Overview

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The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

• The concept of trust is complex and multifaceted. Philosophy, sociology, economics, psychology and medicine understand it differently, and each offers insights into the importance of trust for health, health policy and healthcare provision, and for social cohesion.
  
• Trust in health systems is essential if they are to function effectively. Trust underpins the solidarity that enables quality health care. It is central to the complex interplay of relationships that shape health outcomes.
  • Patients need to trust clinicians and care providers if they are to seek help promptly, share information and follow treatment plans.
  • The health and care workforce needs to trust that they will be valued if they are to stay in the sector, stay motivated and perform well.
  • Policy-makers need to trust that the health system will deliver quality care and do so efficiently if they are to invest resources. They also need to trust the public (and vice versa) in times of crisis.
    
• New technologies in health have significant implications for trust. There is a need to:
  • regulate online resources and safeguard data privacy;
  • manage the use of artificial intelligence (AI), which poses particular challenges for trust because the way it operates and the algorithms it uses are not transparent;
  • ensure workforce monitoring and productivity tracking do not demoralize health and care worker; and
  • make sure technologies are reliable, accurate and used ethically and equitably.
    
• Trust needs to be actively supported.
  • Disinformation and misinformation erode trust if not addressed. They may be politically or commercially motivated with misleading AI-generated content being particularly problematic.
  • Transparency reinforces trust and encourages accountability, whereas a lack of transparency on health care costs, medical errors and conflicts of interest all undermine trust.
  • The complexity of trust dynamics; the context; the experience, expectations and tolerance of different actors and social groups; and changes over time: all need to be taken into account in building trust.
    

• Measuring trust is an important step in addressing trust deficits, but it is difficult. Much research relies on surveys or interviews and focuses on patients’ trust in doctors. There is little work on differences in trust in doctors rather than nurses or on trust in health care teams or organizations. It would be helpful if:
  • lessons from a range of disciplines could inform the way trust is understood (and translated);
  • trust could be studied as an outcome through experimental studies, qualitative and mixed methods measures and longitudinal research;
  • response formats and trust measurement tools could be improved and comprehensive data collected and updated regularly to assess differences within populations and changes over time;
  • centralized data sources were set up with international coordination underwriting comparability; and
  • minority or marginalized groups and their trust in health care could be given particular attention.
    
• Engaging a wide range of stakeholders is essential in building trust. This requires:
  • fostering collaboration across sectors;
  • including civil society, the media and the public;
  • engaging stakeholders in decision-making, for example through citizens' assemblies;
  • recognizing the value of lived-experience; and
  • encouraging co-production of care and tackling the power and information imbalances that undermine it.
    
• Trust in health bodies can be encouraged by consistent delivery of quality care and by:
  • a clear, shared vision and values, underpinned by ethical standards;
  • an explicit commitment to stakeholder well-being that includes staff;
  • embedding reliability, integrity and transparency into policy-making, strategies and practices;
  • leaders who exemplify integrity, ethical behaviour, and accountability;
  • openness on the use (and impact) of resources and in addressing waste or corruption; and excellent communication of all the above.

  The other Tallinn policy briefs:

  Health system performance assessment: A renewed global framework for policy-makings
  Assessing health system performance: Proof of concept for a HSPA dashboard of key indicators
  Financing for health system transformation: Spending more or spending better (or both)?
  Transforming health service delivery: What can policy-makers do to drive change?