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Ninković M, Ilić S, Damnjanović K. Women's trust in the healthcare system in Serbia: Validation of the Women's Trust and Confidence in Healthcare System scale. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241249864. [PMID: 38770772 PMCID: PMC11127576 DOI: 10.1177/17455057241249864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts. OBJECTIVES We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale. DESIGN Two independent samples (N1 = 329; N2 = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale. METHODS We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software. RESULTS The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact. CONCLUSION The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.
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Affiliation(s)
- Milica Ninković
- Laboratory for Research of Individual Differences, Department of Psychology and Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
- Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
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Millar R, Aunger JA, Rafferty AM, Greenhalgh J, Mannion R, McLeod H, Faulks D. Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-130. [PMID: 37469292 DOI: 10.3310/kplt1423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts. Objectives Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements. Design A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances. Data sources Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives. Review methods Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations. Results A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed. Limitations The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork. Conclusions Implementing successful interorganisational collaborations is a difficult, complex task that requires significant time, resource and energy to achieve the collaborative functioning that generates performance improvements. A delicate balance of building trust, instilling faith and maintaining confidence is required for high-performing interorganisational collaborations to flourish. Future work Future research should further refine our theory by incorporating other workforce and user perspectives. Research into digital platforms for interorganisational collaborations and outcome measurement are advocated, along with place-based and cross-sectoral partnerships, as well as regulatory models for overseeing interorganisational collaborations. Study registration The study is registered as PROSPERO CRD42019149009. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ross Millar
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Justin Avery Aunger
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Osei Afriyie D, Masiye F, Tediosi F, Fink G. Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia. Soc Sci Med 2023; 321:115750. [PMID: 36801748 DOI: 10.1016/j.socscimed.2023.115750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/29/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND To improve equitable access to quality essential services and reduce financial hardship, low-and-middle-income countries are increasingly relying on prepayment strategies such as health insurance schemes. Among the informal sector population, confidence in the health system to provide effective treatment and trust in institutions can play an important role in health insurance enrollment. The objective of this study was to examine the extent to which confidence and trust affect enrollment into the recently introduced Zambia National Health insurance. METHODS We conducted a regionally representative cross-sectional household survey in Lusaka, Zambia collecting information on demographics, health expenditure, ratings of last health facility visit, health insurance status and confidence in the health system. We used multivariable logistic regression to assess the association between enrollment and confidence in the private and public health sector as well as trust in the government in general. RESULTS Of the 620 respondents interviewed, 70% were enrolled or planning to enroll in the health insurance. Only about one-fifth of respondents were very confident that they would receive effective care in the public health sector 'if they became sick tomorrow' while 48% were very confident in the private health sector. While confidence in the public system was only weakly associated with enrollment, confidence in the private health sector was strongly associated with enrollment (Adjusted odds ratio (AOR) 3.40 95% CI 1.73 - 6.68). No association was found between enrollment and trust in government or perceived government performance. CONCLUSIONS Our results suggest that confidence in the health system, particularly in the private health sector, is strongly associated with health insurance enrollment. Focusing on achieving high quality of care across all levels of the health system may be an effective strategy to increase enrollment in health insurance.
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Affiliation(s)
- Doris Osei Afriyie
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Felix Masiye
- University of Zambia, Department of Economics, Lusaka, Zambia.
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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Kerasidou CX, Kerasidou A, Buscher M, Wilkinson S. Before and beyond trust: reliance in medical AI. JOURNAL OF MEDICAL ETHICS 2022; 48:852-856. [PMID: 34426519 PMCID: PMC9626908 DOI: 10.1136/medethics-2020-107095] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
Artificial intelligence (AI) is changing healthcare and the practice of medicine as data-driven science and machine-learning technologies, in particular, are contributing to a variety of medical and clinical tasks. Such advancements have also raised many questions, especially about public trust. As a response to these concerns there has been a concentrated effort from public bodies, policy-makers and technology companies leading the way in AI to address what is identified as a "public trust deficit". This paper argues that a focus on trust as the basis upon which a relationship between this new technology and the public is built is, at best, ineffective, at worst, inappropriate or even dangerous, as it diverts attention from what is actually needed to actively warrant trust. Instead of agonising about how to facilitate trust, a type of relationship which can leave those trusting vulnerable and exposed, we argue that efforts should be focused on the difficult and dynamic process of ensuring reliance underwritten by strong legal and regulatory frameworks. From there, trust could emerge but not merely as a means to an end. Instead, as something to work in practice towards; that is, the deserved result of an ongoing ethical relationship where there is the appropriate, enforceable and reliable regulatory infrastructure in place for problems, challenges and power asymmetries to be continuously accounted for and appropriately redressed.
