Trust relations in a changing health service

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Abstract
Objective Trust in health care is an important policy area although research has tended to focus on interpersonal trust between patient and practitioner and has neglected trust relations at the organizational and institutional levels. Each of these levels of trust may have been influenced by recent policy and organizational changes in the NHS as well as wider cultural changes. Our aim was to explore the relationship between patients, practitioners and managers to identify if there was any evidence of changes in trust relations. Method A comparative case study design in two different clinical and organizational settings. Results Trust is still important for effective therapeutic and working relationships but the nature of that trust and how it is lost and won appears to be affected by the organizational context in which health services are delivered. The increasing partnership between patients and clinicians in managing health problems and the greater inter-dependence of clinicians and managers in providing multidisciplinary shared care have changed how patients, clinicians and managers trust each other. For many informants trust can no longer be assumed, it is conditional and has to be earned. However, the sources of trust are the quality of the patient–clinician interaction, the competence and empathy that is displayed rather than informed trust based on abstract disembodied data. Likewise in inter-practitioner relationships and clinician–manager relations trust no longer appears to be primarily based on professional status and seniority, instead it appears to be conditional and may be earned through a variety of strategies that demonstrate honesty, reliability, competence, accessibility and an indication that colleagues share similar values and have a common agenda. Conclusion Trust is still important for effective therapeutic and working relationships.