A Healthy People Blog: Trust
by Heather Torok–
So much depends on trust. I was reminded of that again last month when I had the pleasure of meeting with three small neighborhood-based outreach organizations on three separate occasions. Interested in how they fit into Cleveland’s healthcare sphere, I asked each of them about their relationships with other healthcare providers, and how they see their role in their neighborhood shifting with healthcare reform. Their answers were uniform, and it was all about trust.
Of course, they want nothing more than for each and every person they serve to have a health home – networked partnerships between the individual and their personal healthcare providers and, when appropriate, the patient’s family. They also want to know where to access the care they need, and to know that they can afford it.
Sure, they chimed, a health home could improve quality and coordination and maybe in time, even bend the cost curve. All referred to several of the hospitals and health centers – patient-centered medical homes themselves. They each described sophisticated and complex systems that they employed to help patients navigate through for proper linkages and referrals towards care. But what seems to keep people coming back to them is the relationships they have built with their patients. It seems that they are in the business of trust, not healthcare. These little engines of ingenuity are serving up trust.
This isn’t the “doctor knows best” kind of trust, or the “evidenced-based care” kind of trust that patients feel, but a trust built on familiarity, comfort and habit. It’s the most primal form of trust; knowing the person’s name behind the desk, or what days to get service, having confidence, faith or reliance in someone or something. It’s about feeling socially connected and feeling welcome.
So why does this matter?
In the midst of our excitement about decreasing the cost of medical care and the promise of the patient-centered medical home to meet patients’ needs more effectively, the focus on system change can lose sight of what drives human behavior. Coordination of care, electronic health records and a culturally competent provider can improve satisfaction and health outcomes; but trust is what will bring and keep the patient linked to the health home. This isn’t to say that our health centers, most of which are patient-centered medical homes, don’t have the capacity for building and maintaining trust. They do, and many are their neighborhood’s trusted health home.
We have, for example, tremendous Federally Qualified Health Centers (FQHCs) molded by federal government regulations, to include patients on their boards. Some FQHCs have even created additional patient-only advisory boards. Efforts to bring in beneficiary voice and build trust are part of their very infrastructure. While there are many perceived benefits to larger, expanded networks of care, there is a perceived risk in losing personal connections the larger an organization gets, and the further one must travel from their own neighborhood. It’s easier to get lost, feel overwhelmed by the largeness and the unfamiliar, especially in our healthcare-heavy city. Take our largest employer in Cleveland, Cleveland Clinic; with close to 40,000 employees. Building trust with patients requires an army of designated staff within a dedicated department.
The feds and the state both provide resources and direction to those seeking to be patient-centered medical homes. That infrastructure and capacity building are greatly needed. However, if we go back to my three meetings, what they highlight is the need to shine a light on patients within that infrastructure. Once systems are in place, the next questions we must consider as we advocate for health homes, are:
- How will they engage?
- How will they know where to go?
- Will they find a trusted environment and a team with which they can be familiar?
- Will patients understand the health home and how it can help them?
- Will they choose their team over the emergency department?
This work is not easy or swift, but building trust and patient engagement is critical for improved health outcomes.