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Affiliation(s)
| | - Angeliki Kerasidou
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Monika Buscher
- Department of Sociology, Lancaster University, Lancaster, UK
| | - Stephen Wilkinson
- Department of Politics, Philosophy, & Religion, Lancaster University, Lancaster, UK
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Improving vaccination intent among skeptics through confidence in governments' handling of the COVID-19 pandemic. Acta Psychol (Amst) 2022; 225:103556. [PMID: 35279433 PMCID: PMC8901368 DOI: 10.1016/j.actpsy.2022.103556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/14/2022] Open
Abstract
Scientific evidence suggests that individuals vaccinated with COVID-19 vaccines are less likely to require hospitalization, possibly lowering the burden on the healthcare system. Despite such benefits, substantial segments of the world's population remain skeptical of COVID-19 vaccines and are hesitant to take them. Even if such individuals have been inoculated with COVID-19 vaccines out of economic, social, or legal necessity, they may be less inclined to receive booster shots or vaccinate their offspring when such options become available. What might help reduce this hesitancy? We examined this question using nationally representative survey data across 15 developed countries (max N = 122,516). Our findings suggest that inspiring confidence in the government's handling of the pandemic is pivotal in enhancing vaccination intent among vaccine skeptics. Specifically, results from a hierarchical linear analysis showed that among vaccine skeptics, confidence in the government's management of the pandemic was associated with greater intent to (a) take COVID-19 vaccines (b) take booster shots and (c) vaccinate one's children.
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Castanelli DJ, Weller JM, Molloy E, Bearman M. How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:704-710. [PMID: 34732657 PMCID: PMC9028297 DOI: 10.1097/acm.0000000000004501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE In competency-based medical education, workplace-based assessment provides trainees with an opportunity for guidance and supervisors the opportunity to judge the trainees' clinical practice. Learning from assessment is enhanced when trainees reveal their thinking and are open to critique, which requires trust in the assessor. If supervisors knew more about how trainees come to trust them in workplace-based assessment, they could better engender trainee trust and improve trainees' learning experience. METHOD From August 2018 to September 2019, semistructured interviews were conducted with 17 postgraduate anesthesia trainees across Australia and New Zealand. The transcripts were analyzed using constructivist grounded theory methods sensitized by a sociocultural view of learning informed by Wenger's communities of practice theory. RESULTS Participants described a continuum from a necessary initial trust to an experience-informed dynamic trust. Trainees assumed initial trust in supervisors based on accreditation, reputation, and a perceived obligation of trustworthiness inherent in the supervisor's role. With experience and time, trainees' trust evolved based on supervisor actions. Deeper levels of trainee trust arose in response to perceived supervisor investment and allowed trainees to devote more emotional and cognitive resources to patient care and learning rather than impression management. Across the continuum from initial trust to experience-informed trust, trainees made rapid trust judgments that were not preceded by conscious deliberation; instead, they represented a learned "feel for the game." CONCLUSIONS While other factors are involved, our results indicate that the trainee behavior observed in workplace-based assessment is a product of supervisor invitation. Supervisor trustworthiness and investment in trainee development invite trainees to work and present in authentic ways in workplace-based assessment. This authentic engagement, where learners "show themselves" to supervisors and take risks, creates assessment for learning.
