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What is The Trust Initiative?

The Trust Initiative is a collaborative research project examining how healthcare workers across British Columbia experience trust in the healthcare system. Led by Dr. Nickolas Cherwinski (Post‑Doctoral Fellow), Dr. Lorelei Newton, and Dr. Lenora Marcellus at the University of Victoria, and conducted in partnership with SWITCH BC and the Nurses and Nurse Practitioners of BC (NNPBC), the project explores how trust has shifted during and after the COVID‑19 pandemic.


Our goal is to understand the conditions that strengthen trust, identify system‑level drivers of distrust or moral distress, and generate practical recommendations for improving health, safety, and wellbeing in healthcare workplaces.

Why is trust important?

Many healthcare workers experienced heightened moral distress, heavy workloads, policy instability, and increased emotional demands during and after the pandemic. These pressures affected how workers trusted the systems they relied on—policies, leaders, communications, and organizational processes.


Strengthening trust is essential for:

  • Supporting the health, safety and wellbeing of healthcare workers
  • Improving organizational culture and safety
  • Supporting recruitment and retention
  • Enhancing patient care and public confidence


This work is focused on finding fact, not fault, and bringing forward information to support healthier, safer, and more trustworthy systems.

Who can participate?

Anyone working in healthcare in British Columbia (see definition below) could participate.

Definitions

Trust: For this survey the definition of trust is a "willingness of a party to be vulnerable to the action of another party based on the expectation that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control the other party" (Mayer, Davis and Schooreman, 1995).


Healthcare worker: All healthcare workers in any healthcare position including “…health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and other health service providers not elsewhere classified” (World Health Organization, 2019).


Wellbeing or mental wellbeing: A state of healthiness where people can cope with the stresses of life, work well, feel psychologically safe, and can contribute productively to their communities. 

What has been done so far?

Scoping Review

Our scoping review protocol is published with the Johanna Briggs Institute (JBI). Early findings highlight the importance of factors such as civility, empowerment, psychological safety, commitment, and organizational justice in shaping trust for both healthcare workers and patients.


Validated Survey Tool

A provincial survey was open for participation between December 2024 and February 2025. With nearly a thousand respondents (n = 964), the research team achieved four times the number needed to reach statistical significance. In the narratives put forth in responses to the qualitative questions, healthcare workers shared stories of hope, resilience, camaraderie, and the ways they were impacted by the pandemic. For many, the experiences were such that while systemic trust was lessened, interpersonal trust was galvanized. 


The extensive and rich data gathered from this survey was used to inform focus groups and future publications. Given the amount of data gathered to-date, there are opportunities for the team, as well as other researchers, to use the data for several years to come.

Provincial Focus Groups

Between August and October 2025, the team conducted 12 focus groups with 22 healthcare workers from across British Columbia. This qualitative work revealed:

  • Strong horizontal trust within teams
  • Significant vertical distrust toward organizational and system structures
  • Erosion of procedural justice during the pandemic
  • Feelings of betrayal, organizational amnesia, and moral injury
  • The need for relational leadership practices grounded in fairness, meaningful consultation, and transparency

These findings form the basis of a manuscript currently under review in a public administration journal.

Summary

Across both sets of data, healthcare workers consistently described:

  • Reliance on coworkers as a source of strength and resilience
  • Eroded trust in organizational and system-level leadership
  • Burnout, trauma, and moral distress
  • A widening gap between policy decisions and day-to-day realities
  • Poor communication and lack of transparency

What’s next?

Knowledge Translation Tools

The team is now developing a suite of knowledge translation tools to ensure that the research leads to real, actionable system improvements. 


These include:


  • Executive briefs
  • Leadership resources
  • Team huddle and debrief prompts
  • Implementation checklists and roadmaps
  • Infographics and accessible content
  • Pulse checks
  • Learning materials tailored to role

Each tool will be aligned with the Canadian Standards Association (CSA) National Standard for Psychological Health and Safety, embracing continual improvement and opportunities to pilot with real healthcare workers in real workplaces. 


The development of The Trust Initiative survey adhered to ethical research standards and the protocol has been registered with Open Science Framework.

About The Trust Initiative team

Dr. Nickolas Cherwinski is a social and behavioural scientist, his expertise spans research ethics and methodologies, public policy, public governance, implementation and evaluation sciences, mental health and addiction, traumatology, and conflict facilitation. Nickolas holds a PhD in Law and Public Policy, with a research focus on healthcare, structural marginalization, and mental health policy. He also holds a Master of Philosophy in Public Administration, and a Master of Arts in Conflict Analysis and Management, specializing in Political, Ethnic, and Security Issues, and is a certified addiction counsellor.


Dr. Lorelei Newton PhD RN CGNC is an Assistant Professor in the School of Nursing at the University of Victoria. She has practised as a clinical nurse, advanced practice nurse, professional practice leader, educator and manager in a variety of rural and urban settings including palliative care, oncology, emergency, and community/public health. Lorelei's research interests include nursing ethics, geriatric oncology nursing, the intersection of ageing and oncology with a recent focus on the nursing workforce required for safe and sustainable practice environments. Lorelei is currently the President of the Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) as well as an International Council of Nurses Global Nurse Leadership Institute alumni. She is a certified ICN  Global Nurse Consultant as well as a recent recipient of the NNPBC’s Excellence in Nursing Leadership Award. 


Dr. Lenora Marcellus is a professor and Director of the School of Nursing at the University of Victoria. She practiced as a Registered Nurse for 25 years in a range of perinatal and neonatal settings and roles before joining the School of Nursing in 2009. Her current research interests include perinatal substance use, neonatal opioid withdrawal, supporting infants in foster care, and supporting young families. She completed a Canadian Institutes for Health Research trainee fellowship in gender and addiction at the BC Centre of Excellence for Women’s Health with a focus on the intersections of violence, trauma and mental health.

Contact the team

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