Measuring the Trustworthiness of Health Care Organizations and Systems

Health Equity

Policy Points:

  • Current efforts to measure and improve trust in health care focus on changing patients’ attitudes rather than measuring and improving the trustworthiness of health care organizations and systems.
  • We present a conceptual model to understand and explain the constructs of trust and trustworthiness in the context of health care through the application of existing theories of human behavior.
  • Developing and publicly reporting measures that can enable patients, particularly from historically marginalized groups, to better assess the trustworthiness of providers is necessary to promote health care equity.

Across multiple fields of study, trust is defined as “a psychological state that determines a person’s willingness to be vulnerable under conditions of risk/uncertainty, and interdependence.” Trust underlies both intentions as well as behaviors and can cause or result from risk-taking and cooperation. Patients’ level of trust in their provider influences both their care experiences and their health outcomes. Without trust, it is unlikely that patients will reveal the full extent of their medically relevant history, consent to a physical exam, or act on treatment recommendations. Researchers have described a crisis of trust in health systems, and many examples show the negative effects of mistrust (e.g., lower treatment adherence and lower patient satisfaction). Yet there has been remarkably little work done to understand how to build trust in health systems, and interventions that have attempted to do so have been largely unsuccessful.



A. Anderson and D.M. Griffith. Measuring the Trustworthiness of Health Care Organizations and Systems. Milbank Q. March 15, 2022.