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This paper seeks to reflect on English care trusts as an example of a structural approach to integration.

All current care trusts' chief executives were invited to participate in a semi‐structured interview exploring their experiences. Themes from the interviews were combined with findings from literature and policy review.

The current care trusts can identify a number of advantages from combining health and social care into a single organisation. Equally, they also experienced many of the anticipated difficulties, and in hindsight half of those interviewed would recommend other options to achieving better integrated working. Whilst the “commissioning” function of care trusts will not survive beyond March 2013, “provider” care trusts look set to continue and indeed expand their service delivery. They will be joined both by new integrated social enterprises delivering health and social care.

The experiences of care trusts show the limitations of a single organisational structure as a means to achieve better integration and the impact of a changing national policy landscape on local initiatives. The findings suggest that the current legal flexibilities for integrated working should remain to enable local areas to decide how best to achieve their priorities and to realise the importance of addressing local cultural, practical and leadership issues along with structural barriers.

This paper provides a reflection on the ten years since the option of care trusts were available in England and adds to the current literature which focuses on individual care trusts' development and impact.

If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight‐year period, from 1997 to 2004. The study expected to find a decrease in public trust, with a low point in 2002.

Since 1997, public trust in health care was measured through postal questionnaires to the “health care consumer panel”. This panel consists of approximately 1,500 households and forms a representative sample of the Dutch population.

Trust in health care and trust in hospitals did not show any significant trend. Trust in medical specialists displayed an upward trend. Trust in future health care, trust in five out of six dimensions of health care and trust in general practitioners actually did show a decrease. However, only for trust in macro level policies and trust in professional expertise this trend continued. For the remaining trust objects, after 1999 or 2000, an upward trend set in.

No support was found for our overall assumption. Explanations for the fact that trust did increase after 1999 or 2000 are difficult to find. On the basis of these findings the study questions whether the measure of public trust is sensitive enough to provide information on the performance of the health care system.

The aim of this research is to study public trust in health care on its abilities to be used as a performance indicator for health care systems.

The aim of this paper is to provide a rationale for examining trust in health care.

Conducts a review of the literature of trust relations in health care that highlighted that most empirical research has addressed threats to patient‐provider relationships and trust in health care systems from the patient's perspective, but studies in the organisational literature suggests that trust relations in the workforce, between providers and between providers and managers, may also influence patient‐provider relationships and levels of trust.

Suggests that trust is not primarily dispositional or an individual attribute or psychological state, but is constructed from a set of inter‐personal behaviors or from a shared identity. These behaviors are underpinned by sets of institutional rules, laws and customs.

This introductory paper has presented some evidence from an international, comparative study but there is the need for further, more detailed investigation into why trust relations may vary in different health care systems.

This introductory paper provides a rationale for examining trust in health care and a context for the different elements of trust.

The aim of this paper is to draw together suggestions for future research from the papers and from the discussion that took place at the workshop.

The suggestions are summarised under four broad themes.

At an international workshop on trust organised by the UK MRC Health Services Research Collaboration there was broad agreement that trust was still a salient issue in diverse health care contexts. The workshop proceedings identified a number of important questions for empirical research and several key conceptual, theoretical and methodological questions relating to trust that need to be addressed in support of or alongside this. The collection of papers in this volume starts to address some of these questions.

Considers trust relations in health care from patient, clinical, organisational and policy perspectives.

This paper considers some implications of recent developments relating to patient safety for understandings of trust in health care contexts.

Conceptual analysis focusing on patients' trust in health care providers and health care providers' trust in patients.

Growing awareness of the scale of the problem of iatrogenic harm has prompted concerns that patients' trust in health care providers may be threatened and/or become inappropriate or dysfunctional. In principle, however, patients' trust may be both well placed and compatible with current understandings of safety problems and efforts to address these. Contemporary understandings of patient safety suggest that, to be deemed trustworthy, health care providers should make vigorous efforts to improve patient safety, be honest about safety issues, enable patients to contribute effectively to their own safety, and provide appropriate care and support after safety incidents. Patients who trust health care providers need not be ignorant of patient safety problems and may be vigilant in the course of their care. Iatrogenic harms do not necessarily reflect breeches of trust (not all such harms are yet preventable), and patients who are harmed might in some circumstances appropriately forgive and resume trusting. Health care providers may feel vulnerable to patients in several respects. From their perspective, trustworthy patients will act competently to optimise the outcomes of their health care efforts and to preserve health care providers' good reputations where those are justified. Providers' trust in patients may strengthen patients' trust in them and facilitate safety improvement work.

Shows how, in principle, trust can be compatible with current understandings of patient safety issues and may enhance efforts to improve patient safety.

Trust plays an important role in the organisation of healthcare services. In Norway, the establishment of mandatory municipal acute wards with 24 h inpatient services introduces a new unit into the healthcare system. This article discusses how this new health care service succeeds in building trust with patients and among healthcare workers.

