Repair Following Healthcare Institutional Betrayal

Institutional betrayal occurs when an organization perpetrates wrongdoing against an individual who depends on that system. There are serious known consequences of healthcare institutional betrayal including patient disengagement from care and healthcare organization distrust (Smith, 2017). The aim of this study was to examine specific reparative actions following institutional betrayal to determine the effect of repair behaviors on institutional betrayal, trust, expectations for future healthcare encounters, and intentions to avoid or disengage from healthcare. Undergraduate participants (N=198; 58% women; 53% White) read a vignette depicting institutional betrayal in a healthcare setting. They then completed measures of institutional betrayal, trust in healthcare, healthcare avoidance/disengagement, and expectations for future healthcare encounters. Next, participants were randomly assigned to one of four repair vignettes and completed measures a second time. As predicted, participants who were randomly assigned to one of the repair conditions (vs. control) reported significantly lower institutional betrayal scores at post-test, higher positive expectations for future healthcare encounters, and higher levels of trust. Overall, results from this study indicate that reparative actions following healthcare institutional betrayal influenced participants’ self-reported beliefs about the healthcare system. Given the documented negative sequelae to healthcare institutional betrayal, this study’s finding that relatively small actions can facilitate individual-system repair is clinically meaningful.