Trust is one of the most essential elements in our overall human existence. It is a critical part of our human experience, one that reaches well beyond the boundaries of healthcare. Trust is the element that holds society together. It emerges in the relationship of one human being connecting with another human being, and it reaches to the engagements people have with organizations, institutions, and systems as well. Trust, while hard to hold, is ever present. It is a powerful force that guides our way of being, our interactions, our choices, even if we ourselves are not directly conscious of it. With that, it stands firmly as a cornerstone of experience excellence overall and is why a commitment to human experience matters. Ultimately, a commitment to human experience matters in our conversation specifically here, as it is an essential driver of trust itself. It is not trust that creates experience, but rather it is trust that is fostered by it. And trust provides a path of us to achieve that outcomes we aspired to and that all people deserve.
This study investigates how communication and service quality in Patient Relationship Management impact patient satisfaction through trust. The literature in this field is predominantly in developed countries, whereas it is scarce in sub-Saharan Africa. Combining bibliometric analysis and structural equation modelling, the study highlights emerging research trends and provides empirical evidence to guide healthcare practitioners, policymakers, and researchers in improving patient care. To strengthen its theoretical foundation, the study integrates the Social Exchange Theory and Expectancy–Disconfirmation Theory to explain the model. The study retrieved quantitative data from the Scopus database for bibliometric analysis. A questionnaire was used to collect data from 310 patients for SEM analysis using purposive sampling. Bibliometric findings revealed that while ``patient satisfaction'' is widely studied, key relational constructs such as trust, communication, and service quality are underutilized, with lower keyword occurrences and limited co-citation networks. This indicates a gap in the literature and highlights the need for empirical investigation of these dimensions. The result of the structural equation modelling revealed that communication and trust had significant direct effects on satisfaction. Service quality had an insignificant direct effect on satisfaction. Trust was found to have a significant mediation effect on the link between communication, service quality, and satisfaction. Patient level of education had a significant moderating effect on the association between perceived service quality, communication, and satisfaction. The study explores provider-patient interaction dynamics within healthcare institutions using a mixed-methods framework, contributing to scholarly discussions and benefiting lawmakers and managers.
Rising financial pressures and the need to revitalize culture prompted a renewed emphasis on patient experience at Billings Clinic. This case study describes the impact of redefining patient experience as a measure of trust and a set of care processes. It presents an alternative to the more traditional view of patient experience as an outcome metric based on meeting patient expectations. Billings Clinic chose the patient survey question likelihood of recommending as an organizational goal or key performance indicator (KPI). Under the direction of executive leadership, the patient experience team developed a new strategic framework aimed at driving improvement for this metric. Key features of this framework include reframing likelihood to recommend as a measure of trust, creating strong executive and departmental leadership connections, engaging directly with care teams, developing a patient experience tactic library, sharing patient survey data transparently and utilizing industry developed patient survey goal setting and improvement tools. In all service lines where goals were set, there was an increase in the likelihood of recommending scores. The increase also outpaced the national average increase in several service lines. Patient experience metrics were viewed as a reflection of process consistency rather than individual performance. Overall, this approach created a more focused, collaborative, and actionable way to improve patient experience. By simplifying data, refining communication, and connecting insights to daily workflows, teams were better able to understand their impact and take meaningful action.
Healthcare professionals are often taught that empathy, defined as imagining oneself in the emotional experience of another, is essential to providing excellent care. Yet in high-stress, high-stakes clinical environments, the very tool given to increase patient and employee connection can contribute to disengagement, burnout, and diminished resiliency. This research review article examines the longstanding conflation of empathy and compassion in healthcare and argues that the distinction between the two is not merely semantic but critical to provider well-being and patient outcomes. Drawing on research from neuroscience, psychology, and communication studies, the piece outlines how emotional, perspective-taking empathy activates the brain's pain and stress centers, increasing emotional load for clinicians who are already working in environments defined by high emotion and low control. In contrast, compassion, defined as recognizing another's suffering paired with a desire to help, engages neural pathways associated with regulation, problem-solving, and connection. Compassion-based approaches have been associated with improved resilience, enhanced patient satisfaction, and increased provider engagement. By separating these concepts and examining their distinct impacts, this article highlights why ``compassion fatigue'' may be a misnomer for what is actually empathy-driven overload. The intended takeaway is a reframing of how caring connections are taught and practiced in healthcare: shifting from empathy as emotional immersion to compassion as a sustainable, action-oriented tool that protects providers while still strengthening the quality of connection at the heart of the patient experience.
