Author: Building Trust

With decades of experience in government, academia, and hospital medicine, Dr. Lisa Fitzpatrick has witnessed the profound impact of mistrust and miscommunication in health care, particularly among Black Americans, who often face higher levels of earned mistrust and inequitable health outcomes.

Through her “Dr. Lisa on the Street” interview series, she was able to speak directly to community members to demystify health information and empower patients to make more informed health decisions.

Now at Grapevine Health, she continues to champion health literacy through accessible, engaging content that fosters trust between patients and the health care system.

During this one-hour webinar, we discussed the ongoing challenges of misinformation and highlighted both proven and innovative approaches to reduce its impact on public health. Panelists discussed their work in addressing misinformation, the psychological mechanisms driving science denial, and explored how centering equity and community can strengthen our collective efforts to mitigate the harms of misinformation.

Despite the well-documented benefits of a diverse clinician workforce—including improved patient care and stronger clinician-patient relationships—academic medical centers continue to experience the departure of Black and brown physicians, faculty, and staff. This exodus is driven by systemic issues such as insufficient support and mentorship, limited opportunities for career advancement, and a lack of genuine investment in resources to achieve diversity objectives. The loss of bedside clinicians not only impacts patient care but also places an additional burden on those who leave, depriving the next generation of clinicians of mentorship from those with shared backgrounds.

During this webinar, we will explored the role that trust plays in fostering better workplace cultures, examined the underlying factors driving this attrition of Black and brown leaders in academic medicine, and discussed actionable strategies to create supportive environments where leaders and clinicians can thrive.

We discussed trustworthiness in health care and honored the tenure of Richard Baron, MD, MACP, whose stewardship at the American Board of Internal Medicine (ABIM) and the ABIM Foundation has been defined by a deep commitment to fostering trust among patients, clinicians, and health care institutions.

During this special webinar, we explored the impact of initiatives like Building Trust and Choosing Wisely and discussed Dr. Baron’s vision for cultivating trustworthiness at all levels of health care. From his roots in community practice to influential leadership roles, we uncovered the strategies and insights that propelled the ABIM Foundation’s trust-building efforts forward.

While more than 90% of the US population is covered by some form of health insurance, medical debt remains a persistent problem. For families with limited wealth, even a small unexpected medical expense can quickly become financially overwhelming. The evolution of medical debt into a multibillion-dollar industry raises critical questions: When and why did this transformation occur, and how has it impacted the once sacred clinician-patient relationship?

This conversation will transcend the immediate financial strain that medical debt imposes on families, delving into historical perspectives, examining aggressive debt collection tactics, and exploring medical debt’s impact on the erosion of trust within the healthcare system. 

Trust at multiple levels – between patients and clinicians, between those within a system that must collaborate to create high-quality care, and between communities and their health care institutions and systems – is essential for optimal functioning of the health care system. But, over the past 50+ years, this trust has measurably declined.

In response, the ABIM Foundation partnered with the Institute for Healthcare Improvement (IHI) to lead an initiative aimed at understanding and enhancing trust within health care systems. In 2022, this partnership embarked on a journey to develop a theory of change and intervention strategies to bolster trust, and in 2023, six health care systems from across the US piloted these strategies, focusing on acknowledging historical harms, addressing current trust gaps, and implementing systemic improvements.

Margaret Flinter, APRN, PhD, FAAN, FAANP, senior vice president and clinical director of the Moses Weitzman Health System and its Community Health Center, Inc., Nancy Oriol, MD, faculty associate dean for community engagement in medical education at Harvard Medical School, and Harvard Medical School students Tyler LeComer and William Zhuo-Ming Li, spoke about how mobile health clinics, like The Family Van, are addressing the challenge of providing high-quality, accessible health care while also fostering invaluable community engagement.

• Community Health and Patient-Centered Engagement: Mobile health clinics foster trust and deliver tailored care to diverse communities. They adapt to evolving needs and enhance health care accessibility.
• Personalized Care and Community Outreach: Personalized interactions are key in health care delivery. Understanding patients’ backgrounds, languages, and cultures is essential for effective outreach.
• Trust Building and Equitable Health Care: Mobile health clinics bridge gaps between communities and health care systems. Health care professionals must understand and honor community intricacies. Shared responsibility and partnership with community leaders are vital.
• Human-Centric Medicine and AI Integration: Human interaction is irreplaceable in medicine. AI tools must complement, not replace, human empathy and nuance. Continuous dialogue and active listening are essential. seizing opportune moments is crucial for community medical education.

