People who are more trusting of their healthcare providers tend to have better health outcomes and better quality of life. They also tend to be more satisfied with their care. Yet in the U.S., trust in medical professionals has eroded over the last 50 years. Black Americans tend to be less trusting of both physicians and hospitals than white or Latino Americans, while lower-income people tend to be less trusting of providers than their higher-income peers.
Efforts to build trust often focus only on patients’ trust in doctors. But a 2020 survey found that primary-care doctors recognize that they also need to trust their patients in order to provide them with high-quality care. Doctors and other clinicians need to trust patients for a variety of reasons, including to provide information about symptoms, participate in decisions, and adhere to treatment plans. Yet only half of people with Medicaid think their primary-care doctors trust them as much as they trust people with other types of insurance coverage. An analysis of doctors’ written notes shows that they more often express mistrust of their Black patients than white patients.
While the work needed to foster trust is challenging, the payoff is worth it. Research shows trust improves health outcomes and results in higher patient satisfaction; lack of trust increases physician burnout and costs. Healthcare leaders have an opportunity to lead the charge in building trust, not just with patients and families, but also with clinicians, community partners and payers. To make progress on building mutual trust with patients and families, health system leadership can consider four strategies:
- Prioritize building mutual trust in clinical education. Training clinicians to be aware of biases and build trust with patients and each other can prepare them to create long-term, healthy relationships with patients, families and colleagues. The goal of such training is for leaders to model and support culture change within organizations, and might include topics like how to write notes that do not use stigmatizing language in patients’ medical records and how to avoid unconsciously stigmatizing patients with Medicaid or who are lower-income. Experimenting with and sharing trust-building practices can foster a culture of trust and learning across healthcare organizations.
- Embrace OpenNotes to model mutual trust. Leaders who embrace programs like OpenNotes, which allows healthcare providers to share clinical visit notes with patients and caregivers, can demonstrate their trust in patients in writing. While some providers are hesitant to share medical records with patients, allowing patients access to some notes is now required under federal rules. Stigmatizing language in notes can foster negative attitudes about patients among fellow physicians. Accurate notes can also help avoid safety errors.
- Measure trust in order to improve it. It is difficult to improve on something that is not being measured. Satisfaction surveys can ask patients how much they trust clinicians and, separately, how much they trust hospital systems to do what is best for them. Furthermore, asking patients how much they felt trusted by clinicians can help identify ways to improve patients’ experiences of care. The HCAHPS survey, for example, currently asks patients about whether they felt treated with courtesy and respect, but not about whether they trusted their clinicians nor about whether they felt that their clinicians trusted them.
- Build trust at every stage of the patient experience. Trust can be built or damaged at every stage of a patient’s experience. Healthcare leaders should work with patient experience and quality improvement teams to understand each step in the care journey and approach it as an opportunity to build trust. This includes not just interactions with clinicians in exam rooms or during telehealth appointments. It also includes making scheduling easy, encouraging administrative staff to always extend a warm welcome to patients, ensuring that medical records are seamlessly available to entire care teams, helping patients understand their benefits, and making it easier for care teams to follow up with patients in a timely manner about test results and next steps.
To foster mutual trust, leaders must start by listening to patients and staff to find out what damages trust and to learn from their ideas about how to build it. There are several toolkits to help leaders create strategies for building trust and resources to help them engage with patients and staff.
Approaches can be both formal and informal, such as participating in patient advisory committees, fostering stakeholder deliberation about health system decision-making, reading patients’ social media posts, participating in rounds, and getting together for meals with staff.
Hospital and health system leaders who can see problems through the eyes of patients and staff have taken the first step toward creating trusted and trusting places to work, seek treatment and heal.
