Your Institution May Not Have a Leadership Problem
It May Have a Trust Problem
Relational Trust Diagnostic
A strategic diagnostic for institutions experiencing trust erosion under sustained strain
When trust erodes in institutions, the visible symptoms are often familiar:
- communication becomes guarded or fragmented
- staff stop speaking openly
- teams become defensive or polarized
- conflict increases or goes underground
- good people withdraw, disengage, or leave
- change initiatives stall despite significant effort
Most institutional responses focus on structure:
governance reviews, leadership changes, culture programmes, communication plans, or staff engagement initiatives.
These may all be necessary.
But when mistrust has become embedded in the relational field, structural change alone rarely restores trust.
Under chronic pressure, the relational conditions that make trust possible begin to degrade.
Less becomes available:
less listening, less curiosity, less flexibility, and less capacity to repair rupture.
As these conditions narrow, access to trust, collaboration, and adaptive performance narrows with them.
What often appears as a leadership, culture, or performance problem may therefore be rooted in something deeper:
a breakdown in the relational conditions that allow people and systems to function at their best.
The Relational Trust Diagnostic helps institutions make these hidden dynamics visible.
This diagnostic is not a survey, audit, or generic culture assessment.
It is a strategic relational inquiry designed to identify:
- where trust is breaking down
- what patterns are sustaining mistrust
- what current interventions may be missing
- where leverage for restoration already exists
The work typically includes:
Listening
Structured conversations with key stakeholders across institutional levels.
Mapping
Identification of trust bottlenecks, pressure dynamics, and recurring relational patterns.
Analysis
Synthesis across micro, meso, and system-wide relational conditions.
Strategic Guidance
Clear recommendations for sequencing recovery and strengthening relational capacity. Institutions leave with greater clarity about:
- what is actually happening beneath visible symptoms
- why previous interventions may have had limited impact
- where relational trust can begin to be restored
- what scaffolding is needed to support new patterns
This creates the foundation for deeper work.
From here, institutions may choose to engage in strategic advisory, leadership development, or Islands of Coherence implementation to help new relational patterns become stable and sustainable under pressure.
Why This Work Exists
Asiya Odugleh-Kolev
I am a public health specialist who spent more than two decades at the World Health Organization, working across Africa, Asia, and Europe to support health systems under conditions of increasing complexity.
During that time, I spent eight years in emergency response, training multidisciplinary rapid response teams and designing trust-building community engagement interventions.
Before that, I trained as a nurse and worked in community development within family and social services in the UK.
Across all of these environments, one truth became impossible to ignore.
Teams with similar technical expertise often performed very differently under strain.
The difference was rarely technical competence alone.
It was the relational conditions determining whether trust, clear communication, and adaptive capacity remained available.
Power moves through biology first.
Before hierarchy is understood structurally, it is often felt in the body as bracing, silence, vigilance, or self-censorship.
These embodied responses shape what becomes possible long before anyone speaks.
The Integrated Change Framework, developed through the WISH–WHO report, provided the system-level architecture for making these dynamics visible.
But architecture alone does not change lived conditions.
Islands of Coherence emerged through lived experience at the intersection of professional complexity and personal disruption.
It became a form of scaffolding for staying connected inside systems that often reward disconnection and slowly narrow access to our relational capacities.
This work makes that scaffolding available so others do not have to spend decades finding that path alone.
What is missing
Across decades of health systems research, the same observation appears repeatedly. Programs work. Services work. Teams work. There are documented examples in every country, every region, every level of every health system.
The challenge has been capturing what makes them work.
The relational dynamics, the texture of how teams hold together, the quality of how leaders show up, the way information moves through coherent rather than fragmented relationships, all of this remains implicit. It lives in the people doing the work but has not been articulated fully. The visible elements of working programs (protocols, structures, procedures) can be more easily replicated. The invisible elements that enable those protocols to function are much harder to transfer.
This is why scaling has remained elusive. It is why horizontal learning across teams and programs has been difficult and successes remain isolated. The problem has never been the absence of working examples. The problem is that the relational infrastructure producing success has remained invisible to the systems that need it most.
"The challenge has never been the absence of working examples. It is the relational infrastructure producing success that has remained invisible.”
What this approach offers
The Integrated Change Framework, introduced in the WISH-WHO report on relationality in community engagement, named the systems-level architecture for relational infrastructure in health systems. It made the case that relational dynamics are not soft variables to be managed at the margins of service delivery. They are structural conditions that determine whether health systems can function at their best.
The Map of Relational Awareness is operational scaffolding that allows that architecture to be enacted in real time at the level of micro-interactions. The Framework is the systems-level architecture. The Map is the scaffolding. Together they offer institutions a powerful lens for recognizing and strengthening the relational conditions that allow local order to persist even when wider conditions are strained. In the language of complexity science, these are islands of coherence: relational fields that hold together inside systems that are experiencing disruption.
This approach is not about adopting something new. It offers a way to recognize, strengthen, and work with what systems already have.
What this means for institutions
Three things become possible when relational infrastructure is made visible.
See
Institutions can recognize what is already working in their own system, and identify the relational dynamics producing the success. Most institutions have working programs they cannot fully account for and struggling programs they cannot fully diagnose. The analytical scaffolding makes both more legible.