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Affiliation(s)
- Damian J. Castanelli
- D.J. Castanelli is senior lecturer, School of Clinical Sciences at Monash Health, Monash University, consultant anesthetist, Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Victoria, Australia, and PhD candidate, Centre for Research in Assessment and Digital Learning, Deakin University, Geelong, Victoria, Australia; ORCID: https://orcid.org/0000-0002-5377-809X
| | - Jennifer M. Weller
- J.M. Weller is professor and head, Centre for Medical and Health Sciences Education, University of Auckland, and specialist anesthetist, Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand; ORCID: https://orcid.org/0000-0003-3029-1390
| | - Elizabeth Molloy
- E. Molloy is professor of work-integrated learning, Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0001-9457-9348
| | - Margaret Bearman
- M. Bearman is research professor, Centre for Research in Assessment and Digital Learning, Deakin University, Geelong, Victoria, Australia; ORCID: https://orcid.org/0000-0002-6862-9871
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Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson H. ‘I trust them because my mum trusts them’: Exploring the role of trust in HPV vaccination decision-making among adolescent girls and their mothers in France. Vaccine 2022; 40:1090-1097. [DOI: 10.1016/j.vaccine.2022.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
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Gjerstad B, Nødland SI, Teig IL. Trust building in a Norwegian municipal acute ward. J Health Organ Manag 2021; ahead-of-print. [PMID: 32815327 DOI: 10.1108/jhom-11-2019-0334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Trust plays an important role in the organisation of healthcare services. In Norway, the establishment of mandatory municipal acute wards with 24 h inpatient services introduces a new unit into the healthcare system. This article discusses how this new health care service succeeds in building trust with patients and among healthcare workers. DESIGN/METHODOLOGY/APPROACH The article is an in-depth case study of a single, exemplary inter-municipal acute ward. The study draws on interviews with COPD patients, the leader and doctors at the ward. The study also includes observations of daily work at the municipal acute ward. Moreover, administrators and healthcare workers at related healthcare institutions have been interviewed. Data were analysed using a qualitative method. FINDINGS The study reveals that trust is built in complex relations and that it has both individual and systemic factors. The practices employed in the daily treatment and care of patients and in encounters between health care personnel and patients are important trust-building processes; however, these processes depend on structures and routines that promote efficient and adequate inter-organisational communication and patient-oriented procedures. PRACTICAL IMPLICATIONS The study provides insight into how trust dynamics work on multiple organisational levels and how they depend on both individual and systemic factors. Additionally, the study may provide a picture of the importance of trust in organising healthcare services in the future. ORIGINALITY/VALUE Lessons regarding trust building inspired by data from a case-study care institution can be applied in different care settings and countries.
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Affiliation(s)
- Brita Gjerstad
- Department of Social Science, NORCE Norwegian Research Centre AS, Bergen, Norway.,University of Stavanger, Stavanger, Norway
| | - Svein Ingve Nødland
- Department of Social Science, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Inger Lise Teig
- University of Bergen, Bergen, Norway.,NORCE Norwegian Research Centre AS, Bergen, Norway
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Aunger JA, Millar R, Greenhalgh J, Mannion R, Rafferty AM, McLeod H. Why do some inter-organisational collaborations in healthcare work when others do not? A realist review. Syst Rev 2021; 10:82. [PMID: 33752755 PMCID: PMC7984506 DOI: 10.1186/s13643-021-01630-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/10/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, enabling resource sharing, and promoting innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area; however, further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future. METHODS Realist review methodology was used with the intention of formulating context-mechanism-outcome configurations (CMOCs) to explain how inter-organisational collaborations work and why, combining systematic and purposive literature search techniques. The systematic review encompassed searches for reviews, commentaries, opinion pieces, and case studies on HMIC, MEDLINE, PsycINFO, and Social Policy and Practice databases, and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review. RESULTS Fifty-three papers were included, informing the development of programme theories of how, why, and when inter-organisational collaborations in healthcare work. Formulation of our programme theories incorporated the concepts of partnership synergy and collaborative inertia and found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration to maximise synergy and thus collaborative performance. More integrative or mandated collaboration may lean more heavily on contract to drive collaborative behaviour. CONCLUSION As the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as how to configure the context to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019149009.
