Building trust and collaboration in health care

November 14, 2011 — Ten years ago, when David Shore first began offering a program for health care executives on how to lead their organizations through change, he asked participants a question: If the U.S. health care system is so good—with well-trained clinicians, access to safe and effective drugs, topnotch medical equipment, and Internet access to a wealth of health information—why doesn’t it have better outcomes?

One of the participants gave a simple answer: “The stakeholders don’t collaborate.”

That answer prompted Shore, associate dean and executive director of the Center for Continuing and Professional Education at the Harvard School of Public Health (HSPH), to write about the difficulties of collaboration among various stakeholders in the health care field. His 2011 book­—High Stakes: The Critical Role of Stakeholders in Health Care, written with Eric Kupferberg of Northeastern University’s College of Professional Studies—makes a compelling case that health care stakeholders, such as doctors, hospitals, pharmaceutical companies, and medical device companies, need to find ways to align their interests to best provide good health for patients at good value.

Shore, who wrote two other books over the past decade on the importance of trust in health care, envisions a system in which various players “co-compete” so that they all become more successful.

For instance, although an insurance company and a physicians’ practice may have competing interests—the insurance company wants to minimize claims, but the doctors want to provide optimum care—those two players could choose to work together to insure that patients receive the most appropriate care, not necessarily the most care. In such a scenario, the insurance company could benefit by not having to pay for unnecessary tests. That outcome could be good for patients, too; as Shore notes in High Stakes, patients have sometimes suffered negative health consequences because of “runaway interventional treatment.”

This sort of “stakeholder alignment” is essential, said Shore, because health care, unlike other businesses, has so many stakeholders. And each stakeholder’s success is intertwined with that of the others.

But getting the players to collaborate is far from simple. “Let’s be very clear—one stakeholder’s cost is often another’s revenue,” said Shore. The stakeholders in the U.S. health care system operate mostly independently from one another and they often argue about who will pay for what and who is responsible for what. They are extremely gun-shy about collaboration because, at base, they don’t trust one another.

But Shore argues that more cooperation needs to happen—and they know it. “Everyone understands that all of the reform efforts and initiatives being proposed are dependent upon collaborations,” he said.

Shore’s annual program for executives, called “Forces of Change: New Strategies for the Evolving Health Care Marketplace,” draws on lessons from High Stakes and focuses on how to build trust and collaboration.

–Karen Feldscher