Chapter 5. Building Trust
Trust is established when there is a perceived
good-faith effort to behave in accordance with a group's commitments (i.e.,
delivering on what is promised). Several factors, such as shared social norms;
repeated interactions; shared experiences; and reliable, consistent, and
predictable leadership also have been suggested to facilitate the development
of trust. Perhaps the most fundamental component of trust is the ability to
communicate effectively, which involves much more than sharing information.
Effective communication establishes an understanding between individuals and organizations.
The mutual respect that can lead to trust must
come from this communicated understanding. Once a relationship has experienced
mutual respect, it is possible for participants to experience enduring
relational trust, which is a feeling that binds people together over time and
through trials.
Trust among a diverse group of stakeholders is
essential to building and maintaining a regional coalition. Perhaps the most
daunting obstacle to this kind of open communication for coalitions is the
traditionally competitive relationship among some stakeholders. It takes
effective leadership skills to develop the honest communication and rapport
that will help competitors see beyond their business interests to the larger
social good that collaboration offers.
Competition Versus Collaboration
Competition may be healthy for the economy, but
collaboration is necessary for value-driven health care to succeed. Coalition
leaders need to foster a collaborative process that is open and inclusive and
leads to a consensus among competitors. It is important for leaders to build
trust by lowering traditional barriers. One barrier, in particular, is a
reluctance to share data among stakeholders. Providers may see releasing
pricing data as a disadvantage, and public ratings generate concerns among
competing medical groups. Traditional tensions between physicians (i.e.,
medical associations) and health plans also can be an issue, such as when
physicians question health plan motives.
Suggested processes for lowering competitive
barriers among participants follow.
Appeal to the Greater Good
When talking to stakeholders who are reluctant
to share data with competitors, emphasize that systemically improving health
care quality in the community requires broad collaborative effort. Providing
cost-effective, quality health care should be something on which everyone can
agree to cooperate.
It is also important to emphasize that
stakeholders working collaboratively are able to accomplish larger, more
comprehensive data gathering and reporting than by working individually.
Creating and sharing a larger, broader data set among a range of stakeholders
is essential for significant health care system improvement.
Facilitate Candid Discussions
Coalition leaders should be ready to construct a
coalition at a pace that will allow stakeholders to build trust. During the
startup phase, the most important task is to find the common ground for all
parties. Facilitating frank discussions among physicians, plans, and employers
in a neutral meeting space can ease participants' suspicions and let them find
common ground. Beyond the startup phase, involve as many diverse participants
as possible in overseeing coalition activities.
The Center for Health Information and Research,
for example, upon the inception of Arizona HealthQuery, formed a regular data
partner meeting that includes all regional coalition stakeholders. This process
builds trust, establishes transparency, and promotes an environment in which
sharing is possible. Similarly, Massachusetts Health Quality Partners developed
its Physician Council as part of the governance structure to ensure all
physician groups work together to influence the process.
Develop and Adhere to a Set of
Shared Values
Several coalitions use a strategy to engage
their members in the development of a set of shared values that will govern the
coalition's work. For example, the Wisconsin Collaborative for Healthcare
Quality has a code of ethics that emphasizes the importance of member adherence
to standard measures, consistent timeframes and timelines for reporting, a
willingness to share best practices, and a commitment not to use the
performance results in marketing or other overtly competitive activities.
Tip: In discussions that precede
enrollment of a stakeholder, offer direct, objective responses to all issues of
concern. Do not evade issues or gloss over any problems raised.
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