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Affiliation(s)
- Justin Avery Aunger
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK.
| | - Ross Millar
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK
| | - Joanne Greenhalgh
- Sociology and Social Policy Department, University of Leeds, Leeds, LS2 9JT, UK
| | - Russell Mannion
- Health Services Management Centre, Park House, University of Birmingham, Birmingham, B15 2RT, UK
| | - Anne-Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Hugh McLeod
- Population Health Sciences, University of Bristol & NIHR Applied Research Collaboration West, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
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Perspectives of Australian hospital leaders on the provision of safe care: implications for safety I and safety II. J Health Organ Manag 2021. [DOI: 10.1108/jhom-10-2020-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThere is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.Design/methodology/approachThis paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.FindingsAlthough the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.Practical implicationsIn CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.Originality/valueThis is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.
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Chauhan A, Campbell C. Risk, trust and patients' strategic choices of healthcare practitioners. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:82-98. [PMID: 33034906 DOI: 10.1111/1467-9566.13198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/04/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Research on patients' choice of healthcare practitioners has focussed on countries with regulated and controlled healthcare markets. In contrast, low- and middle-income countries have a pluralistic landscape where untrained, unqualified and unlicensed informal healthcare providers (IHPs) provide significant share of services. Using qualitative data from 58 interviews in an Indian village, this paper explores how patients choose between IHPs and qualified practitioners in the public and formal private sectors. The study found that patients' choices were structurally constrained by accessibility and affordability of care and choosing a practitioner from any sector presented some risk. Negotiation and engagement with risks depended on perceived severity of the health condition and trust in practitioners. Patients had low institutional trust in public and formal private sectors, whereas IHPs operated outside any institutional framework. Consequently, people relied on relational or competence-derived interpersonal trust. Care was sought from formal private practitioners for severe issues due to high-competence-based interpersonal trust in them, whereas for other issues IHPs were preferred due to high relationship-based interpersonal trust. The research shows that patients develop a strategic approach to practitioner choice by using trust to negotiate risks, and crucially, in low- and middle-income countries IHPs bridge a gap by providing accessible and affordable care imbued with relational-interpersonal trust.
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Affiliation(s)
- Apurv Chauhan
- School of Applied Social Science (SASS), University of Brighton, Brighton, UK
| | - Catherine Campbell
- Department of Psychological and Behavioural Science, London School of Economics & Political Science (LSE), London, UK
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Chan HF, Brumpton M, Macintyre A, Arapoc J, Savage DA, Skali A, Stadelmann D, Torgler B. How confidence in health care systems affects mobility and compliance during the COVID-19 pandemic. PLoS One 2020; 15:e0240644. [PMID: 33057450 PMCID: PMC7561184 DOI: 10.1371/journal.pone.0240644] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022] Open
Abstract
Confidence in the health care system implies an expectation that sufficient and appropriate treatments will be provided if needed. The COVID-19 public health crisis is a significant, global, and (mostly) simultaneous test of the behavioral implications arising from this confidence. We explore whether populations reporting low levels of confidence in the health care system exhibit a stronger behavioral reaction to the COVID-19 pandemic. We track the dynamic responses to the COVID-19 pandemic across 38 European countries and 621 regions by employing a large dataset on human mobility generated between February 15 and June 5, 2020 and a broad range of contextual factors (e.g., deaths or policy implementations). Using a time-dynamic framework we find that societies with low levels of health care confidence initially exhibit a faster response with respect to staying home. However, this reaction plateaus sooner, and after the plateau it declines with greater magnitude than does the response from societies with high health care confidence. On the other hand, regions with higher confidence in the health care system are more likely to reduce mobility once the government mandates that its citizens are not to leave home except for essential trips, compared to those with lower health care system confidence. Regions with high trust in the government but low confidence in the health care system dramatically reduce their mobility, suggesting a correlation for trust in the state with respect to behavioral responses during a crisis.
