The sectors of higher education and health care are experiencing increased calls for accountability regarding their outcomes and affordability.  The elevated scrutiny and superimposed fiscal constraints create an opportunity for growth and redesign.  Partnerships and collaborations have emerged as one approach to addressing challenges in both arenas. 

The purpose of this study is to examine the impact of trust on the success of collaborations between institutions of higher education in the health care arena.  A multiple case-study design is used to examine three partnerships created through the National Center for Complementary and Integrative Health (NCCIH) CAM Practitioner Research Education Project Grant Partnership (R25).  The selected partnerships include three colleges of chiropractic, each paired with a university with very high research activity.  The historical tension between chiropractic and traditional medicine, largely due to philosophically different approaches to health care, make the study of trust especially intriguing. 

The mixed-methods study design includes qualitative data collection through interviews of 11 key participants from the chiropractic and research intensive institutions from all three partnerships. Qualitative interview data are used to provide description regarding the three partnerships and to explore the impact of trust on the formation of the collaborations.  Quantitative data are collected through surveys of 101 faculty and administrators from the chiropractic institutions.  Additional qualitative data are also gathered through open ended survey questions.  Quantitative data are used to examine the impact of trust on the perceptions of success of the collaborative efforts.  

The qualitative findings suggest that interpersonal trust, specifically the role of boundary spanners, plays an important role in the formation of collaborations.  The most significant themes related to partnership formation are generative capacity, defined as the willingness to partner with someone based on positive experiences of a past partnership, and transferability, or the transfer of trust to an unknown person based on trust of a third party known by both individuals.  With regard to the willingness of individuals to participate in the activities of the collaboration, identifying, or the degree to which individuals perceive the priorities of the project as similar to their own, emerge as the most significant theme.  Disclosing, or the willingness of individuals to disclose their weaknesses, trusting that the information will not be used against them, is the second most frequent theme.  The most significant themes related to interorganizational trust are: reliability; personal connection; reputation; communication; and expertise.     

Results of a multiple regression analysis indicate statistically significant findings for organizational trust (b = .60, t = 4.17, p < .001), interorganizational trust (b = .30, t = 2.52, p =.01), and interpersonal trust (b = .16, t = 2.74, p = .01) as explanatory factors in perceptions of project success. 

As health care institutions and health care delivery systems respond to the demands for improved services, better outcomes, and increased affordability, interprofessional education and collaborative practice will become the norm.  Given the increased evidence for the effectiveness and cost effectiveness for chiropractic care in the treatment of musculoskeletal conditions, specifically spine pain, chiropractors should be considered as valuable contributors to integrated health care teams.  As academic and health care administrators look to expand opportunities for collaboration between CAM and traditional medicine, they would be wise to consider the important role of trust on the success of these collaborations.