Tag: Building Trust

PHILADELPHIA, November 1, 2021 – The Alliance for Academic Internal Medicine (AAIM), the American Board of Internal Medicine (ABIM), the ABIM Foundation, the American College of Physicians (ACP) and the Josiah Macy Jr. Foundation have announced a second round of grants for internal medicine residents and faculty members, designed to improve the quality of education and training and create a more trustworthy health system that serves everyone.

The first round of grants in 2020 brought in 170 applications, from which 32 projects at medical schools and training programs were selected. The grants, which totaled $287,500, include projects such as expanding community-focused health curriculum for primary care residents at Magnolia Regional Health Center/University of Mississippi Medical Center and developing a training program for medical residents to work directly with the Hispanic community at UT Southwestern Medical Center, among others.

For this second round of grants, sponsors are devoting a total of $400,000 to support new or existing programs that promote trust and create a more equitable health system by incorporating diversity, equity and inclusion (DEI) into the fabric of internal medicine and training. Inter-professional programs that incorporate members from across the care team will be preferred.

Specifically, sponsors are seeking proposals that (a) focus on providing training, skill and competency acquisition with the goal of promoting trustworthiness through equitable outcomes, or (b) focus on engineering care processes to promote trustworthiness through equity.

Examples of successful projects could include:

• Training programs that incorporate DEI, and in particular those that employ inter-professional education best practices.
• Quality improvement programs and program evaluations that advance trustworthiness through health equity.
• Ideas on building trustworthiness and psychological safety among teams, including an intentional focus on recognizing bias, lack of diversity and the barriers to being heard due to hierarchical structures.
• Innovative approaches to create collaborative partnerships between health systems and community-based service organizations in under-resourced communities.
• Approaches that foster and support diverse and equitable pathways into medicine and faculty and leadership positions.

Letters of intent for the second round of grants will be accepted through December 1, 2021 and selected applicants will be invited to submit full proposals early next year. Grants of $20,000 and $10,000 will be awarded in Spring 2022.

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About the Alliance for Academic Internal Medicine
AAIM represents over 11,000 academic internal medicine faculty and administrators at medical schools and community-based teaching hospitals in the US and Canada. Its mission is to promote the advancement and professional development of its members, who prepare the next generation of internal medicine physicians and leaders through education, research, engagement, and collaboration. Follow AAIM on Twitter @AAIMOnline.

About the American Board of Internal Medicine
Since its founding in 1936 to answer a public call to establish more uniform standards for physicians, certification by the ABIM has stood for the highest standard in internal medicine and its 21 subspecialties. Certification has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care. ABIM is not a membership society, but a physician-led, non-profit, independent evaluation organization. Our accountability is both to the profession of medicine and to the public.

About the ABIM Foundation
The ABIM Foundation’s mission is to advance medical professionalism to improve the health care system by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policymakers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, connect on Facebook or follow on Twitter.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 161,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook and Instagram.

About the Josiah Macy Jr. Foundation
Since 1930, the Josiah Macy Jr. Foundation has worked to improve health care in the United States. Founded by Kate Macy Ladd in memory of her father, prominent businessman Josiah Macy Jr., the Foundation supports projects that broaden and improve health professional education. It is the only national foundation solely dedicated to this mission. Visit the Macy Foundation at macyfoundation.org and follow on Twitter at @macyfoundation.

A pharmacist in the Oncology Infusion Center noticed something odd about a chemotherapy order. This was for an established patient, but the drug combination was different than usual. The pharmacist checked for an indicator of a new regimen; there was none. She called the oncology nurse, who quickly notified the charge nurse. The charge nurse contacted the nurse working with the treating oncologist, who walked the order to the treating physician and confirmed that, indeed, the chemotherapy order was incorrect.   

The team member did not hesitate to question the medication order, quickly communicating with colleagues who acted with equal urgency. The genesis of this behavior is a culture of respect – a working environment characterized by teamwork, trust, communication, continuous learning, and a shared focus on patient safety. No organization can simply hope for a culture of respect. Creating one means gathering input – from the front lines to top leadership – and then developing the core attributes of respect and the guiding behavioral expectations. 

