hospital care

 In exploring issues of trust in health care delivery, we consider the human interaction, as well as patients’ engagement with systems and settings. This is the third post in a series highlighting eight studies, managed by AcademyHealth and funded by the Robert Wood Johnson Foundation, which focus on trust and mutual respect. Previous posts in this series have featured studies focused on issues of trust between African American men and providers, and trust and the use of technology.

This post highlights two additional studies in this portfolio addressing what happens when patients step inside the doors of a hospital; what enhances trust for that patient and what undermines it. Darlene Tad-y and colleagues with the Colorado Hospital Association are exploring how patient and family engagement activities affects patient trust in rural hospitals. They seek to understand how trust is built between rural hospitals and their communities through communication and culture, and ultimately how that affects patient and family engagement in those communities. This work is highly relevant in Colorado where nearly half of hospitals serve rural communities and where the needs and resources are different than they are in urban communities.

Kalpana Ramiah and Jennifer Stephens at America’s Essential Hospitals (AEH) are examining patients’ trust in hospitals as an institution, particularly those hospitals that serve vulnerable populations. The team has generated a guide on policies and practices essential hospital leaders can incorporate to increase patient trust in their institution. 

“Extensive research has examined patient trust in providers and patient experience at hospitals,” said Ramiah. “But we know less about trust of hospitals.”

Similarly, the Colorado team’s analysis looks beyond the trust built within the patient-provider relationship to explore how patients trust and communicate with other staff and the rural hospital as an organization.

“The development of trust generally relies upon the communication climate promoted by an organization, and we believe the same will be true for our rural hospital members and their patients,” said Tad-y.

In order for hospitals to develop a positive reputation in a community, it is important to understand the hospital practices that can build or diminish trust. Tad-y and colleagues note that market researchers have devoted a significant amount of work to better understanding things that impact the trust and behavior of consumers or, in this case, of patients. For example, researchers from the Trust Project at Northwestern University have identified three dimensions of consumer trust in an organization: competence, honesty and benevolence.

Work by the AEH team confirmed seven dimensions of patient trust important to vulnerable populations served by essential hospitals:

  • Fidelity, or commitment to patients;
  • Competence, or quality and safety of care;
  • Community integration, or social support for patients and community connectedness; and
  • Environmental quality, or a safe and comfortable environment.
  • Equity, or fair and equal treatment of patients;
  • Honesty, or truthfulness; and
  • Confidentiality or proper use of sensitive information.

Key Trust Considerations for COVID-19 Care

“Although all seven dimensions are highly associated with trust, fidelity, competence, environmental quality, community integration, and equity are most important to vulnerable patients. High-quality, trustworthy COVID-19 treatment may also be closely linked to these dimensions,” said Ramiah.

The pandemic has taxed many hospitals to their limits.

“Yet, even in the face of unprecedented financial, health, and logistical challenges, essential hospitals’ commitment to serving their patients remains constant,” said Stephens. “These hospitals assure competent care through daily treatment guidance provided to their skilled physicians and nurses and workforce adjustments to adequately serve the needs of patients. In addition, with the need for social distancing, inviting, private, and exceptionally clean spaces for patients and caregivers yields greater patient confidence in the hospital.”  

Tad-y and her team point out that rural hospitals are disproportionately affected by COVID-19. As such, multiple policy options are needed to reduce the risk of closure for these facilities. For example, telehealth has become critical to providing care in rural areas. The researchers note that the pandemic has moved the nation forward in using technology to improve access to health care. The changes made to improve reimbursement for these services are critical to maintaining these gains and they should be made permanent.

“The pandemic also highlights the need for continued effort to increase flexibility for health care organizations to pursue alternative payment models,” said Tad-y. “Rural and critical access hospitals have been hit harder than most during this pandemic. The value of financial relief efforts, such as forgivable loans and grants, cannot be overstated.”

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