Care Redesign
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Earning Patients’ Trust: Back to Kindergarten (04:48)

Health care needs to work on the dual imperative of earning patients’ trust and being trustworthy. How can individual clinicians and health care organizations achieve that?

Historical and contextual factors will weigh into trust between patients and clinicians and between patients and the health system, says Russell Rothman, Professor of Internal Medicine and Vice President for Population Health Research at Vanderbilt University Medical Center. But one way to build better trusting relationships with patients and the community is to train individuals and systems in how to better communicate with patients, families, and the community — especially when it comes to listening.

We need to be better listeners “and do a better job of understanding the needs of our communities, and helping them to set shared goals,” says Rothman, “instead of the traditional, hierarchical model where we came in as the clinician and said, ‘Do this, do this, do this. Okay, you good? Great,’ and then we’d send them on their way.”

One of the keys to trust and being trustworthy is mutual respect, adds Consuelo Wilkins, Executive Director for the Meharry-Vanderbilt Alliance. “From the standpoint of many health systems, especially some of the really large academic medical centers, the level of prestige and the power imbalance is so huge that we often forget about the importance of valuing the other resources and the opinions and the needs, and we just think we have all the answers.”

How do you show that respect? By demonstrating that you value people. Instead of putting the blame on others — “they don’t trust us; they haven’t trusted us in years” — we need to take the blame ourselves as not being trustworthy enough.

Another key to being trustworthy is transparency, especially for health organizations entering into partnerships with the community. Far too often, health organizations don’t share the budget or will invite the community organization to join a grant and then not follow up with them, Wilkins explains.

“This is just about relationships, says Wilkins. “If you want to have a relationship with anyone, you have to respect them, you have to be respectful, you have to be transparent and not hide things. It’s just back to kindergarten.”

From the NEJM Catalyst event Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health, held at Vanderbilt University Medical Center, January 25, 2018.

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