Melvin F. Hall, Ph.D.
President & CEO
Press Ganey Associates, Inc.

Are You Trusted?

Patients, employees, physicians, and even communities ask themselves if their providers, their employers, and their health care partners, can be trusted. In the world of health care, trust is built upon a proven ability to preserve and nurture the health and well-being of patients. While earning this trust is at the core of every health care organization’s mission, it is not easily accomplished. Oftentimes, patients and their family members are forced into unfamiliar situations where they must make difficult decisions based on information they receive from people they may not know. The stress—and the stakes—can be very high. Creating trust under these conditions requires creating a patient-centered environment that allows health care professionals to provide top-drawer caring and curing.

David Shore, author of The Trust Prescription, and founding director of the Trust Initiative at the Harvard School of Public Health, says that patient trust is what a health care leader’s work really is. He sees trust as a mission driver and a margin driver. It’s a mission driver because patients have better outcomes when they trust their health care provider. It’s a margin driver because trusted organizations attract the best people, require less bureaucracy, find it easier to raise capital, and attract and keep more customers. Shore asks, "What better legacy can you imagine than helping to create an organization that is trusted?"

Creating trust requires the alignment of competing priorities along a single axis, for a singular purpose: to provide patient-centered care. According to Denis Cortese, M.D., president and CEO of the Mayo Clinic, gaining and keeping patient trust is the one priority around which all others coalesce. If health care leaders spend time and energy on the things that matter most to patients, then other priorities—reimbursement, care for the uninsured, physician relations, quality, personnel, safety, aging physical plant, health care IT—will be addressed in a patient-centered, and therefore efficient and meaningful way.

One critical step toward gaining the trust of patients is for health care organizations to trust their patients to be a part of their improvement process. Health care leaders who are making strides in improving patient care recognize that they do not have all the answers themselves. They garner feedback from patients themselves to drive continuous improvement efforts.

Memorial Hermann City Hospital, a member of the Memorial Hermann Healthcare System in Houston, Texas, decided to undertake a pilot program to personalize the patient experience of its cardiovascular patients. The hospital built trust through activities that demonstrated staff were listening and responding to patients’ needs. The program, named Art of the Heart, aimed at the entire continuum of care—not only the hospital experience, but also aspects of the patient’s pre-admission and post-procedure experience. The program incorporated several tools to assist patients to reflect on, and feel more in control of, aspects of their care. These tools included patient journals—in which patients could keep track of medications, follow-up appointments, and nutritionist consults—as well as feelings and concerns. The hospital also provided family resources, which even included origami kits for families to use while waiting. Enhancing treatment meant enhancing the environment as well. A major museum provided artwork that was replicated for patient areas, staff enjoyed "celebration trays" of healthy treats with patients, and staff underwent training in interpersonal communication. The Art of the Heart pilot produced a jump in cardiovascular patient satisfaction from the 18th percentile in 2005 to the 90th percentile in 2007. Inpatient stays for cardiac service line patients went from 3.9 to 3.4 days, and net income increased over $250,000.

But of course it is not just about the patients. Savvy health care leaders have a finger on the pulse of employee perceptions and have mechanisms for engaging them in quality improvement initiatives. They have discovered that empowering employees exponentially magnifies the organization’s quality improvement efforts. By trusting the employees who serve as the face of the organization and see the problems and obstacles firsthand, health care leaders drive them to be active participants in making the care better.

Advocate Good Samaritan Hospital, in Downers Grove, Illinois, developed standards of behavior across the hospital. These standards helped guide employees to interact effectively with patients, colleagues, and physicians. A common language for addressing the patient experience was developed by physicians. Common, consistent standards increased patients’ trust because they knew what to expect across all areas of the hospital. Advocate Good Samaritan saw that trust in employees translated into trust from patients and higher overall outpatient satisfaction.

Continuous improvement thus revolves around empowered employees and physicians being responsive to patient satisfaction. Our most recent Hospital Pulse Report found that a hospital’s ability to respond to an individual patient’s needs is the strongest predictor of a facility’s overall performance score on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) reporting tool. Performance on HCAHPS will soon be tied to CMS reimbursement, which in turn will improve the hospital’s ability to serve patients. Responsiveness engenders trust, which builds the organization, which engenders trust, and so on.

As high-performing health care organizations demonstrate, the cycle of patient-centered care revolves around trust.