SECOND OPINION:Distrust can paralyse a society and poison our relationships, writes JACKY JONES
SO PEOPLE trust doctors more than any other professionals in Ireland. Not so. The recent survey carried out by the Medical Council claiming strong public trust in doctors, and widely reported in the media, did not actually measure trust.
The only question about trust the public were asked in this survey was, “Would you tell me whether you generally trust to tell the truth or not?” This question does not measure trust, which is a very complex concept and has to be measured using more sophisticated questionnaires.
People tell the truth for all kinds of reasons, most of which are nothing to do with trust, including habit and fear of being caught telling lies. This particularly applies to doctors who now have to be more honest with patients following recent health scandals. Telling the truth is not the same as asking, “Do you trust your doctor to give you a correct diagnosis?”, which is an entirely different question.
Trust is incredibly important and deserves to be measured properly and not trivialised as it has been in this survey. Society cannot function without trust and no co-operation from citizens or relationships between individuals are possible without it.
John Mill, in 1891, noted: “The advantage that it is to mankind to be able to trust one another penetrates into every crevice and cranny of human life.”
In spite of its importance, trust is a poorly understood phenomenon and most people assume trust in society and in their relationships without thinking much about it. Trust is a bit like health – we only pay attention when we no longer have it. Distrust can paralyse a society and poison our relationships to such an extent that our health is affected. Indeed, distrust can absorb a person’s strength to such an extent that he or she has little energy for anything else.
Trust has two distinct dimensions: trusting and trustworthiness. Trusting is about being open and taking risks in our dealings with others. Being trustworthy is about supporting and accepting others. Trust is about keeping commitments, negotiating honestly and not taking advantage. It is about making ourselves vulnerable and trusting others not to let us down. Trust is hard won and easily lost which means that the maintenance of trust is an endless and reciprocal task. Telling the truth just isn’t enough. Trust is essential when people’s co-operation is required and the erosion of trust was the single most important reason for the failure of the HSE as an organisation.
When the HSE was set up little or no thought was given to building trust between staff from the old health boards and, if anything, the new regime went out of its way to erode existing trust. This was probably not deliberate, but it is no coincidence that the HSE structures and processes were developed by senior people from the banking sector who clearly did not take the importance of trust into account.
Those of us who worked in the HSE in the early years were confronted every day by management actions that created distrust within the organisation just at the time when the co-operation of staff was needed. New structures were kept secret and essential information was shared only with an elite few. New and unnecessary layers of management were added. Favourite people were “plucked” to do important jobs which gave them an unfair advantage over their peers when it came to promotion. Consultants and “advisers” were hired at great expense and existing managers were sidelined. The culture of bonuses was introduced for top management. We now know that this is how banks operated in this country with disastrous consequences .
When there is mistrust in an organisation, staff will not co-operate with changes in the way work is organised and, in fact, will go out of their way to resist these changes. This is what happened in the HSE. The recession has, funnily enough, brought some trust back to the health system because now there are no more bonuses, the board has been replaced by HSE managers and senior Department of Health and Children officials, and cuts and pension levies have been applied fairly across the board.
We have to hope that the new Minister pays attention to trust in his efforts to reform the health system because he is going nowhere without it. Getting rid of the board is a good start.
Dr Jacky Jones is a former regional manager of health promotion with the HSE. She studied trust for a PhD and developed a new trust scale which has been validated and peer reviewed. E-mail her for a copy at drjackyjones@gmail.com