In 2011, mandatory service training for all team members at Virginia Mason Medical Center in Seattle yielded groundbreaking feedback: team members wanted to work on improving behavior with each other. A leadership team began surveying team members, asking questions such as: What specific actions show respect? What does respect feel like when you experience it? What makes you feel disrespected at work? Hundreds of responses poured in. An analysis of the responses identified four behavior-centered themes: communication, appreciation, consideration, and teamwork.

An advisory group comprised of team members from across the organization produced 10 Foundational Behaviors that demonstrate respect and build trust: Be a team player; Listen to understand; Share information; Keep your promises; Speak up; Connect with others; Walk in their shoes; Be encouraging; Express gratitude; Grow and develop by committing to personal development and seeking feedback to enhance self-awareness and your abilities.

We added a live theater production with a local improv acting troupe, portraying respectful and disrespectful workplace scenarios, to our Respect for People (RFP) training. More than 5,000 team members – from physicians to board members – completed the training in just four weeks.

As RFP took root in our organization’s cultural rituals – from staff onboarding and CEO messages to team huddles and online education – the leadership team continued to develop its own guideposts through queries such as: How do we encourage others to speak up? How do we show appreciation for everyday work? How do we role model and hold others accountable?

A survey conducted after RFP training revealed that 77% of team members agreed or strongly agreed with the statement: “I feel a greater sense of personal ownership for how I respect, support and appreciate coworkers.” For the 54% who agreed or strongly agreed with the statement, “I have noticed a positive change in my work environment,” the culture shift at Virginia Mason Medical Center was well underway.

Respect, a precursor to trust, is critical to optimizing our work as an effective health care team. Research has illuminated the importance of also treating our patients with respect. We know patients can suffer emotional harm when they don’t feel respected. This, in turn, can negatively affect their health care outcomes. Like many other types of harm in health care, emotional harm is preventable.

Our RFP initiative has a significant strategic benefit and helps us continue to attract and retain the very best people, while also contributing to better patient care. Most importantly, we know it’s simply the right thing to do. Just as we care deeply for our patients, we also care for our team members and strive to treat everyone with the respect they deserve.

Gary S. Kaplan, MD, is co-CEO of Virginia Mason Franciscan Health, a member of the ABIM Foundation’s Trust Practice Network. Katerie Chapman is president of Virginia Mason Medical Center in Seattle.

Tara Montgomery is a trusted change leadership advisor and strategist who strives to connect the dots between healthy people and healthy democracies, bringing consumer and citizen perspectives to conversations about culture change in health care and other complex systems. Tara is driven by optimism about the power of collaboration to solve the world’s most challenging problems, having spent over two decades convening and partnering with US, UK, and international academic, cultural, scientific, and nonprofit institutions and leading strategic initiatives to advance public health, education, corporate social responsibility, and social change.

Dave Ellis is a national leader in providing trainings and facilitating conversations on the lasting impacts of ACEs and generational trauma. He shares his expertise with the State of New Jersey and coordinates statewide work related to ACE’s.

The University of Mississippi Medical Center (UMMC) and Magnolia Regional Health Center (MRHC) both share the mission of decreasing the shortage of primary care physicians, reducing health disparities, and improving health outcomes throughout Mississippi.

In an effort to increase the number of residents and fellows training in primary care programs, Internal Medicine residencies at UMMC and MRHC have developed a partnership to expose trainees to both traditional academic and rural community-based graduate medical education. The intent is to expand the curriculum to strengthen patient-centered relationships as a core feature through a focused emphasis on didactic and clinical activities. This project strives to eliminate health disparities among Mississippians based on race, geography, income or social status.

