Now is an opportunity for organizations to actively rebuild and earn back trust of their communities. But how? The Deloitte Center for Health Solutions conducted two streams of research to gain insights into the “current state” of trust in health care:
1) Focus groups with 525 individuals in the United States who identify as Black, Hispanic, Asian, or Native American to explore their experiences with health care organizations and sentiments around trust
2) Thirteen interviews with health executives, advocates, and academic experts to explore organizations’ strategies to repair and improve trust
In our virtual focus groups:
- Fifty-five percent reported a negative experience where they lost trust in a health care provider.
- Thirty-six percent have skipped or avoided care because they did not like the way the health care provider or their staff treated them.
- After an experience where they lost trust, four out of five participants say there was nothing the provider/health system could do to make them returnto the same provider or health system.
- Having a provider who has empathy, is culturally competent, and/or looks like them is a top priority. About half of the participants are willing to trade off access to convenient, in-person care with longer-distance travel or virtual visits to get a provider who looks like them/is culturally competent.
These findings highlight the importance of trust and its influence on people’s decisions about whether they go for care, where they go for it, and what experiences they will not tolerate. Improved experience is therefore critical for advancing health equity.
To improve interactions with health care providers, participants said they need to:
- Have a voice when something goes wrong. Sixty-two percent of the participants want their local hospitals to ensure patients have a voice to relay their experiences and take action to address their problems.
- Have access to providers who are culturally competent and/or look like them, talk like them/have shared life experiences.
- For Asian (59%) and Hispanic (53%) participants, having a provider who has empathy and is culturally competent is a top priority when choosing a provider.
- Two out of three participants who identify as Black or African American and half of Asian and Hispanic respondents say it is important to see a health care provider similar to them.
- Younger participants (aged 18–44 years) are more likely to say that having a health care provider with a similar background is important.
In prior research with health care executives, we found that many were prioritizing health equity through investments, governance, and resources.3 But despite well-intentioned efforts, trust remains an issue. From our interviews with executives, we found that organizations know that they not only need to make changes, but also take a humble step back and listen. A misstep in the past was to make assumptions on what their communities needed and wanted, instead of asking them. The link between trust and health care is not a new topic in research and academics, but the systems that deliver and pay for care are farther behind when it comes to discussing and strategizing how to make changes. The executives we interviewed noted that more and more, their organizations are recognizing the importance of trust, and to be most effective—hospital leadership should communicate the importance through actions and not just words. The interviewees said they are acknowledging the need for staff to be culturally competent about different life experiences, backgrounds, and languages. And ultimately, the entire care team can deliver better care if they have empathy, ask what patients prefer (language, for example) instead of assuming, and create a nonjudgmental environment.
There is an opportunity for health care organizations, in light of the imperative for health equity, to shape their strategies best if they understand the wide range of perspectives in their communities and what consumers want and what organizations should do to earn back their trust.
Health care organizations have a history of and current problem with mistrust
All physicians, and by association health systems, take an oath to “abstain from all intentional wrong-doing and harm” when they take the Hippocratic oath. However, whether intentionally or not, some providers and health care organizations are not abiding by this oath, and have contributed to the lack of trust that is prevalent across the US health care system.
Even more salient than historical atrocities, may perhaps be the daily subtle and unsubtle experiences of racism.4 Our research shows that people who identify as Black, Asian, or Hispanic feel as though their pain is often denied, they are not heard, and they are not treated well by staff and doctors. In these moments, patients are probably not thinking of historical atrocities, but rather thinking about how a system/provider has failed them and their communities.
We know that patients are less likely to return for care after having a negative experience with a health care provider or staff. Rebuilding that trust is essential as the link between trust and health outcomes is well established. When physicians and patients share a trusted relationship, we see improvement in cholesterol screening, patient understanding of cancer risk, and patient perceptions of treatment decisions.5 When trust is earned over multiple positive interactions with patients who felt previously mistreated, this can contribute to improved health equity.
In our research with health care executives on health equity, organizations acknowledge that they need to do better at improving trust. Many have invested heavily in their communities and determinants of health (DOH). However, despite these efforts, there are still challenges with trust. Where is the disconnect? And what do communities really need to have an improved relationship with the health care institution? We explored this in our research with 525 individuals who identify as Black, Hispanic, Asian, or Native American in the spring of 2021.