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Leadership Dialogue Series: The Critical Role of Trust in Health Care
Trust is a critical component of any healthy society. In health care, any potential erosion of trust can have negative impacts on the field as a whole. In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with two health care leaders, Lynn Hanessian, former chief health strategist at Edelman, and Robert Trestman, M.D., Ph.D., chair of psychiatry and behavioral medicine at Carilion Clinic, about why trust is eroding in society, how that impacts patient care, and what leaders can do to restore and strengthen it.
Transcript
Tom Haederle
erican Hospital Association's: ::Tom Haederle
Trust us. This is a discussion you don't want to miss.
::Tina Freese Decker
ican Hospital Association. In: ::Tina Freese Decker
So today, I want to talk about an issue that seems timelier than ever. Trust. Trust in one another. Trust in our field. Trust in our communities and our government is so important to what we do every day. And everyone should know that our hospitals, our health systems are a place for healing no matter what. And that trust is critical.
::Tina Freese Decker
Yet we see over the past several years, public trust has been decreasing, not just in health care but across the board. So with me today to give us some insights into why this might be happening is Lynn Hanessian who just completed a 28-year tenure as chief health strategist for Edelman, a global communications firm, and has worked directly with a number of hospitals and health systems during her career.
::Tina Freese Decker
And we had the opportunity to meet last month, and I was just fascinated by her presentation and what she's seen. And then we also have Dr. Robert Trestman, who I call Bob, who is the chair of psychiatry and behavioral medicine at Carilion Clinic, based in Roanoke, Virginia. And he also serves as professor of behavioral medicine at the Virginia Tech Carilion School of Medicine.
::Tina Freese Decker
And he's also on the American Hospital Association board. He is passionate about helping health care professionals and emphasizes the importance of remembering that we are human beings. It's a great reminder, with limits, and it's okay to ask for help. So before we get started, I would just love to hear from each of you about what you trust in today and why.
::Lynn Hanessian
Well, I'll go first if you don't mind. So for me, trust is about this sort of sense of confidence. Do I rely on that person, that organization, that institution? Can I count on them to do what's right? And so having that, connection is really important and influences how I operate professionally and certainly how I operate personally and how I take care of my family.
::Tina Freese Decker
That's great. Thank you. Bob?
::Robert Trestman, M.D., Ph.D.
In same way as physicians, we are in a unique situation to bond with a patient and they need to believe that we have their interests at heart, even above our own. That's core to what we're all about. And for hospitals and health systems to be seen as extensions of the physicians, the nurses, the other clinicians who are dedicated to caring for our patients.
::Robert Trestman, M.D., Ph.D.
So their belief in us is paramount because frankly, unless they trust in us, they won't be willing to follow our recommendations and we won't be able to help them heal.
::Tina Freese Decker
Yeah, it's so important why I am so focused on our mission, because it is really about what we do and what we say we do in those values that are aligned there. And that's what gives me that confidence and trust that we're going to continue to focus on the mission. So, Lynn, let's start with you and the Trust Institute and the trust barometer.
::Tina Freese Decker
Can you give us some just general background on the work and the research that has been conducted?
::Lynn Hanessian
Thanks so much. To give you some framing around it, for about 25 years Edelman has been studying trust. And we originally sort of wanted to get a handle on what does the public think? How did they perceive sort of the pillars of society? How do they think about government, business, not for profits, the media? And what does that mean in relation to their behaviors?
::Lynn Hanessian
And I think, Dr. Trestman, you bring up a really good point. If people don't trust they're not going to follow their doctor's recommendations. And we found that if they don't have trust in their health, what we defined as the health ecosystem that includes the doctor, the hospital, all of those factors that help them get into the health care,
::Lynn Hanessian
they're not going to get their regular appointments. They're not going to get the kind of care that's recommended. And I deeply worried that that means they're going to turn somewhere else. As we've studied trust over the years, we've looked very closely at trust in different sectors of business, of industry. Health care is among the areas that we looked at, but we also want to understand how do we build trust?
::Lynn Hanessian
How do we think about the implications of that and how do we sort of, frankly, help to forge a more trusting society? So that's really been quite a journey that Edelman has been on.
::Tina Freese Decker
And so this conversation is particularly timely because Edelman just released the latest Trust Barometer data last month. What are some of the key trends that you can share with us?
