In response to COVID-19, the federal government expanded telehealth services in March as a way of containing the virus and reducing potential transmission between health professionals and patients. Telehealth consultations surged and by May, 4.7 million people had received 7.7 million telehealth services.

In this article, Nicole Gillespie, the KPMG Chair in Organisational Trust and Professor of Management at the University of Queensland Business School, will discuss trust in telehealth.

The starting point is to first understand trust as a general concept before moving to telehealth. Gillespie defines trust as a willingness to be vulnerable to the actions of another, based on confident positive expectations about their intentions and behaviour. She says trust is based on three pillars.

“First, there is ability, which is trusting in another’s competence in the domain that we are relying on them. Second, there is integrity which is believing the person will adhere to moral and ethical principles, such as treating people fairly, being honest, fulfilling promises and commitments, and abiding by the law. And third, there is humanity which is believing the person genuinely cares about others and will treat them with a duty of care.”

“We trust health professionals when we perceive them as operating with competence, integrity and humanity. If any one of those three is missing then it can undermine our trust.”

Trusting virtually

When it comes to virtual health services, Nicole says there is an added dimension and that is unfamiliarity. A sense of the familiar helps build trust. Patients have been socialised into expecting face-to-face services while health practitioners are trained to provide face-to-face.

Telehealth is not as simple as replicating face-to-face health services via technology. Telehealth is unfamiliar for both parties and crossing that unfamiliarity typically takes time and effort.

“What helps to build trust in a virtual consultation is feeling that there’s some sense of connection or commonality. If we can relate to each other that helps to build trust. This is why it’s really important to connect at a social level at the beginning of a consultation.”

It’s not the same as e-commerce

The trust environment for telehealth differs from the environment for other online services such as shopping where the focus is on the online technological interface. In telehealth, the interaction is mediated by a doctor or health practitioner.

Doctors are generally very trusted and this trust can be transferred to telehealth. Interviews with patients revealed some simply trust their doctor’s judgement: if their doctor believes telehealth is an appropriate form of delivering healthcare, the patient also trusts it. Gillespie calls this the transfer of trust.

“With online services, the research shows trusting the technology itself and the online platform is important. But for telehealth, trust in the doctor largely compensates and substitutes for the technology.”

Particularly sensitive clinical interactions such as skin checks that require a patient to undress in front of a computer can be uncomfortable for some people. This can affect trust and Gillespie says anything with that level of sensitivity needs more reassurance.

“People are sensitised to the idea that anything online can go viral. Assurances are needed up front about security and privacy settings to make people feel comfortable.”

The clinician’s perspective

A University of Queensland research project supervised by Gillespie revealed the majority of telehealth clinicians found establishing trust via telehealth was more difficult than face to face.  Trust is harder to establish virtually due to a lack of physical touch and diminished proxemics such as stance, posture and spatial awareness.

In the words of one clinician, “The bond through video conferencing is not as good as face-to-face, it does not feel as solid as talking to someone face-to-face.” Trust also involved more effort and time to establish virtually. “The way a patient comes in as you greet them, as you interact with them, as you touch them, as you help them into a chair, as you do the interview with them… all of those aspects help to develop that relationship. It is a little bit more clinical via technology.”

However, the research identified a set of trust building practices which can help overcome these challenges. These include establishing a social connection and showing genuine interest in the patient, highlighting the doctor’s role and expertise at the start of the consultation and explaining security, privacy and what to expect in a telehealth interaction upfront.

Where to from here?

Prior to the pandemic, telehealth was underutilised and not part of routine care. Then along came COVID-19 and as Gillespie says, “necessity became the mother of invention. That is very apt in describing how the pandemic has enabled many of the barriers to telehealth to be rapidly broken down.”

“One of those barriers was the funding model which gave little incentive for doctors and health practitioners to use telehealth. That has changed with temporary MBS telehealth items available for a wide range of consultations and health practitioners such as GPs, medical practitioners, nurses, midwives, and allied health.”

People have now experienced telehealth on mass and seen its capabilities, advantages and limitations. Gillespie expects it will remain as a viable complement to in person health services, particularly for the treatment of chronic diseases, for the ‘talking’ therapies such as psychology, and for people in rural and remote regions to access specialist services.

As for the future, Gillespie says, “My prediction is that telehealth will be here to stay if the funding model remains intact in a viable way. It is the way of the future because it provides more convenient and timely access to healthcare, greater equity of access for rural and remote patients, and can enhance clinical effectiveness and efficiency in certain areas, such as chronic disease management. And as the pandemic has shown, it can reduce risk of infection for both patients and healthcare workers. But it does rest on having a viable funding model.”

For more information visit KPMG.