Table 3

Main elements influencing the development of trust in collaborative hospital construction projects according to focus group interviews

Level of cultureEvidence of elements in developing trust in case projectsDescription of elements in developing trust in case projects
ArtifactsBig Room, physical (or virtual) co-locationThe Big Room enables them to become familiar with one another's set-up by enhancing personal contacts, providing informal situations and building an atmosphere of trust to form a working community like that of the parent organization
ArtifactsCompetence/alliance capabilityCompetence/expertise as a recognized characteristic of project participants enhances trust; alliance capability specially creates trust in the alliance contract model and for working for the best for the project
ArtifactsCommon decision- making processA defined process for making decisions with alliance partners, even if the decisions are not always pleasant
ArtifactsCommon problem- solvingA defined process for solving problems (e.g. A3 problem-solving, collaborative approach to problem-solving) together in a good spirit without blaming one another strengthens trust; sometimes compromises are needed but without follow-up questions in case the solutions can be found together
ArtifactsCommon processes and toolsDefined processes and operational methods (e.g. change management) or tools (e.g. Target Value Design, Last Planner System) enhance trust and the feeling of community
ArtifactsCollaborationThe contract promotes the primary goal of collaboration but requires special effort to work in a team without permanent organizational borders between the client, main contractor, and designers to operate best of the project
ArtifactsOpen communication (e.g. information sharing)People communicate openly and are willing to share information and express their opinions freely, honestly, and directly on all issues across permanent organizational borders, including on difficult issues such as mistakes, and there is confidence that problems can be solved
Espoused valuesCommon values and objectivesThe project's common values and objectives are defined and accepted together; shared understanding of and conformance to them enhances cooperation and trust
Espoused valuesFair contract conditions (e.g. shared pain and gain, no unusual conditions)Fair and clear contract conditions and risk sharing between contract partners create trust for the alliance contract and commercial model and encourage all the partners to work for the best for the project
Espoused valuesFormal relational contractA relational contract promotes the primary logic of collaborating, innovating, and collaboratively managing risks and opportunities and developing plans during the project
Underlying assumptionsOpen atmosphereAn open atmosphere fosters the feeling that one may communicate easily, express opinions freely and honestly (even when disagreeing), question and ask “stupid” questions without fear of humiliation and raise difficult issues without regard to organizational borders and without fear of fighting; people feel they can speak and will be heard
Underlying assumptionsFeeling of reliabilityPeople or alliance partners do what they promise to do on time and can rely on everybody doing their best; trust is built through actions, such as the implementation corresponding to plans
Underlying assumptionsRespecting peopleA feeling that people respect one another and their opinions, needs, and expertise; people can state their opinions without fear of embarrassment
Underlying assumptionsNon-opportunistic behaviorA feeling that one can be trusted not to pursue their own interests; people operate without hidden agendas, and you can sense the trust in people's actions

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