Introduction and Episode Overview
[00:00:00] Stacey Richter: Episode 477. "What The Tribe Thinks You Need To Know About Trust or It's Gonna Be a Problem."
[00:00:28] Stacey Richter: A couple months ago, I did my very first episode that locked down a very clear through line, a theme tying together a bunch of RHV, Relentless Health Value episodes from earlier this year. That earlier through line was a lack of good primary care means higher emergency room spend.
Let's talk about another emerging in hindsight, throughline. And to be clear, just like that last show, this throughline emerged because of you lot who listen every week. You all wrote great, really insightful comments and reposts that excavated underlying themes tying a bunch of the episodes together. So this show is going to be about one of these underlying themes.
To listen to this episode or read the show notes with mentioned links, visit the episode page.
The Importance of Trust in Healthcare
[00:01:13] Stacey Richter: The very real impact of trust or lack of trust, which may come from too little antitrust. I'll pause for a sec for you to appreciate that little poetic gem I copied from Dr. Mick Connors and I'll tell you where we're gonna finish up, spoiler alert, it's with me telling you Relentless Health Value listener this whole thing is gonna wrap up with me telling you how smart you are.
Because you are ultimately going to be the happiest, probably the longest living, and also most successful. So stick with me here because we're gonna go down before we go up. I also wanna mention the bonus clip that you will find released on the exact same day as this show.
It's from one of the first Relentless Health Value episodes from literally 10 years ago that I did with Charles Green, who is an expert on trust. Most of that original and ancient episode is kind of terribly embarrassing for me to revisit. Don't get me wrong, Charles Green is amazing and totally carries the interview, but I listened to myself and realize that yeah, 10 years of practice makes not perfect for sure in my case, but at least, better.
This is likely TMI, so let me move on and say that the 10 minute bonus clip of that original show covers how to earn trust and to be worthy of trust IRL, and thus really apropos to this conversation. So you will find this clip for your convenience back in the pod feed also released today. Okay, so trust the impact of trust.
Listener Contributions and Insights
[00:02:55] Stacey Richter: Just last week, my guest, Peter Hayes, talked about a pervasive lack of trust that has developed among patients and also Americans scared to become patients as well as clinicians.
Enrico Cullen also called out on LinkedIn the other day. He was talking about the show with Dr. Kenny Cole, and he wrote, “if a patient is not taking the statin, that you prescribe them because their neighbor's uncle developed bad muscle aches while taking it, all it means is they trust their neighbor more than they trust their doctor.”
So that was something that Kenny Cole had said during the show, or as Denise Wiseman wrote the other day again about the Kenny Cole episode from a few weeks ago.
She said, “One key message that stood out. Building trusted relationships isn't soft or secondary. It's a critical lever for better health outcomes and smarter system design.”
As Dr. Cole says, it's our job to earn their trust and go on a journey with patients. Also, along these same exact lines, ie, the impact trust can have when it exists or the problems a lack of trust creates, Julie Siemers wrote: “It's fascinating how trust shapes patient choices. Strengthening those connections with various providers is essential for better healthcare outcomes".
And, right. Let me paraphrase, Enrico and Denise, and Julie with some additional context. If trust isn't built with patients and then if some clinical or pop health or navigator slash coordinator, somebody pops up on the scene and tries to close care gaps or navigate members away from a low quality or ridiculously high cost care setting. Or tries to get a member/patient to not show up in the ER as a default.
Look, anybody trying to do any of these things without a foundation of member or patient trust, will be mopping up the floor while the faucet's still running. Listen to the show with Matt McQuide for this point with five underlines. Listen to the show with Dr. Christine Hale on high cost claimants.
The TLDR on that one, you cannot spreadsheet your way out of high cost claims. You need trust along with strategy and context. You gotta, with all of these things, start with a step one. Build trust and if you hop over that part, yeah, good luck with pretty much anything that you're gonna try to do as many find out the hard way.
Challenges in Building Trust
[00:05:18] Stacey Richter: So what I just said there, starting with a foundation of trust to make almost anything happen as the step two, is this a popular but just kind of rando theory based on nothing much as far as evidence goes. Oh, very much no. So much evidence.
Listen to the pod with Rebecca Etz from a while back that covers a few of the numerous very well-run studies which find over and over again how a patient who answers a question like: “My doctor and I have been through a lot together.” Questions that are essentially assessments of trust. If you get a good answer to a set of questions like this one, you will find a patient panel with far better biometric scores than if you use the biometric scores themselves as the quality metric.
That's a thing that makes you go, huh? But it's because Goodhart's Law will get you. Listen to the show with Dr. Rishi Wadhera. This is wildly counterintuitive I grant you, that if you use as the quality metric what you want to improve, you don't actually improve what you want to improve a lot of times.
