Fallon J. Richie

Background/Objectives: Healthcare institutional betrayal (HIB) is a betrayal trauma that occurs when a healthcare organization or system perpetrates wrongdoing against or fails to protect an individual who depends upon that system for care. Known consequences of experiencing HIB include increased healthcare system and provider 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 post 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 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, higher 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 HIB repair and healthcare provider HIB repair) outperformed the healthcare administrator HIB apology repair 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 HIB to improve patients’ ongoing and future healthcare experiences.