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Affiliation(s)
- Ho Fai Chan
- School of Economics and Finance, Queensland University of Technology, Brisbane, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, Australia
| | - Martin Brumpton
- School of Economics and Finance, Queensland University of Technology, Brisbane, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, Australia
| | - Alison Macintyre
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, Australia
| | - Jefferson Arapoc
- Newcastle Business School, University of Newcastle, Callaghan, Australia
| | - David A. Savage
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, Australia
- Newcastle Business School, University of Newcastle, Callaghan, Australia
| | | | - David Stadelmann
- School of Economics and Finance, Queensland University of Technology, Brisbane, Australia
- University of Bayreuth, Bayreuth, Germany
- CREMA—Center for Research in Economics, Management, and the Arts, Zürich, Switzerland
| | - Benno Torgler
- School of Economics and Finance, Queensland University of Technology, Brisbane, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, Australia
- CREMA—Center for Research in Economics, Management, and the Arts, Zürich, Switzerland
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Abstract
This paper addresses two research questions. The first is theoretical: What is trust? In the first half of this paper we present a distinctive tripartite analysis. We describe three attitudes, here called reliance, specific trust and general trust, each of which is characterised and illustrated. We argue that these attitudes are related, but not reducible, to one another. We suggest that the current impasse in the analysis of trust is in part due to the fact that some writers allude to these distinctions, but unclearly so, whilst others elide them altogether. The second research question focuses on doctor-patient interaction. Trust is often said to be central in medical encounters but this strikes us as too vague. The success of doctor-patient relations in part depends on adopting the most appropriate of the three attitudes we delineate. We argue that reliance is the appropriate attitude for most medical encounters. When circumstances do require trust, the distinction between specific trust and general trust is crucial. We describe medical encounters requiring specific trust. General trust is less often required in medicine; but it is appropriate in some cases and, when called for, it is called for strongly.
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Affiliation(s)
- Stephen Holland
- Department of Philosophy, University of York, York, YO10 5DD, UK.
| | - David Stocks
- Department of Philosophy, University of York, York, YO10 5DD, UK
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Clouder L, Adefila A. Empowerment of physiotherapy students on placement: The interplay between autonomy, risk, and responsibility. Physiother Theory Pract 2017; 33:859-868. [DOI: 10.1080/09593985.2017.1357153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lynn Clouder
- Centre for Excellence in Learning Enhancement, Coventry University, Coventry, UK
| | - Arinola Adefila
- Centre for Excellence in Learning Enhancement, Coventry University, Coventry, UK
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Chancey ET, Bliss JP, Yamani Y, Handley HAH. Trust and the Compliance-Reliance Paradigm: The Effects of Risk, Error Bias, and Reliability on Trust and Dependence. HUMAN FACTORS 2017; 59:333-345. [PMID: 28430544 DOI: 10.1177/0018720816682648] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study provides a theoretical link between trust and the compliance-reliance paradigm. We propose that for trust mediation to occur, the operator must be presented with a salient choice, and there must be an element of risk for dependence. BACKGROUND Research suggests that false alarms and misses affect dependence via two independent processes, hypothesized as trust in signals and trust in nonsignals. These two trust types manifest in categorically different behaviors: compliance and reliance. METHOD Eighty-eight participants completed a primary flight task and a secondary signaling system task. Participants evaluated their trust according to the informational bases of trust: performance, process, and purpose. Participants were in a high- or low-risk group. Signaling systems varied by reliability (90%, 60%) within subjects and error bias (false alarm prone, miss prone) between subjects. RESULTS False-alarm rate affected compliance but not reliance. Miss rate affected reliance but not compliance. Mediation analyses indicated that trust mediated the relationship between false-alarm rate and compliance. Bayesian mediation analyses favored evidence indicating trust did not mediate miss rate and reliance. Conditional indirect effects indicated that factors of trust mediated the relationship between false-alarm rate and compliance (i.e., purpose) and reliance (i.e., process) but only in the high-risk group. CONCLUSION The compliance-reliance paradigm is not the reflection of two types of trust. APPLICATION This research could be used to update training and design recommendations that are based upon the assumption that trust causes operator responses regardless of error bias.
