I’ve been going to my general practitioner, Dr. Cohen, for over a decade now. For my wife, Beth, and her family, it has been since she was in 7th grade at Wood Oaks Junior High. My wife’s family and his met because she and Dr. Cohen’s son were in the same class together. Caring for my wife’s family and now for our own, Dr. Cohen’s memory is the longitudinal clinical narrative to so many moments in our lives. He can recognize when my wife is in the waiting room by her cough with her seemingly annual case of bronchitis. When I joke about my father-in-law’s uncanny ability to hurt himself (knees & shoulders mostly), Dr. Cohen laughs because he remembers each of those injuries, scars that have turn into laugh lines on their faces at each year’s check-up. He’s been with us through sickness and health, through births and deaths. When he and I check in, he asks about family because he is family at this point. I trust he’s looking out for my best interest, and he trusts me that I am going to heed his advice.
The elements that create trust in our lives have a flexibility and fragility that is so typical of the human experience. Your trust in someone can provide a safe space for them to take risks and find growth. At the same time, once trust is broken it is difficult to recreate. Trust & regained trust are not one in the same. In their groundbreaking research at the University of Ohio, Wayne K. Hoy & Megan Tschannen-Moran define “five faces of trust.” While their work is based in the school environment, it has timely relevance to the healthcare industry as it systematically transforms the way that care is evaluated and paid for. Because without trust, how can there be accountability? Without trust, how is quantifying the value and quality of care anything but impossible?
Hoy & Tschannen-Moran describe the five faces of trust as benevolence, reliability, competence, honesty, and openness. The authors define benevolence as “the confidence that one’s well-being will be protected by the trusted person or group.” Reliability is “the extent to which one can count on another to come through with what is needed…combining a sense of predictability with benevolence”. Competence is important because “there are times when good intentions are not enough. When a person is dependent on another and some level of skill is involved in fulfilling an expectation, than a person who means well may nonetheless not be trusted” if they are not competent. The fourth face, honesty “speaks to character, integrity & authenticity…the expectancy that the word of another can be relied upon.” Finally openness is “the extent to which relevant information is not withheld, a process by which (one makes oneself) vulnerable by sharing information” which signals “a confidence that the information will not be exploited and that recipients can feel the same confidence in return.”
How many faces of trust do you find in your patient experience? How many faces of trust inform your overall satisfaction with your ability to provide care? How many faces of trust inform you and your clients’ relationships? And how do our responses to these missing components in the healthcare system make us feel about the nationwide efforts to reform it? Like each of Hoy & Tschannen-Moran’s faces of trust, the advisory services that patients consume have a heavy emotional component to them. It is unavoidable. It is not a mistake that we say we “feel” sick or well. And those feelings have a significant effect on our overall health in many surprising ways. How we feel about our healthcare providers can affect our likelihood to adhere to their advice. How we feel about the spaces we heal in can affect our ability to heal. How our doctor’s and nurses are feeling and feeling about us can affect the care that they provide. Emotions and the behavior of the entire care team can get wrapped into the way patients can evaluate their care experiences, as they are increasingly asked to do in the age of CAPHS surveys and online rating sites.
There’s an undeniable emotional component to establishing trust between clinicians, patients and the technology they interact with during the clinical experience. That emotional component comes across when physicians discuss the role technology is having on their professional satisfaction. It comes across when patients with chronic diseases talk about their patient portals. It comes across when one considers how patient’s satisfaction with their care can affect overall healthcare utilization, expenditures, and even their own mortality. Organizations like the Davies award winning University of Missouri Medicine highlighted some of their approaches to maintaining that trust at this past HIMSS16, including at this year’s User Experience Forum. Drs. Richelle Koopman and Jeffery Belden each explored the effects of room & clinical app design has on the patient experience. CIO Bryan Bliven shared insights as well on the role that focusing on clinician and patient satisfaction can have on a healthcare providers bottom line. Additional stories about the importance of patient and provider satisfaction can be found in the HIMSS Value of Health IT Suite, within examples from the Value STEPS frameworks Satisfaction category.
So how do we make sure that the ancient, elemental trust between a person and their healer survives in the age of the instant, in an age of a digitally mitigated, value-based healthcare environment? It is up to all of us, patient and provider, care giver and receiver to make sure that trust remains intact.