::Lynn Hanessian
Absolutely. And I think, I'm going to share some global trends because it's important to know that we're not alone. We're in a really interesting time, a difficult time because what we've seen is really a rise in distrust, distrust in government, in business, across society. And even as employers, we've seen a decline in the last year, a decline in my trust in my employer, which is, you know, if you think about your daily activities, you know, your employer relationship is among the strongest.
::Lynn Hanessian
If we asked about spouses and loved ones, we'd probably find similar numbers. But what we know is, there's fear. There's fear of globalization, fear of economic pressures, fear of change that's really set upon us. And one of the things that the key concluding point that we saw this year, and again, this influence is what's coming into your health systems,
::Lynn Hanessian
that dialogue with the doctor, the dialogue with the nurse, the whole communities in which you operate. There is a lack of optimism about the future. There is also a real fear of being discriminated against across all of the demographics we look at. And there's a belief that the government and business has their self-interest in that it's not including me, and that our leaders aren't telling us the truth.
::Lynn Hanessian
So there's a real sort of intense worry, and we called it grievance this year that we're not going to get a fair shake. And so that's really the finding that we happened upon. And you can see there's forces in the world in which we live that want to shake our confidence in one sector so that they can have an advantage somewhere else.
::Lynn Hanessian
And we're seeing it play out in the general public.
::Tina Freese Decker
That word grievance, really hit me when you presented that to us and we talked about it. And it really does sum up where we are. And it's hard to be optimistic, but those are the things we need to be focused on and moving forward. So, Bob, as you're listening to this, what do you see are the implications of this distrust as it relates to health care?
::Robert Trestman, M.D., Ph.D.
Well, I think it's really important for us to be aware that there is this level of distrust in the community and to think through very consciously how we can mitigate it. The words that come up grievance, fear, trust, all are woven together. So we need to think through what is it our patients fear? Yeah. There's the fear of pain.
::Robert Trestman, M.D., Ph.D.
The fear of death. The fear of different kinds of morbidity. That's what we as clinicians are trained to focus on. But we now need to talk even more broadly about a range of other fears, because, frankly, people can be afraid that they even if we give them a recommendation, they may not be able to afford to follow it.
::Robert Trestman, M.D., Ph.D.
So we need to think through with our patients the financial implications of our recommendations, what it means for their families. So we as clinicians, as providers of care and as systems of care need to be very, very thoughtful about how to support our patients so they can trust that we are thinking through the implications of how we recommend they deal with their illnesses in ways that actually will benefit them globally, and not that we're just focusing on one issue that may compromise something else.
::Tina Freese Decker
So for both of you, how do we as hospitals and health systems help build that trust with our patients and with our communities and the people that we serve?
::Lynn Hanessian
So I have some good news. While trust in these powers outside of us has really declined, one of the few places where we still have trust is local. My doctor, my institutions, my media. And so that gives us some hope. And I think, Dr. Trestman, when you talked about things so beautifully, it's not just, you know, Lynn, you have a diagnosis, here's your medication.
::Lynn Hanessian
The things you're taking into account reassure me that you're concerned about all of me, that it is your understanding the context in which I live. And this is one of the few places where we have some defense, some opportunity to build trust, because that expertise of my doctor, more so than my CEO, is trusted. And so I think those places where we can lean into helping people to really understand all of those things, that we're seeing them not just as a diagnosis in a particular space, but we understand how that plays out in their whole lives, gives us an opportunity.
::Lynn Hanessian
And I think, you know, the way you described it is so much a reflection of, I'm concerned about you, how you live, those hurdles that may prevent you from achieving all you want to achieve. And so helping the people in the communities that we serve to understand that that's so central. I think you mentioned mission earlier, so central to how we serve, that we have an opportunity to build that trust.
::Lynn Hanessian
Now, one of the big challenges is when your patients are coming in, they're not getting a reliable source of information. They're not getting the news. We're not hearing the kinds of things and we don't trust public authority. So we have to think a little bit more about not only our individual patient, the role of our institutions in serving our communities and filling a little bit of that void.
::Tina Freese Decker
What would you suggest related to that?
::Lynn Hanessian
Well, I think, frankly, for health systems and hospitals, particularly hospital CEOs, take a look at your operations, your communications, your marketing, your public policy. All of your external and internal engagement activities have to be aligned. They have to be communicating. You can't just assume that we're in silos anymore where you've got your marketing team that's going out to bring in your patients, but your public policy folks are out there talking to your elected officials.
::Lynn Hanessian
We need to make sure that there's a an integration, a communication, and, frankly, a little bit of a willingness to share the occasional vulnerability. We have our authority and our expertise because we're doctors and we're anchored in science. On the other hand, having that opportunity to be human together with the people we serve can make a big difference.
