Building trust requires being trustworthy and trusting wisely

“Leadership is getting results in a way that inspires trust.” … SMR Covey


California Department of Public Health


August 8, 2023


Interpersonal trust and trust of government institutions were the strongest drivers of successful population-based, public health interventions during COVID-19 pandemic.

Communities (“trustors”) ask of government (“trustee”) the following questions:

  1. Can I believe you?
  2. Do you care about me?
  3. Can you deliver?
  4. Can I count on you?

These questions apply to all interpersonal relationships. Each of us are always simultaneously in the roles of trustor and trustee, and we are always asking and answering these very questions, implicitly or explicitly.

Key points

  • Both trust and trustworthiness are inherent in all relationships, but rarely defined precisely.
  • Trust is a psychological state of the trustor—the willingness to be vulnerable to the actions of another party. It’s a choice, mostly intuitive, but sometimes deliberative.
  • The trustor asks four questions of the trustee: Can I believe you? Do you care about me? Can you deliver? Can I count on you?
  • The trustor’s willingness to extend trust is determined by their propensity to trust or distrust, their assessment of the risk and benefits of extending trust, and the appraisal of the trustee’s trustworthiness.
  • Trustworthiness are attributes of the trustee—that drive the trustee’s reasoning, thoughts, feelings, and actions that affect the trustor’s willingness to extend trust.
  • The trustee’s trustworthiness is determined by evidence of their character, caring, competence, and consistency.
  • For the trustee to build trust,
    • be trustworthy;
    • use a human-centered approach to assess the needs of the trustor
      • their propensity to trust/distrust,
      • their perception of risk and benefits, and
      • their appraisal of your trustworthiness; and
    • act in ways that inspire trust in the trustor.
  • CAUTION: Being trustworthy is necessary but not sufficient to build trust.
  • For the trustor to extend trust, options include
    • assuming good intent and then learn and iterate;
    • assessing your
      • propensity to trust/distrust,
      • perception of risks/benefits to you, and
      • appraisal of trustee’s trustworthiness; or
    • communicate clearly what you need to have trust and confidence in the trustee.

Online slide presentation

The online slide presentation below was adapted from a commencement address I delivered for the graduation of the California Health Care Foundation (CHCF) Leadership Fellows, Cohort 21, on September 21, 2023. To view presentation, put cursor over slide presentation and select “Toggle fullscreen.”

View or download full slides

You can also download PowerPoint slides or PDF slides.

Feedback is valued and appreciated.

Trust and trustworthiness matter

The evidence is clear: interpersonal trust and trust in government are the key drivers of successful population-based interventions during public health emergencies [13].

Figure 1

Figure 1: Public trust in sources of health information among US adults, by degree of trust, 2022

Figure 2

Figure 2: Major reasons for lacking trust in the Centers for Disease Control and Prevention (CDC) and state and local public health departments to provide accurate information about COVID-19, among US adults with lower levels of trust, 2022

Figure 3

Figure 3: Public Trust in Federal, State, and Local Agencies on Covid-19

4CAPP model of trust

The 4CAPP is my way for remembering

  1. The 4 C drivers of trustworthiness (trustee)
  • Character
  • Caring
  • Competent
  • Consistent
  1. The AAP drivers of extending trust (trustor)
  • Appraisal of trustworthiness
  • Propensity to trust/distrust
  • Perception of risks and benefits
Figure 4: 4CAPP model (picture): Relationships involve both trust and trustworthiness simultaneously between parties. To capture this two-way dynamic, the 4CAPP model was adapted from organizatonal trust researcher Professor Roger C Mayer. It includes key elements from the Feltman and Covey books.

Building trust by being trustworthy

Can I believe you? \(\rightarrow\) Have Character

  1. Universal values - embody and promote
  2. Humility - general, intellectual, and cultural
  3. Moral compass and ethical behavior
  4. Sincerity, honesty, and loyalty
  5. Integrity and courage
  6. Accountability
  7. Transparency

Do you care about me? \(\rightarrow\) Be Caring

  1. Ensure psychological and physical safety
  2. Be kind and compassionate
  3. Ensure equity/fairness and dignity
  4. Promote inclusion and belonging
  5. Be trauma-responsive and -preventive
  6. Be curious, not judgmental
  7. Use humble inquiry

Can you deliver? \(\rightarrow\) Be Competent

“Leadership is getting results in a way that inspires trust.” … SMR Covey

  1. Leadership philosophy and praxis
  2. Interpersonal and team skills
  3. Management (strategic execution)
  4. Occupational mastery

Can I count on you? \(\rightarrow\) Be Consistent (and reliable)

  1. Be consistent by reducing uncertainty
  • improve your “batting average” (percent successful)
  • reduce undesired variability (ie, don’t be erratic)
  1. be reliable (100%) for commitments and promises
  • fulfill commitments
  • keep promises

Extending trust (deciding to risk vulnerability)

  1. Set a default (“assume good intent”) and PDSA to assess your
  • propensity to trust,
  • perception of risk and benefits to you,
  • appraisal of trustee’s trustworthiness
  1. Reciprocate with the “shortcut” method to building trust
  • “I want us to strengthen our trust and confidence in each other.
    • Here’s what I need from you (be honest): 1, 2, 3, …
    • What do you need from me?” (The more specific, the better.)
  1. Model the trust you expect of others
  • be trustworthy,
  • behave in ways that inspire trust, and
  • design systems that promote a culture of trust.


Bollyky TJ, Castro E, Aravkin AY, Bhangdia K, Dalos J, Hulland EN, et al. Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: An observational analysis. The Lancet [Internet]. 2023 Apr [cited 2023 Oct 1];401(10385):1341–60. Available from:
Bollyky TJ, Hulland EN, Barber RM, Collins JK, Kiernan S, Moses M, et al. Pandemic preparedness and COVID-19: An exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. The Lancet [Internet]. 2022 Apr [cited 2023 Oct 1];399(10334):1489–512. Available from:
SteelFisher GK, Findling MG, Caporello HL, Lubell KM, Vidoloff Melville KG, Lane L, et al. Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications: Study reports the results of a survey of public trust in US federal, state, and local public health agencies’ performance during the COVID-19 pandemic. Health Affairs [Internet]. 2023 Mar [cited 2023 Oct 1];42(3):328–37. Available from: