Trust is essential to delivering change in the NHS but it can’t be magicked up out of nowhere. Stephen Eames explains how he tries to build mutual trust

Trust. You can’t bottle it, you can’t spirit it up from the kitbag, but without it you can’t deliver change. When I reflect on a career in which I have had the privilege of leading a number of large NHS organisations through challenging times, my compass has been guided by five simple truths:

  • People are different.
  • Life is complex.
  • No one is perfect.
  • Trust has to be earned.
  • Relationships are all.

‘Building mutual trust is a Rubik’s cube of interlocking cultures and behaviours’

In the past year I’ve tried to apply this philosophy at Mid Yorkshire Hospitals Trust, where we have had the combined challenge of seeking major improvements in quality and performance, financial meltdown, building a long-term clinical service strategy and motivating a workforce in an environment where trust and confidence had been lost. 

All this was writ large against the backdrop of a negative local and national reputation and the post-Francis world in which NHS management needs to restore its reputation with the public.

More to be done

A year on and by many measures we are making progress, though I’m under no illusions that much more needs to be done to embed what we have achieved. Much of our progress has only been made possible by putting a huge amount of effort into attempting to build mutual trust and respect with our communities, our staff and our partner organisations.

Any success we’ve had needs to be tempered by the harsh reality that we still have to win over many of our staff and key parts of our community who, for various historical and contemporary reasons, feel alienated and disempowered.

‘The biggest trust-buster is dressing failure up as success − most people can see through the emperor’s new clothes’

When it comes to developing mutual trust and respect, the ways of doing it are very simple to articulate. Actually doing it is a lifetime occupation and is the whole foundation of any meaningful relationship.

Building mutual trust is a Rubik’s cube of interlocking cultures and behaviours and, for me, is always anchored in a local context so it can’t be rolled out in a manual of best practice. I’ll never have all the answers and others will have better ones than mine. But back to some simple truths derived from what I’ve learned.

Keep people in the communities you serve at the forefront of your mind

It really is very easy to be distracted by fads, bureaucracy and the sheer scale of the agenda.  

To be trusted you have to learn to trust others

I can guarantee that you are likely to suffer some damage along the way. However, this is worth it because, contrary to popular belief, I’ve found the vast majority of people you work with are generally trustworthy. Yes there are those who “given an inch will take a mile” or those who don’t really care but most people, given the right support, want to contribute, lead and succeed.

Anyone in a position of authority − and none of us do it perfectly − must strive to create a climate where positive people can thrive whatever the scale of the challenges. Just think about how hard you work when you feel like you’re trusted, and how you work when you think you aren’t trusted.

Credibility is a major ingredient in building mutual trust

Without this leadership is weakened. Fundamentally you have to demonstrate you are competent and empathetic to get the best out of people and partnerships. It’s what academics call “authenticity”. In other words, you won’t make much progress, whether people like you or don’t like you, if they think you don’t know what you’re doing. They are more likely to be inspired if they believe you can grasp the zeitgeist and be in it together with them as a team.

Keeping promises whether they are small or large

If you cannot deliver on the rhetoric then you really can’t expect people to trust you.  

Collaboration is the watchword

When I analyse my working week, much of my time is spent collaborating with colleagues in local government, primary care and other healthcare institutions. You can’t command and control collaboration; it just doesn’t work. You have to be prepared to compromise, do what you say you are going to do and give some things up for the greater good.

If you get it wrong just say so, put it right and move on

The biggest trust-buster I know is obfuscating or dressing failure up as success − remember most people can see through the emperor’s new clothes.

It may feel uncomfortable to be an NHS manager at the moment but the trust quotient, at least in the public eye, is low. Putting renewed effort into increasing confidence again through building mutual trust seems to strike a chord with the times.

Stephen Eames is chief executive at Mid Yorkshire Hospitals Trust