How to Solve Healthcare’s Trust Deficit
Skip to content
Healthcare Jul 9, 2018

How to Solve Healthcare’s Trust Deficit

Doc­tors, patients, and insur­ers are often skep­ti­cal of each oth­er. Three experts dis­cuss ways to coun­ter­act that.

A nurse uses a stethoscope on a hospital building.

Lisa Röper

Based on insights from

Kent Grayson

Lakshmi Halasyamani

Daniel Dahl

The health­care indus­try in the Unit­ed States has trust issues: doc­tors are sus­pi­cious of insur­ers, who don’t trust hos­pi­tal admin­is­tra­tions. Patients are see­ing their costs sky­rock­et and won­der who, if any­one, is on their side. And despite the costs asso­ci­at­ed with health­care, the U.S. lags behind oth­er devel­oped nations in pop­u­la­tion health. 

Add Insight
to your inbox.

We’ll send you one email a week with content you actually want to read, curated by the Insight team.

The sector’s sheer size — it accounts for near­ly 18 per­cent of U.S. GDP — and com­plex­i­ty mean any poten­tial solu­tions for improv­ing health­care have to fac­tor in a tan­gle of inter­ests, many of which are at odds. 

So what can be done to improve out­comes for every­one involved? 

Kent Grayson, a pro­fes­sor of mar­ket­ing at the Kel­logg School, is joined by Lak­sh­mi Halasya­mani, the chief qual­i­ty and trans­for­ma­tion offi­cer at NorthShore Uni­ver­si­ty Health­Sys­tem, and Daniel Dahl, Senior Direc­tor of Health Solu­tions at Alight Solu­tions, to dis­cuss how the var­i­ous play­ers in the indus­try might tack­le the challenge. 

This inter­view has been edit­ed for length and clar­i­ty.

Kent GRAYSON: Why is it that extreme­ly smart, extreme­ly empa­thet­ic health­care pro­fes­sion­als assume that oth­er peo­ple who are work­ing in the ecosys­tem actu­al­ly don’t have a patient’s best inter­ests at heart? Why do you think a lack of trust hap­pens even to the best of us? 

Lak­sh­mi HALASYA­MANI: Because I think we spend an inor­di­nate amount of time think­ing about what isn’t work­ing well, as opposed to spend­ing even half of that amount of time on what is work­ing well — and think­ing about how we can ampli­fy that. We have to ask our­selves, How do you take some­thing that was good and make it con­sis­tent­ly good all the time?” 

Some of this is our clin­i­cal ori­en­ta­tion, which is always about fig­ur­ing out what’s wrong as opposed to fig­ur­ing out what made some­thing right. A lot of the peo­ple in health­care are a lit­tle bit Eey­ore-like, and we prob­a­bly need a few more Tiggers. 

One way the Kel­logg School is facil­i­tat­ing new think­ing about the chang­ing health­care indus­try is its recent Expert Col­lec­tive on Trust in Val­ue-based Health­care, led by The Trust Project at North­west­ern and the Kel­logg Health Enter­prise Man­age­ment pro­gram. Over the course of this col­lab­o­ra­tive event, more than a hun­dred lead­ers from across the health­care ecosys­tem — includ­ing Kent Grayson, Lak­sh­mi Halasya­mani, and Daniel Dahl — met in an open forum to dis­cuss sys­temic chal­lenges to trust in val­ue-based health­care. This inter­view cen­tered on their reflec­tions after par­tic­i­pat­ing in the Expert Collective.

Daniel DAHL: I think that part of it is price or cost. 

Whether you’re a physi­cian or you work in the indus­try or, most impor­tant­ly, you’re a patient, you’re see­ing the costs go up, and you don’t feel like you’re get­ting any­thing in return. 

We all know tech­nol­o­gy is get­ting bet­ter. But if peo­ple feel like they’re being tak­en advan­tage of from the begin­ning — and a lot of that starts with the pre­mi­um costs or the bills from their physi­cians — they feel like the sys­tem is stacked against them and that the whole sys­tem must be broken. 

I think that wears on all of us in the industry. 

GRAYSON: It’s part­ly due to this idea, which is based in real­i­ty, that there’s a fixed pie. I mean there’s only so much mon­ey that the econ­o­my is going to spend on health­care, and I know it keeps going up, but it’s not going to go up for­ev­er. I think peo­ple are always won­der­ing, How big a piece am I going to get, and why is that per­son get­ting a big­ger piece than I am when I con­tribute more value?” 

HALASYA­MANI: I think there is an ele­ment of that, though I don’t know if peo­ple are that reflec­tive in their day-to-day prac­tice. I think more com­mon is the sense that I am work­ing real­ly hard to make a dif­fer­ence and some­times it seems regard­less of how hard I work, the good out­come that I want for my patient is get­ting hard­er and hard­er to achieve. This to me is at the heart of the change we need to make. We have to align and opti­mize our sys­tems rather than ask peo­ple to work hard­er in bro­ken, dis­con­nect­ed sys­tems. But this is real­ly hard to do. 

I don’t know if any of you have tried a Julia Child recipe — they are incred­i­bly com­plex. And if the meal that comes out after three hours tastes real­ly bad, that feels real­ly bad. It’s like, What have I got­ten for my effort? I’ve got­ten [some­thing that tastes like] a take-out piz­za, basically.” 

