Building Trust in Clinical Research Drives Equity and Better Outcomes
Published: 15 Apr 2025
Reading Time: 3 minutes
In clinical research, trust is often treated as a soft outcome. Yet its absence has hard consequences; missed recruitment goals, delayed timelines, and ineffective therapies. For patients, particularly those from marginalized communities, the stakes are even higher.
As the COVID-19 pandemic laid bare, trust is not a byproduct of effective healthcare—it is a prerequisite.
“Public trust is a critical factor in the success of any public health intervention,” said Dr. Marcella Nunez-Smith, Chair of the White House COVID-19 Health Equity Task Force. “We can’t vaccinate our way out of a crisis we haven’t built trust to enter.”¹
Trust is not a communications challenge. It is a leadership competency—and increasingly, a form of infrastructure required to drive inclusive, high-impact research.
The Trust Gap in Clinical Research
Communities of color and other historically excluded groups remain underrepresented in clinical trials. Black Americans, for example, make up 13% of the U.S. population, but less than 5% of clinical trial participants.²
This gap isn’t just statistical—it’s systemic.
- Historical abuses, such as the Tuskegee Study, created generational distrust.
- Contemporary inequities—from provider bias to lack of cultural humility—sustain it.
- Structural exclusion in protocol design, site location, and engagement strategy reinforces it.
As Dr. Lisa Cooper, Director of the Johns Hopkins Center for Health Equity, writes: “People who have been marginalized historically have good reason to be cautious. It’s not about convincing people to trust us. It’s about making ourselves trustworthy.”³
Redefining Leadership in Healthcare
To rebuild trust, we must redesign leadership. Traditional models emphasize expertise, hierarchy, and control. But inclusive research requires new competencies:
1. Cultural Humility
Rather than “cultural competence,” which implies mastery, cultural humility requires continuous learning and self-awareness. Leaders must reflect on their own positionality and adapt their approach based on stakeholder context.⁴
2. Psychological Safety
Dr. Amy Edmondson, a leading organizational psychologist, defines psychological safety as “a shared belief that the team is safe for interpersonal risk-taking.”⁵ This principle must extend beyond internal teams to patient and community partnerships.
3. Transparency and Reciprocity
Trust builds when communities see outcomes—not just outreach. That means returning results to participants, compensating advisors equitably, and co-owning decisions from study design to dissemination.
Trust as Strategic Advantage
In a 2022 NEJM Catalyst study, trial sites that employed community-based participatory methods—where patients were treated as co-investigators—had significantly higher enrollment and retention rates across racial and ethnic groups.⁶
Moreover, organizations with high trust scores see better performance:
- Improved trial enrollment
- Faster go-to-market timelines
- Reduced litigation and compliance risk
- Greater staff satisfaction and retention
Trust is not a detour from business objectives; it is a direct route to success.
Practical Strategies for Building Trust
Based on Elevate Impact’s work with hospitals and research institutions, we recommend five actionable strategies:
| Leadership Action | Trust Outcome |
| Involve stakeholders early | Increases shared ownership and transparency |
| Share power, not just information | Builds credibility and respect |
| Invest in relationship-building, not just recruitment | Shifts perception from transactional to transformational |
| Acknowledge historical harms and current inequities | Creates space for healing and accountability |
| Center equity in incentives and KPIs | Ensures alignment across mission, metrics, and action |
These aren’t “soft skills”—they are the infrastructure of inclusive leadership.
RECOMMENDED READ: Why Collaborative Leadership Is the Future of Healthcare
A Real-World Example: Lawrence General Hospital
As part of a broader health equity initiative, Lawrence General Hospital partnered with Elevate Impact to train its advisory board in inclusive leadership principles. Over a six-month period, leaders participated in workshops focused on cultural humility, equity-centered governance, and trauma-informed communication.
The result?
- Increased trust and engagement from community partners
- Expanded representation in advisory roles
- Clearer pathways for community-informed policy changes
“This wasn’t about checking boxes—it was about changing how we lead,” said one board chair anonymously during an evaluation interview.
The future of healthcare innovation doesn’t rest solely on technology, data, or speed. It rests on trust—and the leaders who know how to cultivate it.
Inclusive research isn’t about finding new participants. It’s about becoming the kind of institution people want to participate in. That shift requires courage, humility, and strategic vision.
In an era of complexity, uncertainty, and rising inequity, trust may be the most valuable infrastructure we can build.
References:
- Nunez-Smith, M. (2021). Remarks from White House COVID-19 Health Equity Task Force. Health Equity Summit.
- National Academies of Sciences, Engineering, and Medicine. (2022). Improving Representation in Clinical Trials and Research. The National Academies Press.
- Cooper, L. (2020). “Becoming Trustworthy.” Health Affairs Blog.
- Tervalon, M., & Murray-García, J. (1998). “Cultural Humility vs. Cultural Competence.” Journal of Health Care for the Poor and Underserved.
- Edmondson, A. (1999). “Psychological Safety and Learning Behavior in Work Teams.” Administrative Science Quarterly.
- NEJM Catalyst. (2022). “Engaging Patients as Partners: A New Frontier in Clinical Research.” https://catalyst.nejm.org
YOU MAY BE INTERESTED IN: How Cross-Sector Collaboration Accelerates Rare Disease Innovation
