Organizational Factors that Impact Trust in Healing Relationships: A Qualitative Study.

Abstract

Interpersonal trust is understood to be context-dependent, but literature describing patient-clinician trust has often ignored the impact of the local organization on this trust, neglecting the opportunity for clinicians and organizations to intervene to promote trust. To explore the relationship between organizational factors and interpersonal trust between patients and their primary care clinicians. Qualitative study using semi-structured interviews of 40 patient-clinician dyads that were analyzed using a modified grounded theory approach. Primary care clinicians (both physicians and advanced practice providers) and their patients at outpatient internal and family medicine, women's health, and urgent care clinics at two large institutions in Denver, CO. Code and category frequencies, grouped into themes. Patients and clinicians expressed distinct vulnerabilities in the relationship and understood trust differently. As reflected in our conceptual model, patients understood trust primarily in terms of beneficence and clinicians understood trust primarily in terms of honesty and reliability. As a result, each identified different organizational factors that could impact their trust in the other party. The distinct perspectives between patients and clinicians on relevant organizational factors suggest feasible ways in which clinicians and organizations can act to promote bidirectional trust between patients and clinicians, with far-reaching health and relational benefits. Promoting patient trust in clinicians can improve health outcomes, and promoting clinician trust in patients may empower patients in their care and reduce clinician burnout. In the ever-changing practice environment, our findings generate hypotheses for future trust research.