Trust as an Operating Asset in Crisis

Published: April 2, 2025
Author: Greg Wahlstrom, MBA, HCM
Focus: Executive responses to medical mistrust, pricing backlash, data breaches, and clinician transparency.

The Erosion of Trust—Understanding the Stakes

Trust is the currency of healthcare. Without it, even the most advanced technologies, life-saving therapies, and award-winning systems fall short. In 2025, U.S. healthcare faces a multi-dimensional crisis of confidence fueled by misinformation, pricing opacity, racial inequities, and digital breaches. According to the 2024 Edelman Trust Barometer, healthcare trust among Americans fell below 50% for the first time in a decade. A similar analysis by Pew Research found that public confidence in medical scientists declined across political and racial lines. These declines have real consequences: missed screenings, delayed care, increased hospitalizations, and worsening outcomes. As Mayo Clinic CEO Dr. Gianrico Farrugia noted, “Trust isn’t a soft skill—it’s a core competency that determines our ability to heal.” Two real-world examples underscore this point. First, a patient in Dallas declined a critical biopsy after reading a viral thread on Reddit claiming hospitals profit from false cancer diagnoses. Second, a California mother refused to vaccinate her child after encountering a TikTok video alleging falsified CDC data. Undeniably, the stakes are existential.

Executive leaders must view trust not as a sentiment, but as a measurable, actionable, and restorable asset. Healthcare organizations can no longer rely on reputation alone; they must design systems of transparency, responsiveness, and accountability. Cleveland Clinic publishes real-time patient experience data, offering transparency on wait times, provider ratings, and outcomes—a practice that has since inspired similar initiatives at Providence Health. These systems are not merely PR efforts; they are operational commitments embedded in culture and incentives. Furthermore, community trust must be stratified—not all populations distrust for the same reasons. In historically marginalized communities, the memory of unethical experimentation and ongoing disparities fuels legitimate suspicion. According to JAMA Health Forum, Black Americans are 1.7 times less likely to report trust in hospital systems than White counterparts. Consequently, executive teams must develop localized trust strategies. Clearly, trust is both a system-wide and community-specific mandate.

Restoring trust requires sustained, authentic leadership engagement. As Dr. Patrice Harris, former President of the American Medical Association, has said, “Trust is built in conversation, not proclamation.” Leaders must listen more than they speak, acknowledge systemic harms, and co-create solutions with patients and communities. Two instructive models are worth highlighting. At Rush University Medical Center, the anchor mission strategy includes direct investment in neighborhood infrastructure—housing, jobs, and local businesses—building goodwill beyond clinical walls. Similarly, Montefiore Health System has integrated community-based participatory research into service redesign, involving residents in decision-making. These approaches are not fast fixes—but they demonstrate that trust can be rebuilt through consistency and shared ownership. Ultimately, rebuilding trust is not about convincing the public—it is about becoming worthy of their confidence.

Confronting Pricing Backlash with Radical Transparency

Healthcare pricing has become a flashpoint for public frustration, media scrutiny, and legislative intervention. In an era where a routine MRI can cost anywhere from $300 to over $3,000 depending on location and payer, the lack of price transparency erodes confidence and invites allegations of profiteering. According to a 2024 KFF study, 69% of Americans believe hospitals hide costs intentionally, and nearly half have delayed care due to pricing concerns. This perception is exacerbated by surprise billing, charge master complexity, and opaque third-party negotiations. As a corrective, systems like UCHealth and Mercy Health have pioneered interactive price estimator tools with real-time cost ranges by procedure and insurance type. Mercy’s tool even offers patient-friendly definitions and downloadable PDFs. “We should never ask patients to sign blank checks for their health,” said Dr. Sachin Jain, SCAN Group CEO. Undoubtedly, executive accountability in pricing has become a public expectation.

Strategic leaders must not only disclose pricing but contextualize it. Data without interpretation risks further alienation. Executives should align financial counseling teams with clinical departments to ensure patients understand what they’ll pay and why. Health systems like Allina Health have created “cost concierge” programs, assigning financial navigators at the point of scheduling. Likewise, Intermountain Health integrates out-of-pocket calculators into its digital patient portal and includes personalized billing education during discharge planning. Such integrations are not merely operational enhancements—they are trust-building actions. Price transparency should be linked to value conversations, where quality metrics and patient outcomes are provided alongside estimated costs. “The future belongs to those who align financial clarity with clinical quality,” said Elizabeth Mitchell, CEO of the Purchaser Business Group on Health. Accordingly, pricing must be reframed as an extension of care, not just administration.

Examples of bold pricing reform illustrate what’s possible when executives lead with integrity. At UVA Health, after a public backlash in 2019 over aggressive billing practices, the system restructured its collections policy, reduced its lawsuits against low-income patients by 96%, and eliminated wage garnishment. Similarly, Penn Medicine overhauled its charity care policy, expanding eligibility thresholds and automating debt forgiveness for eligible households. These moves were not only ethical—they were strategic. UVA’s patient satisfaction scores improved significantly within 12 months, and Penn saw a decrease in billing complaints and bad debt write-offs. As Dr. Atul Gawande noted, “People don’t mistrust medicine—they mistrust how it’s administered.” Therefore, trust demands clarity, fairness, and humility in financial relationships.

