It's a sign of the times that the Harvard School of Public Health this month sponsored a leadership symposium in Boston on trust and healthcare.
As David Shore, a Harvard healthcare marketing authority and co-chair of the conference, noted in his opening remarks, the level of trust in the industry has dipped to a possibly critical level. Nurses distrust doctors. Doctors hate insurers and HMOs. Doctors resent hospitals. Drug companies are widely perceived as greedy and insensitive. Patients, meanwhile, are terrified by reports on medical errors and sometimes driven into bankruptcy by medical bills. Just as in a bear market all news is perceived as bad, a "tipping point" toward a similar malaise has arrived in healthcare, Shore argued.
"We're not really in the healthcare business," Shore said. "We're in the trust business-a business the public doesn't have a great deal of trust around."
One Harvard political scientist speculated that healthcare's decline on the trust scale is a symptom of a broad public skepticism of all institutions, including government, business, religion and the news media. As we move further away from an agrarian society based on family and community ties, a more educated and individualistic public feels less attachment to traditional institutions. Although there is not much healthcare providers can do to counter a global erosion of institutional trust, some speakers offered some practical tips. One of them, quality-improvement guru Donald Berwick, M.D., asserted "results make trust. ... Improving care is the short circuit to that."
Robert Blendon, a public opinion expert at the Harvard School of Public Health, suggested that all executives-healthcare included-should develop better leadership and public relations savvy. He recalled that many institutions have incurred a world of trouble when they were perceived as violating fundamental values. For example, the savings and loan scandal of the late 1980s frightened consumers, who thought their money was safe in financial institutions. Stories emerged about government regulators and politicians aiding crooks or turning a blind eye toward malfeasance. Even though only a small number of savings and loan customers were affected, the public was incensed and that led to new regulations for banks as well as savings and loans.
When the public turns against an industry for callousness demonstrated in even just a small number of events, Blendon said, you can expect more regulation, larger jury verdicts and more pressure to deny government money to that industry when times are tight.
He advised executives never to do anything that might be seen as helping or condoning harm to the public. Ask yourself, he said, "How would this look if I had to see this decision on `60 Minutes?' "
Healthcare has a tin ear on public opinion. The medical errors issue is a prime example. After a Chicago newspaper published a series on such errors, one hospital featured in the stories took legal action to try to silence plaintiffs who talked to reporters after settlement of their cases. The hospital later retracted the suit, but the damage was done: It painted itself as being more concerned about image than patients.
The industry wants to police itself on quality, but the prime institution for doing that, the Joint Commission on Accreditation of Healthcare Organizations, has earned a reputation as a toothless, inefficient watchdog and a pawn of the medical establishment.
Berwick noted that the American Hospital Association has not embraced all the proposals of the Institute of Medicine. He sympathized with the hospital lobby's dilemma: It's hard to argue that hospitals need more money to heal people when some of their actions are killing patients.
Maybe so, but it's not impossible. Getting out in front of an issue instead of tolerating what most people find morally intolerable constitutes the difference, as Blendon pointed out, between short-term management and real leadership.