Strengthening Trust in Health Systems Through Transparency and Innovation
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August 13, 2024
At both the National Alliance Against Disparities in Patient Health and the Duke-Margolis Institute for Health Policy, my work has determined, and is thus guided by the notion, that trust, transparency, and a focus on embedding lived experiences in socioeconomic inequity held among patients/persons and their caregivers are crucial to build and sustain a functional and thriving system of health.
My work has taught me two critical things about addressing/navigating trustworthiness as it relates to health systems: 1) both time and making time matter to move beyond the façade of fixing long-term, complex issues with short-term, window-dressed solutions to health inequities; and 2) health system trustworthiness is linked to health systems’ willingness, ability, and capacity to collaborate with patients and communities to take real action and at times innovative steps to address the root causes of illness and health instability. Effective approaches to navigate trustworthiness issues involve ensuring that community-based organizations (CBOs) that meet the needs of patients and their caregivers within and outside of the health system are provided with sustainable funding and resources to ensure their operational needs are met. That is, health systems should move beyond simply referring patients to possibly under-resourced entities outside of the health system, leaving patients and caregivers to navigate them alone and sometimes to no avail, to instead embedding access to community-based resources into the process of delivering care. This is especially true for some of our most vulnerable patients seeking reproductive health care, and patients faced with the need to navigate an administratively complex and often broken mental health care system.
I’ve discussed in some of my latest work in Health Affairs Scholar how health care providers and payers can leverage and incentivize the use of structured clinical diagnostic coding mechanisms, like social determinants of health (SDoH) ICD-10 Z codes, to identify and offer support to patients with specific SDoH needs and circumstances. For example, medical-legal partnerships that integrate legal experts into clinical settings could assist patients and their families in their pursuits to address SDoH needs through civil legal procedures. Having actionable, patient-focused and -protective mechanisms like this in place within the health system can contribute to tangible notions of health system trustworthiness. This same virtue also applies to cases where health systems and payers leverage patient data to drive the development and implementation of, and reliance on, computerized algorithms that make batch recommendations to deny care to patients. In this case, trustworthiness can be measured based on whether health systems 1) apply those same algorithms to provide (versus deny) care, 2) offer personalized and effective alternatives to patients that are denied requested care based on those algorithms, and 3) have fast and straightforward administrative and/or legal mechanisms in place that allow patients, their caregivers, and providers to appeal such recommendations to receive timely, uninterrupted, and responsive care.
As a Trust Scholar in Residence for the ABIM Foundation/AcademyHealth Advancing Research on Trust program, my goal is to develop actionable measures of health system trustworthiness that are based on real-world use cases, like the aforementioned. Key outcomes or achievements I hope to see through my work are the development and open dissemination of health system practices that publicly ascribe to such measures.
Rachele Hendricks-Sturrup, DHSc, MSc, MA, is the Research Director of Real-World Evidence (RWE) at the Duke-Margolis Institute for Health Policy and former Chief Data Governance Officer at the National Alliance Against Disparities in Patient Health. As an Advancing Research on Trust Scholar in Residence, Dr. Hendricks-Sturrup will advise on project direction and raise visibility of the trust agenda while exploring the issue of trustworthiness as it relates to health systems by uplifting the knowledge and lived experiences of the communities they serve.
