Author: Building Trust

Over the past 50 years, trust in the health care sector has measurably declined, particularly in communities of color. But trust between patients and clinicians, between clinicians and the health care organizations where they work, and between communities and their health care organizations is essential for optimal health.

This conversation explored a blueprint for how health care organizations can build and strengthen trust, including acknowledging historical harms.

Speakers:

• Kedar Mate, MD, is President and Chief Executive Officer at the Institute for Healthcare Improvement (IHI), President of the IHI Lucian Leape Institute, and a member of the faculty at Weill Cornell Medical College. His scholarly work has focused on health system design, health care quality, strategies for achieving large-scale change, and approaches to improving value. Previously Dr. Mate worked at Partners In Health, the World Health Organization, Brigham and Women’s Hospital, and served as IHI’s Chief Innovation and Education Officer. He has published numerous peer-reviewed articles, book chapters, and white papers and has received multiple honors, including serving as a Soros Fellow, Fulbright Specialist, Zetema Panelist, and an Aspen Institute Health Innovators Fellow. Dr. Mate graduated from Brown University with a degree in American History and from Harvard Medical School with a medical degree.
• Dawn Johnson, MSN, RN is CEO and founder of DHJ Services. She has more than 25 years of experience in healthcare with a special focus on vulnerable populations, health policy and public-private partnerships. Johnson’s professional experience includes more than ten years of management consulting with health systems, payers, providers and government agencies on managing care for populations, developing and implementing performance improvement strategies, government relations, and interpreting health policy for market viability, operations and business development. Her background and experience in nursing allows her to apply an understanding that the health and well-being of individuals and populations are deeply rooted in their exposure to and experience in their community and the condition of their environment. Johnson’s fourteen-year federal career spans agencies that includes the Veterans Affairs and the Centers for Medicare & Medicaid Services (CMS).

Most of the existing literature on trust between patients and clinicians focuses on whether patients trust their care team – but what happens when clinicians don’t trust patients? Diminished relationships, less-than-ideal care, and professional burnout are just a few implications of these scenarios. And although there are differential power dynamics, the nature of trust in the patient-clinician relationship is reciprocal. Each version of trust informs the other, and both are necessary for a successful partnership.

This conversation with Rachel Grob, MA, PhD, and Tara Montgomery explored different facets of the patient-clinician relationship and possible approaches to build trust to improve quality and safety of care, patient health outcomes, and the overall patient experience.

Rachel Grob, MA, PhD, directs the Qualitative and Health Experiences Research (Q-HER) lab in the University of Wisconsin’s Department of Family Medicine and Community Health and in association with its Center for Patient Partnerships. She is also Chair Emeritus of the US Health Experiences Research Network, and Chair of DIPEx International. She is a sociologist whose career, both inside and outside academia, has been devoted to involving patients in the discourse, policy processes and institutional arrangements that impact their health care. Rachel has conducted research about patients’ experiences on a wide array of topics, her work has been supported by numerous funders including Robert Wood Johnson, the National Cancer Institute, and AHRQ.

Tara Montgomery is an EMCC-accredited executive coach and founder of Civic Health Partners, an independent consulting practice that works with purpose-driven organizations to develop trustworthy public engagement strategies and leadership practices. Her academic research on the role of trust in the US leadership response to COVID-19 informs her approach to galvanizing more trustworthy systems leaders. Tara previously spent 14 years with Consumer Reports, where she championed patient advocacy and public education campaigns and partnered with the ABIM Foundation on the launch of Choosing Wisely. Tara serves on the Board of Directors of the American Board of Medical Specialties. She is an Executive in Residence at the Saïd Business School at the University of Oxford, where she collaborates with the Skoll Centre for Social Entrepreneurship, facilitates workshops for MBA students on impact leadership, and contributes practitioner insights to graduate and executive programs in healthcare leadership.

Organizations that directly face health equity as an explicit goal are on the critical path toward demonstrating trustworthiness to the communities they serve, but only a few have made the commitment.

This conversation explores a roadmap that health care organizations should take to build trust and improve equity in health care. Speakers share examples of specific, measurable actions and policies that organizations are currently undertaking to dismantle bias and discrimination in health care and provide guidance for undertaking this work at your institution.

Sachin (pronounced SUCH-in) H. Jain, MD, MBA, is CEO of SCAN Group and SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans, which serves more than 285,000 members across California, Nevada, Arizona and Texas. From 2015-2020, Dr. Jain was President and CEO of CareMore Health and Aspire Health, innovative care delivery systems with more than $1.6B in revenues, which serve 200,000 Medicare and Medicaid patients in 32 states. He also served as Chief Medical Information & Innovation Officer at Merck & Co. and was Senior Advisor to the Administrator of the Centers for Medicare & Medicaid Services (CMS). Dr. Jain was the first Acting Deputy Director for policy and programs at the Center for Medicare and Medicaid Innovation (CMMI). Dr. Jain graduated magna cum laude from Harvard College with a BA in government and earned his MD from Harvard Medical School and MBA from Harvard Business School. Dr. Jain is Adjunct Professor at the Stanford University School of Medicine. A widely read Forbes columnist, he has been recognized by Modern Healthcare as one of the “100 Most Influential People in US Healthcare.” LinkedIn named him its top voice for healthcare industry-related content.

