Comprehensive trauma-informed organizational change at an academic medical center in South Texas

Exposure to trauma is widespread and has significant implications for health outcomes and healthcare delivery. Comprehensive Trauma-Informed Care (TIC) recognizes the prevalence and impact of trauma and seeks to create policies, practices, and environments grounded in safety, trust, collaboration, choice, and empowerment. University Health, a large academic medical center in San Antonio, Texas, launched a comprehensive initiative to embed TIC principles system-wide, positioning itself as both an educator and a provider of trauma-informed practices.

Guided by the 10 key development areas defined by the Institute on Trauma and Trauma-Informed Care (ITTIC), University Health initiated its comprehensive TIC transformation in 2020. The organization established an internal Trauma-Informed Care Workgroup, provided staff and community training, integrated TIC into organizational policies and procedures, created peer support and wellness initiatives, and implemented trauma screening and treatment protocols. Evaluation methods included biennial administration of the TICS-10 (Trauma-Informed Climate Scale) and qualitative feedback from Schwartz Rounds participants.

Over five years, University Health trained more than 130 TIC Advocates, updated over 90 policies with trauma-informed language, and launched programs supporting staff well-being and patient-centered care. In 2024, University Health became the first major health system in Bexar County to earn local Level 1 TIC certification. TICS-10 scores improved from 34.1 (low) in 2020 to 35.0 (moderate) in 2024, indicating progress in creating a trauma-informed work environment. Schwartz Rounds sentiment analysis showed 71% of comments were positive, highlighting increased empathy, connection, and validation among staff members.

University Health's experience demonstrates that comprehensive, system-wide trauma-informed transformation is achievable in large healthcare settings. Through leadership support, cross-departmental collaboration, and intentional policy and practice change, TIC principles were embedded into organizational culture. An impartial certification process and program evaluation data validated the impact of the initiative, although continued efforts are needed to assess long-term outcomes on patient care and staff well-being. This case study offers a replicable model for other health systems pursuing trauma-informed organizational change.