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Millar R, Freeman T, Mannion R. Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. BMC Health Serv Res 2015; 15:196. [PMID: 26081845 PMCID: PMC4470021 DOI: 10.1186/s12913-015-0771-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in safeguarding the care provided by their organisation. However, recent concerns have been raised over boards' ability to enact their duty to ensure the quality and safety of care. This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of study. METHODS The article draws on 10 interviews with key informants and policy actors who form part of the 'issue network' interested in the promotion of patient safety in the English National Health Service. RESULTS The interviews surfaced a series of narratives regarding hospital board oversight of patient safety. These elaborated on the role of trust and intelligence in highlighting the potential dangers and limitations of approaches to hospital board oversight which have been narrowly focused on a risk-based view of organisational performance. In response, a need to engage with the development of trust based organisational relationships is identified, in which effective board oversight is built on 'trust' characterised by styles of leadership and behaviours that are attentive to the needs and concerns of both staff and patients. Effective board oversight also requires the gathering and triangulating of 'intelligence' generated from both national and local information sources. CONCLUSIONS We call for a re-imagination of hospital board oversight in the light of these different perspectives and articulate an emerging research agenda in this area.
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Affiliation(s)
- Ross Millar
- Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, B15 2RT, Birmingham, UK.
| | - Tim Freeman
- Department of Leadership, Work and Organisation, Middlesex University Business School, 131 Williams Building, The Burroughs, Hendon, London, NW4 4BT, UK.
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, B15 2RT, Birmingham, UK.
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Oney E, Oksuzoglu-Guven G. Confidence: a critical review of the literature and an alternative perspective for general and specific self-confidence. Psychol Rep 2015; 116:149-63. [PMID: 25621670 DOI: 10.2466/07.pr0.116k14w0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article provides a critical review of the literature pertaining to self-confidence and advances the argument of the need to separate the construct into its general and specific domains. The rationale is that distinguishing self-confidence into general and specific will increase conceptual parsimony and predictive power of each construct.
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Affiliation(s)
- Emrah Oney
- 1 University of Mediterranean Karpasia, Nicosia, Cyprus, Turkey
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McCabe T, Sambrook S. The antecedents, attributes and consequences of trust among nurses and nurse managers: A concept analysis. Int J Nurs Stud 2014; 51:815-27. [DOI: 10.1016/j.ijnurstu.2013.10.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 10/03/2013] [Accepted: 10/06/2013] [Indexed: 11/29/2022]
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Hernandez JF, van Thiel GJMW, Mantel-Teeuwisse AK, Raaijmakers JAM, Pieters T. Restoring trust in the pharmaceutical sector on the basis of the SSRI case. Drug Discov Today 2013; 19:523-7. [PMID: 24295641 DOI: 10.1016/j.drudis.2013.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/21/2013] [Accepted: 11/22/2013] [Indexed: 01/26/2023]
Abstract
The lack of public trust in the pharmaceutical sector (i.e. industry, authorities and doctors) could compromise the future of drug development and the regulatory system. Public trust integrates two important components, namely the vulnerability of the truster and the competence of the trustee. Because trust appears to have eroded as a result of drug safety controversies, this paper analyzes the role of public trust during the selective serotonin reuptake inhibitor (SSRI) and suicidality controversy focusing on the aforementioned trust components. Because the competence component of trust is argued to be paramount in determining and maintaining public trust, the SSRI case shows that this component is a part of public trust where these institutions can build on, and might therefore be better used to substantiate and reinforce, public trust. Efforts to build trust should rely on the ethical, professional (competence) and societal commitment of institutions and individuals to protect the vulnerability of the public during controversies. Because shared values can create trust or increase its levels within a specific environment, industry, authorities and physicians ought to develop novel and cooperative strategies to highlight their shared values and motivations. Rules, regulations and settlements are indispensable tools but undue regulation is costly and can backfire on the rather sensitive trust relationships in the pharmaceutical sector.
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Affiliation(s)
- Juan Francisco Hernandez
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Ghislaine J M W van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Jan A M Raaijmakers
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands; GlaxoSmithKline, External Scientific Collaborations Europe, Zeist, The Netherlands
| | - Toine Pieters
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands; EMGO, VU Medical Centre, Amsterdam, The Netherlands.
