This blog series is part of the Advancing Research on Trust initiative led by AcademyHealth and the ABIM Foundation.
In the second interview of the series, Thomas H. Lee, M.D., Internist and Cardiologist at Brigham and Women’s Hospital and Chief Medical Officer at Press Ganey, speaks with Taylor Dunlap, Research Assistant at AcademyHealth, about the vital importance of fostering trusting relationships within the health care workforce as well as between patients, clinicians, and health care organizations.
Taylor Dunlap: What is the problem that building trust will solve for you?
Thomas Lee: Building trust is “necessary but not sufficient” for the biggest challenges facing health care today. We cannot take on our cost and quality challenges just by working harder. We have to create social capital – i.e., work together better and interact with our infrastructure with high reliability. And we can’t do that without trust in each other and trusting relationships with our patients.
Trust fosters a collaborative environment where colleagues can rely on one another, even in unpredictable situations – and we have our share in health care. Early in my training, a senior resident emphasized the importance of never refusing a request from a colleague unless you absolutely cannot assist them. This resonated deeply with me, and aligns with sociologist Ronald Burt's definition of trust: the confidence that you'll be treated fairly in unforeseen circumstances.
In a health care setting, this translates to a willingness to step up for your team, even when details are unclear. Building trust fosters a sense of mutual support, which in turn leads to improved workforce retention, loyalty and of course, more effective patient care. Just like the trust we build within families, this professional trust is a two-way street. It requires not only a willingness to help others but also the assurance of receiving help in return.
This foundation of trust is essential for optimal patient outcomes. It allows for open communication, collaboration, and a shared commitment to providing the best possible care.
Taylor Dunlap: What should health system governance boards/senior leaders be looking at when it comes to building trust and trustworthiness?
Thomas Lee: Building trust in a health care system demands a multi-pronged approach from leadership. Staff engagement and alignment data are key metrics to assess if employees feel valued and understand their role in patient care. Transparency in decision-making, coupled with ethical business practices and a commitment to diversity, equity, and inclusion, fosters trust not only among a staff, but also within the community served by a health system.
A robust safety culture, with open communication, a learning environment for mistakes, and investments in safety programs, demonstrates a system's commitment to both employees and patients.
By monitoring these areas and implementing strategies to address any weaknesses, leadership can cultivate a culture of trust that benefits the entire health care ecosystem.
Taylor Dunlap: What have you learned from your work focusing on issues of trust that would be helpful to share with health system leaders?
Thomas Lee: Leadership sets the tone, but the real engine of a thriving organizational culture lies in the micro-cultures that exist on the front lines. These are the day-to-day interactions within each team, department, or unit, and where leaders can become the unsung heroes. Their actions and decisions have a profound impact on the social capital – the trust and respect – that fuels effective teamwork.
Imagine social capital as the glue that holds a team together, and every manager as a "CFO" for social capital in their part of the organization. It allows for open communication, collaboration, and a willingness to go the extra mile for one another. Just like hand hygiene is an essential practice for patient safety, respect needs to be intentionally ingrained in every interaction until it becomes the norm. We can't leave it to chance or rely on occasional courtesy.
By prioritizing respect and fostering a culture of trust, health system leaders become empowered to build a foundation of social capital that strengthens the entire organization from the ground up.
Taylor Dunlap: Great, thank you so much for your time, Dr. Lee.
Read the first interview in our three-part series here.