Dataset Information

First, do no harm: institutional betrayal and trust in health care organizations.

ABSTRACT:

Purpose

Patients' trust in health care is increasingly recognized as important to quality care, yet questions remain about what types of health care experiences erode trust. The current study assessed the prevalence and impact of institutional betrayal on patients' trust and engagement in health care.

Participants and methods

Participants who had sought health care in the US in October 2013 were recruited from an online marketplace, Amazon's Mechanical Turk. Participants (n = 707; 73% Caucasian; 56.8% female; 9.8% lesbian, gay, or bisexual; median age between 18 and 35 years) responded to survey questions about health care use, trust in health care providers and organizations, negative medical experiences, and institutional betrayal.

Results

Institutional betrayal was reported by two-thirds of the participants and predicted disengagement from health care (r = 0.36, p < 0.001). Mediational models (tested using bootstrapping analyses) indicated a negative, nonzero pathway between institutional betrayal and trust in health care organizations (b = -0.05, 95% confidence interval [CI] = [-0.07, -0.02]), controlling for trust in physicians and hospitalization history. These negative effects were not buffered by trust in one's own physician, but in fact patients who trusted their physician more reported lower trust in health care organizations following negative medical events (interaction b = -0.02, 95%CI = [-0.03, -0.01]).

Conclusion

Clinical implications are discussed, concluding that institutional betrayal decreases patient trust and engagement in health care.

SUBMITTER: Smith CP

PROVIDER: S-EPMC5388348 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

First, do no harm: institutional betrayal and trust in health care organizations.

Smith Carly Parnitzke CP

Journal of multidisciplinary healthcare 20170403

<h4>Purpose</h4>Patients' trust in health care is increasingly recognized as important to quality care, yet questions remain about what types of health care experiences erode trust. The current study assessed the prevalence and impact of institutional betrayal on patients' trust and engagement in health care.<h4>Participants and methods</h4>Participants who had sought health care in the US in October 2013 were recruited from an online marketplace, Amazon's Mechanical Turk. Participants (n = 707; ...[more]

PMID: 28435281

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Project description:ImportanceThere is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention.ObjectiveTo examine organizational characteristics associated with trust.Design, setting, and participantsThis prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016.Main outcomes and measuresClinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach ??=?0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more.ResultsThe study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P?<?.001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P?<?.001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P?<?.001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P?<?.001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P?<?.001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P?=?.02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P?=?.04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P?<?.001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P?<?.001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P?=?.02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P?=?.04).Conclusions and relevanceAddressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.

Dataset Information

First, do no harm: institutional betrayal and trust in health care organizations.

Purpose

Participants and methods

Results

Conclusion

Publications

First, do no harm: institutional betrayal and trust in health care organizations.

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