Trust in the healthcare system is an important driver of public health, but is sometimes lacking among individuals and communities. Patient and family engagement in research and service development is one proposed means of influencing trust. Patients and families can be engaged authentically and meaningfully as partners in the conduct of research and the development of healthcare services. When engagement is conducted following best practices, patients and families have the opportunity to build strong mutual relationships with project leads, hold a share of the power in the discipline, and exercise choice to influence the research and service development agenda. These mechanisms might increase trust in researchers and clinicians, potentially extending to institutions and entire systems of care. However, if conducted poorly, patient and family engagement may erode trust, creating frustration, skepticism, and retraumatization. When engagement goes wrong, the utmost care must be taken to building shared solutions to challenges, with the goal of rebuilding trust that has been lost. Importantly, no amount of high-quality engagement can be expected to erase the substantial historical and current harms that have been done to patients and communities within the healthcare system. In order for patient and family engagement to increase trust in the healthcare system, it is incumbent on project leads to be worthy of the trust they seek, while always maintaining the context of a historical backdrop that was not.
Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants completed the Trust in Physicians Scale (TPS) and the Philadelphia ACE Survey assessing conventional ACEs (cACEs: abuse, neglect, household challenges) and expanded ACEs (eACEs: neighborhood/community adversity). Descriptive statistics characterized the cohort, and multivariable linear regression examined associations between ACE exposure and TPS scores adjusting for demographic covariates. To contextualize quantitative findings, we conducted in-depth semi-structured interviews with 10 patients with high cACEs; transcripts were analyzed using thematic analysis. Results: The mean cACE score was 3.0 (out of 15) and 40.7% reported ≥ 3 ACEs. After adjustment for race, age, gender, and ethnicity, higher cACEs were associated with higher physician trust (β = 0.49, 95% CI [0.01–0.96]; p = 0.04). Qualitative interviews (mean cACE 7.8/15) demonstrated that trauma-informed, relational communication—including listening, transparency, and collaborative decision-making—strengthened trust during hospitalization. Conclusion: Trauma-informed relational care represents an actionable strategy to strengthen patient trust in inpatient physicians among individuals with high ACEs.
Violence against healthcare workers continues to escalate despite substantial investments in security measures, workplace violence prevention programs, and legislative protections. Although these interventions are necessary, they have not produced sustained improvements in workforce safety or retention, suggesting that workplace violence is more than a behavioral or security problem. This commentary argues that it also reflects a deeper erosion of trust within healthcare. Drawing on evidence linking workplace violence to burnout, moral injury, psychological distress, and turnover intention among nurses, we propose that repairing trust is essential to sustaining the workforce and healthcare.Building on our earlier work, Rebuilding a Foundation of Trust (2021), we examine how fractured relationships among clinicians, healthcare organizations, patients, families, and communities have weakened the moral infrastructure that supports healing.1 We suggest that reframing healthcare as a social covenant, rather than a transactional contract, offers a stronger ethical foundation for restoring mutual responsibility, accountability, and shared purpose. Within this framework, trust becomes a collective responsibility.This commentary describes two public engagement initiatives developed through the R³: Renewal, Resilience, and Retention of Maryland Nurses Initiative—Humanizing Healthcare and A World Without Nurses—that strengthen dialogue between healthcare professionals and the public. These initiatives illustrate how structured dialogue, storytelling, and community engagement foster empathy, rebuild trust, and promote shared responsibility for creating safe, humane healthcare environments. Renewing the social covenant between healthcare professionals and the communities they serve may be an underrecognized strategy for restoring trust, sustaining the workforce, and advancing more humane healthcare.
