Rebuilding Trust in Healthcare
By Dr. Dhananjay Mankar & Mukul Kumar Jha
A guide to reform the system by addressing the piling trust issues in healthcare.
Trust is one of the most vital elements for the progress of humankind. It is the bedrock which determines the behaviour of people towards each other and ensures coherence among various socio-political systems. This article looks at the importance of trust from pre-historic times to present day and discusses the emerging crisis of trust plaguing the world. It takes “healthcare” as a specific sphere of focus and elaborates on the various factors adding to the trust deficit. It subsequently attempts to view eroding “trust” from a “systems thinking” lens and proposes three major domains of action i.e., Authenticity, Logic and empathy for healthcare leaders. Finally, it proposes a set of comprehensive and practical solutions to be adopted by healthcare professionals to regain the trust of public and develop “futuristic solutions” by keeping patient’s welfare at its core.
“Trust is the glue of life. It’s the foundational principle that holds all relationships”
For every country, its cultural context places a great importance on building trust. It forms the basis of happiness in our relationships, faith in democratic institutions, hope of economic recovery and revival from tragic crisis like COVID. We humans are predisposed to trust each other. Early human societies trusted their leaders for procuring food, tribal groups to collaborate and women to take care of their child while they were away hunting. From pre-historic times, trusting each other has helped us survive and navigate through uncertainties. In present times, while we may not consciously realize, but we place a great degree of trust on various social and political institutions in our everyday life. Payment wallets like Paytm, Electronic Voting Machines for counting votes, neutrality of judiciary and corporate governance measures are just few of the examples that ensure people’s trust is practiced in social institutions. Many a times such a predisposed trust is essential to serve our larger goals. Hence, humans are, by nature, biased towards trusting each other.
But why do we trust? What personal goal does it serve that we are biased to trust each other? Research suggests that trust emanates from our deep desire to connect with each other. When we trust, it creates a positive emotional energy around us which leads to secretion of “oxytocin”, the love hormone, thereby making us more relaxed, calmer, and destressed. Trust makes us derive a rational “sense” out of the context operating around us and utilize it for our own welfare. It then becomes the binding force that can turn our greatest challenges into prospective opportunities.
Emerging crisis of trust
Despite our fundamental predisposition to trust each other, we see a rapid rise in “trust deficit”. According to a Gallup survey, in 2016, Americans average confidence in 14 institutions was just 32%. Geopolitical turbulence is on a steep rise and institutions are losing the touch with public thereby leading to more civil conflicts. We want to trust others but often do not find the required values being practiced by those seeking trust. A Cone Communications CSR study found that around 80% of customers would prefer to boycott a brand if it contrasted with their beliefs and values. Emerging crisis of trust needs a transformational overhaul if we want to realize our envisioned institutions.
To illustrate the gravity of trust deficit, I shall take the example of a crisis in healthcare. So wider is its impact that it has halted our entire planet at this point of time. Despite the massive trials to manufacture vaccine, people are still apprehensive about the agencies that are overlooking its distribution. To appreciate the wider aspects of “eroding trust” in healthcare, let us delve deeper into its root causes.
“Booming crisis of trust” in health sector
Healthcare professionals were one of the most trusted ones in the world with many societies giving doctors the equivalence of a “god”. When medical leaders build trust with patients, they are more likely to follow up treatment plans and adhere to doctor’s advice regarding smoking cessation, diet, and exercise. But the rapid pace of privatization, finance centric care models and mechanical attitude towards patients have lowered people’s faith in the system. As per the report of Federation of Indian Chambers of Commerce and Industry (FICCI) in 2019, 61% were of the view that hospitals did not take the best decisions in favor of patients compared to 37% in 2016. Lack of responsiveness of hospitals, excessive waiting time for patients and low concern for their feedback played a major role in widening the trust deficit. Cases of aggressive behavior and assault of physicians by patient’s kin has increased manifold in recent times. COVID crisis has further exposed the burgeoning inequality and trust vacuum in our health system. Such convoluted trajectory of pandemic has given rise to a spike in the sense of loss of control and has heightened emotional vulnerability due to the high amount of uncertainty.
Trust is built when the leaders’ express authenticity, logic, and empathy simultaneously. Healthcare leaders have ignored several factors within these elements that deteriorated patient’s trust.
Authenticity:
Healthcare leaders often miss being their “authentic self” while working for organizations. They refrain from showing their “caring” side and have become too cosmetic in showing their emotions. We also have glaring examples of ethics being comprised while fixing rates, allocating beds and exorbitant costs of medicine in hospitals. When leaders collude for or ignore such organizational discrepancies, it takes away the faith that patients have showed in them. They perceive them to be just as “profit driven managers” and not “service centered professionals”. Healthcare leaders must ensure that they maintain their integrity, show their vulnerable yet authentic self and be consistent in their “say-do ratio”.
