Trust in Health Care

2018 ABIM Foundation Forum: [Re]Building Trust

At this annual conference, a diverse group of more than 120 health care stakeholders met in large and small groups to discuss various facets of trust from a variety of perspectives, relationships, contexts and settings. This work culminated in a series of articles published in the Journal of the American Medical Association over the course of several months in 2019. (listed below)

A Framework for Increasing Trust Between Patients and the Organizations That Care for Them. Written by Thomas H. Lee, MD, MSc, Elizabeth A. McGlynn, PhD, and Dana Gelb Safran, ScD.

5 Ways to ↑ Trust: Patients & Health Systems  

Health systems must encourage patient engagement and establish procedures to measure and nurture trust. Health care leaders recommend five approaches to organizations working to build trust:

  1. Recommit to patients
  2. Measure patient experience and engagement
  3. Demand accountability; reward results
  4. Build effective teams
  5. Listen to patients

Building Trust Between Physicians, Hospitals, and Payers: A Renewed Opportunity for Transforming US Health Care. Written by Lewis G. Sandy, MD, Hoangmai H. Pham, MD, MPH, and Sharon Levine, MD.

3 Ways to ↑ Trust: Physicians, Hospitals & Payers  

As health care moves toward paying for performance, health care stakeholders must align their understanding of “what success looks like.”
Health care leaders identified three key considerations for building trust:  

  1. Recognize differing perspectives and redefine them together
  2. Use transparency to measure and reward what matters
  3. Assume best intentions

Why Physicians Should Trust in Patients. Written by Rachel Grob, PhD, Gwen Darien, BA, and David Meyers, MD. 

4 Ways to ↑ Trust: Physicians & Patients 

The quality and safety of care that physicians provide their patients, along with physicians’ satisfaction with the practice of medicine, may improve when physicians trust their patients. Health care leaders say that mutual trust between doctors and patients must start with physicians, who can convey trust by:

  1. Reading verbal and non-verbal communications
  2. Understanding and addressing implicit bias
  3. Inviting shared decision-making
  4. Following cues from each patient about what kind of partnership to build

Physicians’ Trust in One Another. Written by Richard Frankel, PhD, Virginia Tilden, PhD, and Anthony Suchman, MD, MA.

4 Ways to ↑ Trust: Physician to Physician

As many examine the erosion of trust in organizations and institutions, scholarly research suggests trust between physicians has room to improve.  Health care leaders identified four principles for enhancing trust:

  1. Value the physician-physician relationship as equally as the patient-physician relationship
  2. Harness differences as a resource
  3. Consciously build relationships
  4. Make accountability a two-way street

Building Trust Between Government and Clinicians:  Person to Person and Organization to Organization.
Written by Peter V. Lee, JD, Christine Sinsky, MD, and Donald Berwick, MD, MPH.

3 Benefits to ↑ing Trust: Government & Clinicians  

Both policymakers and physicians have important perspectives, and with more trust, they could better advance their mutual goals. As a first step, if health care leaders spent more time understanding each other’s universe:

  1. Policymakers could see regulatory burdens first-hand
  2. Physicians could better contribute to system-wide improvement
  3. Both could reduce the regulatory burden together

From Distrust to Building Trust in Clinician-Organization Relationships. Written by Mary Jane Kornacki, MS, Dave A. Chokshi, MD, MSc, FACP; and Jack Silversin, DMD, DrPH.

3 Ways to ↑ Trust within Health Systems

Health system leaders need to proactively engage physicians and others on insight gained from patient care. Health care leaders identified three essential elements:

  1. Listening and acting on clinician feedback
  2. Being transparent and truthful
  3. Conveying motive beyond self-interest

Why Bolstering Trust in Journalism Could Help Strengthen Trust in Medicine. Written by Vineet M. Arora, MD, MAPP; David Rousseau, MPH, and Gary Schwitzer.

3 Ways to ↑ Trust in Medical Journalism

The interconnected relationship between medicine, journalism and patients relies on a solid foundation of trust that must be nurtured.

Health care leaders identified three ways to repair trust in medicine and journalism:

  1. Engage with high-quality local news outlets
  2. Amplify examples of high-quality journalism
  3. Correct inaccurate stories

Trust Between Teachers and Learners. Written by David P. Sklar, MD, and Graham T. McMahon, MD, MMSc.

3 Ways to ↑ Trust Between Teachers & Learners

The dynamic relationships between teachers and learners require a two-way exchange of trust to have successful outcomes. Health care leaders identified three elements for establishing trust:

  1. Teachers must relinquish some control
  2. Learners must be engaged and appreciate their teachers
  3. Both must exhibit humility, openness and interest in a shared goal

Trust Between Health Care and Community Organizations. Written by Soma Stout, MD, MS; Lisa A. Simpson, MB, BCh, MPH, FFAP; and Prabhjot Singh, MD, PhD.

3 Ways to ↑ Trust Between Health Care & Community Organizations

Health care organizations that partner with communities must establish and sustain trust to achieve better outcomes. Health care leaders identified three pillars for trustworthy collaboration:

  1. Understanding the organization’s values, biases, interests and priorities
  2. Sharing expectations and identifying commonalities
  3. Developing a shared vision and plan with agreed outcomes

Building Trust in Health Systems to Eliminate Health Disparities. Written by Donald E. Wesson, MD, MBA; Catherine R. Lucey, MD, and Lisa A. Cooper, MD, MPH.

5 Strategies to ↑ Trust: Tackle Health Disparities

Health systems must eliminate health disparities to promote trust and collaboration with the communities they serve. Health care experts suggested five strategies for health systems to address disparities in order to build trusting relationship:

  1. Develop health-focused community relationships
  2. Establish institutional commitments to address health disparities
  3. Collaborate with community partners as equals
  4. Measure and share progress toward agreed goals
  5. Ensure community interactions are respectful and monitored

Promoting Trust Between Patients and Physicians in the Era of Artificial Intelligence. Written by Shantanu Nundy, MD, MBA; Tara Montgomery, BA; Robert M. Wachter, MD.

3 Ways to ↑ Trust in the Era of AI: Patients & Physicians

Integrating artificial intelligence (AI) with health care creates opportunities for physicians to establish a deeper level of trust with patients. Health care leaders identified three ways in which AI can contribute to higher levels of patient-physician trust:

  1. Expanding physician expertise
  2. Creating more time for meaningful discussion and counsel
  3. Providing insight into the evidence behind clinical decisions

Building Trust in Health Care—Why, Where, and How. Written by Dhruv Khullar, MD, MPP.

4 Ways to ↑ Trust in Health Care

Since January, the ABIM Foundation and the authors of 12 JAMA Viewpoint articles have examined trust in health care from diverse perspectives. Their writings conclude that high-quality, in-person interactions among patients, clinicians, health system leaders, payers, policymakers and many more can contribute to building trust. The authors identified four common principles to build trust:

  1. Facilitate consistent relationship-building interactions
  2. Listen with humility
  3. Align incentives among stakeholders
  4. Organize around the rule, not the exception to it