Who Should Address Healthcare Institutional Betrayal and How? An Experimental Study of Repair Strategies

Background/Objectives: Healthcare institutional betrayal (HIB) is a betrayal trauma that occurs when a healthcare organization or system perpetrates acts of wrongdoing against or fails to act to protect an individual who depends upon that system for care and services. Known consequences of experiencing acts of HIB include increased healthcare provider and system distrust and anticipated healthcare avoidance, highlighting the public health implications of unaddressed HIB. Little is known about actions that healthcare stakeholders can take to repair HIB. Thus, this study experimentally tested the effects of receiving one of two reparative actions following a healthcare encounter containing HIB (empathic apology vs. organizational change) performed by one of two healthcare system stakeholders: healthcare provider or system administrator. Methods: Residual HIB perceptions, trust, expectations for future healthcare, and intentions to avoid future care were assessed post-repair conditions. Initially, undergraduate participants (N = 198) were asked to imagine themselves experiencing a common healthcare scenario which included HIB. After post-HIB encounter baseline measurements, participants were then randomly assigned to one of four conditions (three with HIB repair actions vs. one control). Participants receiving any type of HIB repair reported significantly lower residual HIB, increased positive expectations for future healthcare, and greater trust in healthcare post-repair, with effect sizes ranging from small to large. Results: Generally, two HIB repair conditions (organizational change to repair HIB and healthcare provider apology repair) outperformed the healthcare administrator apology condition; all repair conditions outperformed the control condition. Conclusions: Our finding that specific actions can facilitate post-HIB recovery is clinically meaningful. Medical professionals and healthcare administrators need to address patients' past negative experiences with healthcare and take action to repair pre-existing HIB to improve patients' ongoing and future healthcare experiences.