Author: Treston Codrington & Matt Leighninger

COVID-19 has exposed many frailties in the American health system but has it done some good for Americans’ attitude towards it? A recent Gallup poll shows that over 90% of Americans approve of health care providers’ handling of the COVID-19 response. With daily evening cheers and other signs of enthusiastic support, Americans’ support for health care professionals may be at an all-time high. While Americans may praise the efforts of individual caregivers amidst the pandemic, we know from survey research that Americans’ trust in the health care system has been eroding for many years. If we hope to maintain this newfound appreciation for health care providers, we must take a good look at our system and how we can create an environment conducive to trust.

The ABIM Foundation’s Building Trust initiative seeks to elevate the importance of trust as an essential organizing principle to guide operations and improvements in health care. To support the initiative, Public Agenda has conducted interviews with several consumer and patient experts and advocates about opportunities they see for advancing trust in health care. This will provide the initiative with actions and practices that promote patient trust in their clinicians and the health care system.

One theme that has emerged so far in the interviews is the importance of ensuring that health care facilities are truly accessible. It is hard to trust someone if they don’t devote effort to making their space accommodating to you. Maya Sabatello LLB, PhD, Assistant Professor of Clinical Bioethics in the Department of Psychiatry at Columbia University College of Physicians and Surgeons with decades of experience as a disability rights advocate and scholar says that we need to confront our “generalization of needs” concerning accessibility. “The ramp isn’t enough,” she says. “It doesn’t help a deaf person. Think about the postings in medical institutions. They rarely include braille.” These physical barriers can make patients with disabilities feel unwelcome and reinforce the exclusion they may experience from society at large.

Another theme that has emerged is the need to not only remove physical barriers but actively create welcoming spaces for marginalized patients. Kellan Baker, MPH, MA is the Centennial Scholar in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. As a transgender man, he can attest to the pervasive discrimination that LGBTQ people, especially transgender people face, even in health care settings. “Even if people aren’t overtly experiencing discrimination, they are still guarded.” Baker says that to create trust, robust nondiscrimination policies must be created and prominently displayed in the waiting room area. He also noted the need for respectful and inclusive data collection in healthcare settings about patients’ sexual orientation and gender identity. Health care staff must also know how their behavior creates either a welcoming or hostile environment. “Cultural competency training [must] be made available not only to providers, but to all staff who patients may interact with.”

Over the coming months, the ABIM Foundation, Public Agenda, and the National Patient Advocate Foundation will be diving deeper into this question of what it takes to build sustained trust in the health care system from the perspective of patients, consumers and caregivers. To inform this work, we’ll be talking with many other stakeholders about what’s working all over the country and what people want to try. As we step into an uncertain future with COVID-19, this knowledge can help us meet the challenges of the pandemic and understand how to seize the opportunities to build greater trust.

Treston Codrington is the Public Engagement Associate at Public Agenda. He is a writer, community organizer, and proud native of Brooklyn, New York. With a wealth of local and international engagement experience, his goal is to bridge the divide between communities, scientists, and policy-makers and help facilitate co-productive processes with these stakeholders to improve our world.

Matt Leighninger leads Public Agenda’s work in public engagement and democratic governance and directs the Yankelovich Center for Public Judgment. Matt is a Senior Associate for Everyday Democracy and serves on the boards of E-Democracy.Org, the Participatory Budgeting Project, the International Association for Public Participation (IAP2USA), and The Democracy Imperative. In the last two years, Matt developed a new tool, Text, Talk, and Act, that combined online and face-to-face participation as part of President Obama’s National Dialogue on Mental Health. He is author of The Next Form of Democracy (2006) and co-author of Public Participation in 21st Century Democracy with Tina Nabatchi.