Susan Edgman-Levitan, PA, the executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, and Mike Woodruff, MD, an emergency medicine physician and senior medical advisor for Fidelum Health, discussed strategies to support team member safety and well-being, and offered insights on how to collaboratively enhance the overall quality of patient care and elevate the patient experience.

• Patient-Centered Care and Psychological Safety: Open communication and psychological safety are imperative for improved patient outcomes. Prioritizing patient-centered care and involving clinicians in shaping narratives are essential.
• Leadership, Psychological Safety, and Trust Building: Leadership thrives on psychological safety, emphasizing curiosity, vulnerability, and human factors design. Genuine apologies, deep listening, and co-creation of action plans rebuild trust effectively.
• Trauma-Informed Care: It is crucial to offer trauma-informed care training to all staff and apply social and psychological learnings to elevate care delivery. Additionally, a mindful approach to providing support for health care professionals during challenging events is essential.
• Healthcare’s Emotional, Tech, and Financial Future: The emotional and technological future of health care involves patient-specific data analysis, transparency in health care costs, and empowering patients to ask difficult questions.

Ruth Landé and Noam Levey shared their experiences and insights with Richard Baron, MD regarding medical debt, highlighting the widespread nature of the problem and its effects on individuals and communities.

• Role of hospitals: Hospitals can build trust or destroy it depending on their approach to billing and debt collection.
• Scope of medical debt: Medical debt is widespread and takes various forms, including credit card debt and payment plans.
• Debt collection practices: Outside vendors often collect medical debts, leading to confusion and mistrust.
• Financial assistance: Financial assistance programs should be simplified and standardized to prevent medical debt.
• Insurance and providers: Insurance companies and providers play a role in medical debt and should be held accountable.

They also emphasized the need for policy changes and better communication between health care providers and patients to address this issue.

Additional resources:

• 100 Million People in America Are Saddled With Health Care Debt (KFF Health News)
• Trapped: America’s Crippling Medical Debt Crisis (RIP Medical Debt)
• Debt Collection in American Medicine — A History (NEJM)
• Preventing Medical Debt From Disrupting Health and Financial Health – Recommendations for Hospitals and Health Systems (Financial Health Network)

The COVID-19 pandemic brought unprecedented challenges to the US health care system that created ethical tensions among clinicians, leaders, health care organizations, and the public. Those tensions ultimately resulted in broken trust – a foundation for ethical practice – across the system, and symptoms of moral suffering, burnout, workplace violence, and alarming shortages of health care workers.

This conversation explored the complexities of health care in the aftermath of the pandemic, its effects on communities and the people delivering care, and provided a roadmap for health care leaders to restore a foundation of trust.

Cynda H. Rushton, PHD, MSN, BSN, RN, is the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins Berman Institute of Bioethics and the School of Nursing, and co-chairs the Johns Hopkins Hospital’s Ethics Committee and Consultation Service. A founding member of the Berman Institute, she co-led the first National Nursing Ethics Summit that produced a Blueprint for 21st Century Nursing Ethics. In 2016, she co-led a national collaborative State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing and co-chaired the American Nurses Association professional issues panel that created A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice.

Cynda is the chief synergy strategist for Maryland’s R3 Resilient Nurses Initiative, a statewide initiative to build resilience and ethical practice in nursing students and novice nurses. She is co-creator of the Mindful Ethical Practice and Resilience Academy (MEPRA). She serves on the Nursing Advisory Board for Corporate Counseling Associates. Cynda is a Hastings Center Fellow, Past-Chair of the Hastings Center Fellows Council, and Trustee Emeritus and a Fellow of the American Academy of Nursing. The recipient of many awards, she received the Marguerite Rodgers Kinney Distinguished Career Award and the Distinguished Researcher award from American Association of Critical Care Nurses. She is the editor and author of Moral Resilience: Transforming Moral Suffering in Healthcare and co-creator of the Rushton Moral Resilience Scale (RMRS).

Jessica Perlo, MPH, is the Executive Vice President of the ABIM Foundation, a nonprofit focused on advancing medical professionalism and clinician leadership to improve the health care system. Jessica is an expert in workforce well-being, quality, and safety and teaches and coaches around the globe, building individual and organizational capability for improvement and well-being, and has authored publications on these topics.