Building Trust One Practice at a Time

Researchers have been analyzing trust in health care for decades and developed a matrix of leading attributes that are necessary to establish trust. Three core attributes for trust and trustworthy relationships between patients and physicians are communication, competency and caring.

• Communication involves listening and providing detailed, honest explanations about prognoses and what to expect from medical treatment.
• Competency is demonstrating that you are knowledgeable, thorough and have experience in solving a particular health issue.
• Caring means showing interest in patients as individuals, valuing a patient’s personal experience and committing to resolving his or her health issues.

Such physician behaviors are integral to creating a solid foundation of trust in individual care delivery, but alone they are not enough to ensure a trustworthy health care environment. System factors must come into play as well.

At the system level, some of the core attributes that foster trust are:

• Community integration in health care practice, such as local partnerships in providing screenings, education and care for chronic conditions
• Attention to equity, by providing fair and equal care that conveys the idea that patients come before profits
• Patient engagement in care design, putting the views and preferences of patients and their caregivers at the forefront of treatment

As health care becomes increasingly corporatized, reputable leadership is also essential in setting standards, modeling accountability, and performing evaluations that offer substantive feedback intended to drive improvement, learning and growth. Additionally, leaders must cultivate trust as a key operating principle in order to create a culture that values it.

With these traits in mind, the ABIM Foundation, in partnership with other organizations, has embarked on an initiative to generate a national conversation about trust in health care. Much like our Choosing Wisely campaign to address overuse and unnecessary care, this initiative draws on the collective wisdom of the health care community.

Collectively, we have begun to ask ourselves: How can we better ensure trust in health care? What sorts of practices and approaches to health care delivery will foster trust? One way to reflect on those two questions is through the lens of starting any engagement and what outcomes are desired.

Take, for instance, at-home administration of IV medications. This requires trust on the part of both patients and physicians even before beginning. Patients must trust in the device that delivers the drug, and physicians must trust that patients will follow directions for taking the medication and caring for their PICC lines.

At other times, trust is the outcome of how we engage with others or structure programs and initiatives. For instance, the delivery of imaging results to patients by radiologists can give patients greater confidence in understanding their medical situation.

This is why fostering trust – and by extension the traits above – should be an essential operating principle in health care. Without attention to trust, it has been shown that we can expect less adherence to medical advice, lower levels of physician satisfaction and poorer health outcomes.

We have found that trust-building practices do exist in health care. Whether born of necessity or innovation, frontline physicians, health system leaders, experts in academic medicine and others are developing ways to ensure that trust is fundamental to the way they work.

Trust-building practices reflect intentional relationship building between doctors and patients, physicians and health systems, health systems and payers, medical students and professors, residents and attendings, and others. Such practices often focus on understanding another’s unique situation, supportive conversations, averting misinformation, patient-centered approaches, leadership, transparency and affordability.

When you show interest in someone’s life story, acknowledge a patient’s preferences, share in decision-making or recommend a colleague, trust can naturally gain a toehold and, with consistent encouragement, thrive. Those are just a few of the ways in which trust can be promoted.

Daniel B. Wolfson
EVP & COO, ABIM Foundation