A matter of trust

An attendee at a patient safety conference recently asked the speakers whether we felt that the effect of being placed in special measures was so devastating to staff morale as to render improvements at the organisation in question almost impossible. This prompted me to think about trust and communications across the health community, and their role in facilitating – or blocking – the open and transparent culture that is surely a prerequisite to improving safety. Securing healthy levels of trust is made complex by the multiplicity of relationships between different stakeholders in that community. Within healthcare organisations, the challenge is considerable. In order to identify problems and then find and implement solutions to them, there is a need for staff to trust management; patients to trust healthcare professionals, and different groups of staff to trust each other. In most organisations, there will be varying levels of trust. Somewhere in the policies of all NHS institutions, you will almost certainly find a statement on openness and willingness to learn and improve, rather than to blame. When you ask staff how well this statement translates into practice, it is likely that responses will differ according to local circumstances or personalities, and, sadly, there is still ample evidence that many risks, concerns and failures go unreported. This is due to a range of issues, from lack of belief that anything will happen as a result of reporting, to fear of recriminations for calling practice into question. On the other hand, there are undoubtedly many clinical and other teams which actively learn from experience just as there are also NHS trusts where management has developed and maintained open and positive communications with staff. However, at the macro level, the expectations and behaviours of regulators, politicians and the media add another level of complexity to the challenge of encouraging an open culture which learns from experience and improves its practice. Sir Robert Francis spoke at the recent Annual Regulation Conference in Edinburgh on 31 October 2016 about the need to ‘‘rethink the regulator’s role in patient safety.’’ He told the Heath Service Journal (9th November 2016) of the need for liaison between regulators, a focus on systemic problems and the support and recognition of those who raise concerns in good faith. What marks his comments out, however, is the acknowledgment of the need to win the ‘‘trust and confidence’’ of the public in achieving real change. He suggests, for example: