Navigating Complexity in Healthcare: Building Trust Through Relational Reciprocity
In healthcare, collaboration across multiple organizations is both an opportunity and a challenge. As leaders work to align governance and accountability, two elements can make or break a team’s effectiveness: trust and relational reciprocity. Building trust within and between organizations isn't just a best practice; it's the foundation that holds everything together.
Trust as the Foundation of Healthcare Teams
Healthcare is delivered through relationships. Every interaction, whether between patients and providers or between partnering institutions, relies on trust. Yet, in recent years, we’ve seen fraying trust in some of our largest health institutions. Much of this can be attributed to a growing focus on economic outcomes at the expense of relational ones.
In every business transaction, there are two core components: economic and relational. The economic aspect deals with costs, terms, and financing. The relational aspect, however, focuses on shared values, organizational responsibility, collective action, and trust. With rising pressures in healthcare, we often prioritize economic factors, overlooking the fact that healthcare is inherently personal and relational.
Can Trust Drive Economic Efficiency?
This brings us to one of the most pressing questions in healthcare governance: Is there a better way to improve economic efficiency by fostering trust in institutions tasked with achieving it?
One potential answer lies in the concept of relational reciprocity. Relational reciprocity goes beyond transactional exchanges; it’s the understanding that groups or individuals work together based on mutual benefit and shared obligations. This social norm encourages behavioural actions and willingness to take risks, with the expectation of reciprocation [1].
In complex systems like healthcare, relational reciprocity can shape the norms, rules, and institutional arrangements that govern collective action. Without it, institutions lack the social capital and trust required to foster responsible stewardship of resources and mobilise collective action to address disputes over resource competition, access, and allocation.
The Impact of a “Culture of Relational Reciprocity”
At Intermountain Healthcare (IH), we didn’t just create a mental health program; we established a Mental Health Integration (MHI) community rooted in a culture of relational reciprocity. Over 20 years, this community fostered collective action, resulting in improved outcomes across the system [2].
Key governance conditions in the MHI community included:
- Clear boundaries, roles, and local authority
- Wide participation and collective choice, where everyone had a voice and responsibility
- Fairness in resource use aligned with local conditions
- Implementation monitoring with graduated sanctions or rewards
- Open communication to resolve and prevent disputes, aligning efforts for long-term sustainability
This governance framework enabled routine mental health care to become integrated into everyday medical visits, establishing trust and continuity in patient-provider relationships. Patients, in turn, felt more connected to their care team, leading to their perceived positive outcomes such as: [3]
- "My doctor was the first person to treat me as a whole person."
- "I’m connected to a team that talks to each other."
- "Being on the same page gives me better results."
Creating a Community of Belonging
What we learned is that relational reciprocity fosters a sense of connection, conviction, and belonging. The framework we built at IH and MHI required consistent communication, which in turn reinforced mutual trust and respect. This relational governance provided the adaptive conditions needed to manage the complexities and changes inherent in healthcare.
Ultimately, our goal is to build high-functioning, trust-based teams where healthcare is not only effective but is also delivered through relationships that make people feel truly cared for. By embedding trust in our governance structures, we can create resilient healthcare systems better equipped to navigate challenges and improve outcomes for everyone involved.
Dr Brenda Reiss-Brennan
Mental Health Integration Director
Primary Care Clinical Program
Intermountain Healthcare
Board Member
International Foundation for Integrated Care (IFIC)