Trust can have a positive or negative impact on patients, families, and community healthcare experience. Although important, it is often treated as something soft and intangible rather than something intentionally measured and designed. Currently, healthcare organizations collect and report patient experience data related to communication, courtesy, respect, and responsiveness. But these measures do not capture the specific behaviors that influence whether trust builds or whether it stalls. This commentary explores trust as a foundational behavioral and environmental element in healthcare and challenges that improving trust requires more than good intentions; it requires bringing voices to the table through co-design. Starting with the historical changes in care delivery and relationship building to emerging trust-building frameworks, this commentary highlights the need to move beyond indirect indicators and toward measurable, observable trust-building behaviors, patient and team member co-design, and the design of organizational environments that support relationship-centered care.
Race concordance between patients and clinicians is frequently promoted as a strategy to improve trust and engagement for Black men in healthcare. Evidence suggests that encounters with Black male clinicians often increase patient comfort and observable engagement; however, engagement alone does not necessarily reflect trust. Drawing on professional experience as a nurse and researcher working with Black men, and on prior research examining shared decision-making preferences among Black men with hypertension in the U.S. Mid-South, this Personal Narrative examines how race-concordant encounters may rely on presumed trust, leading clinicians to advance diagnosis and treatment planning without adequate co-construction of care. When engagement is conflated with trust, Black men may appear receptive while remaining insufficiently involved in clinical decision-making. Recent evidence further suggests that high-quality shared decision-making (SDM) is independently associated with reduced healthcare expenditures, and that these effects are amplified within racially concordant relationships, findings that underscore the imperative to move beyond surface-level engagement. This article argues that trust must be deliberately cultivated through practices that assess patient knowledge, elicit preferences, and support shared decision-making. Evidence-informed recommendations are presented to support clinicians and healthcare leaders in strengthening patient-clinician partnerships and advancing equitable patient experience for Black men.
While free clinics provide essential healthcare to socioeconomically disadvantaged populations, patients' lived experiences in these settings remain underexplored. This qualitative study examined how uninsured patients at a U.S.-based free clinic perceive their illness experiences and interactions with healthcare providers. From October to December 2024, semi-structured interviews were conducted with 21 adult patients (ages 18–72; M = 49.14), most of whom were non–U.S.-born and primarily Spanish-speaking. Participants described illness as entangled with emotional distress, social isolation, stigma, and disruptions to identity and family roles—revealing a psychological burden that extends beyond physical symptoms. These findings highlight the need to integrate psychosocial and culturally responsive support into primary care delivery in resource-constrained settings like free clinics.
Transparent communication is key to building and maintaining strong patient-provider relationships. In this article, I interviewed a patient who shared her experience undergoing treatment for a chronic vulvar condition and the consequences that followed. She described a painful procedure for which she felt unprepared and later realized she had not been educated about the need for ongoing care. Years later, this gap in understanding contributed to irreversible disease progression. After re-establishing care with a dermatologist she felt comfortable confiding in, the patient expressed a desire for her story to be shared. This narrative presents her experience as she shared it with me and reflects on the lessons it offers for clinical practice. As a resident physician, listening to her story reshaped how I think about informed consent, patient education, and the responsibility to prepare patients not only for procedures, but for their sequelae.
Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African American, African Refugee, Native American, Pacific Islander, Hispanic-Latino, and Rural Utah. Each group was co-facilitated by trained CHWs from respective communities. Using a phenomenological approach and inductive analysis, we identified key themes based on shared narratives of health, healthcare access, and cultural context. Eight major themes emerged: barriers to accessing care, personal or systemic trauma, humanistic healthcare, building relationships, cultural competency, dimensions of health, navigating the healthcare system, and advocacy. While some themes were common across groups, community-specific priorities also emerged, highlighting the need for culturally grounded approaches. CHWs were consistently described as trusted advocates, helping participants navigate care and elevate their concerns in ways traditional systems often fail to accommodate. Findings underscore the urgent need to reform healthcare systems around the lived experiences of marginalized communities. Embedding CHWs in care delivery, emphasizing cultural humility, and promoting trauma-informed, relationship-centered models can help address persistent health inequities.
