The current pressures within health and social care are experiencing an unprecedented level of pressure with increasing scrutiny testing staff on a daily basis. This assignment will explore the significance of effective team work and trust and how it can be nurtured and developed within teams. An evaluation of current literature will put forward the case for the importance of trust, assessing the causes of barriers and how they can be overcome highlighting the impact on patients when trust is breached.
Trust is the fundamental basis of all relationships (Thagard, 2018 and Frowe, 2005), conversely, Mishra (1996) argues that it is far more complex as to enable the development of trust there is a requirement for both parties to be open to vulnerability, dependence and a reliable transaction. Consequently when it is said that someone is trustworthy it is implied that any act of trust will be of benefit and lays the foundations of cooperation; to be untrustworthy warrants little or no cooperation.
For trust to be effective it is reliant on the effectiveness of both the trust and cooperation of an organisation or relationship (Johns, 1996); this suggests that without one the other will not thrive. Money et all agree, as trust is directly associated with organisational effectiveness and employee job satisfaction, which indicates of the potential success of an organisation
On this basis it is reasonable to maintain that trustworthiness is essential for commitment, loyalty and satisfaction It stands to reason that people who believe that their leaders are trustworthy experience a higher level of engagement with their leaders as a result.
Professional relationships are built on trust and any act of trust is a risk, comments Frowe (2005) in addition Green (2012) recognises that the world of modern business is increasingly diverse and virtual; as such Green (2012) argues that leadership can no longer rely on their trust in power, they have to depend on the power of the trust that people have in them. Understanding the shift in the power-base of trust is vital as the absence of trust is bad news for finance, organisations and political leadership.
Streep (2014) advises that whether we trust or not isn’t a conscious decision it is part of a thought process that we may not be aware of. Withholding trust can impede and dissolve relationships; in contrast extending trust strengthens it as trust is reciprocal (Fisher-Thornton, 2013 and Olson, 2013). In addition, Johnsson et al. (2013) candidly explain that trust can be posthumous, in that we don’t realise that we are expectant until we are disappointed by an outcome. Some are cynical about the irrational nature of trust aligning it to poor judgement (Eisenhardt, 1989) nevertheless others remain steadfast in viewing it as core-factor of human relationships (Gabarro, 1978; Sheppard and Sherman, 1998).
A personal reflection considered a recent 360 degree review by work colleagues; it highlighted that the majority of people who I trust to give me constructive feedback are those who I have known for some time. In my experience, the spectrum of trust is wide-ranging, is tested and is strengthened during times of adversity. The two people I was most concerned about appointing to feedback are people who I have worked with infrequently; however I trust that their feedback will be fair and constructive nonetheless.
These feelings are quite common; Berscheid (1994) advises that there is a risk to self-esteem if there is a breech in trust within a deep relationship, validating why negative feedback from a trusted colleague would be more difficult to hear. Trust is a mitigated risk reports Sheppard and Sherman (1998), prompting that society and teams have rules that are there to safeguard an act of trust in another person or institution; this rationale is short-sighted it is argued, as a person would need to have the confidence to trust the safeguards of society or an institution to be assured by the mitigation they offer.
It is acknowledged that the relationship and trust between an employee and their leaders has a powerful impact on an individual’s work performance and job satisfaction (Gerstner et al., 1997) and it is further complemented by working within a real team benefitting from a reflexive approach (West, 1999). Working within an effective team with shared goals and values adds resilience and nurtures the development of its people, which Carter and West (1999) suggest reduces the risk of work-related stress.
Rees (2019) defines that the most effective leaders nurture others to develop into new leaders; nurturing demonstrates that your teams are valued and that the organisation wants to improve. In addition, Wallace (1991) contends that team commitment and collaboration is essential to enable innovation. The ability to nurture a team is based on the empowerment of team members to actively participate in tasks, training, to ask questions and resolving conflict (World Health Organisation, no date). This isn’t dissimilar to the fundamental principles of patient-centered care (PCC), as to enable a nurturing team culture or PCC there needs to be an engaged relationship and appreciation of the individual’s goals and challenges (Davis and Kumar, 2003).
Reflecting on a team activity to reduce team waste and resources identified that many barriers preventing team engagement and a nurturing environment are hidden in plain sight. I realised that we had become accepting of the barriers as individuals, but as an engaged team we could address them together increasing trust and resilience.
Kramer and Pittinsky (2012) warn of the erosion of trust within public and private organisations, a view supported by Walshe and Higgins (2002), flagging that there is an increased lack of trust leading to a sharp rise in the demand for public inquiries of the NHS. It is unsurprising that the reasons for inquiries are poor communication, organisational isolation; poor leadership and the disempowerment of patients and staff, Walshe and Higgins (2002) emphasise that this will continue as recommendations alone will not change culture, values and behaviours. Hope-Hailey (2012) rationalises that there is a way forward, teams that trust adapt and accept change more readily.
The public attitude towards healthcare is dependent on the individual’s personal experience and the reporting of events by the media (Mechanic, 1996). We must be under no illusion that the doctor knows best, Hupcey and Miller (2006) reinforces the need to focus on a PCC approach as the notion that a doctor or nurse will be trusted because of their profession is a barrier to trust; advising that once trust has been lost it is unlikely to be salvaged which can be catastrophic for the patient.
