34 Trustworthiness in health care: building trust between healthcare organizations and clinicians

Background

Trust at multiple levels—between patients and clinicians, between clinicians and the organization where they work, and between communities and their health care organizations–is essential for the optimal functioning of the health care system, and especially for those from historically marginalized and BIPOC (Black, Indigenous, and people of color) communities.

Objectives

This session will explore the history and complexity of healthcare organizations building trust with clinicians as a driver of health equity, articulate the theory of change within the Organizational Trustworthiness in Health Care framework, and discuss the results from Oak Street Health.

Methods

Following an innovation cycle, IHI convened a ten-month 2023 Organizational Trustworthiness in Healthcare Prototyping Network, comprised of six health care organization teams, to test the theory of change. Oak Street Health will share its preliminary results from their prototyping network efforts, including process, outcome, and balancing measures, in addition to the successes and challenges of testing the change package. Implementation of this change package can help guide organizations toward meaningful and measurable improvements in trust.

Results

Through multiple rounds of Plan-Do-Study-Act (PDSA) cycles, the project at Oak Street Health uncovered two fundamental aspects impacting trust with the organization: (1) there is a heavy emotional & cognitive load inherent in serving historically disenfranchised communities that need to be acknowledged and addressed, and (2) there is a priority misalignment between the clinical and operational arms that requires more frequent and open conversations between front line teams and operational leaders.

Conclusions and Implications

Oak Street Health is continuing to advance this work by integrating our findings into the organization’s broader Wellness and retention strategy through the development of a preventative framework for mitigating burnout, ensuring care team wellbeing, and maintaining bi-directional trust.