Ronald Wyatt, MD, is an internationally known patient safety expert and health equity expert, and the founder and CEO of Acieving Equity LLC. Previously, Dr. Wyatt was a Vice President and Patient Safety Officer with MCIC Vermont, a major medical malpractice company. He was born in Selma, Alabama and grew up in nearby Perry County (Heiberger) Alabama. As a child, his family relied on public health clinics for practitioner in Greensboro, Alabama whose office was segregated by race. Black people were walk-in only. Prior to joining MCIC Vermont, Dr. Wyatt was Chief Quality and Patient Safety Officer at Cook County Health in Chicago and the first Patient Safety Officer at the Joint Commission. He co-chairs the Institute for Healthcare Improvement (IHI) Equity Advisory Group and is faculty for the IHI Pursuing Equity Initiative. Dr. Wyatt holds an honorary Doctor of Medical Sciences from the Morehouse School of Medicine and is a graduate of the University of Alabama Birmingham School of Medicine. He was chief resident in Internal Medicine at St. Louis University School of Medicine, where he was the first Black American Chief resident in the history of the Saint Louis University System.

Created to fill a gap for Spanish-speaking communities during the COVID-19 pandemic, Factchequeado is slowing the spread of Spanish-language medical mis- and disinformation in the U.S. by generating original, factual content that responds to false claims circulating in Spanish-speaking communities.

This conversation examines Hispanic Americans’ historical mistrust in the health care system and the effectiveness of fact checking, how Factchequeado is forming alliances with local and national media to reach the “hard-to-reach,” and how the initiative is harnessing the power of social media to find and correct misinformation.

Clara Jiménez Cruz is the co-founder of Factchequeado and CEO of Maldita.es, a Spanish foundation and nonprofit news organization created to fight disinformation and lies in public discourse through fact-checking and data journalism. After a decade-long career as a TV journalist, Clara, who works regularly with national media organizations in Spain, was appointed to the High Level Group against Disinformation by the European Commission and is a current member of the International Fact-Checking Network Advisory Board. Among other recognitions, she has been awarded a 2019 Ashoka Fellowship and was named Spanish Young Journalist of the Year in 2020.

Laura Zommer is the co-founder of Factchequeado and general director of Chequeado, the first fact-checking organization in Argentina, Latin America, and the Global South. She is also the creator of LatamChequea, the largest regional fact-checking network, which brings together more than 30 media organizations across 15 countries to fight disinformation and lies in public discourse. She is a Knight ICJF Fellow, a board member for SembraMedia and La Silla Vacía (Colombia) and also a member of the advisory board for the International Fact-Checking Network (IFCN) and Género & Numero in Brazil. For her work as a journalist, she has received more than half a dozen awards, including the Gabriel García Márquez Award in the “Innovation” category from the Fundación Nuevo Periodismo Iberoamericana (FNPI).

While medical mis- and disinformation about numerous health topics have long run rampant online, the dissemination of misleading information during the COVID-19 pandemic was unprecedented, leading to vaccine avoidance, mask refusal, and the use of unfounded medications.

This conversation explores how medical misinformation is impacting the physician community and making it harder for clinicians to build trust with their patients and colleagues. The speakers offer ways for clinicians to have conversations about misinformation in the exam room and online, as well as provide resources and suggestions for clinicians that want to play an active role in mitigating misinformation on social media.

Hussain Lalani, MD, MPH, is a board-certified internist and fellow at Brigham and Women’s Hospital and Harvard Medical School. His research focuses on understanding the challenges and inequities patients face in accessing affordable prescription drugs and evaluating the impact of health policies and interventions. Hussain is a first-generation Muslim-American from Dallas, TX, who trained in medicine at Duke University School of Medicine and public health at the Johns Hopkins Bloomberg School of Public Health. He completed his residency in Internal Medicine at UT Southwestern Medical Center and Parkland Hospital. His research has been published broadly, including in the Annals of Internal Medicine and JAMA Internal Medicine, and he is a frequent opinion contributor on health policy, public health, and health misinformation. He serves on the National Steering Committee of Doctors for America’s Drug Affordability Action Team, and is the Co-Founder of #ThisIsOurShot and VacunateYa, national grassroots organizations that combat misinformation and elevate the voices of trusted medical professionals on social media.

