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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

The relevance of different trust models for representation in patient organizations: conceptual considerations

Authors: Helene Gerhards, Karin Jongsma, Silke Schicktanz

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Trust within organizations is important for ensuring members’ acceptance of the organization’s activities and to expand their scope of action. Remarkably, Patient Organizations (POs) that often both function as a forum for self-help and represent patients on the health-political level, have been understudied in this respect. This paper analyzes the relation between trust and representation in POs. We distinguish between two models of representation originating from political theory: the trustee and delegate model and between two types of trust: horizontal and vertical trust.

Methods

Our theoretical approach is illustrated with an analysis of 13 interviews with representatives of German POs.

Results

We have found that the delegate model requires horizontal trust and the trustee model vertical trust. Both models: horizontal/delegate and vertical/trustee exist within single POs.

Conclusions

The representation process within POs demands a balancing act between inclusion of affected persons and strategically aggregating a clear-cut political claim. Trust plays in that process of coming from individual wishes to collective and political standpoints a major role both in terms of horizontal as well as vertical trust. Horizontal trust serves the communication between affected members, and vertical trust allows representatives to be decisive.
Footnotes
1
The focus of this paper is on the self-perception of the representatives, rather than on the perception of these representatives by other actors in the political arena.
 
2
“The Federal Joint Committee (G-BA) is a public legal entity comprising the four leading umbrella organizations of the self-governing German healthcare system: the National Associations of Statutory Health Insurance Physicians and Dentists, the German Hospital Federation, and the Central Federal Association of Health Insurance Funds. In addition to these four pillar organizations, patient representatives also participate in all sessions; they are entitled to put topics on the agenda, but not to vote.” [48].
 
3
Other papers have been published based on the primary analysis of this material, see: Beier K, Jordan I, Wiesemann C, Schicktanz S: Understanding collective agency in bioethics. Med Health Care Philos. 2016; doi:10.​1007/​s11019-016-9695-4. And Jordan, I, Schicktanz S: Kollektive Patientenautonomie: Theorie und Praxis eines neuen bioethischen Konzepts. Patientenautonomie: Theoretische Grundlagen - Praktische Anwendungen. Mentis:Münster, 2013.
 
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Metadata
Title
The relevance of different trust models for representation in patient organizations: conceptual considerations
Authors
Helene Gerhards
Karin Jongsma
Silke Schicktanz
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2368-z

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