Faith and trust: Social capital and Ralph Fiennes’ electrifying speech in ‘Conclave’

At the Press Ganey Pediatric Summit on May 20, we played a clip from the movie Conclave right before a fireside chat between me and Dr. Alejandro (Ale) Quiroga, the new CEO of Children’s Mercy Kansas City. In the clip, Cardinal Lawrence (Ralph Fiennes) gives instructions to other cardinals as they begin the process of choosing a new Pope. He warns against choosing someone completely confident in his views, saying:

“There is one sin which I have come to fear above all others: certainty. Certainty is the great enemy of unity. Certainty is the deadly enemy of tolerance. Even Christ was not certain at the end. ‘My God, my God, why hast Thou forsaken me?’ he cried out in his agony at the ninth hour on the cross. Our faith is a living thing precisely because it walks hand in hand with doubt. If there was only certainty and no doubt, there would be no mystery—and therefore no need for faith. Let us pray that God will grant us a Pope who doubts.”

Why did Ale and I choose to open our conversation with this clip? We see analogies between the uncertainty that Cardinal Lawrence describes in the movie and the complexity of the challenges we face in healthcare. And we agree that social capital—based upon trust among colleagues—is a critical element of our response. In short, in uncertain times like these, we cannot be successful without colleagues we can trust and without trust in our colleagues.

Before the summit, Ale set the stage for our discussion in an email that challenged us to think differently—urging us to move beyond traditional styles of leadership and management to meet the complex problems we face in healthcare. He also highlighted the difference between “complicated” and “complex” problems. Complicated problems require many people doing many different tasks (e.g., building a car). But if we organize well, learn from mistakes, and constantly refine our approaches, we’ll get there.

In contrast, complex problems involve many unpredictable factors, producing challenges that defy simple solutions. Think: patients with multiple clinical conditions and issues related to social determinants of health, emergency department overloading, and clinician burnout.

Management approaches for complicated challenges (e.g., organizing groups with reliable people operating at “the top of their license”) don’t work for complex problems. Complex problems call for something more, something different.

Complex problems demand social capital. They demand real teams, with collective resilience and flexibility. The team can adapt to meet the unpredictable challenges posed by each patient before them, or the array of factors causing congestion in the emergency department that day. Job descriptions still matter, but they are far from the complete story of how individuals understand and approach their work.

For teams with real social capital, everyone sees themselves as part of the group. They know their colleagues. Ideally, they like their colleagues. But even if they don’t choose to spend their free time with them, they know they can count on each other, especially in the moments that matter most. They have psychological safety to speak up when safety or some other aspect of the group’s goals are threatened.

They trust each other.  In these settings, trust means having confidence in one another amid circumstances no one has yet imagined. No one can know, with certainty, what challenges will be posed by the next pandemic or the next patient to walk through the door. In the face of such complexity and uncertainty, it’s reasonable to adapt the wisdom of Cardinal Lawrence, and consider the equivalent of faith to be trust.

There are no silver-bullet solutions for complex challenges, but social capital is at least part of the antidote. We need to measure and build currencies of social capital—such as teamwork and high reliability. And those can only exist upon a foundation of trust among colleague

This is not wishful thinking. All of Press Ganey’s data on the workforce are consistent with that observation. And the data point out the steps that managers can take to build social capital—to hardwire trustworthiness among individuals, teams, and systems.

Rather than try to summarize them here, I’ll just end with another quote from Conclave—the final instructions from the now-deceased Pope to Cardinal Lawrence:

“Some people are chosen to be shepherds. Others, to manage the farm. You’re a manager. So manage.”