Is trust at scale an oxymoron?

I’m in a car on the way to the airport after two conferences in Nashville. Everyone kept saying how important “trust” is, but I wasn’t always sure what they meant by it.

In terms of health interoperability and for the purposes of this article, there are two flavors of trust:

1. Trust in the data exchange network – These are the infrastructure and processes to exchange data efficiently and securely.
2. Trust between partners exchanging data on the network – This is the confidence that exchange partners have in each other based on their relationship and consistent results.

Take care not to confuse them. It is possible to construct an elegant trust network with participants who distrust each other.

Imagine a scenario in which everyone on the network felt cajoled, manipulated, bribed or coerced into joining. These individuals might trust the infrastructure but do the least amount of data exchange possible. They could make excuses to not share anything, and they might even try to undermine the network.

How humans and other life forms build trust

There’s a good deal of research around how individuals and teams build trust, even if they have had historically acrimonious relationships. Here are a few steps my team takes when working with our ancient adversaries – the health plans:

1. We reach out to the health plan's team and tell them that them that we want to partner.
2. We try to establish a shared objective, usually around the populations we jointly manage through Value Based Care contracts.
3. We focus on reciprocal data exchange, meaning that we ask the health plan's people what data they need to be successful, and we tell what we would like in return.
4. We do not overcommit because we know how important it is to deliver consistently on schedule.
5. We move quickly but not too quickly. Speed can lead to team burnout, missed deadlines and cutting corners. It may not leave adequate time to validate the results.
6. We start small and build incrementally. Mutual confidence grows gradually as partners fulfill the promises they make to one another. After small wins, we work together
7. We communicate transparently. No one tries to hide their mistakes, and they certainly don’t deceive to get their way in the moment.

Our attempts to forge relationships with health plans do not always work out, and that’s expected. People are busy and have other priorities. We’ve had some great successes and developed some great partnerships though.

Betraying your partners’ trust while building your trust network

As you build your network, don’t violate your participants’ trust hoping that a solid technical framework will be enough to keep people engaged anyway. Here are some examples of behavior that would discourage trust in a network and between network participants:

1. Instead of reaching out asking organizations to join voluntarily, make it clear they don’t really have a choice.
2. Make half-hearted attempts to explain why they will benefit from participation.
3. Structure the network in a way that benefits one party or industry group more than it does others while telling everyone it is balanced data exchange.
4. Promise the network will solve every data exchange problem you can imagine on day one.
5. Develop the network so rapidly that participants don’t have a chance to provide thoughtful input or share negative feedback.
6. Do not create a pathway for participants to dip their toes in the water before exchanging all data for all purposes.
7. Make decisions on how the network should be structured behind closed doors and attempt to hide their missteps from network participants.

It’s understandable that you are eager to launch the product and to convince others to join, but do it the right way. At the very least, structure your framework in such a manner that participants could eventually have confidence in each other.

Balancing strong relationships with the long tail of trust

Many healthcare entities have a small number of partners that are critical to their success. A provider organization, for example, might have a handful of priority health plan partners, other providers, and a few technology vendors that have an oversized impact on their business. With these prized relationships, the parties involved need high levels of trust in the network and in each other.

For the long tail of other organizations that have little impact on the business, it may not be possible to build strong personal relationships with all of them. The total number of exchange requests could still be high even though data exchange is infrequent with each one. These low-volume partners may not need strong personal relationships, but they will need to rely on a secure network when the need for exchange arises.

By combining a few close data partnerships with broadly accessible-but-secure data networks, we could indeed have a kind of trust at scale. We cannot have it though if the trust we have in the network or in our closest partners is frequently broken. Actual trust is so much better than the alternative of talking about trust while pitting groups against each other as they struggle in a deeply flawed network.