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Trust in Provider Care Teams and Health Information Technology–Mediated Communication
Minakshi Raj, MPH; Jodyn E. Platt, PhD, MPH; and Adam S. Wilk, PhD
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Trust in Provider Care Teams and Health Information Technology–Mediated Communication

Minakshi Raj, MPH; Jodyn E. Platt, PhD, MPH; and Adam S. Wilk, PhD
Rapidly advancing health information technologies are changing the nature of team-based care; there is a critical need to examine how trust functions in contemporary team-based care.
ABSTRACT

Teams of healthcare providers use health information technology (HIT) to facilitate communication and collaboration. Effective team-based care requires trust, yet we know relatively little about how physicians build and maintain trust with their fellow providers and, further, how HIT affects trust among provider team members. We describe priority areas for advancing our understanding of trust within healthcare teams, which may inform policies and HIT design in efforts to improve clinical decision making, provider satisfaction, quality of care, and patient health outcomes.

Am J Manag Care. 2020;26(1):23-25. https://doi.org/10.37765/ajmc.2020.42141
Takeaway Points

In the context of team-based care, providers often communicate via forms of health information technology (HIT). Studies of trust within this context can inform provider decision making and collaborative practices, with implications for provider and patient well-being.
  • In the context of team-based care delivery, communication and collaboration increasingly take place using HIT systems (eg, electronic health record notes, interprofessional consults, artificial intelligence); this may affect how providers come to trust one another.
  • Studies of provider team trust that account for trust’s multiple dimensions, bidirectionality, and context can present opportunities for improving the quality of providers’ team-based care and, ultimately, patient health outcomes.
  • It is important to understand how to measure trust in care teams, violations of trust, and rebuilding of trust, as well as how HIT-mediated communication affects these dynamics.
Physicians are expected to coordinate patient care effectively with other providers in care teams—which might include a mix of other physicians, nurses, trainees, technicians, or physician’s assistants—with different combinations of these other providers when comanaging the care of patients with different needs. Physicians are also often incentivized to use health information technology (HIT) to facilitate team-based care. For example, the patient-centered medical home is a team-based care delivery model that is expected to measure and improve quality, track and coordinate care, and improve patient experience and provider satisfaction while also reducing costs1; many of these objectives are supported with HIT in the context of face-to-face team-based care.2,3 Team-based care and interprofessional consults also increasingly occur in the patient’s absence via phone or HIT systems such as the electronic health record (EHR). Importantly, effective team-based care delivery, which promotes collaboration and high-quality care outcomes, requires trust among its participants.4-8 For example, trust is an important construct in explaining relationships and learning between clinicians and staff in practices transitioning to patient-centered medical homes.9 Although physicians typically serve as leaders of provider teams, there remains much to learn about how physicians and their fellow providers trust one another. How can we measure trust in care teams? What are the causes and implications of violations of trust, and how can we best rebuild trust when it has been breached? How will trust among provider team members be affected as provider teams increasingly communicate via EHRs and other HIT systems?

Although academic researchers have begun examining the roles of artificial intelligence, telemedicine, and EHR systems on trust between physicians and patients, our review found that trust within provider teams, in addition to how HIT-mediated communication can affect provider team members’ trust in one another, has received considerably less attention.10,11 This represents an important gap in our collective understanding of both team-based care models and HIT. In settings where HIT-mediated communication affects trust among provider team members, significant opportunities may exist to improve HIT interfaces or health system policies with the immediate goals of improving providers’ job satisfaction, reducing burnout, and enhancing productivity or efficiency (eg, by cutting out work-arounds or repeated activities).12,13 Downstream, the potential benefits of well-managed HIT-mediated communication and the subsequent improved trust in provider teams may be significant in improving clinical decision making and care quality, as well as patient safety and health outcomes—something long promised by HIT advocates.12,14-17

In this commentary, we summarize priority areas for enhancing our understanding of trust among care team providers and the mediating role of HIT, guided by established conceptual models of trust and communication and the findings of our relevant systematic review.11 We offer examples of each priority area, drawing from our ongoing study of the dynamics of physician trust within care teams.18

Trust Is Multidimensional

Trust is defined as a willingness to be vulnerable to another person performing a given task, based on expectations about another’s intentions of behavior.19-21 Yet no single measure or characterization fully represents trust in a given relationship; trust is multidimensional and can be described using multiple aspects of the construct (eg, competence, fidelity, integrity). Further examination of how the dimensions that may be most relevant in forming trust among providers may be modified as the mode of communication changes (eg, in person, over the phone, through HIT systems) is greatly needed.11 For example, physicians may have fewer opportunities to observe another provider’s thought process—a measure of trustworthiness by virtue of competence—when they communicate via HIT versus when meeting in person.

Trust Is Bidirectional

It is important to examine trust as a bidirectional phenomenon to avoid reinforcing asymmetry between team members. A trustor, such as a physician, may trust another individual—a trustee—such as a nurse. However, the nurse—in the converse role as the trustor—may not trust the physician likewise. This could also be in part a result of the hierarchical nature of the relationship. Future studies of trust dynamics in healthcare settings should assess trust from each perspective—the physician as well as the trainee, nurse, or technician. These assessments should also weigh how each experiences trust, or a lack thereof, in the other and how each experiences or perceives being trusted by the other. This can help us to understand the signals and observations that providers use to build and maintain trust that can be used in team formation and to encourage team cohesion.

A research area related to the bidirectionality of trust is asynchronous communication through HIT systems (eg, telemedicine). For instance, when nurses use the HIT tool, they may (1) trust that fellow providers will interpret their notes accurately and act accordingly and (2) assume that other providers will trust them to input information faithfully into the system.


 
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