Green ghosted shapes image

From Mistrust to Collaboration: 5 Tips for Building Trust with Our Communities

Why It Matters

After working for over a decade to make connections between her organization and the people it serves, a community relations professional shares lessons she believes all health care organizations can apply to earn or rebuild trust.


Angela Morris, MPH, was in a tough position. She knew she was not responsible for why a non-profit organization in her community did not trust Parkland Health (Dallas, Texas, US), but she also knew, as Parkland’s Senior Director of Community Relations, that she had to be the one to earn it back.

Morris learned of the rift when she contacted the organization to request their backing for a new Parkland initiative. Despite their misgivings, she eventually persuaded them to support the project, but she knew she could not stop there. “I needed to restore the relationship,” she told the Institute for Healthcare Improvement (IHI) during a recent interview. After several years of Morris representing Parkland’s commitment to genuine partnership, a trusting relationship is flourishing. “I cultivated the relationship, worked to acknowledge and restore what was broken, and I shared this information with [Parkland’s] leaders.”

Having grown up as a Black middle-class kid in Dallas, Morris is all too familiar with her community’s reasons for distrust in a large health care system. All Parkland Health staff members, she says, must be willing to acknowledge and take responsibility for “missteps or things we may have done that we didn't realize might have been a trigger for experiences that are associated with racism in the city or maybe biases that [community members] experience within the system.”

“I had to first prove myself as an individual and earn trust,” Morris explained. “I had to show that I’m open, I’m transparent, that I share [information when] I’m able to, and that I’m truly here to collaborate and to serve.” After working for over a decade in community relations, Morris has learned lessons she believes all health care organizations can apply to build trust with their communities:

  • Acknowledge barriers to trust. Patients and community members often have multiple reasons for distrusting local health care organizations. These reasons can range from patterns of institutional racism to negative firsthand experiences with individual providers. The Association for American Medical Colleges (AAMC) put this bluntly in their Principles of Trustworthiness: “The community is already educated; that’s why it doesn’t trust you.” As described in the Healing ARC framework, the first step in addressing institutional inequity is to acknowledge and voice responsibility. This can include apologizing for past and current harm, which organizations should ensure communities perceive as genuine and authentic. Morris described the recent renaming of a Parkland health center and the naming of a street on the Parkland campus after trailblazing African American physicians as opportunities to own up to disparities and “be honest with the community about our understanding of the systemic and racial constructs we live and interact in.”
  • Show respect by being genuine, authentic, and honest. Trust and respect must be bidirectional. When patients and community members feel health care professionals or other representatives of an organization are talking down to them or otherwise not showing respect or trust, they are unlikely to trust or respect that organization. According to Morris, “sometimes people just want you to treat them like they can understand what you’re saying.” Health care professionals should focus on building authentic connections by demonstrating respect for patients’ knowledge, lived experiences, and perspectives.
  • Be transparent and share the information you can. Morris has learned to balance staying true to her responsibilities to her organization while being as transparent as possible when she meets with community members. She is honest about what she can and cannot share, and people respect her professionalism. “They understand I can’t tell them everything,” she explained.
  • Remember that earning trust is a long haul and that minor changes can add up. Creating strong alliances can take years. Even after organizations and communities form relationships, it takes ongoing work to maintain them and avoid losing trust. Building trust, like other types of work in patient safety and quality improvement, involves making small, incremental changes. But, as Morris said, “if you make change, small pieces every day . . . when you look back after a month, you see you’ve made strides.” For Morris, this has included showing up across Dallas County “in the trenches” of trust-building: going to local churches, sharing meals with community members, and attending town hall meetings and other events.
  • Build trust with communities and not just your patients. Large health systems like Parkland have a responsibility to their communities that goes beyond who comes in for an appointment. In many cases, health care organizations are among the largest employers in their respective communities, so a key starting point for trust-building is in prioritizing workforce joy and well-being. Health systems also have an opportunity to build trust by working with local businesses even if their staff members are not their patients. Beyond direct patient care, these key touchpoints with the community are important ways health care organizations can show themselves to be trustworthy institutions.

While Angela Morris’ impact on Parkland’s standing in the community is impressive, it takes more than one person to build trust between organizations and communities. Every individual at a health care organization has a role to play.

Sophia Cunningham is an IHI Associate Project Manager.

Editor’s note: Parkland Health is one of six organizations currently participating in IHI’s Trustworthiness in Health Care Prototyping Network, funded by the ABIM Foundation. To learn more, register for SH05: Trust: An Imperiled Determinant of Healthy Health Care Systems, a session at the IHI Forum (December 10–13, 2023).

You may also be interested in:

It’s Not You, It’s Us: Earning Trust to Build Community Connections

What I Am Learning About Trust