Responding to Data Breaches and Digital Mistrust

As hospitals digitize rapidly, cybersecurity has become a frontline trust issue. In 2024 alone, more than 95 million patient records were exposed due to healthcare-related data breaches, with ransomware attacks targeting health systems like CommonSpirit and HCA Healthcare. These incidents not only jeopardize patient privacy but also corrode public faith in a system increasingly reliant on digital tools. According to a recent Fierce Healthcare survey, 72% of Americans lack confidence in healthcare organizations’ ability to safeguard their personal data. Executive leaders must realize that cybersecurity is no longer a back-office issue—it’s a leadership function. “Data stewardship is clinical stewardship,” said John Riggi, the AHA’s national advisor for cybersecurity. Thus, executive failure to prioritize data safety now constitutes reputational malpractice.

Leading systems are embedding digital trust protocols into governance and strategy. For example, Mayo Clinic has created a Digital Ethics Board to review AI use, data sharing policies, and patient consent models. Likewise, Mass General Brigham has implemented AI auditing tools that detect algorithmic bias and flag security vulnerabilities in real time. Cyber resilience is now tracked on board dashboards alongside infection rates and readmission metrics. Leadership education on ransomware mitigation, vendor vetting, and breach simulation has become routine. These measures reinforce the reality that trust in digital systems is earned—not assumed. In fact, trust is best restored by anticipating and preempting breach scenarios, not simply reacting. Accordingly, digital governance is a cornerstone of institutional credibility.

Case studies show that transparency in breach response can limit reputational damage. When Norton Healthcare experienced a breach in 2023, its CEO issued a public video within 48 hours detailing the scope, next steps, and support for affected patients. The system offered 24-month credit monitoring, identity theft insurance, and a dedicated response line staffed 24/7. Conversely, in the HCA breach, slow communication and vague statements led to public criticism and loss of patient loyalty. These contrasting examples affirm that breach communication must be swift, specific, and compassionate. “The moment of breach is not the time to find your voice,” said Dr. Raina Merchant of Penn Medicine’s Center for Digital Health. Ultimately, how leaders respond under pressure reveals their institutional values. Therefore, breach readiness is a moral and strategic imperative.

Addressing Clinician Transparency and Communication

Clinicians are often the most trusted voices in healthcare—yet even this trust has begun to fracture. Patients report increasing frustration with rushed visits, limited eye contact, and confusing care plans, which erode their perception of clinician empathy and integrity. According to a Joint Commission brief, poor communication is the root cause of over 70% of serious patient safety events. Health systems like Cedars-Sinai and Nemours Children’s Health have responded by embedding relational training into CME requirements, focusing on empathy, listening, and shared decision-making. “Trust doesn’t require perfection—it requires presence,” said Dr. Adrienne Boissy, Chief Experience Officer at Qualtrics. Two powerful examples bring this principle to life. At Mount Sinai, a “See Me as a Person” campaign trained over 500 staff members on trauma-informed care. At Stanford Medicine, the “Presence 5” framework standardized relationship-building techniques across specialties. Undeniably, transparency begins with clinicians behaving less like technicians and more like partners.

Executive teams must reinforce clinician transparency through culture, incentives, and system design. This means allowing time for meaningful conversation, not just documentation. Organizations like Rush University Medical Center have redesigned appointment slots to accommodate interpreter use and culturally responsive communication. At Hackensack Meridian Health, transparency is codified in scripting guides and simulation labs, training staff to deliver difficult diagnoses or explain errors without evasion. Executive rounding and shadowing programs help ensure that communication values modeled at the top are mirrored at the bedside. These strategies have yielded real results—Rush reported a 17% increase in patient understanding scores and a 23% decrease in miscommunication-related incidents. Clearly, when transparency is intentional, outcomes improve. Therefore, clinicians must be supported as communicators, not just diagnosticians.

Examples of transformative transparency also emerge in how clinicians discuss uncertainty. At Oregon Health & Science University, palliative care teams use a “certainty spectrum” to help families navigate evolving prognoses. At UC Davis Health, surgical departments include patients in morbidity and mortality reviews when errors occur—an extraordinary act of openness. “We need to move from disclosure to dialogue,” said Dr. Thomas Gallagher, a national leader in patient safety. This principle is further validated by research from the BMJ, which found that honest apologies reduce litigation risk and improve satisfaction. When clinicians are empowered to acknowledge risk, regret, and revision, they become not weaker—but more human. Ultimately, communication isn’t just a clinical skill—it is a relational contract. Consequently, leadership must protect time, tools, and training for clinician transparency.

