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Employee trust is key to overcoming the NHS crisis

Trust is an important commodity for any organisation, but particularly in the high stakes world of healthcare. Evidence shows that where patients trust their healthcare providers, they are more compliant with their care regime and less questioning and challenging.

This makes healthcare delivery quicker and contributes to a less tense and aggressive context. Trusted hospitals are cheaper to run, have improved healthcare outcomes, and find it easier to attract and retain quality staff. 

Yet the news indicates a growing crisis of trust in our NHS. The Incomes Data Services NHS trade unions report reveals that more than 66% of staff in the NHS have considered leaving. It is not just the NHS; across the public sector trust is low. 

Our research indicates that those working in the public sector are more likely to have lower levels of trust in senior leadership and their employing organisation than their private or not-for-profit sector counterparts. The problems of retaining trust in very large organisations are evident, with complex lines of communications and different stakeholders. Employees in the public sector also report greater job insecurity and more political and conflict-ridden climates. 

Our latest study shows that public sector leaders are running organisations where politicians often dictate strategy, compromising their credibility as definitive decision makers. They are charged with delivering large scale, externally imposed, organisational transformations with little recognition of what had been done and tried before locally. This diversion of their attention from specific local strategic matters can create a frenetic and ongoing programme of change described as ‘surfing tsunamis’. 

The current programmes include increased bureaucracy, and result in NHS staff feeling that they are no longer trusted professionals. Such feelings are compounded by the added scrutiny of individual performance data for some roles, e.g. surgeons’ data in England. This leads to a level of psychological distancing and increased caution by healthcare workers, which can obstruct the care they want and need to provide their patients, plus a reduction in capacity for innovation.  

Employees no longer regard themselves as necessary life-long recruits. There is a value clash, with some staff adhering more rigidly to contracted hours and tasks as a means of protecting themselves from burnout. Others see this behaviour instead as evidence of a lack of organisational fit.

Critically the loss, whether physically or psychologically, of experienced staff denudes the NHS by potentially lowering professional standards, and reducing expertise for vulnerable service users at a time when the volume of complex cases is increasing. This will also hinder the development and training of the next generation. 

Clearly the employee trust deficit within the NHS is bad news for engagement, patient outcomes and development and training, so what role can leadership play in addressing the issue? 

Show recognition and respect – this sounds simple, but it is easily forgotten. When organisations are under pressure, leaders can often be curt. Acknowledging work well done, or those who have gone the extra mile is key. Such efforts should start from the top down.

Recognise the impact of change – the pace and level of change being asked of staff is often very high, without due recognition of its impact. The most effective and trusted businesses are those that attend to the emotional toll of change and ensure that managers are physically and psychologically available for staff during periods of transition.

Focus on input and process – getting the job done requires having staff with the right skills and competence, but also the right attitude and behaviours. Identifying the attitudes and behaviours that staff need are a significant step, but it starts with role modelling throughout the organisation.

Treat employees consistently – employees are acutely sensitive to inconsistencies. Treating employees but also other stakeholders differently is noticed, and can undermine trust.  

Attend to distrust first our latest work shows that distrust is distinct from low trust. Leaders need to understand the scale and source of distrust in their organisation before they can even attempt to restore low trust.

Professor Rosalind Searle is professor of organisational behaviour and psychology, and head of trust research at Coventry University