Leadership Trust Emerges as Key to Health Care Workforce Retention

A new crowdsourced survey has revealed that trust in organizational leadership significantly shapes health care workers’ (HCWs) professional satisfaction and quality of work. Despite national efforts to rebuild patient trust in the US health care system, this study emphasizes that internal trust—specifically between HCWs and their organizational leaders—remains a largely unaddressed yet critical issue. Conducted through outreach by national medical organizations, the survey gathered responses from 353 HCWs who provided insight into how leadership trust or the absence of it affects their work.

Only 20.2% of participants currently working in health care said they trusted their organization's leadership “very much,” while 36.9% expressed “somewhat” trust. Alarmingly, 42.9% reported low levels of trust. This erosion of confidence in leadership is not without consequence. Nearly all participants (97.7%) reported that their trust level had a tangible impact on their professional lives. Among those with strong trust in leadership, more than half described feeling deeply satisfied in their work, often referencing emotional well-being, organizational pride, and a desire to remain in their roles. A physician noted, “When you trust your organization, you can confidently practice and speak proudly of where you work.” Additionally, nearly 48% of HCWs who trusted leadership said it directly contributed to their ability to perform high-quality work. These workers described being motivated, engaged, and empowered to go beyond minimum expectations, frequently crediting trust as a driver for innovation, collaboration, and better patient outcomes.

In stark contrast, HCWs who lacked trust in leadership conveyed markedly different experiences. Most described feeling disillusioned and emotionally drained, with 74.1% citing a poor work environment and nearly a third attempting to leave their jobs. Many attributed stress, frustration, and disengagement to organizational leadership failures. Some described “silent quitting,” a reduction in effort due to the perception that leadership neither acknowledged nor valued their contributions. Work quality also suffered, with 28.2% admitting to lower performance, less initiative, and reduced collaboration.

The study identified 3 primary leadership behaviors that foster trust: effective communication, respectful treatment of workers, and prioritization of patient care. Of these, effective communication emerged as the most frequently cited, with 77.7% of HCWs emphasizing the importance of transparent, honest, and consistent dialogue from leaders. Respondents praised leaders who routinely updated staff, openly discussed challenges, and followed through on commitments. Regular engagement—through emails, town halls, and visible presence—was seen as key to building connection and credibility.

Equally important was the way HCWs were treated. Those who felt seen, appreciated, and respected by leadership were significantly more likely to express trust. Gestures such as public recognition, professional development opportunities, and equitable compensation were repeatedly cited. Good salary and benefits, particularly among nonphysician staff, reinforced perceptions of fairness and value.

Finally, leaders who demonstrated a genuine commitment to patient care, rather than financial gain, earned the trust of their teams. HCWs, especially physicians, responded positively when they saw investments in staff support, safe working conditions, and quality initiatives. One HCW explained they trusted leadership because “every decision was made to improve care—not drive their own bonus potential.”

The findings present a compelling case for health care executives: investing in leadership behaviors that build trust is not optional. It directly correlates with higher retention, better morale, and improved clinical performance. As one respondent succinctly put it, “Please ensure that leaders understand that trust is not something that is purchased off the shelf. They are responsible for fostering cultures that are safe and trustful.”

Reference

Greene J, Gibson D, Taylor LA, Wolfson DB. Health care workers' trust in leadership: why it matters and how leaders can build it. Jt Comm J Qual Patient Saf. 2025;51(1):11-18. doi:10.1016/j.jcjq.2024.09.002