May 19, 2021
A vast trove of news articles and academic publications describe the earned distrust of historically marginalized populations in our health care system. However, we have a much smaller supply of suggestions for building trustworthiness in health and addressing the structural racism that is largely responsible for health inequities in the United States.
As part of the ABIM Foundation’s Building Trust initiative, we are asking a wide range of organizations to describe the practices and actions they employ to promote trustworthiness in relationships of all types. There is a growing cadre of organizations that are interested in using trust as an intentional strategy to improve performance. These organizations include health care systems and hospitals, medical groups, certifying boards, specialty societies, health plans, employers, consumer groups and others, and they are joining the initiative. One example comes from UnityPoint Health in Iowa, which addressed the needs of the LGBTQ community by opening a clinic to provide a safe and welcoming space. Other practices are described on the Building Trust website from over 50 health care organizations.
I have been thinking and reading the literature about the drivers of trustworthiness in health care that underpin these actions and practices. I’ve relied on the writing and thinking of—and conversations with—Jessica Greene from Baruch College/CCNY, Jennifer Stephens from America’s Essential Hospitals and Consuelo Wilkins, MD from Vanderbilt. A common definition of trust centers on vulnerability and the need to care for the vulnerable patient. I’ve used this definition to begin constructing drivers of trust around four “Cs.”
Competency: Your organization delivers services competently, reliably and consistently, delivering on what you promised.
Caring: Your actions demonstrate that you “care about me” and that you have compassion and empathy for me as a person.
Communication: Your communication shows me that you know me, respect me and humanize me.
Comfort: Your organization makes me feel safe, you treat me fairly, and I feel a sense of belonging.
Looking through the lens of building trust, we can consider how the four Cs relate to UnityPoint’s LBGTQ Clinic.
UnityPoint’s leadership describes the clinic as follows:
“There is special focus given to the interactions and communication among all team members in the practice. The success of the care experience in our clinic is dependent on everyone’s willingness to function in a coordinated and efficient way with each person fully invested in their role on the team. Patients express how much it means to have someone within health care make it safe for them to live authentically, and often state that they have started to care about themselves again. The key practice elements include compassion, multi-disciplinary teamwork, robust huddles, story-telling, and person-centered care.”
The clinic enhanced clinicians’ knowledge of psychological and physiological issues of importance to the transgender community, improving their competency. The emphasis on the coordination of the team increased the reliability and consistency of their service delivery.
Setting up a specially designed clinic sent a message to the community that UnityPoint truly and authentically cared about them and showed them compassion. The clinicians’ reflective practice built into their daily work, which increased their compassion.
Clinicians and staff also received training about the proper use of pronouns. Their communication spoke to knowing their patients, appreciating their humanness and respecting them.
The clinic became a safe space for patients to receive care, be treated fairly and have a sense of belonging – key features of comfort that marginalized populations have long deserved, but have not historically experienced.
The ABIM Foundation invites organizations to learn more about our Trust Practices Network and submit practices that promote trust. We aim to promote trustworthiness in all relationships in health care as a means to achieve excellence in the health care system. This community will collaborate with others across health care to better understand the many facets of increasing trust. As we continue this journey, we welcome your thoughts about other trustworthiness drivers, and hope that you’ll join us.
Please visit our website www.buildingtrust.org to learn more.