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Scientists and clinicians need to work to rebuild trust in the healthcare system, according to officials from the American Board of Internal Medicine (ABIM) Foundation.

"We really are living in a world in which facts themselves -- the whole existence of facts -- is in dispute," said Richard Baron, MD, president and CEO of the foundation, at an event last week to launch the foundation's Building Trust initiative. "How do we explain the number of people in the country who are just not interested in that COVID vaccine, or who are turning away from pretty established science? ... The scale on which we're seeing that suggests a major politicization of knowledge."

"We're hoping this initiative will advance this conversation," he continued. "The scientists themselves have to stop believing that if they just put more data out there, if they just put more science out there, we'll change minds. I think we really need another strategy, and we need to understand the way in which relationships shape the way people experience information ... We realize that healthcare institutions need to think differently about trust."

Surveys Give Nurses, Doctors High Marks

The foundation commissioned NORC, a nonpartisan research organization at the University of Chicago, to perform two different surveys: one of 2,069 healthcare consumers and another of 600 physicians. The consumer survey included oversamples for Black, Hispanic, and Asian respondents and had a margin of error of +/- 3.15 percentage points. It showed that 64% either "completely" or "somewhat" trusted the healthcare system as a whole, while 17% "slightly" or "completely" distrusted it and 19% neither trusted nor distrusted it. Nurses fared better, with 85% completely or somewhat trusting them, and physicians were close behind with 84%. Health insurers fared the worst, garnering only 33% of "complete" or "somewhat" trust from the public.

Results were similar when respondents were asked about their own specific healthcare facilities and doctors: 76% said they "completely" or "somewhat" trusted the place they go for routine care, while 78% expressed that level of trust in their primary care physician and 68% said the same for their specialist. Only 11% said the pandemic had increased their trust in the healthcare system overall, while 32% said it had decreased their trust and 56% said their trust remained the same.

The pandemic "has been a stress test for the healthcare system," Baron said. "It's a stress test where there have been some remarkable successes; the creation of a vaccine in under a year is truly astonishing. But there have been some glaring failures. We've seen hugely disparate outcomes in Black and Brown populations. And we know that those populations see that as evidence today, that maybe healthcare institutions are not that trustful."

In addition, he said, "we've also seen an enormous amount of stress and strain in the relationship between clinicians and patients, and between clinicians and the healthcare delivery systems in which they work." Shortages of personal protective equipment and difficulties allocating ICU beds "created an enormous set of stresses and strains on the system and exacerbated some fissures of trust."

Among the physicians surveyed, 63% said they "completely" or "somewhat" trusted the healthcare system as a whole, while 20% said they "slightly" or "completely" mistrusted it and 17% said they neither trusted nor distrusted it. Fifty-four percent said they completely or somewhat trusted healthcare leaders and executives, while 30% said they slightly or completely distrusted them. Health insurers again fared the worst, with only 20% of doctors giving them somewhat or complete trust, while 58% said they lightly or completely distrusted them, the survey found.

Government health agencies such as CDC and FDA fared well here, with 78% of physicians saying they completely or somewhat trusted them and only 14% indicating mistrust.

Three-Pronged Strategy

Daniel Wolfson, MD, executive vice president and COO of the ABIM Foundation, said the initiative will involve a three-pronged strategy to help rebuild trust. "One, convene leaders to have conversations on the importance of trust; two, help develop research on the evidence that trust impacts performance, done in conjunction with AcademyHealth. And three, identify best practices and behaviors that drive trust. Our ultimate aim is to elevate trust as an essential organizing principle for improving healthcare."

The strategy will also have three areas of focus, he said: relational or organizational trust; building equity and reducing systemic racism; and bolstering the importance of trusting science and safeguarding facts.

The initiative started with an open call for examples of practices that build trust, and more than 50 organizations submitted their strategies, Wolfson said. "We call this group our Trust Practice Network, and in many instances their innovations led to stronger healthcare leadership, improved transparency, and greater consideration of the patient's needs in the practice of medicine," he said. The foundation posted the strategies on its and is encouraging other groups to submit their own ideas and strategies.

The foundation will also launch a monthly communication that shares information and resources and spreads best practices across the healthcare continuum, Wolfson added. And "we will host a series of conversations to highlight how different organizations, physicians, patients, and stakeholders have cultivated trust, and what lessons they can teach us. That's just a few of the things planned for the coming months."

Experience at Parkland

Fred Cerise, president and CEO of the Parkland Health and Hospital System in Dallas, said his health system did its own version of a "trust challenge" to solicit ideas for building trust. "We know if patients are more trusting, they're going to be more engaged," he said. "So we started soliciting ideas at our place and it was amazing how much people wanted to talk about it and to bring those ideas forward."

Parkland implemented a program "where we sent clinicians out with fire and EMS to deal with behavioral health crises in the field," as a number of places are now doing, Cerise said. "And it was a real partnership between police, our social workers, and the dispatch system, but the idea was to meet community members in the field to divert them from jail, divert them from hospitals. We put clinicians in the field to be able to de-escalate conditions, and get people into care at that point."

Another program Parkland implemented was "basically a psychological first aid for healthcare providers who were experiencing stressful situations, primarily patient interactions that went bad," he added. "We had a series of trained peer counselors to do work with staff to deal with some psychological injury that they may have had."

MedPage Today asked Baron via email what clinicians could do right away to start rebuilding trust with patients. "Clinicians should not assume that being in a position of authority is enough of a basis for sound patient relationships. We should look for explicit opportunities to build trust with patients -- for example, by using electronic health records to assure clinicians and staff pronounce their names right, or remembering important personal information and carrying through on commitments or promises made. Clinicians should never assume trust exists -- we need to continually consider how to earn it," he responded.

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