Published: 14/07/2005, Volume II5, No. 115 Page 42

If all good relations are built on trust, organisations should be doing all they can to encourage it. Carols Harris says the challenge is getting staff to believe in one another NHS leaders and managers increasingly need to trust their own staff to encourage the initiative and commitment crucial to producing highquality services.

Ian Chisholm, who chaired the General Medical Council fitness to practise panel, is all too aware of the consequences when trust is lost.

Last month the panel struck off Professor Dick van Velzen, the pathologist at the centre of the Alder Hey Children's Hospital organ retention scandal.

Announcing the verdict, Ian said the professor 'has undermined the trust placed in medical practitioners to such an extent it has damaged the medical profession as a whole'.

'The parents of children who died trusted Professor van Velzen to care for and respect the remains of their loved ones.

Professor van Velzen violated that trust.' Les Morgan, who leads the development organisation Educare, says people tend to trust doctors because doctors listen to them. 'Listening is how, initially, they make a diagnosis, ' he says.

Les argues that trust between staff is fundamental to good performance in any environment.

'The major challenges in organisations today are not around the abilities of the staff to do the job, but the interaction of the workforce, especially the management, to do it interdependently.

'Almost all the challenges in companies today are internal - appoint the right people and they will make the right decisions at the right time for the right reasons.' Les says that this means not worrying so much about skills, which can be acquired, as the interaction between team members.

Les has developed 'trust audit', a tool for team members to assess and compare opinions of each other. This creates the foundation for dialogue between staff and, ultimately, better performance.

Team members assess each other on various criteria and statements such as: I can freely disagree with my team member; they are equally committed to uncovering the truth and the best solution.

'Trust has a significant influence on team effectiveness, enabling members to express feelings and differences openly, and avoid sabotage and defensiveness, ' says Les.

He identifies four levels of leadership, all of which hinge on taking responsibility for your own behaviour and attitude to work and colleagues:

Personal: do what you say you are going to do.

Inter-personal: the trust between individuals.

Managerial: empowerment based on trust between management and employees.

Organisational: alignment of the company vision with employees' principles and values.

'The internal costs of mistrust are inefficient entanglements of hierarchy, communication, misperception, anger, blame and cynicism. It wastes time, energy, goodwill, and money, ' says Les.

Les says building trust is also crucial to getting people to take responsibility for their own health, to eat healthily and take regular exercise, requiring a major shift in attitudes from patients and staff.

In north-west London, senior managers believe that a new approach to employing agency allied health professional staff would not have worked without the openness and trust of its staff.

The new scheme involves a 'master vendor', a single agency to supply all temporary staff.

'It used to be very easy for managers to pick up the phone and order a temp.

That was not always the best solution, ' said North West London workforce development Confederation procurement director Mansell Chamberlain.

'Now the AHP staff are themselves responsible for thinking through whether agency staff are the best way to fill a post.' It will save an estimated£3m a year.

'There is a wider management focus on this than just saving money: we can now draw together a lot of useful data such as identifying which posts are especially hard to fill, ' adds Mansell.

The new approach needs the support and involvement of all therapy staff in making the decisions to employ agency AHPs.

This was established through the involvement of chief executives and other senior management in meetings with AHP managers as the scheme was put together.

'We are changing the culture of how we work with our therapy staff and it needed a high profile to show that commitment. It is about better management and better services, ' says Mansell.

'Working together, you can deliver something meaningful.' E-mail Les Morgan at info@educare-to-lead-out. co. uk