Logic:
It measures the faith a patient shows in the competence and capability of leader. Unfortunately, physicians recklessly order for complex diagnostic tests even for minor ailments thereby drilling massive holes in poor patient’s pockets. Their lack of “active listening” skills have not only affected their accuracy of decisions but also made patients feel isolated and unheard. Another blind spot that has costed doctors a lot of trust is their inability to accept something they don’t know. They often misconstrue their skills and develop a false sense of ego which makes them ineffective thereby hampering patient’s trust in their advice. Leaders should encourage the various hard and soft skills that make healthcare professionals trusted in the eyes of people and ensure that the standard of qualification do not dilute.
Empathy:
Showing empathy is not merely asking for medical history and symptoms, it goes beyond that. It is about putting ourselves in the shoes of the patients and visualize the context from their point of view. Healthcare workers are missing empathy from their communication and fail to provide due emotional value to patient’s anxieties, worries and sorrows. They need to recognize every patient is a” human” first with a deep desire for connection, love, care, and sensitivity.
Trust and confidence in medical leaders are seriously deteriorating at a drastic scale. As per a study published in New England Journal of Medicine, only 34% of people trusted their medical leaders while the figure was more than 75% in 1966. Trust affects patient’s acceptance of an innovative therapy and the more they trust the physician, more they are willing to experiment with new drugs. It is high time that healthcare community acknowledges those issues that dampen their trust and re-imagine a patient centric model where every patient is not just treated but cared for as well.
Rebuilding the “lost trust”
A closer look at analyzing such a deficit leads us to conclude that it is not “trust” per se that is eroding, but “trust worthiness”. Philosopher Baroness Onora O'Neill famously quotes “I would aim to have more trust in the trustworthy but not in the untrustworthy”. To reform our “trustworthiness” we must evaluate our beliefs and values about leadership. Leadership should not be considered as a quest for control and power rather it is about empowering others to make the best decisions for their own life. When our view shifts from retaining power to empowering others, our values also shift towards bringing in more consultation and collaboration. In such a scenario, gaining trust and confidence becomes a goal rather than financial metrics. “Trustworthiness” is a measure of how competent, honest, and reliable a leader is.
Healthcare professionals need to be constantly updated with the latest technology and medical procedures. The more skilled they are, the more patients will form trusted opinions of them. During regular visits, while performing certain expensive diagnostics test may be essential, they should not randomly prescribe it for every minor ailment. Nowadays, many physicians are getting so reliant on diagnostic test-based decisions that they are afraid to prescribe anything purely based on their experience. While it makes them accurate, not all sections of people can afford such expensive diagnosis. Considering patient’s socio-economic status and purchasing capacity in mind can help doctors empathize with them. Doctors will have to customize their solutions based on the context of patients.
A great deal of trust is also built by the way healthcare workers interact with patients and their family members. With more time at their hands, doctors should aim to build an emotional rapport and involve in some informal conversation, is possible, as well. Having a sense of humor can be a great tool to reduce patient’s anxieties and worries. Another critical skill here could be to conduct a conference with the patient’s family. Physicians should listen to them, acknowledge their emotions, understand their values, and elicit questions from them. If time permits, they should explain about the disease in a simple language and brief them about the logic behind medicines prescribed. Such an integrated conversation built around genuine concern and inquisitive questioning leaves a deep impression of trust.
Medical leaders need to be equally concerned about their business model. Hospitals need to allocate work design such that no physician is under an urgent pressure to see large number of patients. A model that incentivizes financial gains and costly prescriptions needs to be replaced with the one that values patient’s holistic care and their experiential feedback. They need to shy away from any covert fee structure and inform patients, well in advance, about the various feasible options available. Such medical leaders should also disclose any conflict-of-interest present and aim to create long-term relationships with patients. It is equally vital that organizations keep up integrity in sharing patient’s medical records with third party vendors. An overhauled system with transparency, honesty and data-privacy at the core shall serve as beacon of hope to revive trust.
Healthcare organizations receive constant feedbacks daily about their various functions. If they wish to rebuild trust, leaders should take them seriously, record them digitally and have regular evaluation of the progress made on this front. A feedback centric health organization gives confidence to people that leaders are listening to them and prioritize their welfare. A constant eye on feedback can also help leaders to recognize some of the blind spots in their organization like siloed thinking and perform due corrective measures.
Way Forward
Trust is the key component of ensuring sustainable institutions within our society. As we move towards a highly digitally interconnected world, we must evolve and incorporate new dimensions of trust to serve us in our unique context. While it is uncertain the way future would unfold, it is clear that the organizations of future shall be those who prioritize human experience, emotions, and values over other metrics. Such an organization shall place “building trust” at its core and enable other functional systems to align towards a welfare centric purpose. “Trust” is going to be the beacon for the revival of our institutions.
“Trust opens up new and unimagined possibilities”
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Authors:
Dr. Dhananjay Mankar
Assistant Professor, Center for Hospital Management, School of Health Systems Studies, TISS, Mumbai.
Mukul Kumar Jha
Student of MA(ODCL), School of Management & Labor Studies, TISS, Mumbai.