Hospital Doctors' Trust Relations at Work: A Multi-Case Analysis

In the organizational trust literature low trust and distrust are increasingly seen as two distinct but related concepts. We offer an in-depth analysis of how low domain-specific workplace trust and distrust transitions into high distrust among senior hospital doctors in the UK NHS. Our analysis - informed by psychological contract, trust, and distrust theory - draws on qualitative data from three related studies of doctors in 2015, 2020 and 2023. These data points allow for an examination of senior hospital doctors' experiences over time. Our findings indicate that an exogenous event in the form of COVID-19 created heightened expectations of doctors’ being valued and being granted greater autonomy during the early stage of the pandemic. These heightened expectations led to increased trust in the short term but were ultimately interpreted as unfulfilled during the post-COVID-19 period, so turning longstanding feelings of psychological contract breach into violation, high pervasive distrust of the healthcare system itself, and widespread intentions to retire prematurely or scale down their work commitments.