The importance and paucity of trust in today’s health care system

The ancient Chinese philosopher Confucius told his disciple Tszekung that three things are needed for good government: weapons, food and trust. If a ruler cannot hold on to all three, he should give up weapons first and food next. Trust should be guarded to the end: "Without trust we cannot stand." Last year, in accepting the AHA Health Research and Educational Trust's (HRET) first TRUST Award, my mentor, David Lawrence, retired chairman and CEO, Kaiser Foundation Health Plan Inc., eloquently summarized the gaps in hospital care identified by the Institute of Medicine's 2001 report: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. He discussed the harm done every day to real people our neighbors, our loved ones, ourselves because of these gaps. He compared the toll from safety defects to deaths in the Vietnam War. He said (and in our hearts we all know this is true) that the gap between what we actually do and what we could do is costly, persistent, enormous and indefensible. Unfortunately, except for a minority of people in health care, improving American health lacks a sense of urgency. That puts each person's trust in our health care system at risk. The harm caused by defects in health care quality is real and its impact enormous. Yet, too many of us tolerate it. (April 2005)