This happens because in short, humans, even very smart ones, tend to try to shortcut our way to a goal to be efficient and all. But then what we wind up doing is inadvertently undermining our ability to achieve the goal because we inadvertently slice out essential parts of the process actually necessary to achieve the goal and goodbye trusted relationships or trust or establishing trust with patients, which seems kind of optional. And then goodbye, our best shot at the goal.
So that's a do not, you know, don't cut out the part where you're earning trusted relationships. But what's a "do"? Lots of things. Listen to any of the episodes I have already mentioned. They will be linked to in the show notes, including the bonus add-on with Charles Green.
But here's also some interesting comments that I read to this end on LinkedIn. James Button wrote, and this aligns very much with Charles Green's writings and trust formula that again, you can hear about if you listen to the bonus add-on.
But James Button wrote, “Trust often grows through proximity, like in-home care coordination and familiarity peers who truly get it. It's not that I don't trust my doctor, I do, but when it comes to decisions about my health, I tend to lean on those who have a better understanding of my day-to-day life. And or those who have been through similar experiences. If we don't start recognizing and integrating those connections into care models, we're gonna keep missing opportunities to truly support people and drive meaningful behavior change. This isn't just about fine tuning operations, it's about building a system that genuinely meets people where they are”.
And I'm gonna add on the end and that people can trust, now is earning trust simple. Well, Dr. Mick Connors wrote an article entitled "Trust Is Hard To Earn, Easy To Lose". So that's the short answer.
He also wrote, "The Irony of Antitrust in Healthcare, Why No One Trusts the System”. Which is a very well done headline by you, Dr. Mick Connor, as I said earlier, and I'm gonna very opportunistically use it as a segue because I'm scrappy like that.
Trust Among Healthcare Professionals
[00:08:30] Stacey Richter: So speaking of antitrust, here we are asking patients to trust their doctors.
When many doctors and other clinicians, especially in consolidated or rolled up organizations subject to antitrust, these clinicians do not trust their bosses, be they their admin, leadership, or their private equity ownership.
I just read a post by Dr. Olusoji Olakanpo about pediatric physician shortages and he wrote, "The participation rate is falling. We have many licensed pediatricians in the country, but there is a distrust/unwillingness to work for employers, (corporate/hospital systems) who employ 74% of doctors. This causes a vacancy crisis. Our workforce is working part-time. They work flex or just plain not working at all. Rather than hit this wall of moral injury."
I mean, you start to get why with the lack of trust that healthcare workers have for some of their bosses. When you hear stuff like Yashaswini Singh, PhD was saying in that episode from a few weeks ago about how some private equity owned practices have been rumored to hang up scoreboards and give doctors bonuses based on like how many injections they do. I'm picturing the sign above the scoreboard “Always Be Injecting”, you know, like Always Be Closing.
I was just at the MSK, Memorial Sloan Kettering Direct Summit, and I heard Dr. Robert Sidlow comment that this country is in a state of crisis right now because never have fewer medical students selected primary care or pediatrics.
Dr. Dan Pomerantz said that the primary care crisis has many causes, such as all the things aforementioned. Two main contributors are government neglect and the ordinary business practices of commercial payers. It's corrosive the level of distrust we've got going on here. We have a situation where future PCPs or future peds aren't thinking they're gonna be able to count on margin for sure, but they also distrust that they're going to be enabled to fulfill any sort of mission.
I mean, we got medical students are rational actors and they see and have heard about this hornet's nest. They do not trust the system enough to spend however many years of their lives and accrue however much medical school debt. They can't count on mission. They can't count on margin.
Listen to the show with Dr. Komal Bajaj with a whole lot of stats on the lack of trust amongst clinicians for their bosses at hospitals or elsewhere. They don't trust their admin teams to have their backs or to do right by patients.
And look, let's be clear, not talking about all hospitals, not talking about all administrators. There are some excellent ones, but as a bell curve, this all is very striking.
[00:11:15] Cora Opsahl: Hi, this is Cora Opsahl with the 32BJ Health Fund. If you love Relentless Health Value just like I do, then I will encourage you. Please sign up for the newsletter, follow on your podcast app, and leave a review. Tell everyone else about how great this is, and I'll let you're learning.
[00:11:31] Stacey Richter: Alright, now I was gonna go off on a little diatribe about how distrusted insurance carriers are, but I'm not gonna bother except to say, yeah, December 4th, 2024. Sadly, that about sums it all up. But keep in mind plan sponsors who are handing out insurance cards with some of those so-called in “brand names” on them.
And also, if a patient goes in for like a free mole check or a mammogram or preventative something or other, and then winds up in some kind of diagnostic code zone and gets a $600 bill, that's benefit design. And, the huge distrust in the system that results from that, sorry gang, it's on the plan sponsor who let that happen.
Alright, just one more little trust/distrust context setting before I turn this ship around. And we talk about why you listening right now, you who are in the Relentless Health Value tribe who listens every week. You are uniquely positioned for good amongst all this murk.