The article is an in-depth case study of a single, exemplary inter-municipal acute ward. The study draws on interviews with COPD patients, the leader and doctors at the ward. The study also includes observations of daily work at the municipal acute ward. Moreover, administrators and healthcare workers at related healthcare institutions have been interviewed. Data were analysed using a qualitative method.

The study reveals that trust is built in complex relations and that it has both individual and systemic factors. The practices employed in the daily treatment and care of patients and in encounters between health care personnel and patients are important trust-building processes; however, these processes depend on structures and routines that promote efficient and adequate inter-organisational communication and patient-oriented procedures.

The study provides insight into how trust dynamics work on multiple organisational levels and how they depend on both individual and systemic factors. Additionally, the study may provide a picture of the importance of trust in organising healthcare services in the future.

Lessons regarding trust building inspired by data from a case-study care institution can be applied in different care settings and countries.

The purpose of this paper is to investigate whether principals can have an impact on organizational learning (OL). The authors use a cultural perspective, based both in the emerging literature from positive psychology and the relatively well-developed research tradition in studying the nature and impacts of OL to address four questions: first, is principal’s cognitive trust in teachers’ professional capacities related to knowledge sharing/OL among teachers?; second, is principal’s trust in teachers’ professional capacities related to teachers’ reports of being in a caring school setting (relational trust)?; third, is principal caring related to knowledge sharing/OL among teachers?; and fourth, is principal trust particularly important in school contexts with low income students?

An existing database that includes principal and teacher surveys in 116 schools in the USA provides the basis for examining the four questions. Optimized scaling techniques were used to develop measures of principal trust in teachers professional capacities, teachers’ perception of principal caring, an indicator of academic support for students that includes a social justice of equity emphasis, and capacity for OL. The demographic characteristics of the student body and school size were used as possible moderating variables. The data were subject to both regression and path analysis.

Principal trust was directly related to teachers’ perceptions of principal caring, and indirectly related to OL. The measure of academic support for students had the strongest direct effect on OL. While the percentage of non-white students and school size had some relationship to OL, they do not change the overall results. The model, which supports the role that principals play in fostering both equity and OL is sustained when the authors examine student achievement.

The limitations of the study stem largely from the nature of the sample and measures, which are confined to 116 schools in the USA, and a secondary analysis of a cross-sectional survey database. Because understanding the dynamics of a relationship-based/positive leadership perspective require detailed qualitative studies and longitudinal data, the results are presented as suggestive of issues that should be studied further.

Both trust and OL have been extensively studied both in education and other settings. However, few studies have simultaneously examined leadership, different types of trust and OL and none have done so in the context of positive psychology. The contribution of this analysis is thus empirical (extending the boundaries of what is known using concepts that are familiar) and theoretical (beginning the development of a theory of positive leadership that incorporates multiple factors associated with healthy and productive school environments).

Based on a workshop commissioned by the West Midlands branch of the Association of Directors of Social Services, this editorial considers possible alternatives to care trusts. Although the recent consultation on a new vision for adult social care emphasises the need for more effective partnerships between health and social care, the current care trust model has a number of limitations for many health and local government communities, that could be overcome by alternative approaches.

Using data from the General Social Survey (2002), structural equation modeling is employed to examine the intersections and relationships between various socio-demographic and contextual variables, patient trust, and patient preference for behaviors that indicate a desire to be an active health care participant. In so doing, a gap in the literature is addressed by uniting previous research on patient trust with research on patient participation. Findings reveal that patient trust in doctors and various socio-demographic and contextual variables are associated with people wanting to participate in the health care process by learning about medical issues on their own and by contributing to medical decisions. Results also shed new light on past research, which finds a relationship between various socio-demographic variables and patient trust. Specifically, they highlight the importance of distinguishing between patient trust in doctors and patient trust in the broader health care institution and the economic pressures it exerts on doctors. A discussion of what these findings might mean for our understanding of the doctor-patient relationship and the delivery of health care concludes the chapter.

Existing descriptions of trust in health care largely assume a straightforward association between a patient’s relationship with a regular provider and his or her trust in health care. I extend status characteristics theory (SCT) and social identity theory (SIT) to suggest greater variability in this association by investigating the role of social differences between patients and their regular providers. Whereas the SIT extension predicts lower trust in dissimilar than similar dyads, the predictions from the SCT extension depend on status in dissimilar dyads. Further, research examining how social differences in patient–provider dyads shape trust largely emphasizes racial differences, but the theories implicate gender differences too.

I analyze a longitudinal dataset of patient–provider dyads offering a conservative test of the extensions.

Results generally support predictions from the SCT extension. Specifically, patients’ status based on differences in either race or gender: (1) is inversely related to their trust in health care and (2) influences the resiliency of their trust, whereby the degree health care met prior expectations matters less (more) for the trust of low (high) status patients than equal status patients.

When patients and providers differ on both race and gender, findings sometimes depart from predictions. This indicates differences in two social categories is a unique situation where the contributions of each category are distinct from that of the other.

This research extends SCT to explain greater variability in the connection between patient–provider dyads and trust in health care, while also showing how gender compares to race.