Investing in Health | January 30, 2023

Trust, not technology, bonds patients and providers

Sarah Mullane

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Guest Author

Sarah Mullane

Editor’s note: This article is sponsored by Johnson & Johnson Impact Ventures, which supports ImpactAlpha’s Investing in Health coverage. In partnership with J&J Impact Ventures, ImpactAlpha is exploring the market potential of impact investments in purpose-driven entrepreneurs working to improve health outcomes for underserved communities around the world.

The United Nations Secretary-General recently summarized the world’s state of digital affairs: “The world is shifting from analog to digital faster than ever before, further exposing us to the vast promise and peril of new technologies.”

This contrast of promise against peril is particularly life-threatening in healthcare. 

While there is disagreement about how to specifically define trust, it has been described as the “keystone” of patients’ relationship with health professionals and an important concept in all caring disciplines, where relationships are not necessarily formed by choice. In this context, trust is a set of expectations that the healthcare provider will do the best for the patient, acting with goodwill while recognizing the patient’s vulnerability. 

Unfortunately, lack of trust in healthcare remains a major issue. This is most notable among groups with unmet healthcare needs or those living in socially and economically under-resourced situations. In a study led by The Deloitte Center for Health Solutions in 2021, 55% of respondents reported a negative experience where they lost trust in a healthcare provider. A further 36% said they had skipped or avoided care because they did not like the way the provider or their staff treated them. Overall, since 2020, due in part to the COVID-19 pandemic, there has been a significant increase in initiatives exploring the role of trust in healthcare.

Healthcare leaders recognize that trust is central to well-functioning, equitable health systems, but it is not guaranteed. That is why it is critical for us and other impact investors to support health innovators – especially those in the ever-growing digital social enterprise space – that prioritize values like trust over mere volume as they scale their ideas.

Investing in high-trust environments generates high returns

At Johnson & Johnson Impact Ventures (J&J Impact Ventures), a fund within the Johnson & Johnson Foundation, we are committed to transforming health systems and driving equitable healthcare by not just investing in a technology, service or delivery mechanism, but also the people behind them who have demonstrated interest and commitment to building trust into their market-driven solutions. This is key to our investment philosophy and why we put capital behind enterprises like Penda Health and work with organizations like Village Capital to fund projects that strengthen patient trust.

Penda Health is a tech-enabled network of health facilities across three counties (Nairobi, Kiambu & Kajiado) in Kenya and led by Stephanie Koczela, a passionate entrepreneur who puts patients at the heart of their mission. As a signatory of the Ethical Principles in Health Care (EPiHC), Penda Health has adopted 10 fundamental principles designed to promote ethical decision-making and behaviours that build transparent, trustworthy and resilient health systems. It has become one of the largest outpatient health care providers in East Africa, owing in large part to their focus on relationships. Their success stands upon a foundation of trust they have built externally with their stakeholders in the health sector and internally with staff at their facilities.

Penda is paving the way in value-based care, bolstering their fee-for-service business model with the additional benefits of a capitation model. This holds them increasingly responsible for prioritizing patient outcomes, not only financial outcomes. Their commitment to focusing on the patient experience has allowed them to maintain an industry-leading 65% + Net Promoter Score, a measurement of customer loyalty and satisfaction. 

A similar intent motivates our support for Village Capital, which runs accelerator programs for health entrepreneurs with lived experience and supports emerging innovators to develop essential skills, secure funding and access networks that can advance their businesses. The accelerators operate on the fact that health providers’ cultural competency — skills to recognize and respond to patients’ needs not only medically but mentally, socially and culturally — directly relates to their ability to build trust with their patients. 

Health entrepreneurs with lived experiences reflecting those of their communities and patients are often uniquely suited to provide culturally competent care. Through Village Capital, we support health tech innovators who are creating outstanding solutions that are informed by their own lived experience with health systems. 

In healthcare, technology and trust must grow hand-in-hand

Tech-enabled care (TEC) (a collective term for telecare, telehealth, telemedicine, mobile, digital and electronic health services) plays a significant role in breaking down barriers to healthcare access, but it is important that we do not lose sight of the “enabled” piece of tech-enabled care. We must remember it is truly an enabler and not a silver bullet. 

At a recent RockHealth Summit, impact investors heard this message loud and clear: while technology is important, relationships and community are essential. Still, they are not receiving enough investment or attention across society. Tom Cassels, President and CEO of Rock Health Advisory, put it succinctly: “We are not organized for the ongoing relationships that people want with their primary care providers.”

One area where the limitations of technology alone are being acknowledged is in AI, where researchers are exploring the role of trust in the acceptance of tools for preventive care. They have observed that the effectiveness of AI-based health interventions can be improved by combining them with human expert opinions, increasing their algorithmic transparency or emphasizing their genuine care and warmth. Advancements in health technology cannot reach their full potential unless they are also accompanied by investments in the relationship that actually delivers them to patients.

Remembering the roots of healthcare

The Hippocratic Oath has long captured the ideals of good intent and excellent work that foster patient-provider trust. We and other health impact investors would be remiss to overlook these values in our mission to provide equitable access to healthcare for all. By investing in trust as a core priority and criteria for investment, we can help ensure we are not led astray by the benefits of technology, but effectively enhance them.

Sarah Mullane is health tech lead for global community impact at Johnson & Johnson.