Never has reputation been so important, the construct of social media, applications and review platforms has enabled the public to share their experiences publicly and in real-time. More organisations are sharing widely to engage with stakeholders and build corporate identity (Swift, 2001). It is commonplace for organisations to measure the experience of their customers and employees as it gives a competitive advantage (Tam, 2004) as when asking about experience you are measuring trust (Bleuel, 2001).
Whetten (2005) identified that a lack of trust in health services equally impacts all patients, not just minority groups. It is countered that the most vulnerable people in society who need support to be heard are at risk of being overlooked due to the substantial feedback of those who are able. Which Barchard et al (2017) assert is a key reason that we must understand the clinicians interpretation of courage and its role in practice so that we can prepare people to be resilient advocates.
When things do go wrong organisations should apologise, express remorse and acknowledge the anger people feel to demonstrate that they accept responsibility for the incident and reduce the level of reputational damage petitions Pace et al (2010).
It is apparent that the processes of trust, engagement and nurturing and are vital for organisations to succeed in delivering PCC. To develop a nurturing culture within teams, it is necessary to ensure that their work has meaning, that they have the necessary resources, supportive relationships within the team and access to coaching to aid in their personal development to prevent de-skilling (Serrano et al 2011). This will enable the team to think and work differently and become more adapt at realising and addressing ‘wicked problems’, as the resolution will be systemic rather than an limited solution O’Leary et al (2010).
It is argued that the leader sets the pace for the nurturing of others, by doing so the climate is set for the team to nurture itself. This point is supported by Howe (1993) when outlining that team integrity is dependent on its ability to nurture each member of the team to develop unity, but not everyone works in the same way. Some team members are described as ‘guerrillas’ (O’Leary et al., 2010) or ‘renegades’ and ‘venturers’ states LaRosee (2004) encapsulating that these people are particularly skilled in driving organisations forward, but without consistent nurturing and trust in their abilities can be side-lined as troublemakers inhibiting their natural skill-sets and motivation.
When trust is breached it can quickly escalate into a headline crisis or scandal leading to increased analysis to improve the ‘public trust’. Dibben and Davies (2004) vehemently discredit this knee-jerk response, warning that the rush to remedy the crisis can impact trust again in the future. The issue of ‘private trust’ such as the relationship between a clinician and a patient can protect the incompetent Dibben and Davies (2004) warns, highlighting that Dr Harold Shipman was a trusted family doctor who is now noted a one of the world’s most prolific serial killers.
By abusing the trust patients had in him, Harold Shipman exploited the trust placed in him, the legacy of which has led to greater scrutiny of clinical professionals (Esmail, 2005). The doctors who worked with Shipman unknowingly authorised cremation papers for his victims, but they trusted him; it would be short-sighted to conclude that to distrust should become the norm as a result (Baker, 2004). Subsequently, it is vital to recall that the same doctors who trusted Shipman informed the Coroner of their concerns (Pulse, 2001). The patient is central to the solution prompts Entwistle et al., (2006), stating that the clinicians trust in patients when effective can be reciprocated and contribute to the strengthening of patient safety.
It is suggested that although Shipman’s crimes were extraordinary, there have been system breaches which could have happened in many organisations that have demonstrated leadership failings at many levels within different organisations (Anonymous 2, 2012). Maternal and baby deaths at Morecambe Bay NHS Foundation Trust highlights the systemic failure of safeguards failed and reviews by the Care Quality Commission and Monitor were not effective and could not be trusted (Dowler, 2012).
Despite codes of professional practice and criminal laws explicitly directing staff to speak up, raising a concern remains a minefield for staff who feel personally at risk for doing so which impacts sometimes catastrophically on patient well-being (Greenberg and Edwards 2009) which needs to urgently change (Reid, 2013). In order to support people in re-engaging when a breach of trust has occurred, the events and the learning needs to be reported correctly so that they are not misunderstood pleads Kirkup (2017), frustrated that the legacies of Morecambe Bay has been misrepresented reducing the impact of learning and engagement.
A reflection: I was moved at short notice to manage a ward on another hospital site. The new ward was chaos, a few weeks later the Trust were informed that a nurse had been filming undercover on the ward for a television expose`. The nurse was one of only four staff that I had initially felt I could trust. The day after the programme aired an elderly patient said, “Please don’t hurt me”. I felt destroyed. When reflecting, I realised that I have to trust in myself to trust others; I also have to earn the trust of each of my patients, no longer assuming that they would. I also had to re-learn how to trust people in general. The only way I could do this was to first forgive my undercover colleague and then extend trust to others, finding a shared purpose, as treating people with dignity and respect builds trust and a mutual regard (Revell, 2017).
It has been evidenced that trust can be nurtured and developed within teams by coaching and ensuring staff have the resources they need to enable their work to be sustainable and prevent them from becoming deskilled (Serrano et al, 2011). It has been identified that not everyone works the same way and some employees may present as a challenge, however the climate may just need to be reset to support them in the most effective way, thereby setting an example of how the team should adapt and thrive. An effective team is one associated with good patient and staff satisfaction.