But just one more example of earned distrust before I move on to really inspiring pastures, so stick with me. I just wanna mention now healthcare vendors or tech and collaborations between them and others right now, which by the way, are essential if anyone wants to defragment a patient journey or do pretty much anything seamlessly.
I was talking to a friend the other day who works at a pretty innovative healthcare company. And she was telling me a whole story about how a major player in the industry told them they wanted to collaborate on a big bid. They took all the information from my friend's company, incorporated it into their own bid, and then submitted the bid by themselves. Is that trustworthy? It's a hornet's nest, right?
It makes me admire even more the physicians and other clinicians and administrators who do their level best to try to get a bead on what's going on around them and attempt to protect their patients from getting sucked into it.
The Role of Trust in Business Success
[00:13:26] Stacey Richter: But okay, now let me do a complete 180 and say something directly to you who are listening here, and I'm saying this and I really, really want you to hear it because it's rough out there, and maybe this is a dose of optimism and inspiration.
Two points I wanna make. The first one is this business success. Charles Darwin is reputed to have said in the long history of humankind, and animal kind too, those who learned to collaborate and improvise most effectively have prevailed.
And the best collaborators, the ones with the highest collaborative IQ, yeah, these folks are trustworthy. I mean, think about it. No one is going to collaborate with someone or share data with someone if they get a reputation for sucking up someone else's IP and then submitting the bid themselves or putting profits over patients or members or clinicians or just being untrustworthy in any number of other ways.
Whoever rolls like this will likely win a few in the short term, that's undeniable. But if they are in any given business long enough that their reputation catches up with them, yeah. Not saying that regulatory capture or “too big to fail” nature of some of these organizations won't protect any individual who's doing stuff like this for a while at the organizational level.
But at the personal level, ha. Admit it. You're thinking the same thing I'm thinking. When someone who used to be part of a team who did everyone dirty comes looking around for a job or a favor.
To that end, there's this book, it's called “Give and Take,” by Dr. Adam Grant, where he breaks people into three categories, givers, takers, and matchers. Givers can be trusted to give even if they know they won't get anything in return. Takers can be distrusted to take even when the boundary where they know someone else is gonna be hurt by their taking.
And matchers can be trusted to keep score like a matcher thinks, oh, you did me a favor, so now I owe you one. But also matchers keeps score for others. Like if they see a taker taking advantage, then they also shun the taker and they will inform others as to what the taker has done.
And likewise for givers, like if a matcher sees a giver doing someone a solid, it certainly works both ways and they will make sure there's enough compliments to go around.
And this is why whenever the game is a long game, givers will ultimately prevail. The most successful people in history are in fact givers. We all know how truly wonderful it is to work with people you can trust to help you when you need help, and we gravitate toward these folks.
Now it's important as a giver to set boundaries and all that. But yeah, I'd strongly suggest that most Relentless Health Value tribe members are probably somewhere on the giver or giver/matcher continuum. And maybe this is the place to state for the record, how smart you are to be who you are. Not for being here precisely, but for thinking the way that you obviously think to have made it here to begin with.
Because what this show is all about, every single episode, every single week, is how we can make sure that we give patients or members the best that we can manage to give them. How do we show up and work together to create a new healthcare system that just does better? I hear over and over again instances where someone who listens to the show reaches out to a guest or someone else who they see commenting on LinkedIn so they know also listens, and how something great happened as a result.
The collaborative IQ of this tribe is big, big, and this matters because here's a second reason why you're smart to be here as a giver or the giving kind of matcher.
The Benefits of Being Trustworthy
[00:16:58] Stacey Richter: You know who is the happiest in life, you know who lives the longest? Right, people who have friends, a community who have purpose, they are dedicated to fulfill.
We are social beings after all and giving and helping others in our community actually confers much more happiness, than selfishly taking. I read that book, the “Purpose of Life” by Viktor Frankl many years ago, and it sticks with me. Viktor Frankl was in a concentration camp. It was clear to him that those who survived were not the ones who were physically the strongest.
It was the ones who had purpose in their lives. And that's a common finding in all those longevity studies too, like the blue zones and all that. Finding meaning and also investing in relationships, which means being trustworthy helps combat loneliness, and all of this is particularly important as people age.
But lastly, this is healthcare we're talking about, and I'd strongly suggest being a taker is kind of antithetical to the whole practice of medicine.
I mean, think about it. You want an organization providing healthcare to sick people solely focused on how they can manage to take or get their clinicians to take? As a culture that just feels very, very off. And the danger there, as they say is culture eats strategy for breakfast, lunch, and dinner.
So thanks for being trustworthy. Thanks for being a giver. Thanks for being here. It really matters.
Conclusion and Call to Action
[00:18:22] Stacey Richter: My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
[00:18:26] Tom Nash: Hi, this is Tom Nash, one of the RHV team members. You might recognize my voice from the podcast intro. If you love this show and you wanna show us your support, please follow us on your favorite podcast app. Sign up for the newsletter, or maybe consider making a small donation in the tip jar. Thanks so much for listening.