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      Trust in health care theoretical perspectives and research needs

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          Abstract

          Purpose

          This paper presents some key theoretical issues about trust, and seeks to demonstrate their relevance to understanding of, and research on, health systems. Although drawing particularly on empirical evidence from low and middleincome countries LMICs, the paper aims to stimulate thinking across country settings.

          Designmethodologyapproach

          Drawing both on conceptual literature and relevant empirical research from LMICs, the paper presents an argument about the role of trust within key health system relationships and identifies future research needs.

          Findings

          Theoretical perspectives on four questions are first discussed what is trust and can it be constructed Why does it matter to health systems On what is it based What are the dangers of trust The relevance of these theoretical perspectives is then considered in relation to understanding the nature of health systems issues of equity and justice in health care and policy and managerial priorities. The identified research needs are investigation of the role of trusting workplace relationships as a source of nonfinancial incentives the influence of trust over the operation of different forms of citizenhealth system engagement approaches to training trustworthy public managers and the institutional developments required to sustain trustworthy behaviour within health systems.

          Practical implications

          The policy and management actions needed to strengthen health systems within LMICs, and elsewhere, include recruitment of health workers that have the attitudes and capacity for moral understanding and motivation training curriculae that develop such motivation and developing the institutions e.g. communication and decisionmaking practices, payment mechanisms that can sustain trusting relationships across a health system. It is also important to recognise that distrust in some relationships may act to guard against the abuse of power.

          Originalityvalue

          Although the notion of trust has become of increasing importance in health policy debates in highincome countries, it has received less attention in the context of LMICs. The papers adds to the very limited literature on trust in LMIC health systems and also opens new lines of thinking for those working in high income countries particularly around the role of health systems in generating wider social value.

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          Most cited references30

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          Developing and Maintaining Trust in Work Relationships

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            Poor people, poor places, and poor health: the mediating role of social networks and social capital.

            V Cattell (2001)
            This paper explores the dynamics between poverty and exclusion; neighbourhood, and health and well being by considering the role of social networks and social capital in the social processes involved. It is based on qualitative research taking two deprived areas as exemplary case studies, and involving depth interviews with residents. Neighbourhood influences on networks and social capital were explored, network typologies developed reflecting structural and cultural aspects of individual's networks, and pathways implicated in health effects considered. The complexity of social capital is addressed. The role of three factors in influencing social networks and social capital are demonstrated: neighbourhood characteristics and perceptions; poverty and social exclusion, and social consciousness. Perceptions of inequality could be a source of social capital as well as demoralisation. Different network structures-dense and weak, homogeneous and heterogeneous- were involved in the creation of social capital and had implications for well being. Coping, enjoyment of life and hope are identified as benefits. Although participation in organisations was confirmed as beneficial, it is suggested that today's heterogeneous neighbourhoods also require regenerated local work opportunities to develop bridging ties necessary for the genesis of inclusive social capital and better health. Despite the capacity of social capital to buffer its harsher effects, the concept is not wholly adequate for explaining the deleterious effects of poverty on health and well being.
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              Does organisational culture influence health care performance? A review of the evidence.

              To review the evidence for a relationship between organisational culture and health care performance. Qualitative comprehensive review: all empirical studies exploring a relationship between organisational culture (broadly defined) and health care performance (broadly defined) were identified by a comprehensive search of the literature. Study methods and results were analysed qualitatively to provide a narrative review with integrative discussion. Ten studies met the inclusion criteria. There was considerable variation in the design, study setting, quality of reporting and aspects of culture/performance considered. Four of the ten studies reviewed in detail claimed to have uncovered supportive evidence for the hypothesis that culture and performance are linked. All the other studies failed to find a link, though none provided strong evidence against the hypothesis. There is some evidence to suggest that organisational culture may be a relevant factor in health care performance, yet articulating the nature of that relationship proves difficult. Simple relationships such as 'strong culture leads to good performance' are not supported by this review. Instead, the evidence suggests a more contingent relationship, in that those aspects of performance valued within different cultures may be enhanced within organisations that exhibit those cultural traits. A striking finding is the difficulty in defining and operationalising both 'culture' and 'performance' as variables that are conceptually and practically distinct. Considerably greater methodological ingenuity will be required to unravel the relationship(s) between organisational culture(s) and performance(s). Current policy prescriptions, which seek service improvements through cultural transformation, are in need of a more secure evidential base.
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                Author and article information

                Contributors
                Journal
                jhom
                10.1108/jhom
                Journal of Health Organization and Management
                Emerald Publishing
                1477-7266
                01 September 2006
                : 20
                Issue : 5 Issue title : Trust in health care organisations Issue title : Trust in health care organisations
                : 359-375
                Affiliations
                Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa
                Article
                0250200502.pdf 0250200502
                10.1108/14777260610701768
                17087400
                f9ef0d8c-6aaa-4744-abfd-d7373b4129ab
                © Emerald Group Publishing Limited
                History
                Categories
                review-article, General review
                cat-HSC, Health & social care
                cat-HMAN, Healthcare management
                Custom metadata
                no
                yes
                included

                Health & Social care
                Trust,Motivation psychology,Management accountability
                Health & Social care
                Trust, Motivation psychology, Management accountability

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