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The Keckley Report

The Healthcare Workforce and Public Trust: What They Think Matters

By January 11, 2016March 1st, 2023No Comments

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article.

As the 2016 North American International Auto Show opens in Detroit today, industry watchers believe its biggest challenge is restoring trust. Well-documented safety issues have tainted the industry’s reputation and deflated sales. Trust matters.

Like the auto industry, the foundation of the U.S. health system is the public’s trust. It is its most important asset.

We trust our physicians to recommend the most appropriate treatment absent consideration of their personal financial gain. We trust the science on which drugs are approved and prescribed is valid and reliable. We trust our hospitals to do the right thing and our payers to help facilitate access and cover what’s medically necessary.

Like the auto industry, the public’s trust in the system is eroding. Consider:

  • Trust in healthcare institutions: 37% of the U.S. adult population has confidence in the U.S. medical system, ranking it ahead of Congress (8%), big business (21%), TV news (21%), newspapers (24%), banks (28%), public education (31%), the Supreme Court (32%) and the Presidency (33%), but below the military (72%), small business (67%), police (52%), and organized religion (42%). Per Gallup and NORC surveys, since 1973, trust in the medical system has slipped since 1973 (58%), but not as much as the media, big business, organized religion and Congress. Similarly, Harris polling found trust in health insurance and drug companies particularly problematic: their “least trusted” industries include tobacco (3%), oil (6%), social media (8%), managed care (9%), telecom (9%), health insurance (11%), pharmaceuticals (12%), car manufacturers (12%), airlines (12%), and life insurance (12%), thus explaining why the majority in their polls favor increased regulation of their business practices.1
  • Trust in healthcare professionals: Trust in the honesty and ethical standards of health professionals remains high but is declining: nurses (80%), pharmacists (68%), physicians (67%) and dentists (62%) are rated highest. By contrast, HMO managers (12%), car salespersons (8%), Members of Congress (7%) and lobbyists (6%), are the least trusted professions. But the public’s trust in our physicians ranks 24th in the world: 58% of Americans surveyed said they “strongly agreed” or “agreed” with the statement that “doctors in your country can be trusted,” versus 83% in Switzerland, and 79% Denmark. And in the U.S., trust in physicians has slipped in recent years.2

Per these polls, the decline in trust cuts across all generations and is steepest among those who are younger and those in lower income categories. It explains why only 22% of the public is optimistic about the future of our health system vs. 53% who are not. It is a reality with which every company and organization must grapple.

At a recent meeting in New York, 35 prominent healthcare organizations across all sectors of healthcare convened to discuss the issue of trust at the invitation of the Consortium for Trustworthy Organizations.3 The facilitator, Dr. Robert Hurley, a Fordham University professor, presented his research offering a framework whereby a company may assess its trustworthiness. He pointed out that how companies interact with their employees is a major factor in the level of trustworthiness they achieve. It makes sense. Who knows better how a company actually behaves, what it values, and how it operates than its employees?

Friday, the U.S. Department of Labor released December job figures showing impressive gains in overall employment: for the month, 295,000 jobs were added to the economy, bringing the unemployment rate down to 5.0%. Healthcare continued to be a job producer in the economy: we added 500,000 jobs last year bringing total healthcare employment to 15 million.4 Looking ahead, healthcare jobs lead the list of occupations with the strongest growth led by pharmacy technicians (28%), operating room technicians (27%) and registered nurses (24%)—all skilled worker occupations.(Forbes) These jobs pay well and require college degrees/advanced training.

As the population grows, seniors age and as the newly-insured enter the system, demand for healthcare will increase, and the need for healthcare workers will follow. It will manifest itself in traditional settings—hospitals, clinics, research labs and call centers—and in new (digital health, alternative therapies, distance medicine, and more). Thus, in most communities, healthcare is among the biggest employers. But often overlooked is the fact that half who work in healthcare are not its skilled clinicians, technicians or knowledge workers. They’re the nursing assistants and home care workers who are paid hourly, the maintenance, food, security personnel and others who provide support – often without recognition. The views of both groups—from the most educated and best trained to the hourly—impact the trustworthiness of our healthcare organizations. Their knowledge about how their organization makes its decisions, what it values in its leaders, what acceptable behavior is and the reality of its culture are keys to trustworthiness.

