Beyond Broken Promises: How to Rebuild Trust in Healthcare

Carson.ralphs@wixcorp.com
April 23, 2024

Remember that time when someone broke their promise? Or the time when someone didn’t do what they said they would do? Or that time when someone deceived you into thinking something that wasn’t true?

Violations of trust have a way of being sticky in the worst ways. We tend to remember the people and organizations that violate our trust, and rebuilding that trust doesn’t happen overnight.

One example occurred to Matt and Lucy, parents of a middle-school-aged boy named Tommy who loved to play games. This love of video games grew so much that Matt and Lucy came up with a rule that he could only play video games on the weekend.

One day, not on the weekend, they found Tommy playing video games. Disappointed, they removed the device from his room and told him how sad they were that he had lost their trust.

About an hour later, Tommy contritely approached them and asked: “What do I need to do to regain your trust?”

Matt and Lucy were pleasantly surprised by their son’s words, and together they all came up with a plan of action items that would lead to a restoration of trust and a reinstitution of video game privileges.

While some violations of trust are universally more serious than a boy playing video games when he shouldn’t, there are still actions that can be taken to restore that trust.

In healthcare, patient trust in healthcare organizations is falling. According to one study, 68% of patients say their trust in healthcare has declined in the last two years. The top reason patients feel trust has eroded comes from the feeling that the “healthcare system acts out of their own self-interest rather than mine as a patient”. ¹

Unfortunately, healthcare as an industry has provided countless reasons to justify that lack of trust.

From criminal research practices that violated human rights, to pharmaceutical executives raising prices excessively, to re-writing of legal contacts to justify not having to pay severance packages right before massive layoffs, to the opioid pandemic fueled by unethical and deceptive marketing practices, to negligence in patient care that has resulted in lost limbs and lost lives, and adding on top of all that history the distrust of the oft-misaligned financial incentives that permeate healthcare as a whole, one doesn’t need to look far to identify why patients might have a time placing trust in healthcare organizations and professionals.

The Trust Triangle

In the Harvard Business Review article titled “Begin With Trust”, the authors describe how they helped Uber rebuild it’s reputation by focusing on what they called the Trust Triangle. ²

The Trust Triangle has three points: Authenticity, Logic, and Empathy. When trust is lost, it can almost always be traced back to a breakdown in one of the tree points of this triangle.

Authenticity is described as whether or not people feel they are experiencing the real you. Logic is how much people can trust you to do something well. And the Empathy triangle point is explained as other people believing that you care about them and their success.

Applying this to healthcare, we can see how Authenticity can be equated to Transparency, Logic can be represented by Quality, and Empathy can be reinterpreted as the Patient Experience.

The article goes on to explain that organizations don’t always recognize how the information they’re broadcasting through their operations and policies may undermine their own trustworthiness. With that said, most organizations produce a “stable pattern of trust signals”, which means that even small improvements can lead to meaningful change.

At times when trust is lost, it’s usually the same triangle point that goes “wobbly”. Or in other words, this is the point of the triangle of trust that you’re most likely to fail on. According to the article, everybody and every organization has a “trust wobble”, and a key to building or restoring trust is identifying what your particular “trust wobble” is.

The article then explains how helpful it can be to look at a pattern of “wobbles” across multiple incidents where you can identify that trust was compromised. By picking three or four interactions that stand out to you, for whatever reason, ask yourself the following two questions for each interaction:

What does your typical “wobble” point seem to be, Transparency, Quality, or the Patient Experience?
Does the pattern change under stress or with different kinds of stakeholders? For example, do you “wobble” on one trait with your staff but on a different one with patients?

If you’re like most healthcare leaders, you’ve experienced or heard about how healthcare organizations have “wobbled” on each of the three Trust Triangle points.

Gratefully, as mentioned above, even small improvements in Transparency, Quality, and the Patient Experience can rebuild trust. There are even some simple practices that can be instituted quickly with little or no cost that bring substantial and almost immediate results.

Transparency

One method to increase Transparency would involve healthcare organizations publishing their prices in a way that makes it easy for patients to understand. Unfortunately, many healthcare organizations still try to bury their prices on the website in hard to find locations, and they often don’t provide the pricing in an easily consumable fashion. Both practices build frustration for patients in place of trust. To remedy this, utilizing tools like a Cost Estimation tool can make it easy for patients to understand their costs before their visit or procedure.

Quality

In regards to Quality, there are many factors and resources and institutions that can support efforts to improve the quality and safety of healthcare organizations. The Leapfrog Group even has a website that gives out free safety grades for hospitals in your area that can be helpful when deciding where to receive healthcare. ³

When it comes to improving the quality of healthcare, utilizing tools like a safety checklist before surgery have shown to produce a significant reduction in both morbidity and mortality and decrease the amount of surgical errors. ⁴

Here is an example checklist created by the World Health Organization:

If these safety checklists were more frequently utilized, medical errors resulting in additional pain, the loss of life, or other tragic events could be better avoided. The horrifying case of a hospital performing an abortion on the wrong pregnant woman is a recent and devastating example of how vitally necessary these safety checklists are. ⁵

Patient Experience

A low-cost tool championed across multiple healthcare organizations around the country is called “Rounding on Patients”, as popularized by the healthcare consultancy Studer Group. This includes having nurse leaders round on individual patients asking them about what is going well and what could be going better. This feedback is then relayed to employees to help identify where and how the patient experience can be improved in their department.

Studer Group has said that “Nurse leader rounding on patients has proven to be the number one most important tactic in determining [clinical] patient experience. When nurse leaders round, patients feel important and leaders can review first-hand the outcomes from nursing behaviors to identify opportunities for coaching and recognizing top performers.” ⁶

It is also important to note that while providing clinical care is the reason the healthcare industry exists, only 4% of patient complaints are related to Quality of Care, 96% are from Customer Service. ⁷ While we are providing exceptional care, it’s often the processes accessing and paying for that care that impact a patient’s overall experience the most.

The Road Ahead

Trust is a delicate yet vital component in any relationship, whether it’s between individuals or between healthcare organizations and their patients. As illustrated by Matt and Lucy’s experience with their son Tommy, trust can be broken by even minor transgressions, but it can also be rebuilt through genuine effort and commitment.

The current state of healthcare, as highlighted by declining patient trust, calls for urgent action, and a renewed focus on the three Trust Triangle points of transparency, quality, and the patient experience.

While the road to rebuilding trust may be challenging, even small improvements can yield meaningful results. By identifying and addressing their own “trust wobbles,” healthcare organizations can take concrete steps towards regaining the trust of their patients and ensuring a brighter, more trustworthy future for everyone.

Learn More about Patient Expereince at Wixcorp.com