Trust is delicate, needing time to establish, and hard to maintain. Trust between a person and their clinician has immense implications for successful diagnosis and then management, treatment, and healing. Clinicians must trust the health care system in which they practice, systems must trust clinicians and other staff, and we all must trust (to some extent) our community, state, and nation. A PubMed search for “trust” finds 423,646 results, a Cochrane search, 48 reviews. I am a researcher at heart, and find comfort in the structured understanding of our shared world. Within and across health care, trust is paramount, much researched, and effort intensive. In Beyond Tuskegee — Vaccine Distrust and Everyday Racism the authors state that while historic traumas have contributed to distrust, the way that black Americans are treated and misdiagnosed individually and daily within a health care system are larger factors in mistrust. This experience is shared by many marginalized groups and must be acknowledged and addressed.
Building trust to identify and work collaboratively toward shared goals is the heart of our work at the Foundation for Health Care Quality. Bringing together clinicians who work on the same organ system (e.g., cardiovascular surgeons and interventional cardiologists) or biological processes (e.g., obstetricians/gynecologists, family medicine physicians, midwives) as well as administrators responsible for the systems supporting the clinician-patient interaction, and patients themselves is necessary to holistically improve a health care service for every patient, in every system, across our region, and especially for those who have been historically marginalized. We all deserve high-quality, high-value care, and we all have a role to play in building this better system.
From the beginning of the COVID-19 pandemic in early 2020, we have all been witness to an erosion of trust, race-based violence, and spread of disinformation. The pandemic served to highlight and in some cases increase a very human instinct for self-preservation, to question whether those around you have your best interests at heart. Risk of COVID-19 infection is associated with lower levels of community trust – indicating a need for more communication and community engagement. We do a disservice to our community by putting up financial and language barriers to scientific evidence, including peer-reviewed articles; scientific understanding should be accessible and easy to understand for everyone. As social animals, we need to trust our communities for our own health; depression is associated with low self-reported trust. Our individual health is only as good as that of our neighbors’ health, our happiness at work depends on the morale of those around us, and our community needs all of us to help rebuild trust.
Working to build trust between groups, systems, and sectors through our Foundation for Health Care Quality is a privilege. I am grateful for every person and every organization involved, for your trust in us as a convener, and for the trust extended to one another. I trust I will talk to you all soon!
By Ginny Weir, MPH
CEO, Foundation for Health Care Quality