In healthcare, patient experience (PX) and employee experience (EX) are often managed as separate priorities despite their interdependence. This article presents a case study from NYC Health + Hospitals/Community Care, a 250-person safety-net division providing home-based services across New York City. In response to frontline staff repeatedly asking, ``But what about me?'' when offered PX best practice suggestions, the organization integrated patient experience, staff engagement, and wellness into a unified Care Experience portfolio led by the Chief Experience Officer. From this structural redesign emerged a practical framework for trust-building organized around three pillars: Purpose, Presence, and Partnership. Purpose aligns staff with mission and frames organizational values as a mutual commitment. Presence emphasizes visible, responsive leadership and a listening ecosystem that identifies strain early and closes feedback loops. Partnership extends beyond listening to shared governance, co-designed safety protocols, staff-led committees, development opportunities, and recognition structures that reinforce agency and belonging. Early indicators from 2025 employee feedback survey data and 2026 participation metrics suggest stronger staff engagement, visibility of support, and voluntary involvement in shared governance. Although these findings do not establish causation, they suggest that integrating PX and EX may serve as an upstream strategy for trust-building, workforce support, and patient care improvement. Implications for scalability, sustainability, and future study are discussed.
The Bondi Beach tragedy of December 14, 2025 profoundly disrupted Australia's collective sense of safety, belonging, and trust. Beyond the immediate loss of life and injury, such events exert lasting impacts on healthcare systems and the people who work within them. This article explores how trust can be rebuilt not only for patients and communities, but also for caregivers themselves. Drawing on trauma-informed care, psychological safety, and human experience design, it examines the often-overlooked dimensions of staff safety, the essential role of pastoral care and chaplaincy, and the particular vulnerabilities experienced by faith-based caregivers during periods of social fracture and fear. Rebuilding trust, it argues, is not simply a return to pre-trauma norms, but a collective and relational practice grounded in belonging, protection, reflection, and moral courage.
This personal narrative recounts a 25-year diagnostic odyssey with Ehlers-Danlos syndrome, defined by medical fragmentation, dismissed symptoms, and profound isolation. It illustrates how Online Health Communities (OHCs) bridged the chasm between lived experience and a clinical system ill-equipped for complex chronic illness. For patients like me, these digital forums provide the peer validation, practical knowledge, and self-advocacy tools necessary to navigate a disjointed healthcare landscape. For providers, this story underscores a critical opportunity: proactive, non-judgmental engagement with OHCs is not a threat to expertise but a foundational strategy for patient-centered care. By acknowledging and constructively partnering with these patient-led spaces, clinicians can transform the therapeutic alliance, combat isolation, and co-create a more collaborative, effective, and humane model of care for the most vulnerable populations.
Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. Age distribution revealed that the largest group was 40–49 years old (26.0%). Among the job positions, 57.6% of the respondents aged 50–59 were nurse managers. Significant differences were found in the first factor, reliability, and the second factor, assurance and responsiveness of the M-SERVQUAL when comparing the age groups. However, no significant differences were found in the third factor, empathy, or tangibles in the fourth. Post-hoc analysis revealed significant differences in reliability, assurance, and responsiveness between the 20–29, 30–39, and 50–59 age groups. Conclusion: Although introducing new healthcare services is necessary in the post-pandemic era, providing care based on trust between patients and providers remains important. Strengthening educational involvement and creating an environment in which nurses of all ages can provide optimal care is essential for achieving this goal.