Project initiatives include:

• Creating new educational activities and partnerships   with both non-profit and privately funded organizations to enrich learner exposure to patients.
• Expanding primary care resident curriculum, including a series of community-focused educational health topics and interactive lecture series, with input from various stakeholders from the community and other health care workers.
• Educating students, residents and nursing leaders at local neighborhood centers, clinics and health fairs. The collaboration will focus on patient mistrust and physician bias, presented through a series of lectures, reflective narratives and community engagement activities.

Program quality and efficacy will be assessed by comparing patient assessments between residents actively involved in the program and those who are not. “Mississippi is the state known for having some of the worst health outcomes. We thought it would be great to have residents out in the community [in patients’ homes and at community events] to see if there are improved health outcomes. Getting residents out into communities where patients live will help to restore trust,” said Margaret Hayes Baker, MD, Program Director, Internal Medicine, MRHC and Director, Magnolia Hospitalist Group.

This project aims to strengthen the doctor-patient relationship by building trust with patients and decreasing bias in trainees. Project leaders will also measure the program’s impact on retaining primary care physicians to practice in Mississippi after training.

“By accomplishing each of these outcomes, we will impact the health care of Mississippians by increasing the number of primary care physicians who are well-trained in delivering safe, equitable care to our diverse patient population,” said Baker.

She entered the room, on my side of the clinic. She had set up an appointment to see a new primary care provider. I have complete oversight of all aspects of the practice but on that day of the week, to her, I was just the new ‘doctor.’ We started with the pleasantries but the conversation took a turn. 

She wanted to know if she was assigned to this side of the clinic because she was Black. I was taken aback. I tried to understand the context of the question and find a way to make her feel at ease. However, deep inside, I knew why she asked: because she perceived me as another Black woman. 

This is what it is like to ‘Doctor’ while Black…

I felt the brunt of her pain and knew I had to answer for myself and the system as well. We were now well into our visit and this detour meant that I would be running late. So, I asked myself: How much can I deal with her visit and the system today?

The conversation started again: “I can see that you are upset. Can you tell me more about why you feel that way?” 

I took a deep breath to actively listen. 

I paused to collect my thoughts.

She was silent so I continued.

We were able to move on. And by the end of the appointment, we were laughing and bonding as you would hope happens during a primary care visit. I was only five minutes behind and it was well worth it.

The question I have: Does everyone build trust this way?

Dr. Lypson is the 2021-2022 President of the Society of General Internal Medicine. She is Professor of Medicine and the Vice Dean for Education at Columbia University’s Vagelos College of Physicians and Surgeons. She previously served as a professor, Vice-Chair of Medicine, Division Director of General Internal Medicine at The George Washington University School of Medical and Health Sciences. Her work focuses on innovations and improvements in health professions education and assessment, health equity, workforce diversity, faculty development, medical care delivery, and provider communication skills.

The COVID-19 pandemic has hit the communities that were already under-served by health care and other institutions the hardest. Over the past 18 months, addressing social determinants of health — the conditions in which we live and work — has taken on more urgent importance. Trauma has been widespread and far-reaching, particularly in communities that confront daily racism and other forms of marginalization. And distrust in our systems has heightened.

At the Camden Coalition of Healthcare Providers, much of our work improving care for people with complex health and social needs centers on building and rebuilding trust: first and foremost, our care teams build trust with patients, and with the health care and social service providers we connect patients to. Our data team builds trust with organizations throughout the region to enable cross-sector data-sharing, which facilitates a less fragmented continuum of care. Our policy team builds trust with national advocates and state policymakers to advance large-scale changes that would improve services for those who need it most. Without a foundation of trust, we can’t build the interconnected complex care ecosystem that provides our clients with the help and services they need to achieve better health and well-being.

When COVID-19 swept the country in the spring of 2020, we leveraged the trust we had spent decades building in Camden to bring vulnerable community members, the institutions that serve them, and local and state policymakers together. We listened to what was needed and advocated for strong, equitable responses that centered on those at highest risk. For the past year and a half, we have leveraged our trusted partnerships to ensure access to testing, vaccination, services, and accurate information for communities throughout Camden and South Jersey.