There is a sim­i­lar mis­match between the effort and sin­cer­i­ty that med­ical pro­fes­sion­als have and what ends up as the result for patients. And that can be very demor­al­iz­ing because we want to do a good job. 

GRAYSON: What about patient edu­ca­tion? A high-school kid is going to get train­ing, if they’re lucky, in finan­cial lit­er­a­cy. But even the luck­i­est ones don’t get train­ing in health lit­er­a­cy: what to ask your gen­er­al prac­ti­tion­er, what does insur­ance do, all that kind of stuff. Do you see that as low-hang­ing fruit for improv­ing trust in the system? 

HALASYA­MANI: I actu­al­ly do. I think what it does is it takes the patient from being a pas­sive vic­tim of what­ev­er the sys­tem devel­ops or cre­ates for them, to some­one who can actu­al­ly get the sys­tem to work for them. 

Employ­ers are increas­ing­ly adding tools and resources to help work­ers learn more and to get and stay healthy.” —Daniel Dahl

DAHL: Health — and real­ly total well-being edu­ca­tion — is an area that employ­ers are increas­ing­ly address­ing with their peo­ple. Employ­ers are increas­ing­ly adding tools and resources to help work­ers learn more and to get and stay healthy — every­thing from online resources, well­ness apps, in-per­son coach­ing, and infor­ma­tion ses­sions. So many employ­ers are try­ing to fill the void in some ways, though there’s always room for improvement. 

GRAYSON: Could you imag­ine com­pa­nies hir­ing patient advo­cates to serve an edu­ca­tion­al function? 

DAHL: Absolute­ly. Employ­ers can and do hire health advo­cates, peo­ple that their employ­ees can call who are more high­ly trained than your typ­i­cal cus­tomer ser­vice cen­ter or HR ben­e­fits per­son. The advo­cates can access your claims infor­ma­tion, your treat­ment plan, and help you nav­i­gate if you’re dou­ble-billed or run into oth­er roadblocks. 

Anoth­er thing employ­ers can offer is bet­ter tools. We all have phones and com­put­ers in our pock­ets that can help us; how do we pack­age the data and make it more acces­si­ble so that peo­ple can make good deci­sions around cost and qual­i­ty in real time? 

As a patient, if I am enrolling for ben­e­fits and I know I’m going to have a baby and that’s going to cost a cer­tain amount, how can I use the appli­ca­tions I have in my pock­et to help make real­ly good deci­sions? New enroll­ment apps are avail­able that help guide patients through the enroll­ment process, tak­ing into account those life events and indi­vid­ual needs to make the deci­sion-mak­ing process eas­i­er and bet­ter for patients. 

GRAYSON: As we think about these advo­cates or apps, I won­der whether a con­flict aris­es between what might be best for the patient and what might be cost-effec­tive for the employ­er? I know these goals align in many cas­es because the employ­ers want healthy employ­ees. But I imag­ine there are also times where, if the advo­cate was real­ly a patient advo­cate, there might be times when the employ­er is like, Oh gosh, I wish he didn’t actu­al­ly advo­cate for that.” 

DAHL: I think the employ­er has the most to lose with a patient who is unhealthy: absen­teeism, being away from work, or low-qual­i­ty work when they’re there. It is in the employer’s best inter­est to help their work­ers get and stay healthy. 

To answer your ques­tion about con­flict of inter­est, there are laws that pro­tect the pri­va­cy of work­ers, so employ­ers don’t have vis­i­bil­i­ty into the advice or care indi­vid­ual employ­ees are receiving. 

HALASYA­MANI: A big com­po­nent of patient edu­ca­tion is a trust­ing rela­tion­ship, and that’s some­thing that takes time to devel­op and isn’t always going to emerge with an employer. 

What I think is inter­est­ing is I’ve talked to some of my friends and col­leagues about, Hey, what would you think if an employ­er offered ser­vices like a patient advo­cate?” Sev­er­al of them have said to me, Well, first of all, I’d be very sus­pi­cious if my employ­er made me do some­thing because why are they mak­ing me do it?” 

So I think who the mes­sen­ger is is real­ly impor­tant. Even though we might get the mes­sage right, it has to come from the right messenger. 

Featured Faculty

Kent Grayson

Associate Professor of Marketing; Bernice and Leonard Lavin Professorship

Suggested For You

Most Popular


How Are Black – White Bira­cial Peo­ple Per­ceived in Terms of Race?

Under­stand­ing the answer — and why black and white Amer­i­cans’ respons­es may dif­fer — is increas­ing­ly impor­tant in a mul­tira­cial society.


Why Warmth Is the Under­ap­pre­ci­at­ed Skill Lead­ers Need

The case for demon­strat­ing more than just competence.

Most Popular Podcasts


Pod­cast: Our Most Pop­u­lar Advice on Improv­ing Rela­tion­ships with Colleagues

Cowork­ers can make us crazy. Here’s how to han­dle tough situations.

Social Impact

Pod­cast: How You and Your Com­pa­ny Can Lend Exper­tise to a Non­prof­it in Need

Plus: Four ques­tions to con­sid­er before becom­ing a social-impact entrepreneur.


Pod­cast: Attract Rock­star Employ­ees — or Devel­op Your Own

Find­ing and nur­tur­ing high per­form­ers isn’t easy, but it pays off.


Pod­cast: How Music Can Change Our Mood

A Broad­way song­writer and a mar­ket­ing pro­fes­sor dis­cuss the con­nec­tion between our favorite tunes and how they make us feel.