Explaining Coexisting Trust and Distrust Transitions: The Case of Senior Doctors in the UK NHS

The emergence of distrust in organizations damages working relationships and leads to poor organizational performance. We examine how senior doctors in the UK NHS transitioned from low trust/low distrust to low trust/high distrust in their managers and employer. Drawing on qualitative data from three time periods, we show, counter‐intuitively, how a positive crisis response by doctors' leaders during COVID‐19 intensified a long‐term downward trust–distrust trajectory. This response temporarily restored confidence and elevated expectations of a renewed psychological contract among doctors. When those expectations were later violated, scepticism and value incongruence grew, inciting negative expectations and a descent into distrust. We make three contributions to trust–distrust theory. First, we identify a previously unexplained pathway from coexisting low trust/low distrust to low trust/high distrust through a temporary state of high trust/low distrust. Second, we explain how ideological contract violations, perceived betrayals of core values and professional identities, drive the development of distrust. Third, we extend punctuated‐threshold explanations of distrust emergence by demonstrating that distrust can arise not only from accumulating negative experiences but also from the collapse of newly restored positive expectations. This has broader implications for the leadership of change, particularly the management of hope and expectations during crisis.