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• Organizational trust: the responsibility of the leadership
  Nicole J Tweddle
  Published on: 13 May 2016

• Published on: 13 May 2016

  Organizational trust: the responsibility of the leadership

  • Nicole J Tweddle, Allied Health Safety and Service Improvement Project Officer

  Dear Editor

  Firth-Cozens article explores the effect of trust and the ways in which it can be developed in health care organizations to enhance patient safety.[1] Leadership attributes of ability, benevolence and integrity most certainly contribute to the establishment of trust in a leader however, these attributes alone are not enough to overcome the barriers to open disclosure of errors.

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  Dear Editor

  Firth-Cozens article explores the effect of trust and the ways in which it can be developed in health care organizations to enhance patient safety.[1] Leadership attributes of ability, benevolence and integrity most certainly contribute to the establishment of trust in a leader however, these attributes alone are not enough to overcome the barriers to open disclosure of errors.

  Organizational trust must first be earned by its leaders through demonstrated commitment to a ‘no blame’ policy with respect to adverse event investigations. The author acknowledges ‘the importance of considering the multi-causal and sociotechnical nature of most accidents’[1] however, I believe this aspect of the article requires more explicit discussion as it is fundamental to the development of organizational trust.

  Quick judgments and routine assignment of blame obscure a more complex truth, a series of events and departures from safe practice, each influenced by the working environment and the wider organizational context.[2] If analysis of adverse events focused less on individual error and more on organizational or system factors, an environment of trust may begin to prosper and strategies to enhance patient safety would become visible. No amount of leadership ability, benevolence or integrity will lead to organizational trust if fear of blame exists. A consistent and transparent process for a root cause analysis of adverse events is essential for health care leaders to demonstrate in order to achieve any degree of organizational trust and subsequent open disclosure.

  As Firth-Cozens states in a previous publication, ‘the main driver of higher organizational trust is going to have to come from the actions and attitudes of leaders and managers at every level’.[3] Actions undoubtedly speak louder than words when it comes to investigation and assignment of blame in the analysis of adverse events. A culture change is required and it must begin with the leadership of each health care organization. Leaders who consistently demonstrate and acknowledge the role of system failures as the root cause of adverse events, will have greater success in establishing the trust that health care organizations so desperately require. Maybe then we will begin to impact on the quality and safety of the health care which we deliver.

  References

  1. Firth-Cozens J. Organisational trust: the keystone to patient safety. Qual Saf Health Care 2004;13:56-61

  2. Vincent C, Taylor-Adams S, Jane Chapman E, Hewett D, Prior S, Strange P, Tizzard A. How to investigate and analyze clinical incidents: Clinical Risk Unit and Association of Litigation and Risk Management protocol 2000;320:777-781

  3. Firth-Cozens J. Learning from error. In: Harrison J, Innes R, Van Zwanenberg T, eds. Regaining trust in health care. Albingdon: Radcliffe Medical Press, 2003.

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  Conflict of Interest:
  None declared.

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