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Foster V, Young A, Modi N, Brocklehurst P, Abbott J, Costeloe K, Field D, Majeed A, Kemp J, Ashby D, Young A, Petrou S. The use of routinely collected patient data for research: a critical review. Health (London) 2011; 16:448-63. [PMID: 22071234 DOI: 10.1177/1363459311425513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over recent years in the UK there has been growing interest in the potential for routinely collected NHS (National Health Service) patient data to be used for secondary purposes, facilitated by the potential of increasingly sophisticated electronic databases. This article is based on a critically reflective literature review which analyses the key debates pertaining to this issue. The work arose in the context of a programme of research concerning routine patient data use in neonatal care. The article includes analysis of commentary (opinion and ethical inquiry) as well as empirically derived claims. It aims to deconstruct the knowledge assumptions on which relevant research studies have been based or are proposed and it also incorporates ontological position and moral argument. Results are presented according to three predominant debates: the prevailing claim that all health research benefits civic society; the varieties of informed consent and choices open to patients regarding secondary uses of their data; and the 'rights and responsibilities' of patients when it comes to their data being used for research purposes. It examines the relevance of these themes specifically to the neonatal context and the implications for our own research, concluding that employing an alternative ethical model to the traditional professional one might be useful in order to provide a further perspective on the issue.
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Affiliation(s)
- Victoria Foster
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, University Place, Oxford Road, Manchester, UK.
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Mullarkey M, Duffy A, Timmins F. Trust between nursing management and staff in critical care: a literature review. Nurs Crit Care 2011; 16:85-91. [PMID: 21299761 DOI: 10.1111/j.1478-5153.2010.00404.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper aims to provide a comprehensive review of the topic of trust between nurses and nurse managers in the context of critical care units. METHOD A comprehensive literature review exploring the concept of trust between nurse and nurse managers was undertaken. Search terms were used both singularly and in combination and 71 relevant citations were found. Abstracts were read and in total 20 peer reviewed articles were retained as a result of consistency with project aims. RESULTS Trust emerged as an essential component in the nurse-patient relationship. However, trust among staff and management received little attention. CONCLUSIONS Trust emerges as an important attribute of effective nurse managers. Nurse managers need to appreciate the importance of fostering a trustworthy relationship with subordinates. Engendering trust between management and staff empowers staff and has positive organizational outcomes.
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Affiliation(s)
- Majella Mullarkey
- Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Brhlikova P, Harper I, Jeffery R, Rawal N, Subedi M, Santhosh M. Trust and the regulation of pharmaceuticals: South Asia in a globalised world. Global Health 2011; 7:10. [PMID: 21529358 PMCID: PMC3104379 DOI: 10.1186/1744-8603-7-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 04/29/2011] [Indexed: 11/25/2022] Open
Abstract
Background Building appropriate levels of trust in pharmaceuticals is a painstaking and challenging task, involving participants from different spheres of life, including producers, distributors, retailers, prescribers, patients and the mass media. Increasingly, however, trust is not just a national matter, but involves cross-border flows of knowledge, threats and promises. Methods Data for this paper comes from the project 'Tracing Pharmaceuticals in South Asia', which used ethnographic fieldwork and qualitative interviews to compared the trajectories of three pharmaceuticals (Rifampicin, Oxytocin and Fluoxetine) from producer to patient in three sites (north India, West Bengal and Nepal) between 2005-08. Results We argue that issues of trust are crucial in reducing the likelihood of appropriate use of medicines. Unlike earlier discussions of trust, we suggest that trust contexts beyond the patient-practitioner relationship are important. We illustrate these arguments through three case studies: (i) a conflict over ethics in Nepal, involving a suggested revised ethical code for retailers, medical representatives, producers and prescribers; (ii) disputes over counterfeit, fake, substandard and spurious medicines, and quality standards in Indian generic companies, looking particularly at the role played by the US FDA; and (iii) the implications of lack of trust in the DOTS programmes in India and Nepal for the relationships among patients, government and the private sector. Conclusions We conclude that the building of trust is a necessary but always vulnerable and contingent process. While it might be desirable to outline steps that can be taken to build trust, the range of conflicting interests in the pharmaceutical field make feasible solutions hard to implement.
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Affiliation(s)
- Petra Brhlikova
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK.
