How Trust Leads To Change

For a while now I have been thinking about the erosion of trust in our society and its effect on health care. Apparently, I’m not alone. A recent New York Times piece entitled, “Do You Trust the Medical Profession?” took on this very subject.

In health care, large shifts in quality have often depended on trustful relationships among health care stakeholders. Trust is what allows people and organizations to break through self-imposed and institutional boundaries, which leads to fresh, creative ideas. Trust can help make untenable situations feel not-so-insurmountable and new practices achievable. And, perhaps most importantly in our world, trust enables groups of stakeholders to come together around a shared goal and change things for the better.

My favorite example of how trust can be a driving force for change—perhaps because I was there—is the unlikely collaboration of the nation’s leading group practice HMOs with employers, patient groups and physicians to develop and collectively subject themselves to one of the nation’s earliest systems of quality measurement, the Healthcare Effectiveness Data and Information Set (HEDIS).

In the late 1980s, working as the Alliance of Community Health Plans, this combined group took on this incredible cooperative effort. To get there, all of the parties involved had to understand diverse viewpoints, enter into authentic, purpose-driven conversations and bring their best selves to the table—and they did. Much to the credit of the non-profit National Committee for Quality Assurance and the leadership of Margaret O’Kane, HEDIS was completed by the early 1990s and continues to provide direction, guidance and benchmarking to a multitude of health improvement efforts.

The ABIM Foundation views trusting partnerships and collaborations like that of the Alliance as the secret sauce of sustainable invention and advancement. Within a shared mission of ensuring the highest standards and outcomes in the practice of medicine and with each partner contributing their strengths, great outcomes are possible.

Such has been the case with our partnerships with medical specialty societies, patients and employers to create and grow the Choosing Wisely campaign, now in its sixth year of supporting clinicians and patients to reduce overuse and unnecessary tests and treatments in medicine.

• More than 80 specialty societies have developed lists of treatments, procedures and test that clinicians and patients should discuss.
• The Choosing Wisely grantees program, through two rounds of funding from the Robert Wood Johnson Foundation, brought together medical centers, statewide health collaboratives and medical training programs with the shared goal of creating implementation models from which others can benefit.
• Our network of partners continues to expand as organizations like the Patient-Centered Primary Care Collaborative and the American Hospital Association are looking to collaborate with us around the shared goal of engaging their members in conversations about overuse.

What we have come to understand about fruitful partnerships—and what has made our work successful—is that all parties involved share a purpose-driven goal, are clear about their own strengths and what they are prepared to deliver, and state for the record their level of commitment. Each partner must be realistic about the resources they have at their disposal to support the common goal, and there needs to be open and effective lines of communication to ensure alignment of expectations.

No partnership can plan for every detail, but with a foundation based on the principles above and a good deal of trust, almost any alliance can achieve its goals.

Daniel B. Wolfson
EVP & COO, ABIM Foundation