Trust in a time of uncertainty
Trust is in short supply in society today. And the impact of that trend has serious implications for healthcare. Without trust, patients cannot get peace of mind that their outcomes are as good as they can be, given the cards that they’ve been dealt. And without trust, healthcare organizations cannot recruit and retain the employees that they need.
The latest data from Press Ganey shows both good news and bad news. The worrisome news is a recent downturn in workforce “engagement” measures, based on 2.3 million healthcare employee surveys across the U.S. This worsening followed a marked drop with the onset of the COVID-19 pandemic, then a period of stabilization. It suggests that a period of high-risk employees leaving healthcare may be upon us.
The good news is that we also see a path forward—active efforts to build trust. There’s been a “spreading of the pack” in recent years, with strong organizations (as reflected in higher engagement levels) getting stronger, and weak organizations getting weaker. In fact, in the top 10 percentile of organizations, engagement never dropped below pre-pandemic levels. But in the bottom 10 percentile, the floor fell out—they never recovered, and continue to go down.
Two key questions emerge from these trends. What exactly is trust in the 2025 healthcare world, and how do we build it among the people working in healthcare organizations?
A useful operational definition of trust is “confidence you will be treated fairly in circumstances that you have not even thought of yet.” This definition (which is directly derived from the writings of sociologist Ronald Burt) is particularly relevant in 2025, a time of extraordinary uncertainty. No one knows if there will be a pandemic this fall, or climate disasters, or abrupt drops in funding for healthcare delivery or health insurance.
People working in healthcare and their patients want to be able to trust that, no matter what happens, their organizations will do all they can to treat them fairly. But can they? Achieving that goal requires a reframing of the unit of analysis for trust itself.
In the past, trust has been thought of as an interpersonal relationship issue. Does a patient trust their physician? Does an employee trust their supervisor? These 1–1 interpersonal dynamics remain important, of course.
But it is increasingly clear that, today, patients and employees need to be able to trust their teams and the systems in which care is delivered. Trust has suddenly become something that must be built at an organizational level, not just an interpersonal level. And it is immediately obvious from analyses of data that trust at these levels means something more than having a collection of trustworthy individuals.
For example, both patients and employees place a high value on teamwork—which means excellent people working together. Last year, for the first time, teamwork was the strongest driver of patients’ overall likelihood of recommending their healthcare providers in every setting (hospitals, offices, emergency departments, etc.). And teamwork is one of the strongest indicators that they want to stay at their organizations.
Building teamwork takes more than encouraging it; it must be hardwired. Interventions like “safety huddles” and interdisciplinary rounding (e.g., doctors and nurses seeing patients together) disrupt the autonomy of individuals trying to get through their day, but the payoff in safety, quality, and peace of mind is priceless.
Hardwiring teamwork is one important step down the road to the overarching goal of becoming a high reliability system—one that adapts lessons learned in the patient safety movement to reduce harm. “Harm” includes physical harm for patients, but the last several years has led to a broadening of that definition to include emotional and financial harm to patients—and to employees.
"Harm" in healthcare includes loss of trust by patients or by employees. They need to trust that their organizations will treat them fairly in circumstances they haven’t thought of yet. And that requires more than wonderful 1–1 relationships. It requires organizations characterized by respect, teamwork, and high reliability.
Social capital is the foundation for the kind of trust healthcare needs in 2025. That work doesn’t require new values. What it does require is bringing the intensity and discipline applied to financial capital to social issues—i.e., how people work together. It’s hard work, but it’s great work, and the game plan for how to go forward is increasingly clear.