It all comes back to trust and confidence

Here at the Office of the Auditor-General, our overall strategic outcome is about making sure that Parliament and New Zealanders have trust and confidence in the public sector. So it was a familiar topic at October’s Leaders Integrity Forum when the focus was about building and maintaining trust.

Hospital corridor - Photo from maxpixel.netThe chairperson for this session was the Chief Ombudsman, Judge Peter Boshier. Like ours, his agency is very focused on the performance and effectiveness of the public sector, so he was the perfect Chair. He set the tone well with a Warren Buffett quote:

It takes 20 years to build a reputation and five minutes to ruin it. If you think about this, you’ll do things differently.

The first speaker was Ashley Bloomfield, who’s the Director-General of Health. Ashley’s take on this topic was interesting at every turn, given his experience in health roles here and overseas. Let’s just say we’re very lucky we’re not trying to manage health-related conflicts of interest in Moscow...

Ashley reminded folks about the layers involved: fundamentally, public sector leaders can’t carry out their roles unless they are trusted, particularly with Ministers. And it’s essential to retain New Zealanders’ trust in our public service. Ashley reflected that it is the personal experience of the people who use our public services that has the most impact on trust and confidence – either directly or through the experiences of friends and whānau. Health services are universal – everyone is affected at some stage of their lives. As a result, the experience of one can become the experience of many. When Ashley was in charge of the Hutt Valley DHB that led to an aspiration that every person, every time, would have a good experience of the DHB.

A good experience is built on good communication – it’s not just what happens to a person, but understanding why.  In the health sector, the more people can be involved in their own health care, the more trust they have in the services they receive. Years ago, when Ashley was a younger doctor, the standard question when a patient walked in was some form of “what’s the matter with you?” question. But people have a much better experience of a health service when the first question is more about “What matters to you?”

First and foremost, service providers have to listen. Given that I was providing some post-op support to a family member the week after this forum, the reminder that there’s far more to a person’s response to treatment and recovery than the purely biological and medical aspects was both timely and welcome.

In another anecdote about how times have changed, Ashley talked about the GOMER code described in a satirical book called The House of God. It was short for ‘get out of my emergency room.’ It wasn’t entirely wrong; doctors used to be focused on clearing patients quickly. The doctors were working incredibly long hours, so people with complex and time-consuming health issues were unwelcome. Now it’s about owning matters, and a “we’ll sort that out for you” mindset.

Despite all those good intentions, with so many people using our health services every single day, something will go wrong for someone. As a former employee of LV Martin and Sons, Ashley was quite taken with that firm’s very appropriate and well-known marketing phrase – it really is the putting right that counts.

Open disclosure of mistakes is the first step. Listening to people; owning the error; putting it right. Being able to “fess up” and talk about mistakes is more than important, it’s fundamental to trust and confidence.

Another challenge in the public sector is the mismatch between people’s expectations and the ability to meet those expectations.  If we can’t be open about that gap, trust can be eroded. For most public organisations, this is tricky; there is always a limit on money and resources, but there’s political tension in telling the public that some services can’t be provided. Ashley noted a health sector example where this is done well – Pharmac often takes a beating in the media for difficult and unpopular decisions about medicines funding, but what they do really well is to be open and transparent about what they can and can’t deliver with the funding they manage.

The next speaker was Dr Katie Elkin, who’s the recently appointed Deputy Chief Executive: System Leadership at the Crown Law Office, but who joined us at the LIF to talk primarily about her experiences as Acting DCE of Corporate Services at the Department of Corrections. In an organisation charged with managing offenders in prisons and the community, both to keep New Zealanders safe from harm and to help reduce re-offending, Corrections’ world is another in which trust and confidence is key.

Katie talked us through what Corrections does to try to build, maintain, and (when necessary) rebuild trust. She expressed frustration at the portrayal of the organisation’s work in the media – with images used over and again of barbed wire prison fences when there’s so much more to the Corrections service.

To try to paint a fairer balance, Corrections uses social media to show the human side of the service – the rehabilitation focus, the amazing “From Prison Gate to Plate” Wellington on a Plate event (if you haven’t been, check it out next year – it’s so popular there’s a ballot for tickets), and stories about staff and their families.

Like Ashley, Katie reflected on the impact on trust and confidence when something goes wrong. A bad news day in the world of Corrections can be catastrophic – failure can result in loss of life or a threat to public safety. Katie shared some great examples about how Corrections has tried to live by the expectations of the State Services Commissioner – own it, fix it, learn from it – when things have gone wrong.

For Katie, much of building and maintaining trust boils down to integrity at an individual level. Corrections supports its staff, trains them, and trusts them. It’s paying off – Corrections appeared in the top five “most improved” list when Kiwis were surveyed by Colmar Brunton recently.

The ensuing conversation among the audience was fascinating. What does trust really mean? In the end, the strongest message I came away with was this: trust is about many things ... integrity, reliability, honesty, credibility, and respect. These are not descriptions of public sector organisations, they are descriptions of the individuals who make up our public sector organisations – who come to work every day with a spirit of service and a determination to do the best for the New Zealanders we serve, and earn their trust and confidence in the process.

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