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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.
Trust Is Situational

Defining and measuring trust requires recognizing that it is situational (eg, a physician may trust a trainee in some contexts or to perform some tasks but not others). In different contexts or situations, different dimensions of trust may be more relevant; thus, we need to better understand the role of context in trust to construct meaningful measures. Additionally, when empirical researchers use measures of trust to examine its driving factors or its impact on care processes or patient outcomes, they must account for important features of the study’s context to ensure that inferences are appropriate.

How HIT modifies trust dynamics in provider teams can also be situational. For example, in an emergency department with little time for interpersonal interactions, EHRs and patient monitoring tools could be helpful for accessing patient information quickly and may not meaningfully affect providers’ trust relationships. In contexts like oncology care, in which teams provide care over an extended period of time, communication via HIT may inhibit trust building by limiting social interactions that promote familiarity and comfort among team members.

Trust May Be Violated

We also know little about the principal causes and implications of violations of trust and how the nature of these violations may affect downstream provider interactions (including approaches to rebuilding trust). Disrespectful challenging by fellow providers, bullying, and dishonesty are some examples of behaviors that may lead to mistrust or distrust within care teams.6 In our developing work, physicians described violations of trust stemming from misuse of the EHR (eg, copying and pasting template data over several days without updates) leading to complications or delays in patient care due to inaccuracy.18 Further, patterns of delayed or absent responses to EHR communications could have both direct effects (eg, clinical decision making based on inaccurate patient information, negative patient outcomes) and indirect effects through mechanisms of bidirectionally violated trust. For instance, not receiving a response through the EHR may be perceived differently from not receiving a response by phone, perhaps because of the expectations that the EHR should expedite communication and improve coordination overall.

Trust Can Be Rebuilt

A trustor may be willing to rebuild trust in some instances of violation but not others; for example, violated trust resulting in a tragic patient outcome may be handled differently from a violation resulting only in care task redundancies (eg, due to confusion about EHR documentation). Empirical studies of violations and rebuilding of trust should be approached via both cross-sectional and longitudinal studies so that we can gain an understanding of the dynamic nature of trust over time.5,6 We need to learn more about (1) when and why one decides to rebuild trust, (2) alternative approaches to rebuilding trust once it is violated and how HIT may enable or disable these approaches, (3) implications of violations of trust in the longer term, and (4) costs of rebuilding trust to prevent these outcomes.

Implications of Trust

There is a need to examine the downstream impacts of trust (and mistrust) on patient care, patient outcomes, and provider well-being measures such as burnout, job satisfaction, and turnover.12,13,22,23 We also need to learn more about the longer-term implications of trust when HIT is used to manage relationships or coordinate care. For example, current medical trainees practice medicine exclusively in a context that includes HIT, whereas providers who also practiced medicine prior to the advent of HIT may be more inclined to supplement HIT use with in-person interactions. Consequently, older and younger physicians may build trust and collaborate in team-based care settings differently. Moreover, when trust is violated in these circumstances, preferred approaches for rebuilding trust may vary across care team members, slowing its rebuilding. On the other hand, the advent of HIT may have improved collective trust because of its transparency or its capacity to hasten the production of knowledge and support the use of evidence-based treatment to improve clinical outcomes.

Conclusions

As long as HIT continues to evolve rapidly, providers’ use of HIT will evolve likewise. It is critical that we continue to study these developments to optimize providers’ communication and collaboration in the context of team-based care. Future research can draw on qualitative methods to identify how HIT influences trust dynamics between physicians and other providers and the rebuilding of trust following violations. These studies can also inform the development of quantitative surveys and new, multidimensional, contextually relevant measures of trust among care team providers. Such measures could be used to examine both organizational and provider-level factors that foster trust and the relationship between trust and patient outcomes.

Author Affiliations: Department of Health Management and Policy, University of Michigan School of Public Health (MR), Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School (MR, JEP), Ann Arbor, MI; Department of Health Policy and Management, Emory University (ASW), Atlanta, GA.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MR, JEP, ASW); acquisition of data (MR); analysis and interpretation of data (MR); drafting of the manuscript (MR, JEP, ASW); and critical revision of the manuscript for important intellectual content (MR, JEP, ASW).

Address Correspondence to: Minakshi Raj, MPH, Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109. Email: miraj@umich.edu.
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