::Tina Freese Decker
That goes back to your quote. So I'm curious to know what you think, Bob, we can do to build trust. And I know you're also very passionate about all of our teams that work in health care. And so how do we not only build trust with our community, but build it with our team members?
::Robert Trestman, M.D., Ph.D.
There is an aphorism that at least is true today, as it was when it was first uttered, that people don't care how much we know until they know that we care. And how is it that they know that we care? It's by what we do, what we say, how we interact. And so I think hospitals and health systems are uniquely positioned to be an integral part of the community.
::Robert Trestman, M.D., Ph.D.
In many of our communities, we are the financial driver, we are the main employer. And that gives us an enormous opportunity to think globally about the impact of care delivery to our patients. But also our clinicians need to feel supported and safe so that they can do their best to provide care to those in their charge. So, as Lynn just said, we need to think in a coordinated fashion.
::Robert Trestman, M.D., Ph.D.
Silos can no longer exist if we want to thrive as a health care system, we really need to work in a coordinated fashion so that all of the information is shared. And it's really, really hard to overcommunicate these days. We really need as long as we're on message, and our message is driven by our mission to improve health and health care for the people we care for, that our internal folks, our employees, our colleagues know that we are doing everything we can to support them, to provide them the infrastructure they need to deliver the care they want to do and to deliver.
::Robert Trestman, M.D., Ph.D.
Because so many of the people they're caring for are their neighbors in the communities in which we serve.
::Lynn Hanessian
I have to say, the one other real benefit from that is trust is built. When we look at a business or an institution, trust is built by how you treat your colleagues, your workforce. And seeing those folks, appreciating that - and I think that gets back to sort of this really integrated communication model when I know when your teams, everyone from the person I see as I'm walking into the institution who may be at the information desk all the way to the clinician, to the nurse, to every touchpoint - when I know that they have the confidence because their institution trust them, engages with them, that radiates and rebuilds my sense of trust and my confidence.
::Lynn Hanessian
So it's a nice virtuous cycle. And I would not underestimate the power of being a little bit more public sometimes with your internal communications, whether it's using your spokespeople or knowing that, as you said, so well, Dr. Trestman, that the people who are your employees are also part of your community, but that that then radiates out to their neighbors as well.
::Lynn Hanessian
And so I think that's a that's an important place to be in it. It's a little bit challenging when we think with respect and deference to our, our patients, but letting our hair down just a little bit helps people to understand. And that's sort of that a little bit of the genuine and authentic kind of engagement that people look for these days.
::Robert Trestman, M.D., Ph.D.
And if I may, as someone who serves on AHA the board with me, what do you think are some of the things that AHA members can be focusing on?
::Tina Freese Decker
Well, we've talked a little bit about it. I have this view of a kind of paradox. We have to overcommunicate and we have to over-listen, and we have to show both of those in an authentic, vulnerable way to make sure we know we're really connecting with people. We're hearing where their fears are or where they are anxious, or where they want to go in places and really understand that and then communicate it back and forth.
::Tina Freese Decker
So I think this power of communication is really critical. Also accepting grace. We're going to make mistakes and we need to make sure we continue move forward, and we have the best interests of people at heart. And how do we do that? Always focusing on the mission. And then lastly from the American Hospital Association, sharing and communicating stories are so important for us.
::Tina Freese Decker
Talking about stories in the local community about what you can do to help patients, to help people live a healthier life. Those are really helpful as we drive those forward. As Lynn said, that local piece is critical. And then thinking about how do we represent ourselves well that delivers the trust and reinforces the trust in everyday actions. So I think we have to connect all of those dots and recognize that what we do is, is who we are, and we need to make sure we're delivering on that trust every single day.
::Tina Freese Decker
So thank you so much, Lynn and Bob, for your time today, for sharing your expertise. Every one of our hospitals, our health systems is here for their communities. Despite the challenges that we all face, making sure that everyone has access to the care that they need and trying to build that trust every single day, trying to build that trust with our teams, with one another, with our communities.
::Tina Freese Decker
And I think that the lessons that we've learned here about storytelling and over-communication and over-listening and connecting on a human level and really addressing it back to how we're serving everybody, and not assuming that people know that our mission is at the forefront of everything that we're doing, I think it's really great feedback for us. So thank you all for taking the time to listen to this Leadership Dialogue
::Tina Freese Decker
and we'll be back next month for another good conversation.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.