For example, access to transportation is a social determinant of health that took on heightened importance during the pandemic. Initial mass testing sites were only accessible by car, so we advocated for, set up, and staffed testing sites that were easily accessible by foot and public transit, in locations that our data showed were COVID-19 hotspots. We also knew that our community members were as affected by the social and economic impacts of the pandemic as by the virus itself, so at the testing sites we screened for social needs and connected residents to social service navigators in addition to providing clinical services.

As communities across the country continue to grapple with distrust and deepening health disparities as the pandemic stretches on, the need to regain and rebuild trusting relationships is more important than ever. To that end, we have dedicated the sixth annual conference of our National Center for Complex Health and Social Needs, Putting Care at the Center 2021, to the theme of trust, trauma, and healing in our communities.

Over the course of three half-day virtual sessions on October 20-22, we will explore the theme of trust and its relationship to trauma and healing in the context of the COVID-19 pandemic. Three plenary panels will discuss trust between patient and provider, trust between organizations in a community, and trust between the public and our systems. Keynote speakers Daniel Dawes and Dr. Angel Love Miles will address political determinants of health and disability justice, and complex care innovators will share their lessons with others through workshop sessions, an interactive Beehive, and informal networking opportunities.

This convening of stakeholders from across the country is an important step in sharing the models that will advance the field of complex care in countless health systems and communities, while also recognizing the vital role of trust in ensuring equitable health care for all.

I was pregnant and labeled high-risk due to my “advanced maternal age” (a term I hope someone revisits in the near future). My regular ob-gyn recommended that I see a high-risk specialist because I had miscarried during my first pregnancy and to make sure the pregnancy was advancing as expected. During my first trimester, my pregnancy visits were filled with anxiety, especially given my prior miscarriage. Visiting the high-risk specialist was no exception.  I recall my husband gently taking my hand in the waiting room and quietly reminding me that the visit was just precautionary.

We were led into the exam room for an ultrasound and to meet the specialist. I undressed nervously and put on a paper gown. The medical assistant asked me to lay on the exam table with my feet in the requisite stirrups; I waited for the physician to come in, my husband sitting beside me in a chair. You learn to accept that vulnerability and pregnancy go hand in hand. In this case, I was feeling particularly exposed (pun intended) with a thin piece of paper separating my naked body from anyone who walked in the room, my legs in the air. But I trusted that this was all just part of the health care experience.

The physician walked in the room, with a male medical student trailing behind. He proceeded to introduce the student to my husband, but not to me. The student shook hands with my husband. The physician, whom I had not met before, didn’t directly acknowledge me. I think the student was somewhat embarrassed that he was not introduced to me and so he awkwardly said hello – all while I was laying on the table, legs in the air, exposed to the world. The rest of the visit was somewhat unremarkable. The physician completed his exam and the pair left the room. 

I went on to have a healthy, beautiful baby boy with my regular ob-gyn. But that visit left an indelible mark. Did the physician and his student not acknowledge me because I am a woman? Was I somehow considered inferior because I am a woman and did not deserve acknowledgment? Why did he shake hands and engage in conversation with my husband and not me? It all left me feeling even more vulnerable. And sadly, the physician was setting an example for his student. How many other women would experience the feeling of being “less-than?”

I have spent much of my professional life advocating for patients in vulnerable communities. My experience was minor when I think of the number of women of color who have felt vulnerable and ignored in health care settings. Building trust in health care starts with the very basics: courtesy, respect, and dignity. A kind word, an acknowledgement of me and the vulnerability I (along with every other woman I know in that situation) felt at the time, and perhaps a better gown, would have gone a long way to eliminating fear, establishing a trusting connection, and having a satisfactory patient experience.

With a lifelong passion for ensuring that all individuals have access to high-quality healthcare, Wendy has served in senior leadership roles in patient advocacy, quality, and patient safety in a variety of healthcare settings. She is currently the President of the Health Care Improvement Foundation, an organization committed to improving the health and lives of the community through collaborative solutions.

