Facilitating a just and trusting culture

PURPOSE: The purpose of this paper is to identify managerial and organizational characteristics and behaviors that facilitate the fostering of a just and trusting culture within the healthcare system. DESIGN/METHODOLOGY/APPROACH: Two studies were conducted. The initial qualitative one was used to identify themes based on interviews with health care workers that facilitate a just and trusting culture. The quantitative one used a policy-capturing design to determine which factors were most likely to predict outcomes of manager and organizational trust. FINDINGS: The factors of violation type (ability vs integrity), providing an explanation or not, blame vs no blame by manager, and blame vs no blame by organization were all significant predictors of perceptions of trust. RESEARCH LIMITATIONS/IMPLICATIONS: Limitations to the generalizability of findings included both a small and non-representative sample from one health care region. PRACTICAL IMPLICATIONS: The present findings can be useful in developing training systems for managers and organizational executive teams for managing medical error events in a manner that will help develop a just and trusting culture. SOCIAL IMPLICATIONS: A just and trusting culture should enhance the likelihood of reporting medical errors. Improved reporting, in turn, should enhance patient safety. ORIGINALITY/VALUE: This is the first field study experimentally manipulating aspects of organizational trust within the health care sector. The use of policy-capturing is a unique feature that sheds light into the decision-making of health care workers as to the efficaciousness of particular managerial and organizational characteristics that impact a just and trusting culture.