Trust is central to healthcare encounters involving fear and uncertainty. This quasi-experimental study evaluated changes in anxiety before and after dental extractions performed during orthodontic treatment planning and examined whether patient experience factors were associated with post-extraction anxiety. Fifty patients aged 11–40 years undergoing fixed orthodontic treatment requiring extraction were recruited consecutively at a tertiary care hospital from October 2023 to June 2024. Anxiety was measured immediately before and after extraction using the Beck Anxiety Inventory. Post-procedure patient experience was assessed with a structured questionnaire addressing reassurance, communication, privacy, shared decision-making, perceived understanding, and overall experience. Paired t-tests and simple linear regression were applied at p ≤ 0.05. Mean anxiety scores decreased significantly from 18.84 ± 4.09 before extraction to 13.12 ± 4.55 after extraction (p ≤ 0.001), indicating a transition from anticipatory distress to post-procedural relief. Most participants reported positive experiences, including feeling reassured (60%) and well cared for (66%). Positive overall patient experience and feeling understood by the doctor were significantly associated with lower post-extraction anxiety, whereas perceived exclusion from decision-making and lack of privacy were associated with higher anxiety. Female gender and previous painful dental experiences were associated with higher pre-extraction anxiety. These exploratory findings suggest that relational aspects of care, particularly communication, privacy, shared decision-making, and feeling understood, may influence emotional outcomes during orthodontic extractions and strengthen patient confidence through patient-centered care.
Trust remains a fundamental pillar of the physician–patient relationship, ensuring care that is safe, evidence-based, and grounded in shared decision-making; however, the increasing use of artificial intelligence tools such as ChatGPT has introduced a new dynamic in how patients interpret symptoms and seek medical advice. This narrative describes a clinical encounter involving an elderly patient with multiple myeloma whose caregiver used ChatGPT to evaluate new-onset slurred speech suggestive of stroke, resulting in an urgent recommendation driven by incomplete clinical information. Through comprehensive history-taking, physical examination, and careful review of the Artificial Intelligence (AI)-generated response, the physician reassured the caregiver, contextualized the limitations of AI input, and provided guidance on its appropriate use. Rather than undermining trust, this interaction demonstrated that AI can serve as a catalyst for patient engagement and timely care-seeking, while offering physicians an opportunity to validate concerns, enhance communication, and reinforce clinical reasoning. When integrated thoughtfully into clinical conversations, AI has the potential to strengthen trust, improve patient satisfaction, and support safer, more collaborative care.
After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Three themes were identified: (1) making sense of pain and medications amid uncertainty; (2) pain and fear shaping graded mobilisation; and (3) turning advice into action in real home contexts. Patients used discharge instructions as an initial reference point but often needed clearer guidance on expected versus concerning pain, safe analgesic use, mobilisation progression, and help-seeking. Family involvement was important, although family-related findings reflected patients' accounts rather than direct caregiver perspectives. Findings suggest that trust-building discharge and follow-up support should provide practical symptom thresholds, medication counselling, task-specific mobilisation guidance, family-aligned education, and accessible escalation pathways to reduce uncertainty and support safer recovery at home.
Self-medication has become a central experience for youth transitioning toward independent medical decision-making. In the digital era, young people must navigate a complex landscape of health information while seeking independent health solutions. This study investigates self-medication experiences and healthcare trust among youth, utilizing a regionally concentrated digital survey approach in Indonesia. Data were collected via a cross-sectional approach using digital platforms (Instagram, TikTok, and Twitter/X), facilitated by 76 trained enumerators. While respondents from all 38 provinces participated, the sample (N = 2,790) exhibits a major geographical concentration in the Sumatra region. The study employed a validated 16-item instrument to evaluate health-seeking behaviors, following a 100-participant comprehensibility pilot study. Among the total respondents, 2,168 (77.71%) reported active self-medication experiences (mean age 20.05 ± 1.97 years; 71.61% female). These independent choices were primarily driven by perceived mild symptoms (84.59%) and prominent operational barriers at primary health centers, specifically long waiting times (35.65%), driving them toward the convenience of independent health management. Notably, among the self-medicating subsample (n = 2,168), 51.75% (n = 1,122) utilized non-prescription antibiotics, representing 40.21% of the total sample. In navigating self-medication, respondents relied on drug packaging labels (71.22%) and pharmacist advice (46.96%), with drowsiness being the most frequent adverse reaction (38.42%). Ultimately, a fundamental erosion of trust in formal healthcare, coupled with the convenience of independent decision-making, drives this cohort to pursue self-medication. This trend requires urgent interventions to rebuild clinical trust, as high non-prescription antibiotic use directly amplifies the global threat of antimicrobial resistance.
