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Commentary: Growing Trust

Tim Size
Executive Director, RWHC

Our country is now seeing the return of a disease that previously had been considered “eliminated”–measles. As reported by CBS News, in the last few months we have seen outbreaks in Virginia, New Jersey, Pennsylvania and Delaware.

A report last November in the Milwaukee Journal Sentinel noted that Wisconsin kindergartners have one of the lowest rates of vaccination in the country against measles, a preventable disease that is highly contagious and that can cause severe illness in young children. “Last school year, only about 86% of Wisconsin kindergartners had been fully vaccinated against measles. That’s compared to an estimated 93% of kindergartners in the rest of the country. (Wisconsin, also, has among the lowest vaccination rates for other vaccines, which protect against such diseases as chickenpox, polio, and whooping cough.)”

There are many good people more expert than I am on this issue who are looking to respectfully increase the number of children receiving what we have long considered as routine vaccinations. I am old enough to remember the fear felt before the polio vaccine became available in the 50s and perhaps that has made it easier for me to appreciate the miracle of our modern vaccines.

As important as vaccination rates are, it is used here as an important introduction of an even larger challenge–how do those of us in healthcare, rural and urban, most effectively work to grow the trust in the communities we hope to serve?

People who know me well know our family lost a number of folks during the pandemic under circumstances that didn’t help my understanding of those not comfortable receiving the vaccine. Later than it should have been, I realized my anger was not helpful. I needed to redefine the larger situation as one about relationships more than people accepting science, and that the challenge can’t be defined as about “those other people” but as about “all of us.”

About 30 years ago I wrote “Managing Partnerships: The Perspective of a Rural Hospital Cooperative,” published in Health Care Management Review. It focused on RWHC’s experience maximizing collaboration amongst hospitals. The first principle was to develop relationships based primarily on mutual trust. I just reread that paper and I think, lightly edited, it remains relevant and has something to offer us about the partnerships and trust we need to assure we have with our patients and our communities. Here are a few highlights:

Formal agreements define minimum performance and penalties for failure; they are limited by yesterday’s knowledge and vision. In contrast, mutual trust assumes the potential of limitless performance and visions not yet fully formed. These relationships fill deep needs, enable work to have meaning and to be fulfilling. True mutual trust, however, is risky because it requires individuals to depend on each other, to be vulnerable to what both contribute.

The understanding of who shares a common future or dependency clearly becomes a critical issue when developing trusting relationships. This is an area in which rural communities have a natural advantage as there are typically closer ties amongst the participants and an understanding of how both patients and “providers” are critical to the health and future of each other.

Examples of Healthcare Behaviors That Encourage Trust

  • Listen deeply.
  • Actively, consciously work to build trust with patients and the community.
  • Protect trust that is developed as the critical asset it is, both from real or perceived breaches.
  • Recognize that earning trust takes time and has limits to how quickly it can be developed.
  • Recognize that collaborative relationships entail calculated risks and are more messy than relationships built on control of one party over another.
  • When you can’t implement a previous agreement, you need to say so.
  • Without fanfare, admit all significant mistakes as soon as they are discovered.
  • And of course, treat all patient information as confidential.

Healthcare is a complex “business” but without growing the primacy of trust, we will not achieve the results that our patients and communities are expecting and deserve and those of us in health care wish to provide.

(Tim Size is executive director of the Rural Wisconsin Health Cooperative, Sauk City. RWHC is owned and operated by 44 rural hospitals, including Tomah Health.)



Tomah Health