How do we prevent trust violation in healthcare?

08 Feb 2023

Building trust is fundamental to safe healthcare, as is responding effectively when a practitioner breaches that core responsibility to a patient.

Our first Taking care podcast episode of the year further explores this important conversation with international guest Professor Rosalind Searle. Rosalind Searle is a Professor of Human Resource Management and Organisational Psychology at the Adam Smith Business School at the University of Glasgow. She is inaugural director of the EAWOP the (European Association of Work and Organisational Psychology) Impact Incubator. 

Her research has examined trust in healthcare, specifically the matter of professionals’ misconduct. Exploring the differences in their forms and frequencies across different professions she has examined in detail proven cases of sexual misconduct and abuse to reveal the moral mindsets that accompany these activities. 

Speaking with host Susan Biggar, Professor Searle unpacks the areas where trust can be built – and eroded. Managing the complaint process in that context is especially challenging.

‘One of the most fundamental things is about trying to understand that a harmed person is a fragile person,’ Professor Searle said.

‘That whole process can be hugely daunting to people and little human touches of care and respect really make a difference in navigating that space. Even when there is enough trust in a regulator or authority to report harm, that trust is tested when complaints are mishandled, or the process takes too long.

'We are effectively asking people to hold open that trauma and sometimes that can be months, or years. Particularly if they have lost a loved one, or suffered some kind of really major trauma, that is really hard for them.

‘I know the work that you have been doing in Australia has been really stellar in terms of putting support staff (around notifiers), and many of our regulators have support staff there to help people through those experiences.’

There is also the practitioner experience. Professor Searle’s research has found different ways practitioners rationalise their bad behaviour and responsibilities.

‘We are finding evidence that there is a difference in different types of professions about how they excuse their behaviour in terms of their responsibility,’ she said.

‘We are finding that when it’s nurses they are often saying “Oh, it’s people above me that are making me do this”. Whereas doctors can’t get away in the same with that, so often they are defusing it “Oh, this is what the culture is like in this space.”’

Denial is another reaction, particularly when the behaviour is especially serious, for example sexual misconduct, Professor Searle found.

Professor Searle has also shared valuable insights on how to maintain that trust and improve the culture of healthcare. 

For practitioners, employers, and educators, instilling those values and having respectful conversations begins at the start of their career, she said. 

‘We can look at who is coming through the profession right at the start, because sometimes there are clues there in how that person as a trainee behaves that raise concerns.’

‘It is also creating a workplace that supports it. Sexual misconduct, for example, is more likely to occur when staff are overworked, and culture does not stamp out staff bullying.’

Genuine compassion and clear communication are the key to maintaining the public trust. You can listen to the full episode here.

Links and resources

Professor Searle recommends:

• Why do good people do bad things
• Silence is golden?
• EAWOP impact incubator 
• Insights from a mixed-methods study of professional misconduct
• Sexual Misconduct In Health And Social Care
• Understanding types of abuse and perpetrators’ moral mindsets
• Misconduct amongst health professionals
• Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty

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