Healthcare organizations are facing what many describe as “historic” workforce shortages and a “talent emergency,” while the U.S. Surgeon General has formally declared healthcare worker burnout a crisis. Against this backdrop, understanding how leadership behavior shapes trust is a core operational and ethical concern.
Moreover, healthcare organizations would benefit from leaders seeking to earn healthcare workers’ trust, as evidenced by The Joint Commission Journal on Quality and Patient Safety’s study on Healthcare Workers’ Trust in Leadership: Why It Matters and How Leaders Can Build It.
When trust is present, “Healthcare workers report higher work quality and greater professional satisfaction.” Among the many leadership behaviors examined, communication was identified as the strongest driver of trust. Since most of our communication now happens electronically, HIPAA compliant emails can be used to share information securely, promoting trust in the workplace.
According to the article on Healthcare Workers’ Trust in Leadership, survey data suggest that distrust in leadership is not a marginal phenomenon. In a 2021 physician survey, “one third (34%) reported distrusting their organization's leadership.” A subsequent 2022 survey of frontline clinicians found that “less than half trusted their organization's leadership to do what is right for patients, and less than a quarter trusted leadership to do what is right for HCWs.”
Moreover, the study found that trust in leadership had a professional impact on nearly all respondents: 53.9% said it affected them “very much,” and 31.9% said “somewhat.” Only 2.3% reported no impact at all.
Trust was strongly associated with the following two outcomes that health systems are actively trying to improve:
Among healthcare workers (HCWs) who trusted leadership, 58.3% described high professional satisfaction, and 47.7% reported engaging in high-quality work. On the other hand, among those who did not trust leadership, 74.1% reported low professional satisfaction, and more than a quarter reported lower work quality.
As one physician in the study explained, “When you trust your organization, you can confidently practice and speak proudly of where you work.” Another clinician stated that trust allowed them to “focus on caring for patients,” rather than worrying about internal politics.
Across the study, more than three-quarters (77.7%) of HCWs who trusted leadership cited communication as a reason for that trust. Similarly, two-thirds of HCWs who did not trust leadership said better communication would help build it.
HCWs consistently stressed transparency, honesty, and regularity. For example, one manager described how weekly leadership emails improved connection, stating, “There are weekly emails from both our organization president and my division leader… These emails just make me feel more connected to my leadership by always reading their thoughts and encouragement.”
HCWs also called for “truth telling,” stating, “Tell us everything, information makes us feel included even if it's to say, ‘I don't know.’” As a result, emails can reach staff working in different shifts, roles, and locations, and when it is consistent, it can function as a reliable leadership presence.
HIPAA regulations require HCWs to safeguard individuals’ protected health information (PHI). Leaders who communicate via HIPAA compliant emails show that they take confidentiality, professionalism, and accountability seriously.
This matters because a lack of integrity was a major driver of distrust in the study. More than a third (36.4%) of respondents who did not trust leadership cited integrity concerns, including situations where “actions do not match what is stated.”
Therefore, leaders must use HIPAA compliant emails to reinforce alignment between stated values and actual practices. It allows them to share meaningful operational information, so HCWs can communicate candidly about staffing challenges, quality initiatives, and safety concerns while maintaining appropriate safeguards.
Trust, as one HCW put it, “is not something that is purchased off the shelf.” It requires leaders to “foster cultures that are safe and trustful” through consistent action. Leaders must use HIPAA compliant emails intentionally and transparently to support the three trust-building strategies identified in the research:
In the Joint Commission Journal, HCWs repeatedly stated that they wanted to be heard. Leaders who built trust were described as those who “solicit HCWs’ input and be responsive.” For example, a pharmacist explained: “I felt my thoughts for improvement, and my concerns were heard. If a decision went a different way, it was explained.”
HIPAA compliant email can support this kind of dialogue when it is intentionally designed for feedback, not just announcements. Secure reply functions, protected surveys, and direct follow-up can help promote engagement among staff and leadership.
Accessibility also matters, as evidenced in the article. HCWs valued leaders who were visible and available, rather than “hiding in an administrative suite.” While email cannot replace in-person presence, regular, personalized communication from leaders can reduce perceived distance, especially in large or multi-hospital systems.
The second major driver of trust identified in the study was how leaders treat HCWs. More than 40% of respondents said that being treated with “appreciation, respect, and kindness” was needed to build trust.
More specifically, leaders must use HIPAA compliant emails to acknowledge staff contributions. They should also avoid dismissive or purely transactional language. HIPAA compliant solutions, like Paubox email, can be personalized, so leaders can include appropriate context that promotes productivity. This helps leaders “recognize every person as having something valuable to contribute to the organization and treat personnel as important people.”
However, HCWs were also clear that respect must extend to pay equity, benefits, scheduling flexibility, and professional development, which were all cited as concrete indicators of being treated well. While email isn’t a substitute for these, it can provide transparency about how and why decisions are made to help reduce worker frustration, even when resources are constrained.
The third pillar of trust identified in the study was leadership’s commitment to patient care. More than a quarter of HCWs who trusted leadership cited a focus on “patient care (not money making)” as a reason for that trust.
One respondent explained that trust came from knowing that “every decision was made to improve care—not drive their own bonus potential.” Others stated that investments in staffing, infrastructure, and safety are tangible signals of this commitment.
Using HIPAA compliant emails for patient-centered communication improves patient outcomes. When leaders explain how staffing models, technology investments, or workflow changes support safer, higher-quality care, they reinforce shared values. For example, leaders can communicate how implementing a new electronic health record system will streamline communication between providers, leading to more coordinated and efficient patient care. Here, transparency helps build trust and engagement among staff, ultimately improving patient experiences and outcomes.
The study also states that leaders must encourage HCWs to speak up about safety concerns. Secure email solutions can provide a psychologically safer space for raising issues, particularly when anonymity or confidentiality is necessary.
Read also: HIPAA compliant email as a reporting mechanism for healthcare workers
According to the researchers, poor communication was the most commonly cited reason for distrust, reported by nearly 60% of respondents who lacked trust in leadership. HCWs described situations where “leadership shares no information” or where there was “no pathway through which they seem to hear what we see or need on the front lines.”
Consequently, HCWs who did not trust leadership described disengagement, “silent quitting,” and intentions to leave. As one clinical team member wrote, “Our work has become the bare minimum needed to accomplish a day's work.”
These outcomes could lead to high staff turnover, reduced engagement, and lower care quality that undermines organizational resilience, especially in a post-pandemic environment where workforce stability is already fragile.
HIPAA compliance refers to adhering to regulations outlined in the Health Insurance Portability and Accountability Act to safeguard patients’ protected health information (PHI).
Go deeper: What is HIPAA?
When providers are HIPAA compliant, they demonstrate a commitment to safeguarding patient privacy and upholding federal laws. Providers reinforce patients’ confidence that their sensitive information will be handled responsibly, which strengthens trust and supports more open patient–provider relationships.
Providers can implement administrative, physical, and technical safeguards, like using Paubox email, conducting regular risk assessments, establishing clear privacy and security policies, and training staff on appropriate data handling practices to maintain HIPAA compliance.