Perspective from Shivaraj Nagalli, MD, FACP
Disclosures: Lin reports no relevant financial disclosures. Linzer reports receiving research and training support from the ABIM Foundation, ACP, Agency for Healthcare Research and Quality, AMA, Hennepin Healthcare and/or the Hennepin Healthcare Research Institute, Institute for Healthcare Improvement and NIH. He also performs consulting work for Harvard University.
December 14, 2021
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Study identifies characteristics that promote physicians’ trust in their organization

Perspective from Shivaraj Nagalli, MD, FACP
Disclosures: Lin reports no relevant financial disclosures. Linzer reports receiving research and training support from the ABIM Foundation, ACP, Agency for Healthcare Research and Quality, AMA, Hennepin Healthcare and/or the Hennepin Healthcare Research Institute, Institute for Healthcare Improvement and NIH. He also performs consulting work for Harvard University.
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Researchers identified four characteristics that were likely to improve a physician’s trust in their organization.

“Trust is an intrinsic and critically important aspect of the health care workplace. Health care workers need to believe their workplaces will watch out for them, keep them safe and provide a work environment where they can provide high-quality care for their patients,” Mark Linzer, MD, a physician with Hennepin Healthcare in Minneapolis, told Healio Primary Care.

An infographic that describes the four characteristics that were associated with high-clinician and high-patient trust: emphasis on quality; emphasis on communication between doctors, nurses and electronic information systems; cohesion among clinicians; and agreeance between clinicians and leaders about values
Reference: Linzer M, et al. Ann Fam Med. 2021;doi:10.1370/afm.2732.

Linzer and colleagues conducted an analysis of the Healthy Work Place Study, which was a randomized trial of workplace interventions designed to improve work conditions in 34 primary care clinics in the Midwestern and Eastern United States.

“Prior analyses of Healthy Work Place trial data have shown that increasing trust in the organization by clinicians over time is associated with two times lower odds of intending to leave the organization,” Linzer said.

For the current analysis, the researchers examined data from 162 clinicians, 55 of whom were determined to have patients who highly trusted them.

The findings, published in Annals of Family Medicine, revealed four characteristics that were associated with high-clinician and high-patient trust: emphasis on quality (OR = 4.95; 95% CI, 2.02-12.15); emphasis on communication between doctors, nurses and electronic information systems (OR = 3.21; 95% CI, 1.33-7.78); cohesion among clinicians (OR = 2.29; 95% CI, 1.25-4.2); and agreeance between clinicians and leaders about values (OR = 1.86; 95% CI, 1.23-2.81).

“The results were not too surprising, although we did not know which aspects of organizational culture might relate to trust,” Linzer said. “It turned out that all the organizational culture aspects we measured did so. This provides strong support for involving clinicians in organizational culture discussions and moving forward together to co-create the structure and components of the culture in which care is provided.”

The data were collected before the COVID-19 pandemic, and it is unclear whether the pandemic would impact the study findings, according to Linzer.

“Because the findings mainly involve relationships between culture variables (values, quality, communication, cohesion) and outcomes (trust), we don’t know that the pandemic would have changed those relationships substantively,” he said. “However, the 34% prevalence of clinicians in the ‘high zone’ (where trust flourishes, with high trust in the organization by clinicians with highly trusting patients), may have changed after the experiences of the past 20 months. We cannot say in which direction, though.”

In a related editorial, Kenneth W. Lin, MD, MPH, a physician at Georgetown University Medical Center, acknowledged that “trust in medicine is at a low ebb,” and suggested that organizations that utilize Linzer and colleagues’ findings “may have happier clinicians and more satisfied patients.”

References

Lin KW. Ann Fam Med. 2021;doi.org/10.1370/afm.2752.

Linzer M, et al. Ann Fam Med. 2021;doi:10.1370/afm.2732.