression equations held in the predicted direction and the effect of the independent variable of informational mentoring was less in the third step than in the second (Baron & Kenny, 1986), ability partially mediated the relationship between informational mentoring and trust. The statistical relationships suggest that health care workers who have received mentoring assistance in the form of job-related information are more likely to rate their manager higher in ability and to trust them more, supporting Hypothesis 1.

In Hypothesis 2, integrity and benevolence were proposed to mediate the relationship between interpersonal mentoring behaviors (i.e., role modeling, counseling, protection, acceptance and confirmation, and friendship) and trust in a mentor (Table 3). In the first step, the mediator of integrity/benevolence was regressed on the independent variable of interpersonal mentoring and this relationship was significant (β = 0.84, t = 26.34, p ≤ .01). Next, the dependent variable of trust was regressed on the independent variable of interpersonal mentoring. This relationship was also significant (β = 0.76, t = 20.03, p ≤ .01).

Table 3

Table 3

In the third step, trust was regressed on interpersonal mentoring and the mediator of integrity/benevolence. The relationship between trust and integrity/benevolence (β = 0.42, t = 6.48, p ≤ .01) was significant. The effect of the independent variable of interpersonal mentoring was less in the third step than in the second (β = 0.41, t = 6.31, p ≤ .01). Thus, Hypothesis 2 is also supported because there was an indirect effect of interpersonal mentoring on trust through the trustworthiness factors of integrity and benevolence. This suggests HCMs who demonstrate caring will be viewed as more benevolent and be trusted more by employees.

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Discussion

The purpose of this study was to integrate Kram’s (1988) typology of mentoring functions with the Mayer et al.’s (1995) model of trust to better understand the specific behaviors used by HCMs that may build trust. Mayer et al.’s (1995) theory of trust focuses on the actions and behaviors of the person being trusted (Colquitt et al., 2007). This parallels Kram’s (1988) mentoring behaviors that support workers’ professional and personal growth. The focus on the linkage between mentoring behaviors and the trustworthiness factors of ability, integrity, and benevolence can assist managers in deciding the types of behaviors to engage in to engender trust from their workers.

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Key Findings

Both hypotheses were supported, suggesting that mentoring behaviors, via trustworthiness factors, influence assessments of trust. HCMs rated higher on informational mentoring behaviors were more likely to be perceived as able and competent and, thus, be rated higher by workers on trust. Those managers who provided interpersonal mentoring support tended to be rated higher on integrity and benevolence and to be trusted by workers.

These findings support the claim by Mayer et al. (1995) that employees make decisions about whether to trust managers based on perceptions of trustworthiness. Furthermore, our findings contribute to research on trust because they provide an empirical test of the mechanisms, that is, mentoring behaviors, used to make such decisions. This study also contributes to trust research in health care that has conceptually explored antecedents of trust and trustworthiness (McCabe & Sambrook, 2014; Rogers, 2005). Our results provide empirical support for mentoring behaviors such as coaching, “[my manager] taught me an awful lot, and yes I would trust her” (McCabe & Sambrook, 2014, p. 820); role modeling, “…[manager] rolled up her sleeves and helped” (McCabe & Sambrook, 2014, p. 821); and friendship, “I would definitely trust my immediate superior… She is a caring person.” (McCabe & Sambrook, 2014, p. 822) that promote trust.

Interestingly, all study participants reported receiving mentoring-related support at least to some extent, even if they did not report having a mentor. This finding is important because it indicates that workers who did not perceive their manager as a mentor still rated their managers on informational and interpersonal mentoring, being competent and caring, and worthy of trust. This suggests that managers who make an effort to engage in more informational and interpersonal mentoring behaviors may be evaluated higher on trustworthiness and may more likely to be trusted.

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Practical Implications

HCOs may institute formal mentoring programs to ensure workers are receiving the knowledge and support needed to provide quality patient care (Allen, Eby, & Lentz, 2006). The findings presented suggest the resources HCOs devote to establishing and maintaining formal mentoring programs might be more effective in training all managers in mentoring behaviors. As Kram (1988) noted, it is more productive to examine the mentoring behaviors being provided than to simply identify if a mentoring relationship exists. The results indicate that the more managers engage in mentoring-related behaviors, the more they are trusted by workers. Organizations could evaluate managers on their mentoring behaviors in annual performance reviews. Building such expectations into the organization’s structure and incentivizing them could help to develop the collaborative cultures most organizations are seeking. This study suggests that trustworthiness engendered through managerial mentoring behaviors may be one mechanism for building necessary trust from frontline workers.

By understanding the impact of different mentoring behaviors on different aspects of worker trustworthiness perceptions, managers can determine how to best invest their energies to effectively engender trust in their workers. For example, in a critical care situation, a manager may only be concerned about being perceived as competent to address a patient’s needs in a timely manner, whereas in an end-of-life situation, perceptions of benevolence may be more salient. Given the results from this study, a manager can choose to engage in differing mentoring behaviors depending upon the situation to effectively build trust and high-performance work relationships.

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Limitations

The primary limitation of this study is that the survey was cross-sectional, which prevents any causal interpretation of results. Although it makes sense to assume that health care workers observe their managers’ behaviors and then make assessments about the managers’ trustworthiness, we recommend that future research employs a longitudinal design to see if trustworthiness grows over time because of managerial mentoring behaviors. A second limitation of the study is that the response rate was relatively low, at 30%, which means that the findings may not be generalizable. However, this rate is a conservative estimate based on the number of returned questionnaires divided by the number of total employees at the time of the survey. Given that the survey was conducted in-person by the first author, it is possible that not all of the HCO’s employees had the opportunity to participate, as HCOs are very busy organizations. Moreover, response rates have been trending downward (Johnson & Wislar, 2012) and do not fully explain the validity of the data (Halbesleben & Whitman, 2013). Finally, given that our variables were hypothetical constructs, the measures may be less susceptible to problems because of nonresponse bias.

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Future Research

There are several avenues for future research that appear promising. First, the impact of context on health care workers’ evaluations of the trustworthiness of and trust in their managers should be investigated. For example, what is the effect of telemedicine on the building of trust when interactions between a manager and his/her workers occur only through videoconferencing, not face-to-face interactions? Would certain mentoring behaviors become more salient in different contexts to build trust? Second, time pressure may also be an important factor to consider. Which combination of mentoring behaviors is more important in critical care situations versus acute care versus chronic care? In each of those situations, how might time pressure influence a manager’s behaviors and the trust that is engendered in his/her workers?

Third, changes in reimbursement models driven by regulations such as the Affordable Care Act and by cost considerations have led to an increased focus on interprofessional team-based patient care in which workers from different medical disciplines coordinate care for patients, especially those with chronic illnesses. Future research could examine the types of mentoring behaviors that effectively build trust within interdisciplinary teams. The mentoring functions and behaviors examined in this study form the basis of effective relational coordination with its emphasis on developing shared knowledge, goals, and mutual respect within teams (Gitell, 2002).

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Conclusion

HCMs are faced with the challenge of engendering trust in their workers as they work together to effectively address patient needs. To build trust, HCMs can engage in mentoring behaviors that facilitate productive workplace relationships and empower health care workers who are dedicated to quality patient care.

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Keywords:

health care; health care management; mentoring; trust; trustworthiness

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