The quality of interaction between managers and clinicians: a question of trust

A lack of trust between clinicians and junior/middle managers is well documented in health care systems but under-theorized. Face-to-face interactions between clinicians and managers, through which trust is constructed, are vitally shaped by assumptions drawn from local organizational characteristics, which in turn are embedded within national policy structures. These latter conditions require reform in order to enhance the quality and effectiveness of National Health Service management.