Parkland Health & Hospital System is one of the largest public hospital systems in the country, averaging more than one million patient visits annually. The system also includes 20 community-based clinics, 12 school-based clinics, numerous outreach and education programs, and is the primary teaching hospital for the University of Texas-Southwestern Medical Center.

In collaboration with the ABIM Foundation and America’s Essential Hospitals, Parkland conducted an inaugural Building Trust Challenge from January – March 2020. The challenge was hosted by Parkland’s Center for Innovation and Value and Patient Relations departments and was designed to identify who was building trust within and outside of the institution.

To encourage challenge submissions, Parkland launched an organization-wide survey comprised of questions ranging from ‘What does building trust mean to you?’ to ‘Are you building trust in your area?’ This survey was first shared at the executive level, and then through various Parkland platforms, including a letter from the CEO, the staff newsletter, and through discussion at various meetings, including a population health forum. The challenge received 36 submissions; surpassing initial expectations.

Addiction Psychiatry Services was the challenge winner. Honorable mentions were awarded to The Village Project and Supporting Parkland Staff (SPARKS).

• Addiction Psychiatry Services: Historically, acute care hospital settings have done a poor job of identifying and treating substance use disorders. The Addiction Psychiatry Services team is building trust by engaging patients during acute hospitalization to provide an opportunity for patients to obtain a substance use disorder diagnosis, participate in initial treatment and become engaged with ongoing outpatient treatments. The team has also built trust with community-based organizations to ensure patients have access to resources they need immediately after being discharged from the hospital.
• The Village Project: In 2017, the Centers for Disease Control reported that Black people accounted for 13% of the U.S. population but represented 43% of new HIV diagnoses. The HIV Services Department identified that there was a health care delivery gap for HIV+ Black men ages 17-34 who have sex with men (BMSM) in the Dallas area and implemented a nine-month intervention program. Participants receive weekly visits from a dedicated case manager and peer patient navigator for the first six months, followed by monthly contact for the remaining three months. A customized care plan is created with the patient and a comprehensive acuity assessment is re-evaluated every 90 days. This initiative helps young BMSM access HIV care to achieve viral suppression and expands access to behavioral health in an outpatient care setting.
• SPARKS: Supporting Parkland Staff (SPARKS) is a peer support program comprised of employee volunteers who receive psychological first aid training and provide confidential support to Parkland employees who experience a stressful patient-related event. In this peer-based support program, trust in implicitly built into the model because volunteers understand experiences at Parkland first hand. In the first 10 months of the program, 230 employees received peer support, showing significantly higher utilization than similar initiatives.

Keys to successful implementation included, yet were not limited to, gaining verbal support from organizational leaders, engaging in 1:1 communication with departments, streamlining the submission process, and ensuring a multidisciplinary effort, explained Sheryl Mathew, LCSW, ACM-SW, Grants & Research Program Manager at the Center for Innovation and Value at Parkland (CIVP).

“Establishing and maintaining trust is essential if we are to provide the best possible care for our patients, our employees, and the community. We saw the opportunity to take advantage of the creative thinking from the ABIM Foundation to highlight the importance of trust and recognize the types of behaviors and activities that will promote greater trust within our institution and between Parkland and the community we serve,” said Fred Cerise, MD, MPH, President and CEO of Parkland Health & Hospital System.

You can read more about Parkland’s Building Trust Challenge here.

Claire is a federal policy analyst and patient advocacy blogger whose health history goes back to the early 1980s. Since then, she has managed a raft of serious conditions, both acute and chronic. She has also been a caregiver for both chronically ill and terminally ill family members. A few years ago, she realized that her experience with healthcare could be used to help patients, so she started a blog and started looking for ways to use her skills to make positive changes to the healthcare ecosystem. Claire has a BA in Government from Smith College and an MA in Political Management from George Washington University.

You can reach Claire Sach’s blog here.