Erosion of Trust in Healthcare Leadership: An Analysis of Anomie and Social Exchange During the COVID-19 Pandemic

Background: The COVID-19 pandemic disrupted healthcare systems worldwide, posing profound challenges for healthcare professionals. This study examined how the pandemic affected healthcare workers' trust in their leaders, comparing the acute 2021 phase and more managed 2022 period. 

Objective: To investigate how healthcare workers' experiences of moral distress, organizational change, belongingness, and perceived organizational support influenced trust in supervisors and senior leaders across two pandemic phases.

Methods: Anonymous survey data were analyzed from healthcare professionals at a Southeastern U.S. academic medical center in 2021 (n=2,991) and 2022 (n=2,581). Ordinal logistic regression examined relationships between trust and experiences of moral distress, discrimination, mistreatment, rapid organizational change, belongingness, and perceived organizational support, controlling for demographics.

Results: Trust in leadership declined over the two periods, especially trust in senior leaders (59% in 2021, 54% in 2022). Moral distress from patient care challenges and rapid organizational changes negatively influenced trust, while feeling a sense of belongingness was positively associated with trust. Perceived organizational support strongly mediated these relationships between experiences and trust. Significant differences emerged in how these factors related to trust when comparing the two pandemic phases.

Conclusion: Frontline healthcare workers' trust in their organizational leadership eroded during the COVID-19 pandemic, shaped by distressing care experiences and perceived failures of organizational support and justice. Actively supporting staff wellbeing and fostering belongingness within the workplace community could help bolster trust in leaders. As the findings showed, leaders play an integral role in proactively nurturing workplace trust to reinforce institutional resilience during times of crisis.