Trust > Technique

There was this medical researcher a few years ago studying the outcomes of surgeries and how well patients recover after a major operation such as hip replacement, knee replacement, or a hernia procedure. They collected data on over ten thousand surgeries and came up with their hypothesis on what they thought they’d find. What factors do you think they estimated would most affect the outcomes of these surgeries, once they controlled for standard factors like economic status and health going into the operation?

They probably discussed the most seasoned doctor and how that would lead to the best outcomes, right? Nope.

It’s probably the hospital environment, then. Better hospital, better surgical success. Wrong again.

Access to rehabilitation? Important, sure. But the most predictive? Not even close.

After digging deep into what makes for the most successful surgeries, the factor that was most strongly associated with better outcomes had nothing to do with the surgery itself.

The biggest predictor of post-surgery satisfaction? Before we get to that, let me first share another story.

It’s the height of the pandemic in 2020 and me and my colleagues are trying to figure out how to better measure what we do as mental performance coaches. This is still early enough in 2020 that we were still excited about Zoom calls and having hours long brainstorming meetings. So we got thinking...What questionnaire or assessment would we want to use? Do we create something from scratch? Is there a device that could measure stress and show changes in stress level that would also work on a baseball field? What are we even trying to measure?

We had plenty of ideas that could work, but wanted a good return on our time investment, and something that would really be able to give us meaningful feedback, if only for our own learning purposes, to make us better mental coaches.

Something that we always seem to come back to is building relationships with clients. “If you always strive to build strong relationships, you’ll do great” was the concept consistently taught to me by mentors throughout my career. But how do we measure relationships? And, yeah, we always talk about how important relationships are, but is that the type of data we would want to show to the organization? Is it really that important from a scientific standpoint?

Thus began my journey down the rabbit hole of trust, and something called the working alliance.

I start devouring articles on trust in a client-practitioner relationship in the corporate world. This is actually how I end up with many of the early topics for this blog! This is like the origin story, because I’m reading all this stuff about the working alliance (which basically is the quality of the professional relationship between a practitioner and any client they’re working with) and the learning and development industry actually had borrowed the idea of the working alliance from the counseling world, so lots of borrowing of ideas happening here. Pretty much all of these studies across industries showed some level of the same thing: Trust, in your teacher, coach, massage therapist, whoever, helped you feel better and do better in that area of your life.

More trust, better outcomes. Less trust, less good outcomes.

In fact, and here’s where this gets fascinating, trusting relationships matter so much in counseling and coaching that trust accounts for almost 3 times as much variance in outcomes as any particular technique! Yup. How you coach is 15% of the outcome equation. The working alliance, that trust piece? 40%!!!

This made it clear! Instead of trying to invent something that could measure our impact, we could measure what mattered with a few simple questions surrounding trust and our relationships with the people we were working with.

Let's circle back to our medical research now. I originally wanted to lead into the story on building trust in coaching and teaching relationships by contrasting it with the idea of going to your doctor. My thinking being that while you might want to be at the best rated hospital or be working with the best trained doctor, in the teaching arena, trust is the biggest predictor.

But, it turns out this rabbit hole is way deeper than I thought, because the medical researchers found that the working alliance is the biggest predictor in medicine too!

Hip replacement? Trust in the surgeon had the biggest impact on recovery satisfaction.

New knee? Trust the doctor.

Hernia repair? Believe that the surgeon has your best interests in mind.

The trust piece extends to doctor-patient outcomes just like it does in a coaching or teaching scenario!

Yes, we need to keep in mind that these outcomes assume a level of competence in the practitioner. You can’t just be a trustworthy person that stayed at a Holiday Inn Express last night and go into the operating room ready to help. But think about what this says about helping people improve.

Across the board, it’s not about pushing knowledge onto or operating on an inanimate object. These are people you are working with. Maybe an engineer really does need to follow a specific industry standard when you’re designing a bridge, but with people, they need to trust that you are looking out for them. And that trust isn’t built by you saying “I know more than you, and here’s what you have to do.” I've made that mistake before. Nor is trust built by being the expert and taking a cookie-cutter approach with every client you work with. Trust is built through taking the time to work with the person.

The working alliance stems from collaboration between you and the person you’re working with, not the person you're working on.

So if you interact with people at all in your life, which I know in early 2021 is still a legitimate question, maybe try spending more time working on building trust and less time worrying about what the perfect technique might be, because moving toward a successful outcome with a client is not rocket science, it's people science, and people are more willing to change when your relationship with them is strong.

Trust me.