A recently published study offers insight into what is being done differently at practices where patients express high trust in their clinicians and where clinicians trust their organizations. The study, published in Annals of Family Medicine, found there are four cultural variables in trusted organizations.

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They are:

  • An emphasis on quality.
  • An emphasis on communication and information.
  • Clinician cohesion.
  • A values alignment between clinicians and leaders.

Many strategies to improve trust focus on adjusting financial incentives, the study notes, but the results from studying 165 clinicians with 1,132 patients shows that aligning values and focusing on quality is a way to increase that trust.

Mark Linzer, MD
Mark Linzer, MD

“The emphasis on organizational culture is not an area that gets a lot of attention, but at least from these data, it’s an incredibly powerful variable that organizations should think more about,” said Mark Linzer, MD, lead author of the study, “Where Trust Flourishes: Perceptions of Clinicians Who Trust Their Organizations and Are Trusted by Their Patients.”

Dr. Linzer directs the Institute for Professional Worklife and is vice chair of the medicine department at Hennepin Healthcare in Minneapolis.

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With increased physician and patient trust, organizations could see important downstream benefits, the study says. For example, there could be:

  • Less clinician turnover.
  • Healthier patient behaviors
  • Greater rates of medication adherence.

“The organization that cares for people and addresses some of these cultural values, I think, will be the place where people want to stay,” said Dr. Linzer, who also is a professor of medicine at the University of Minnesota.

A 2019 JAMA Network Open paper that Dr. Linzer also wrote showed that trust is related to stress and professional satisfaction, finding that satisfaction was substantively higher and that stress was moderately lower. The paper further showed that with improved trust over time, a clinician’s odds of intending to leave was explained by improved trust.

“Trust may impact one’s retention, a key factor during this time of job shifting, work-hours reduction and reduced staffing,” Dr. Linzer said.

Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing, issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face.  By focusing on factors causing burnout at the system level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction. 

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Health care organizations have a menu of options that they can use to start increasing trust, Dr. Linzer said.

“We encourage organizations to contemplate with their clinicians how their organizational emphasis on values, quality, communication and cohesion—teamwork—can be assessed and improved,” he said. “We are optimistic that trust and several other favorable outcomes, such as satisfaction with work and intent to stay with the organization, will improve with it.”

Leaders can, for example, start by putting an emphasis on quality to start improving trust. “Show the clinician team that is what you value,” he said. “Then you might move to something like values alignment so clinicians know that the values they have are the ones reflected in the organization.”

From there, it is important to measure the favorable outcomes for clinicians and patients that were spurred by the changes.

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