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Essential Hospitals Institute Researchers Discuss the Importance of Patient Trust


Dayna Clark, MPH, and Kalpana Ramiah, DrPH, MSc, explain why patient trust is important for hospitals to have, as discussed in their poster presented at the 2021 AcademyHealth National Health Policy Conference.

Dayna Clark, MPH, a senior research assistant, and Kalpana Ramiah, DrPH, MSc, vice president of innovation and director of Essential Hospitals Institute, explain why patient trust is important for hospitals to have.


Why should patient trust matter to physicians? What are the implications for care if patients lack trust in a hospital?

Ramiah: Before I get into patient trust, let me say who we are as an association. America's Essential Hospitals is an association that advocates for 300-plus member hospitals around the country. Dayna and I work on the research and education portfolio, so the work that we do is with our member hospitals and to benefit our hospitals. You asked a question about patient trust, and I would like to separate it into 2 pieces: (1) about the trust with the physician and (2) about trust with the hospital. Patient trust in physicians has historically been linked to improved health outcomes, such as improved patient satisfaction, adherence to medication, or prescribed health behavior. So, they would stick with the health behavior if they trusted the physician. What we did in our work is about the patient trust in health care institutions, and the impact that the patient trust in health care institutions, such as hospitals or health systems, has on patient outcomes is unclear. Patient trust in hospitals, including the impacts of lack of patient trust, has not been extensively studied. So, more information is available on physician trust, not about the institutional trust.

What patient populations should hospitals be targeting to better ensure trust in their facilities?

Clark: So, up until this past year, patient trust has been decreasing across the country over the past decade. Keeping that in mind, hospitals should really try and build trust with every patient that walks through the door. That said, patient trust with physicians and health care systems has been historically low among Black and Hispanic populations compared to White. Our study confirms these findings, and then further suggests that patient trust is lower among patients who are of lower income, younger, and female, so it's also important to give extra attention to these populations to help address disparities in trust. I'd also like to point out that this past year with the pandemic has actually been the first time in many years that there has been an increase in trust in medical institutions. This really isn't surprising given the work and sacrifice that our health care workers have given to meet the current needs. But since we don't know how long this trend will last, or if it will continue in the future, hospitals should still continue to make increasing patient trust a priority.

How can hospitals tell what factors of trust they are lacking in and what areas need more focus?

Ramiah: Asking the right people, the patients and the caregivers. How do you ask? It could be through traditional surveys or having a group discussion. Patients and caregivers have suggested that hospitals gather input from groups of patients and include patients in their meetings. Those actually increase trust. You may have heard about patient-family advisory committees. Those are great, but that might not be sufficient. So, hosting public deliberations or traditional focus groups might work too, and including patients in clinical meetings. Every hospital has so many policies and procedures and just adding one more eye to that, adding a voice to that and asking the patient something like, "Hey, what do you think about this policy?" It might be a simple transporting patient from one place to another policy but asking the patient, "What do you think if I actually push you through a wheelchair from this place to this place, would that sound okay? Or do you think we should go around to take you to the examination room?" So, those increase trust and hearing from patients and the caregivers increases trust.

One of the things I will say is that the quantitative data that is available could be used as a proxy. Some of the data like [Hospital Consumer Assessment of Healthcare Providers and Systems] have certain aspects that could give one path towards digging deeper into a topic. Is it about confidentiality? Is it about engagement with community? So, it gives a pathway into it and the qualitative information is what we need to hear more. I'll also say that gathering information should go beyond the patients who walk into the hospital walls. It's about the community. Gathering information from the community, getting out of our hospital walls to gather information on what people think about the hospital and health system will be even more beneficial.

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