Article Figures & Data
Figures
- Figure 1.
Proposed conceptual model of work conditions, mediators, and final outcomes.
Note: Variables tested in the present study are highlighted in bold below column headings. The primary outcome of the study was consonance of clinician and patient trust.
- Figure 2.
Organizational culture variables and probability of clinicians having high trust in their organization and patients having high trust in their clinician (high-high).
Note: Increase in probability of being in high-high quadrant for each percentile increase in organizational culture items.
Tables
High Clinician Trust, no. (%) Low Clinician Trust, no. (%) High patient trust 55 (34.0) 50 (30.9 Low patient trust 21 (13.0 36 (22.2) Note: Clustered patients for 162 clinicians with sufficient data for modeling.
- Table 2.
Multilevel Logistic Regression Models of Congruence of High and Low Trust in Clinicians and Patients
Variable Values Alignment Model Quality Model Cohesion Model Communication Model OR (95% CI) 1.86 (1.23-2.81) 4.95 (2.02-12.15) 2.29 (1.25-4.20) 3.21 (1.33-7.78) McKelvey-Zavoina pseudo R2 0.487 0.616 0.701 0.698 C-statistic 0.804 0.866 0.854 0.827 P >|Z| .003 .001 .008 .01 OR = odds ratio.
Note: Adjusted for the covariates of clinician age, clinician sex, physician vs advanced practice clinician, specialty (family medicine vs internal medicine), average clinician monthly patient load, and racial concordance between clinician and patients. Details provided in Supplemental Tables 3 and 4. The McKelvey-Zavoina pseudo R2 approximates percent of variance explained in being in high-high category by organizational culture characteristic.22
Supplemental materials
- Linzer.pdf -
Supplemental tables 1-4
- Linzer.pdf -
In Brief
Where Trust Flourishes: Perceptions of Clinicians Who Trust Their Organizations and Are Trusted by Their Patients
Mark Linzer and colleagues
Background Researchers sought to determine the characteristics of health organizations that promoted clinician trust. They further hypothesized that clinician trust may be correlated with patients’ trust in their clinician.
What This Study Found Trust in the medical profession has dropped from a high of 75% in a 1966 survey to a low of 33% in 2018. “High clinician-high patient” trust occurred when clinicians perceived their organizational culture as having: 1) an emphasis on quality; 2) an emphasis on communication and information; 3) cohesiveness among clinicians; and 4) values aligned between clinicians and their leaders.
Implications
- The researchers concluded that addressing organizational culture may improve trust at the organizational and patient levels. Lack of trust in the medical profession has implications for patient care since research from past epidemics has shown that lack of trust decreases the likelihood of patients adhering to public health recommendations. Linzer et al write that it is critical to identify factors that will assist health systems to better understand how to create the most trust within their work environments.