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Abstract
The purpose of this paper is to investigate a nurse's understanding of the concept of confidence and what a nurse thinks affects the experience of confidence in the patient relationship. The project has a hermeneutic design using a research interview method. Nine nurses were interviewed. A hermeneutic approach was used in the analysis of the data. Interpretation of the data was linked to Segesten's model for confidence. Analysis of the data generated two major themes in relationship to the comprehension a nurse has of confidence. One theme was 'to feel comfortable, be relaxed'; the other was: 'feeling secure'. The result shows that nurses' definition of confidence is dependent on two security-creating factors: the significance of a professional network of co-workers and the importance of confirmation of professional role and competence.
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Ebert TA. Facets of Trust in Relationships – A Literature Synthesis of Highly Ranked Trust Articles. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s12087-008-0034-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee YY, Lin JL. Trust but verify: the interactive effects of trust and autonomy preferences on health outcomes. HEALTH CARE ANALYSIS 2009; 17:244-60. [PMID: 19130247 DOI: 10.1007/s10728-008-0100-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 09/10/2008] [Indexed: 01/26/2023]
Abstract
Patients' trust in their physicians improves their health outcomes because of better compliance, more disclosure, stronger placebo effect, and more physicians' trustworthy behaviors. Patients' autonomy may also impact on health outcomes and is increasingly being emphasized in health care. However, despite the critical role of trust and autonomy, patients that naïvely trust their physicians may become overly dependent and lack the motivation to participate in medical care. In this article, we argue that increased trust does not necessarily imply decreased autonomy. Furthermore, patients with high levels of trust and autonomy preferences are most likely to have the best health outcomes. We propose a framework for understanding simultaneous trust and autonomy preferences and for recognizing their interactive effects on health outcomes in the dynamic medical encounter. This framework argues that policy makers and health care providers should make efforts to foster not only patients' trust but also their preferences for autonomy and thus gain the best position for achieving health-related goals.
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Affiliation(s)
- Yin-Yang Lee
- Ophthalmology Department, YongKang Veterans Hospital and College of Management, I-Shou University, Kaohsiung, Taiwan.
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Barrett R, Moore RG, Staines A. Blood transfusion in Ireland: Perceptions of risk, a question of trust. HEALTH RISK & SOCIETY 2007. [DOI: 10.1080/13698570701612600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier's requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and 'trust pretenders' on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist.
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Affiliation(s)
- Derek Sellman
- University of the West of England, Faculty of Health and Social Care, Glenside Campus, Bristol, UK.
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Abstract
PURPOSE This paper considers some implications of recent developments relating to patient safety for understandings of trust in health care contexts. DESIGN/METHODOLOGY/APPROACH Conceptual analysis focusing on patients' trust in health care providers and health care providers' trust in patients. FINDINGS Growing awareness of the scale of the problem of iatrogenic harm has prompted concerns that patients' trust in health care providers may be threatened and/or become inappropriate or dysfunctional. In principle, however, patients' trust may be both well placed and compatible with current understandings of safety problems and efforts to address these. Contemporary understandings of patient safety suggest that, to be deemed trustworthy, health care providers should make vigorous efforts to improve patient safety, be honest about safety issues, enable patients to contribute effectively to their own safety, and provide appropriate care and support after safety incidents. Patients who trust health care providers need not be ignorant of patient safety problems and may be vigilant in the course of their care. Iatrogenic harms do not necessarily reflect breeches of trust (not all such harms are yet preventable), and patients who are harmed might in some circumstances appropriately forgive and resume trusting. Health care providers may feel vulnerable to patients in several respects. From their perspective, trustworthy patients will act competently to optimise the outcomes of their health care efforts and to preserve health care providers' good reputations where those are justified. Providers' trust in patients may strengthen patients' trust in them and facilitate safety improvement work. ORIGINALITY/VALUE Shows how, in principle, trust can be compatible with current understandings of patient safety issues and may enhance efforts to improve patient safety.
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Affiliation(s)
- Vikki Ann Entwistle
- Alliance for Self Care Research, Social Dimensions of Health Institute, Dundee, UK.
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