Aneil K. Mishra

Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?

Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.

Measuring Patients’ Trust in their Primary Care Providers

Existing scales to measure trust in physicians have differing content and limited testing. To improve on these measures, a large item pool (n = 78) was generated following a detailed conceptual model and expert review. After pilot testing, the best-performing items were validated with a random national sample (n = 9) and a regional sample of HMO members (n = 99). Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model.Compared with previous scales, the Wake Forest physician trust scale has a somewhat improved combination of internal consistency, variability, and discriminability. The scale is more strongly correlated with satisfaction, desire to remain with a physician, willingness to recommend to friends, and not seeking second opinions; it is less correlated with insurer trust, membership in managed care, and choice of physician; and correlations are equivalent with lack of disputes, length of relationship, and number of visits.

Giving Up Control Without Losing Control TRUST AND ITS SUBSTITUTES' EFFECTS ON MANAGERS' INVOLVING EMPLOYEES IN DECISION MAKING

Because involving lower echelon employees in decision making requires risk on the part of managers, we suggest that certain contextual features must be in place for managers to be more willing to do so. We hypothesize that managers’trust in employees, and two impersonal substitutes for trust—performance information and incentives—will increase managers’ involvement of lower echelon employees in decision making. Managers’involvement of lower echelon employees is further hypothesized to enhance organizational performance. Path analysis of survey data from the automotive industry provides support for the hypotheses.

The determinants of NLRB decision-making revisited

The authors develop a model of NLRB decision-making that, unlike the models employed in previous studies, distinguishes between decision-making in more important, complex cases and less important, simpler cases. Using a representative sample of Board decisions over 1957–86, they find that in deciding the minority (20%) of disputes that were particularly important or complex, Board members were influenced by their personal preferences and those of Presidents who appointed them—a finding consistent with the results of previous studies. In the remaining cases (about 80%), however, Board members were influenced in their decisions by little more than the recommendations of regional offices and administrative law judges. Another finding that substantially modifies the conclusions of earlier studies is that Board members appear to have been highly influenced by their accountability to the public when deciding more important, complex cases.

Digital literacy in the marketing curriculum: Are female college students prepared for digital jobs?

Employers seeking to capitalize on current marketing graduates’ technological savvy may find a disappointing gap between their expectations and students’ digital preparedness. This study examines these issues by investigating female students’ attitudes and expectations with regard to using digital tools in marketing coursework and in a future career. Although students often claim they are confident about using technology, many actually feel discomfort about their preparedness for using technology in career contexts. Females in particular struggle to feel confident about their technological competence. This presents a challenge for marketing instruction, because employers have indicated that digital tools are critical for new marketing careers. Thus, it is incumbent upon marketing faculty to help prepare students for the job market not only by offering instruction on marketing’s theoretical foundations but also by providing hands-on opportunities for students to improve their digital skills and confidence.