This blog series, part of our Advancing Research on Trust project led by AcademyHealth in collaboration with the ABIM Foundation, is exploring strategies for enhancing trust in health systems.
In this interview, Marya Khan, Senior Manager at AcademyHealth interviews April Joy Damian, Ph.D., M.Sc., Vice President and Director of the Weitzman Institute and Senior Scholar at AcademyHealth about the longstanding commitment that Federally Qualified Health Centers (FQHCs) have had towards fostering and holding trust within their communities.
Marya Khan: How have you seen Federally Qualified Health Centers address issues of trust, e.g., related to clinicians, patients, or the broader community?
April Joy Damian: Addressing, building, and preserving trust is a key cornerstone to FQHCs given their roots in the Civil Rights movement. The cofounders of the health center movement, Drs. H Jack Geiger and Count Gibson, and medical students and doctors from the Medical Committee for Human Rights, were there during Freedom Summer, including Bloody Sunday, to provide life-saving treatment to marchers who were brutally attacked.
FQHCs continue in this same spirit of service and justice, fighting to make sure health care is a right and not a privilege, as evident by the 32.5 million patients (1 out of 10 Americans), about 90 percent of whom are living at or below 200 percent of the Federal poverty level, and a significant proportion of whom are uninsured, on Medicare, and/or Medicaid, and are without homes. Second, health centers are addressing issues of trust by addressing the social drivers of health beyond the four walls of clinical practice. This includes hiring from the community to create a workforce that better looks like and can relate to the patient population being served.
The Moses/Weitzman Health System, in which the Weitzman Institute is housed, is an example of going one step further by creating career training pathways and programs to overcome barriers to entering and advancing in the health care workforce. Additionally, normalizing training in diversity, equity, and inclusion (DEI) is another key area. For example, our health system’s Chief Justice, Equity, Diversity, Inclusion (JEDI) Officer worked with our Weitzman Institute Education team, which includes experts in instructional design and adult learning, to create the Justice, Equity, Diversity, and Inclusion (JEDI) Certificate Program: Organizational Change Series for Leaders. The training covers core definitions while also including numerous scenarios where unconscious bias and unintentional harm can play out in the clinical setting.
Marya Khan: Are there any lessons about building trust that you think would be helpful to share with others working in this area, e.g., related to strategies for assessing or measuring trust, or for addressing or improving trust?
April Joy Damian: First, meet patients and communities where they are. Trust is built by acknowledging the humanity, health, and well-being of patients extends beyond health care. Go to the community events, the churches and places of worship—make it a priority to understand who and what matters most to patients and communities.
Second, get to know the community gatekeepers—who are the trusted leaders and voices of the community that you need to get to know as they have significant influence. Third, collect both quantitative and qualitative data on trust. Once you have this data, critically look both at who is responding and who is not responding as the latter can be just as important, if not more so, in understanding who you may need to better invest in and make greater effort to reach and establish trust with. Building trust is not rocket science, though it does take time to build.
Marya Khan: What should health center governance boards and/or senior leaders be considering or looking at when it comes to building trust and trustworthiness?
April Joy Damian: It is important to emphasize the importance of investing in enhancing data systems infrastructure and collection efforts. For example, an overall 95 percent satisfaction rate may make it appear that a health center is doing excellent and is well-trusted by its patients and the community, though one needs to be willing to go one step further and ask the hard questions: If we breakdown the data by various racial/ethnic, linguistic, age, gender/sexual orientation subgroups, will the 95 percent still stand? If there’s missing data/no response in questions regarding trust, why is that the case?
Our CEO and Founder, Mark Masselli, often says, “What the eye sees, the heart feels.” When you walk into our clinical sites, see our online and print marketing materials, there is great intentionality in making sure that patients can see themselves in these materials and know this is a place for them.
We learn from history and from others. There is much that health centers can learn and apply from practices by other health centers, as well as outside of the health care field.
Read the first two interviews in this series here: Building Trust: Insights from a Health System Leader and Building Trust: A Critical Value for Health Care