Repair Following Healthcare Institutional Betrayal
Institutional betrayal is a type of betrayal trauma that occurs when an organization or system perpetrates wrongdoing through acts of omission or commission, against individuals who depend on that system. Originally applied to systems responding to sexual assault allegations (e.g., colleges and universities), the construct has been extended to healthcare organizations. There are serious known consequences of healthcare institutional betrayal including greater patient healthcare disengagement and increased healthcare organization and provider distrust, highlighting the public health implications of uncorrected institutional betrayal in healthcare (Smith, 2017). Little is currently known about corrective actions to help repair institutional betrayal in healthcare. Thus, the aim of this study was to examine specific reparative actions performed by different stakeholders following institutional betrayal to determine the effect of repair behaviors on feelings of institutional betrayal, trust, expectations for future healthcare encounters, intentions to avoid or disengage from healthcare, and feelings of repair. Undergraduate participants (N = 198; 58% women; 53% White) read a vignette depicting institutional betrayal in a primary care setting. They then completed measures of institutional betrayal, trust in healthcare, and expectations for future healthcare encounters. Next, participants were randomly assigned to one of four conditions—interpersonal repair by a physician, interpersonal repair by a healthcare administrator, organizational repair by a healthcare administrator, or no repair (control condition). As predicted, participants who were randomly assigned to one of the repair conditions (vs. control) reported significantly lower institutional betrayal scores at post-test, F(3, 190) = 23.85, p < .001, and higher positive expectations for future healthcare encounters, F(3, 193) = 5.77, p < .001. Similarly, participants randomly assigned to any repair condition (vs. control) reported significantly higher trust in healthcare at post-test, F(3,191) = 15.69, p < .001. No differences were found among experimental conditions. In terms or repair, results indicated that there was a significant effect of repair condition on repair scores, F(3, 192) = 48.59, p < .001. Follow-up analysis indicated that participants in each of the three repair conditions reported statistically significantly higher repair scores compared to participants randomly assigned to the control condition (all p’s < .001). Participants in both the interpersonal-provider and organizational change conditions reported significantly higher levels of repair compared to the interpersonal-administrator condition; however, there was no significant difference between the interpersonal-provider repair condition and the organizational change condition, indicating that the interpersonal repair performed by the healthcare provider and the organizational change were equally as effective for repair following an instance of institutional betrayal. Overall, results from this study indicate that interpersonal and organizational reparative actions following institutional betrayal in healthcare influenced patients’ self-reported beliefs about the healthcare system. Following repair, specifically in the interpersonal-provider and organizational change conditions, participants reported decreased feelings of institutional betrayal, increased healthcare system trust, and increased positive expectations for future healthcare. 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. Training programs for healthcare professionals may wish to reflect on these findings and prepare the next cohorts of medical professionals to remain cognizant of patients’ past negative experiences in healthcare, prevent institutional betrayal when possible, and repair instances of institutional betrayal through genuine conversation and connection.