The trust crisis in healthcare : causes, consequences, and cures

The lack of trust in our healthcare system brings ominous results, from decreasing health outcomes to increasing costs, from organization inefficiencies to a pervasive pattern of litigation. This will only worsen as healthcare becomes subject to greater market mechanisms, and as patients, providers, and payers view each other with increasing suspicion. Healthcare professionals are just now coming to realize what other professionals have known for years: trust is earned, not assumed. The Trust Crisis represents the first comprehensive survey of the causes and consequences of declining trust in healthcare, and more importantly, it provides suggestions for restoring that trust. Editor David A. Shore, founder of the Harvard School of Public Health's Trust Initiative, brings together an unparalleled collection of healthcare leaders for this volume. Chapter authors include Donald Berwick, Robert Blendon, Lucian Leape, and George Lundberg. The book also features an introduction by Cokie and Steve Roberts. Causes, consequences, and cures for the crisis in trust are specifically addressed. Critical areas treated by the authors include: - systemic conditions that lead to medical errors, and remedies for promoting quality of care. - outdated modes of doctor-patient communication that hinder compliance. - novel modes of interaction to improve satisfaction. - patient-centered care and metrics to evaluate its presence or absence. - media communication and miscommunication, and new standards for medical reporting. - clinical insights applied to the use of human subjects in biomedical research. - recommendations for revising medical school curricula and strengthening the peer-review process in medical journals. - practical strategies for decreasing the lingering discord between patients, providers, and health plans. While presenting a diversity of topics and opinions, the authors of this volume agree upon a few principles. The trust famine will have dire consequences if it continues unchecked. Healthcare leaders can take measures to improve trust. Regaining trust requires that entire organizations pay closer attention to the "human factors" of healthcare. And perhaps most critical for change, trust-building is not only good medicine, but good business as well. ## Abstract The lack of trust in the U.S. healthcare system brings ominous results, from decreasing health outcomes to increasing costs, from organizational inefficiencies to a pattern of litigation. The trust famine carries dire consequences if allowed to continue, but measures to regain trust are possible. This book provides a comprehensive survey of the causes and consequences of declining trust in healthcare, and provides suggestions for restoring trust. Part I describes the state of trust in society and in healthcare. Part II examines the impact of quality and safety on trust. Part III considers the relationship between medical communication and trust. Part IV suggests innovations which lead to building trust. Critical areas discussed include: the changing patient-physician relationship; systemic conditions that lead to medical errors; novel modes of interaction to improve satisfaction; definition of patient-centered care and metrics to evaluate its presence or absence; the sources of exaggerations in the media and on the internet; new standards for medical reporting; insights from clinical settings applied to concerns about the use of human subjects in biomedical research; recommendations for revising medical school curricula and strengthening the peer-review process in medical journals; and practical strategies for decreasing the lingering discord between patients, providers, and health plans. As healthcare professionals are now coming to realize what other professionals have known for years: trust is earned, not assumed. This book aims to demonstrate that trust-building is not only good medicine, but good business as well. The (sorry) state of trust in the American healthcare enterprise / David A. Shore Why Americans don't trust the government and don't trust healthcare / Robert J. Blendon Skeptical patients: performance, social capital, and culture / Pippa Norris Building quality in the healthcare environment / Donald M. Berwick Medical errors and patient safety / Lucian L. Leape Assessing quality: today's data and a research agenda / Christine G. Williams Patients' trust in their doctors: are we losing ground? / Dana Gelb Safran Healthcare research: can patients trust physician scientists? / Greg Koski Medical education: teaching doctors to be trustworthy / Jordan J. Cohen Trustworthy information: medical journals and the Internet / George D. Lundberg Trustworthy information: the role of the media / Trudy Lieberman Confusion at the table: can we trust that our food is healthy? / Walter C. Willett Trust in vaccines / Marie C. McCormick Trust in the trenches: developing the patient-physician dyad in medical genetics / Susan P. Pauker Gaining competitive advantage in the healthcare marketplace by building trust / David A. Shore The changing relationship between health plans and their members / Charles M. Cutler Building trust in a healthcare system / Michael J. Dowling Building trust in the clinician's office and at the bedside / Richard Toran and Howard King Conclusion: trust in healthcare, trust in society / Marc J. Roberts Trust in the professions and institutions that provide healthcare in America has been eroding for many years and is now close to an all-time low. This decline in trust compromises medical outcomes and presents challenges to all healthcare professionals. This book traces that trend, identifies the basic elements of trust in the environment of modern healthcare, analyzes the sources of mistrust in key areas of medicine, and makes constructive suggestions for restoring trust This is a comprehensive survey of the causes and consequences of declining trust in healthcare, and provides suggestions for its restoration. The authors identify the elements of trust in the environment of modern healthcare, and analyse the sources of mistrust in key areas of medicine