Transfer
What is working in one part of the system can inform another. What is being learned at the team level can inform the institutional level, and what is being learned at the institutional level can inform team-level practice. Horizontal and vertical learning becomes possible because the relational mechanics that produce success can be named.
Strengthen
The most relational specialties in health care, such as family and community health, pediatrics, obstetrics and gynecology, and oncology, carry the heaviest relational load. They also pay the highest cost for the rest of the system’s fragmentation. They are where the system meets the human, and they need infrastructure that supports the relational work they are already doing.
“They are not solutions to scale. They are relational capacities to steward.”
From Insight to System Orientation
A diagnostic makes visible what has been difficult to see.
But insight alone does not change systems.
Once trust bottlenecks and relational patterns become clearer, the next challenge is strategic:
How do institutions translate relational intelligence into meaningful system change?
This is where strategic advisory begins.
The work focuses on helping leadership identify where structural, cultural, and relational interventions need to align.
Together, we examine questions such as:
- What conditions are currently narrowing trust, communication, and adaptive capacity?
- Which existing interventions are helping, and where are they falling short?
- Where are the highest leverage points for change?
- What sequencing will support sustainable rather than performative transformation?
- What relational capacities need to be strengthened across leadership, teams, and frontline staff?
This is not about layering another initiative onto an already burdened system.
It is about improving the conditions under which existing structures, processes, and people can function more coherently.
Strategic advisory may support institutions in areas such as:
Leadership Reorientation
Strengthening leadership capacity to work with trust, uncertainty, and relational complexity under pressure.
Organizational Development Integration
Embedding relational intelligence into organizational development, culture change, and transformation programs.
Workforce Retention and Team Stability
Addressing the relational conditions that contribute to burnout, withdrawal, fragmentation, and attrition.
Islands of Coherence Implementation
Introducing practical relational scaffolding that helps new patterns become stable and sustainable under pressure.
The goal is not permanent external dependence.
The goal is to provide transitional relational infrastructure: scaffolding that supports new patterns until they become strong enough to sustain themselves from within.
As relational capacity strengthens, the scaffolding naturally falls away while the underlying capability remains.
The Four Shifts That Restore Relational Capacity
Individual shifts that scale into team and system transformation
shift one
From reacting to seeing
Noticing bracing, shutdown, over-functioning, or defensiveness earlier, before they fully take over.
shift two
From feeling to naming
Gaining language for what is happening internally, relationally, and systemically.
shift three
From confusion to navigation
Using the Map of Relational Awareness, orientating more clearly across self, others, and system.
shift four
From survival to choice
Not perfect regulation. Not endless calm. But more moments where a different response becomes available.
These shifts are not linear stages or a compliance framework.
They describe observable changes in what becomes possible when relational conditions begin to strengthen. People start recognizing patterns earlier rather than only reacting once those patterns have fully taken over.
Teams develop shared language for naming dynamics that previously remained felt but unspoken. Confusion begins to give way to orientation as people learn to distinguish what belongs to the self, the relational field, and the wider system.
At an institutional level, these shifts matter because they increase access to the capacities on which trust and performance depend:
- honest communication
- adaptive decision-making
- conflict repair
- psychological safety
- coordinated action under pressure
This is how relational scaffolding becomes practical infrastructure for institutional change.
From Intervention to Institutional Capability
The goal of this work is not permanent external support.
It is to help institutions strengthen the internal capacity to recognize, strengthen, and sustain healthy relational conditions from within.
Islands of Coherence is designed as scaffolding.
It provides temporary relational infrastructure that supports new patterns while they are still fragile under pressure.
As these patterns become more stable, more embodied, and more widely shared, the scaffolding naturally begins to fall away.
What remains is institutional capability.
This is where relational capacity moves beyond intervention and becomes part of how the institution functions.
Over time, relational intelligence can be embedded into existing systems such as:
Leadership Development
Helping leaders recognize how pressure shapes the relational field and influences trust, communication, and decision-making.
Organizational Development
Integrating relational diagnostics into culture change, transformation, and trust restoration efforts.
Team Development and Supervision
Strengthening the capacity of teams to notice rupture earlier, repair faster, and remain coordinated under pressure.
Workforce Retention and Staff Support
Addressing the relational conditions that contribute to burnout, withdrawal, disengagement, and attrition.
Internal Stewardship
Developing internal relational stewards who can maintain the language, practices, and diagnostic lens over time.
The aim is not to create dependency on a methodology.
It is to help institutions develop their own capacity for relational stewardship.
When this happens, trust restoration is no longer driven only by external interventions.
It becomes part of the institution’s operating architecture.
Islands of Coherence is designed as scaffolding.
Where broader implementation support is needed, delivery can be extended through a curated multidisciplinary team aligned with the relational architecture of the work.
It provides temporary relational infrastructure that supports new patterns while they are still being practiced.
An invitation
If you are considering whether this approach is relevant to your institution, the next step is a conversation. Not an application, not a procurement process. A conversation about what you are seeing in your institution and whether this work can serve what you are trying to do.
This is a thinking space, not a sales call. We will explore:
- what is happening beneath visible symptoms
- where trust may be narrowing
- whether a relational diagnostic is the right next step
Grounded in two decades of field practice across Africa, Asia, and Europe.