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November 9, 2023
Taking on the role of Executive Vice President at the ABIM Foundation has been a tremendous honor and thus far an exciting first couple of months as I’ve delved into our focus on Building Trust. As someone deeply committed to improving health care, I couldn’t ask for a more fulfilling opportunity to contribute to a meaningful and values-driven mission. Here, I’d like to share some of the insights I’ve gained during my first 60 days on the topic of trust:
The Importance of Trust in Health Care
Patients trust health care professionals to provide them with the best possible care, and those professionals rely on trust between colleagues and institutions to deliver quality service. In fact, we know, thanks to Mark Linzer and colleagues, that clinicians who trust their organizations are trusted by their patients. However, trusting relationships have faced innumerable challenges over the years, heightened by the pandemic. These challenges arise from a myriad of causes, such as increasing complexity, rising costs, and historical instances of harm and inequity. The ABIM Foundation is centered on addressing these issues and the importance of Building Trust in achieving equitable, patient-centered, quality outcomes.
Transparency and Accountability
Transparency aids in patient trust by allowing for reliable access to accurate, understandable, and complete information about their health care. It also entails being open about the challenges we face, and navigating uncertainty about what we know and don’t know. Accountability involves taking responsibility for our actions and decisions, which can help rebuild trust when things go wrong. At the ABIM Foundation, we are dedicated to promoting transparency and accountability in medical practice through initiatives like the Choosing Wisely campaign, which encouraged clinicians and patients to engage in meaningful conversations about appropriate care. Through our partnership with the Public Good Projects, we are also seeking to get information about trends in misinformation to clinicians, along with evidence-based responses they can employ in their conversations with patients.
Workforce well-being is an often overlooked but crucial component of trust in health care. We know a healthy and motivated health care workforce is better equipped to provide high-quality patient care, but clinicians are often over-worked and under-supported. This is leading to poor outcomes, turnover, reduced patient safety, and decreased quality of care. We have work to do, but this is an ongoing focus for our work with the Institute for Healthcare Improvement on Building Trust in US health systems, and one I am particularly motivated to address.
Continuous Quality Improvement
Trust also relies on a commitment to continuous quality improvement. Health care organizations and practices must strive for excellence and demonstrate a genuine dedication to improving patient outcomes and evidence-based practice. To aid in this effort, we have worked with AcademyHealth to support a deep dive into how trust has been measured—and where the gaps in measurement remain—and we look forward to the publication of this compendium in the near future. We are also working to persuade more health systems researchers to study trust topics, and are providing them with resources such as opportunities to present and receive advice from peers about their research; our Research Community on Trust now includes more than 175 researchers, clinicians, patients, health system leaders, policymakers and funders.
Trust is a powerful catalyst for health care equity. Minority communities, the LGBTQ+ community, and people with disabilities, often have a history of health care mistrust due to discrimination and disparities. By acknowledging historical harms, systematically identifying needs, actively working to promote cultural competence, and addressing socio-economic barriers, we are beginning to learn how to build and strengthen trust — intentionally and proactively — where it had been broken or did not previously exist. You can learn more about our equity efforts and grants here.
As I reflect on my first months as Executive Vice President of the ABIM Foundation, I am deeply humbled by the work being done, and the opportunities and challenges that lie ahead in our mission to build trust in health care. I am sincerely grateful for the opportunity to learn from this ever-expanding community. You have already achieved considerable progress in advancing this work, yet there is so much more work to be done. I am excited to join you on that journey.