David Scales, MPhil, MD, PhD, is an internal medicine hospitalist and medical sociologist at Weill Cornell Medicine and Chief Medical Officer at Critica, an NGO focused on building scientific literacy. His dissertation examined how the World Health Organization seeks to control the spread of diseases across international borders. His post-doc was at HealthMap.org at Harvard Medical School in spatial epidemiology, using non-traditional sources for epidemic disease detection. He completed a primary care Internal Medicine residency at Cambridge Health Alliance. His research focuses on medical communication in clinical and online settings with his current research focus on understanding how to address misinformation within communities as well as how structural factors affect our information environments to allow misinformation to propagate and misconceptions to persist. Dr. Scales’ work leverages qualitative and quantitative methods to the problem of misinformation, training “infodemiologists” to build COVID-19 vaccine confidence in online communities with community-oriented motivational interviewing. He has also written about applying models of epidemic disease surveillance and response as a guide to the problem of misinformation.

The COVID-19 pandemic has generated an unprecedented spread of medical misinformation, exacerbated by the overwhelming amount of information accessible on social media which can make it difficult for the public to discern what’s trustworthy and what’s not. Vineet Arora, MD, MPP, dean for medical education at The University of Chicago Pritzker School of Medicine, has seen first-hand the dangers that medical misinformation can cause – including foregoing life-saving tests and treatments – and is preparing future clinicians to build trusting relationships with patients in order to help dispel misinformation.

Dr. Arora, along with two UChicago medical students – Naomi Tesema and Maeson Zietowski – shared their personal experiences with medical misinformation and discuss the ways that a newly-created science communications course (funded by AAMC through a CDC grant) is teaching enrollees how to harness the power of storytelling to decrease the spread of misinformation.

Over the past few years, UC Davis Health has created new community partnerships to build trust through reducing disparities across its care settings, improving health outcomes for its patients, and increasing access for community members to much-needed social services.

Reshma Gupta, MD, and Hendry Ton, MD, shared how UC Davis Health engages with local stakeholders, addresses historical distrust between the health system and its patients, and creates best practices for staff to build a better care model.

In 2017, Dell Medical School at the University of Texas at Austin and Costs of Care Inc., in partnership with the ABIM Foundation and the Josiah Macy Jr. Foundation, created the Choosing Wisely STARS program to catalyze grassroots, student-led initiatives to advance health care value in medical education. Based on a model developed in Canada, the program, which began with a cohort of 50 first-year medical students from 25 medical schools across the U.S., has grown to include more than 500 medical students from more than 50 medical schools.  

Now the STARS program is expanding to include an explicit focus on trust, with an emphasis on the role of trust in conversations and efforts to reduce overuse. Program directors are in the process of defining learning objectives related to building trust in health care, with the goal of introducing curricular components to the STARS program that aim to achieve these learning objectives. Medical students will also be encouraged to lead or participate in initiatives that contribute to advancing the Building Trust initiative.

In spring 2020, The Johns Hopkins Hospital’s medical intensive care unit (MICU) and Chaplain Elizabeth Tracey quickly realized that her colleagues were having a difficult time connecting with patients, and patients with their care providers, and devised a way for MICU clinicians to learn more about their patients in order to better treat them – through short audio interviews with family members. This Is My Story (TIMS) has since expanded beyond its COVID-19 origins and is being replicated at hospital systems across the country.

Chaplain Elizabeth Tracey, director of Johns Hopkins Health NewsFeed, and Richard J. Baron, MD, MACP, president and CEO of the American Board of Internal Medicine and ABIM Foundation, discussed how the two-minute connection provided by TIMS is building trust by giving care teams a humanizing window into the lives of patients who often can’t speak for themselves.

Additional Resources:

• An Introduction to a Novel Intervention, “This is My Story”, to Support Interdisciplinary Medical Teams Delivering Care to Non-Communicative Patients
• An ICU Expansion of a Novel Chaplain Intervention, “This is My Story,” to Support Interdisciplinary Medical Teams Delivering Care to Non-Communicative Patients in an Academic Medical Center Patients
• Review: This Is My Story
• Watch: Right Here Right Now-Solutions: Telling Stories About Patients as People
• Watch: TIMS “How To”

On March 25, 2022, former Vanderbilt University Medical Center nurse RaDonda Vaught was found guilty of criminal negligent homicide and abuse of an impaired adult for her role in the death of 75-year-old patient Charlene Murphey. The trial – a rare example of a health professional facing prison for a medical error that happened as a result of many contributing systems factors – was closely watched by clinicians, hospital staff, and patient safety advocates.

Patients, families, and the public must be able to trust that organizations providing care, and the oversight organizations that protect the public, are doing their jobs and can be held accountable. In addition, those who provide care must be able to feel safe to speak up and report mistakes (as is their professional ethical responsibility) to guide improvements that reduce harm.

Members of the Institute for Healthcare Improvement Lucian Leape Institute, Julianne M. Morath, BSN, MS, CPPS, an advisor and leadership coach in quality and patient safety; Susan Sheridan, MIM, MBA, DHL, a founding member of Patients for Patient Safety; and Susan Edgman-Levitan, PA, Executive Director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, spoke about this loss of trust from various perspectives.