Building trust in healthcare cannot be accomplished with a checklist.
There's a plethora of research that analyzes patient-clinican trust, but two important relationships often capture less attention: The trust between healthcare organizations and their employees, and trust between healthcare organizations and the communities they treat.
In collaboration with the Institute for Healthcare Improvement, six healthcare organizations tested a three-step framework to repair, create and fortify trustworthiness through an antiracist research approach. The three steps are acknowledging past breaches of trust, closing current trust gaps and building systems to strengthen future trust.
Two healthcare leaders who led this effort — Surabhi Bhatt, health equity lead at primary care company Oak Street Health, and Elizabeth Goelz, MD, chief wellness officer of Minneapolis-based Hennepin Healthcare — said trust must be bidirectional.
"A lot of times our operational leaders were like, 'We gotta close our quality gaps, we gotta reduce our admission rates, we gotta —' but we weren't giving our front-line teams the autonomy to really do their job in the way that they were trained to do, right?" Ms. Bhatt said.
To find out what might obstruct employees from accomplishing these goals, Ms. Bhatt and Oak Street's Chief Wellness Officer Deb Edberg, MD, dedicated time to hear employees' concerns. They didn't start with questions; Ms. Bhatt and Dr. Edberg entered conversations by simply listening.
"People were so incredibly open," Ms. Bhatt told Becker's. "And to this day, I truly am honored by the level of trust that was placed in us because they knew that we were going to do something with it."
This feedback is critical, because if the loop is not closed, that "is a great way to subtly chip away at trust," Dr. Goelz said.
"I don't think any organization intends to break trust," she added, "but that's one way that it happens over time."
For example, a young Black physician told Ms. Bhatt that he often sits in his car before returning home. This practice helps him refrain from unloading residual trauma with his family.
Seventy percent of Oak Street Health's patients are people of color, according to Ms. Bhatt. For staff members with similar race or ethnic backgrounds as their patients, she said Oak Street underestimated the burden of vicarious trauma before beginning this work.
Health systems might hesitate to admit former breaches of trust out of fear of liability. Kate Hilton, an Institute for Healthcare Improvement faculty member, said this perceived danger is a misconception.
"People feel like if I admit that we did something wrong, then we'll get sued," Ms. Hilton said. "In fact, the finding is the opposite: If I admit that we did something wrong, and I apologize, we're much less likely to get sued."
Many did not want an apology for former breaches of trust, Dr. Goelz said. Rather, they often sought to be heard, seen and valued.
Based on the results, the Institute for Healthcare Improvement will provide healthcare organizations with an assessment tool to self-examine their trustworthiness in spring 2025.