Chapter 5. Building Trust

Regional Coalition Collaboration Guide

Trust is established when there is a perceived good-faith effort to behave in accordance with a group's commitments (i.e., delivering on what is promised). Several factors, such as shared social norms; repeated interactions; shared experiences; and reliable, consistent, and predictable leadership also have been suggested to facilitate the development of trust. Perhaps the most fundamental component of trust is the ability to communicate effectively, which involves much more than sharing information. Effective communication establishes an understanding between individuals and organizations.

The mutual respect that can lead to trust must come from this communicated understanding. Once a relationship has experienced mutual respect, it is possible for participants to experience enduring relational trust, which is a feeling that binds people together over time and through trials.

Trust among a diverse group of stakeholders is essential to building and maintaining a regional coalition. Perhaps the most daunting obstacle to this kind of open communication for coalitions is the traditionally competitive relationship among some stakeholders. It takes effective leadership skills to develop the honest communication and rapport that will help competitors see beyond their business interests to the larger social good that collaboration offers.

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Competition Versus Collaboration

Competition may be healthy for the economy, but collaboration is necessary for value-driven health care to succeed. Coalition leaders need to foster a collaborative process that is open and inclusive and leads to a consensus among competitors. It is important for leaders to build trust by lowering traditional barriers. One barrier, in particular, is a reluctance to share data among stakeholders. Providers may see releasing pricing data as a disadvantage, and public ratings generate concerns among competing medical groups. Traditional tensions between physicians (i.e., medical associations) and health plans also can be an issue, such as when physicians question health plan motives.

Suggested processes for lowering competitive barriers among participants follow.

Appeal to the Greater Good

When talking to stakeholders who are reluctant to share data with competitors, emphasize that systemically improving health care quality in the community requires broad collaborative effort. Providing cost-effective, quality health care should be something on which everyone can agree to cooperate.

It is also important to emphasize that stakeholders working collaboratively are able to accomplish larger, more comprehensive data gathering and reporting than by working individually. Creating and sharing a larger, broader data set among a range of stakeholders is essential for significant health care system improvement.

Facilitate Candid Discussions

Coalition leaders should be ready to construct a coalition at a pace that will allow stakeholders to build trust. During the startup phase, the most important task is to find the common ground for all parties. Facilitating frank discussions among physicians, plans, and employers in a neutral meeting space can ease participants' suspicions and let them find common ground. Beyond the startup phase, involve as many diverse participants as possible in overseeing coalition activities.

The Center for Health Information and Research, for example, upon the inception of Arizona HealthQuery, formed a regular data partner meeting that includes all regional coalition stakeholders. This process builds trust, establishes transparency, and promotes an environment in which sharing is possible. Similarly, Massachusetts Health Quality Partners developed its Physician Council as part of the governance structure to ensure all physician groups work together to influence the process.

Develop and Adhere to a Set of Shared Values

Several coalitions use a strategy to engage their members in the development of a set of shared values that will govern the coalition's work. For example, the Wisconsin Collaborative for Healthcare Quality has a code of ethics that emphasizes the importance of member adherence to standard measures, consistent timeframes and timelines for reporting, a willingness to share best practices, and a commitment not to use the performance results in marketing or other overtly competitive activities.

Tip: In discussions that precede enrollment of a stakeholder, offer direct, objective responses to all issues of concern. Do not evade issues or gloss over any problems raised.

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Proceed to Chapter 6

Page last reviewed April 2008
Internet Citation: Chapter 5. Building Trust: Regional Coalition Collaboration Guide. April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/collabguide/collabguide5.html