The business case for trust is simple: without it, business relationships are more difficult, attracting and keeping a qualified workforce more challenging, and financial success less likely.5 Healthcare has traditionally operated out of the spotlight; some would say it has cloaked itself in secrecy. Now, in the age of social media and mandated transparency, no healthcare organization can avoid the spotlight. Not surprisingly, our misdeeds, gaps in ethicality and the distinction between a company’s brand and its behavior are increasingly uncovered through discovery with employees and former employees. Whistleblowing actions get media attention, but perhaps more harmful are employee doubts about their organization’s sustainability or leadership. What employees think and say—whether accurate or not—matters.

Hospitals are a case in point; their operations are complicated by rules and regulations that prescribe how work is to be done and by whom. Their workforce competencies are changing from bricks to clicks and their scope of services from facilities to households and workplaces. And their finances are stretched by payers wishing to pay less while operating costs and bad debt goes up. The hospital workforce—skilled and hourly—is key to the hospital’s performance, and the most important determinant of its trust. Calls for efficiency gains, including outsourcing of key functions (revenue cycle, IT, et. al.) and improvements in workforce productivity fall on deaf ears if leaders have not created culture of openness with employees. It takes effort, but it is a necessary investment in trust.

Trust in the hospital, like trust in a lab, clinic, drug company or insurer, is at risk if our leaders are inattentive to what their employees observe day to day. Years of investment in branding and good will can be destroyed by an employee’s recounting of a misdeed or violation.

If culture eats strategy for lunch, it’s the employees who know our cultures best and the difference between what we aspire to project publicly and the reality of how we operate.

The session in New York was timely for the 35 companies assembled. The discussion was energetic; the concern about the erosion of trust in the U.S. health system deep and palpable. And the important role our employees play in building, maintaining and securing the trust of our customers and partners is an important wake-up call.

Trust in virtually every domain of the health system is eroding. It’s an issue in every sector and in every community.

The healthcare workforce and public trust: what our employees think matters.


PS: Marina Karp, Associate Director of the Navigant Center for Healthcare Research and Policy Analysis, attended the Consortium for Trustworthy Organizations meeting of healthcare organizations and was the major contributor to this Pulse Weekly. Much appreciation!


1-“Confidence in U.S. Institutions” Gallup Historical Trends Gallup June 2015; “Oil, Pharmaceutical, Health Insurance, Tobacco, Banking and Utilities Top The List Of Industries That People Would Like To See More Regulated,” The Harris Poll by Harris Interactive, November, 2012;; Tom W. Smith and Jaesok Son General Social Survey 2012 Final Report “Trends in Public Attitudes about Confidence in Institutions,” NORC at the University of Chicago, May 2013; “Restoring the pharmaceutical industry’s reputation,” Nature, October 29, 2014; Baum, S., “Survey finds lack of transparency drags down pharma reputation among patient groups,”Medcity News, January 15, 2013

2-“Public Trust in Government: 1958-2013,” Pew Research Center, October 18, 2013; “Young Adults Less Trusting In General but with Exceptions,” Pew Research Center, May 23, 2013; “Confidence in U.S. Institutions Still Below Historical Norms,” Gallup, June 15, 2015; Twenge, Jean M., Campbell, W. Keith, Carter, Nathan T., “Declines in Trust in Others and Confidence in Institutions Among American Adults and Late Adolescents, 1972-2012,” Psychological Science, 2014, Vol. 25(10), 1914-1923. doi: 10.1177/0956797614545133; Eelman Trust Barometer: Life Sciences and Trust, 2013; Honesty/Ethics in Professions, Gallup December 2015; “Consumer Attitudes toward Family / Primary Care Physicians and the U.S. Healthcare System,” Physician Foundation Consumer Omnibus Survey, Physicians Foundation, July 2012

3-Consortium for Trustworthy Organizations Consortium of Trustworthy Organizations: Trust and Patient Value in Health Care, November 9, 2015, Fordham University

4-“Jobs Report: U.S. Economy Added 295,000 Jobs in February, Unemployment Down To 5.5%,” Forbes, March 6, 2015; “Current Employment Statistics December 2015,” Prepared by Staff of the National Estimates Branch; Current Employment Statistics Survey, U.S. Bureau of Labor Statistics, Release Date: January 8, 2016

5-Brigham, A.F. & Linssen, S., “Your brand reputational value is irreplaceable. Protect it!” Forbes, February 1, 2010; Gaines-Ross, L., Corporate Reputation, 12 Steps to Safeguarding and Recovering Reputation, John Wiley & Sons, Hoboken, NJ, 2008

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

©2015 Navigant Consulting, Inc.