Direct patient care requires knowledge sharing between clinical\ud professionals. However, clinicians have often been suspicious of managers'\ud motives, this lack of trust often resulting in reluctance to share knowledge for\ud managerial purposes.\ud Trust is one component of the psychological contract - an unwritten set of\ud expectations between employees and employer. There are strong links between\ud components of the psychological contract and defensive behaviours. There is\ud much theory to support these links but little research evidence to support and\ud explain these links.\ud To overcome defensive behaviours requires an understanding of how they\ud have developed, and particularly the role played by the psychological contract.\ud This research builds on research first undertaken by Argyris in the 1960s,\ud enhanced and made relevant to the current business environment and\ud organisational arrangements currently prevailing in the NHS. A model and an\ud analytical framework were developed for this research to assess organisational,\ud professional and employee health in two health authorities.\ud This research concludes that organisational ill-health, and failure to ensure\ud the psychological contract is intact, result in employees displaying defensive\ud behaviours and keeping knowledge to themselves. Components of the\ud psychological contract were found to have strong links with organisational\ud arrangements. Subtle variances were found between clinical and non-clinical\ud employees, and between Chief Executives/Directors and those below this level.\ud This research adds to our knowledge by identifying the different ways in\ud which these groups develop paradigms that are often in conflict, sometimes\ud intangible, and usually difficult to change. This added knowledge will allow\ud organisational, team and personal development to have a sharper focus,\ud particularly with reference to development of the psychological contract in the\ud NHS, overcoming defensive behaviours, and breaking down barriers to knowledge\ud sharing. This will support the development of infrastructures, teams and individuals\ud to take NHS organisations into the 21st century with added confidence
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