Extra Resources: E 137 After Alder Hey: Trust and Mistrust in Contemporary Healthcare

Introduction

My booklet is about issues of trust in healthcare. However, I am aware that a good number of the readers of the booklet will be clergy, and most of the others will have a serious interest in the life of the church. Exploring the life of a parallel profession, provides those of us who are clergy with a very helpful mirror on our own vocation. In this web resource I therefore want to suggest some questions which clergy and others may want to ponder, in relation to the text of the booklet.

2.1 A Climate of Suspicion

Is it your experience that people find it harder than previously to trust the clergy? What are the factors that encourage or militate against trust in your own local church?

2.2. A Brief Theological Perspective on Trust

Where have you found Christian relationships that manifest trust of a high order? Do you expect a high level of trust: In your local church? Amongst clergy colleagues? At a diocesan or regional church level? Being honest, have you found the church as a whole to be significantly more trustworthy than other organisations you have experienced?

2.3. Sztompka’s Model of Trust

Primary Trust

“Primary Trust” is a vital commodity for any Christian leader. How has your own stock of “primary trust” grown (or fallen) during your ministry? What are the things you have done that have enhanced it? Have you done anything that has significantly damaged it? How do we care for clergy whose ministry may be ruined because their stock of primary trust is destroyed through wrongdoing, misjudgement or scandal?

Within your community, what are the (probably unspoken) features of external appearance (e.g. race, gender, age) that evoke or diminish primary trust in a Christian leader?

Consider how our church buildings evoke or diminish trust.

Secondary Trust

Do you think that the existence of an ecclesiastical hierarchy, the Clergy Discipline Measure, and the Capability Procedure envisaged in the MacLean report (for Anglicans) make a significant difference to people’s trust in their local ministers?

Do you think the existence of the clergy freehold (for Anglican vicars) reduces secondary trust (or not)? (For those who have seen it, the play Racing Demon offers a devastating critique of trust within ecclesiastical hierarchies.)

Does Sztompka’s criterion of “situation” help explain why trust is sometimes much less evident at, say, a deanery level than a parish level?

Trusting Impulse

Sztompka’s analysis seems to suggest a very positive potential role for the Christian community. Does your church function as a community in which young people and adults are enabled to develop a “trusting impulse”?

Trust Culture

Is the culture of our church (both as it grows from below and is guided from above) one which makes for a high level of trust? Are you, personally, inclined to trust those with ecclesiastical authority more (or less) than you might trust, say, your doctor?

3. Trust Betrayed

3.1. Learning from the Shipman experience

Clergy don’t have the power to kill with drugs that doctors do. Nonetheless, a rogue clergyperson can have a devastating impact on a community. Do you think the levels of “controls” on clergy (selection, training, deployment and redeployment) are adequate? Are there areas that need strengthening?

3.2. Learning from the Bristol Hearts Case

Consider Sir Donald Irvine’s understanding of the characteristics of modern professionalism:

  • Clear professional values
  • Explicit standards
  • Collective as well as personal responsibility for standards of practice
  • Local medical regulation based on teams
  • Effective systems for dealing with dysfunctional doctors
  • Systematic evidence of keeping up to date and of adequate performance.

Would clergy count as “professionals” by these standards? Should they? What are we to do about clergy who work in isolated situations, with no concern for personal development, resisting peer support, and whose performance may continue in an erratic manner until disaster strikes?

Do you think the church is a “supportive environment that can deal with poor performance without this being merely an exercise in allocating blame”?

3.4. Learning from Alder Hey

How good are we at keeping proper records when incidents arise?

How willing is the church to adopt modern values of “transparency” and “openness”?

Can one be “priestly” without being “paternalistic”? What kind of partnership between clergy and laity ought we to seek?

4. Rebuilding Trust

How can we build a church culture where people are “free to report errors and learn from mistakes, rather than one of ‘blame, shame and punishment’”?

What has been the impact of “fear of litigation” on the way we conduct ourselves?

Sir Ian Kennnedy proposed four moves for doctors: from tribalism to teamwork; from blame and defensiveness to openness and accountability; from ignorance to information; and from division to understanding between clinicians and management. What might similar moves amount to for the church?

Overall, do you think church culture operates with:

  • blind trust?
  • enlightened suspicion?
  • enlightened trust?

Author: Revd Dr Robert Innes

After a career in business consultancy, Rob taught theology at Cranmer Hall and ministered in several County Durham parishes, before becoming Senior Chaplain and Chancellor of the pro-Cathedral of Holy Trinity, Brussels. He has written and edited books and booklets in the areas of spirituality and ethics, including 'Rebuilding Trust in Healthcare' (eds. Harrison, Innes and van Zwnenberg) published by Radcliffe Medical Press. He is married to Helen and they have four children.

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