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New Guide to Building Institutional Trust in Essential Hospitals

Public trust in U.S. institutions and professionals has declined over the past 50 years. In health care, patient trust is highest for providers, followed by payers, with health care institutions lagging. A new guidance document from Essential Hospitals Institute evaluates patient trust in essential hospitals and provides strategies for hospitals to cultivate institutional trust.

Patient Trust: A Guide for Essential Hospitals shares the results of a consumer panel survey of 1,000 patients and caregivers, along with focus groups and interviews with patients, caregivers, and staff at three essential hospitals. This research occurred before the COVID-19 pandemic reached the United States.

Overall, patients and caregivers expressed high levels of trust in essential hospitals, with a weighted average trust score of 8 out of 10. But within that population, researchers saw differences that fell along sociodemographic lines. For example, higher trust was recorded among white patients versus nonwhite patients. Trust also tended to be higher among older patients and those with higher incomes. Because essential hospitals serve large numbers of patients who tend to have lower levels of trust in institutions – people of color, communities living in poverty, and uninsured patients — they must work harder to gain trust.

Researchers identified five dimensions of trust most important to essential hospital patients and their caregivers: fidelity; competence; environmental quality; community integration; and equity. The guide offers potential approaches that can be applied within a hospital or health system to bolster community and patient confidence, including:

  • building an organizational culture to facilitate trust;
  • focusing on patient-centered care;
  • cultivating a physical environment to support trust; and
  • engaging the community.

The Institute thanks the Robert Wood Johnson Foundation for financially supporting this work and acknowledges the contributions of essential hospital members who participated in the survey, focus groups, and site visits.

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