Jennifer Stephens, MPH, principal researcher at America’s Essential Hospitals, contributed to this article.
Patient trust in health care providers is associated with positive health outcomes, yet few studies have explored patient trust in hospitals, particularly those serving vulnerable populations. Essential Hospitals Institute is working to fill that knowledge gap.
Through a project, supported by the Robert Wood Johnson Foundation, the Institute examined patients’ trust in essential hospitals, those that disproportionately serve vulnerable patients, including racial/ethnic minorities; people living in poverty; Medicaid and Medicare beneficiaries; the uninsured; individuals with multiple chronic health conditions; and people with other social risk factors.
The Institute first conducted a literature review to identify existing dimensions of patient trust. Four dimensions frequently appeared in previous research:
- fidelity, or commitment to patients;
- competence, or quality and safety of care;
- honesty, or truthfulness; and
- confidentiality, or proper use of sensitive information.
Institute researchers hypothesized three other dimensions conducive to well-being might be important to the vulnerable populations served by essential hospitals:
- equity, or fair and equal treatment of patients;
- community integration, or social support for patients and community connectedness; and
- environmental quality, or a safe and comfortable environment.
These seven dimensions formed the basis of a survey of patients’ institutional trust of essential hospitals. Pilot testing the survey with patients helped safeguard against inconsistent interpretations, definitions, and understanding of the questions, as well as unsuitable or inappropriate phrasing and response options.
The final survey contained 96 items concerning each dimension of trust, overall trust in the hospital visited, and demographics of the patient and caregiver. A panel of 1,000 patients and caregivers seen at member hospitals within the last year submitted survey responses.
Survey items were inspected individually and as a group with other items measuring the same dimension before being included in the final data analysis. For example, data analysts tested that responses to items in a singular dimension were related to each other. Once the nonrelated responses were removed, data analysis could be used to determine which dimensions were most associated with overall trust. Patient and caregiver demographics, coupled with essential hospital data, enabled further examination of differences in overall trust across various patient and hospital characteristics.
Researchers found statistically higher trust levels among patients and caregivers who were older, wealthier, white, non-Hispanic, male, commercial insured or covered by Medicare, and attended a scheduled visit. Patients also were more likely to report higher trust in hospitals with more beds on average compared with other hospitals in the survey.
Despite these differences based on patient demographics and hospital characteristics, patients and caregivers expressed high levels of trust in essential hospitals, with an average overall trust rating of 8 out of 10—offering a stark contrast to historically low ratings of trust for health systems overall. All seven dimensions were highly associated with trust, although fidelity, competence, and environmental quality were most highly associated.
The survey results will be used to learn more about policies and practices essential hospitals employ to build and maintain patient trust. Further study will emphasize fidelity, competence, environmental quality, and community integration.
The findings, together with input from site visits to member hospitals, will provide the foundation for a guide on policies and practices essential hospital leaders can incorporate to increase patient trust in their institution. The guide will be released later this year.
A webinar recording is available to members of America’s Essential Hospitals offering a more detailed account of the survey approach and results.