Executive Credibility in the Era of Public Scrutiny

In today’s environment, health system CEOs are public figures—judged not only by balance sheets but by tweets, town halls, and televised hearings. Public trust hinges on the visibility, authenticity, and consistency of executive behavior. According to a 2025 Modern Healthcare CEO perception survey, 78% of Americans believe hospital executives should engage directly with the public during times of crisis. Unfortunately, only 19% could name their local hospital CEO. That trust gap is dangerous. Leaders like Dr. Shereef Elnahal, Under Secretary for Health at the VA, and Lloyd Dean, former CEO of CommonSpirit Health, demonstrate what visible leadership looks like—regular community engagement, candid media appearances, and policy advocacy rooted in lived mission. Their examples show that trust is not built from behind a podium—it’s built in proximity. As Dean said, “You can’t lead people you don’t know.” Clearly, executive trust must be earned in person and in public.

Internal credibility is just as essential. Staff morale, clinician retention, and innovation all depend on whether employees believe in executive vision and values. At Northwell Health, CEO Michael Dowling writes weekly internal emails addressing national events, frontline challenges, and personal reflections. Similarly, Main Line Health executives conduct open listening sessions with employees and publish feedback themes alongside action plans. These gestures foster trust not by solving everything—but by acknowledging what matters. Staff want leaders who name pain, share power, and remain present. “In uncertain times, constancy of leadership becomes its own form of care,” noted Dr. Toyin Ajayi, CEO of Cityblock Health. When executives model vulnerability and voice, institutional resilience grows. Thus, executive credibility is not just symbolic—it is a stabilizing force.

Case studies also illustrate the reputational upside of transparent executive action. During the COVID-19 crisis, UVA Health published its ICU capacity data, PPE inventory, and staff infection rates weekly. Meanwhile, Providence Health livestreamed CEO Q&As with frontline workers and board members alike. These moves didn’t eliminate fear—but they built credibility. “People can handle hard news if they trust the messenger,” said Dr. Lucy Kalanithi. Systems that prioritize clear, candid, and continuous executive communication weather crises better—and recover faster. Accordingly, trust in executive leadership is not only a reputational asset—it is a clinical one.

Partnering with Communities to Restore Legitimacy

Healthcare organizations cannot rebuild trust alone—they must do so alongside the communities they serve. Community legitimacy comes not from glossy brochures but from deep, enduring partnerships rooted in mutual benefit. In 2025, leading systems are moving beyond episodic outreach to co-governance with community organizations. For instance, Henry Ford Health launched a Community Advisory Council with real voting power in resource allocation decisions. Similarly, Atrium Wake Forest Baptist involved residents in its community health needs assessments and hospital planning process. “You can’t build trust if you’re always the one holding the mic,” said Dr. Monica Peek of UChicago Medicine. In both cases, the key wasn’t just inclusion—it was influence. Consequently, community partnership must be strategic, not symbolic.

Systems should embed community voices across decision-making, not silo them in advisory boards with no power. At Children’s Hospital of Philadelphia, families participate in ethics committees and hiring panels. Brigham and Women’s Hospital employs community health workers (CHWs) as full members of care teams. These CHWs are trusted messengers, especially in immigrant and low-income neighborhoods. Their presence improves medication adherence, preventive screenings, and patient satisfaction. Executives must fund, elevate, and protect these roles—not just pilot them. “If you want to repair the harm of exclusion, you have to share power,” said Dr. Rishi Manchanda. Accordingly, partnership requires infrastructure—not just intent.

Bold community investment signals seriousness about shared destiny. Systems like Rush University Medical Center have invested millions into affordable housing near their campus, helping stabilize vulnerable populations while reducing readmissions. Bon Secours funded minority-owned businesses through a community benefit loan fund. These programs not only address social determinants—they demonstrate institutional loyalty to place. “When people see you reinvesting in their lives, it changes the conversation,” noted Michael Curry, CEO of the Massachusetts League of Community Health Centers. Ultimately, trust follows proximity and persistence. Therefore, community investment must be embedded into capital strategy.

Restoring Institutional Memory and Moral Leadership

To build forward, healthcare leaders must look back—with honesty. Public trust has been harmed not only by individual errors but by systemic abuses that have never been fully acknowledged. From the Tuskegee study to the sterilization of Indigenous women to racial redlining in hospital placement, the history of medicine includes betrayal. Acknowledging this history is not political—it is foundational. In 2023, Mass General published an institutional apology for its role in past discrimination and launched an equity action plan with measurable goals. Similarly, Penn Medicine produced a “Truth and Healing” curriculum now required for all new staff. “You can’t lead change if you pretend nothing happened,” said Harriet Washington, author of *Medical Apartheid*. Restoring memory is a prerequisite for moral leadership.

Executives should create institutional rituals that honor this work—not one-time statements. At Morehouse School of Medicine, annual remembrance events commemorate victims of medical racism while celebrating equity innovation. Northwell Health launched an oral history project documenting staff and patient experiences of bias and resilience. These practices deepen internal culture and affirm external credibility. Moral leadership also includes public advocacy. When hospital systems take stands on gun violence, climate change, and voting access, they model that health includes justice. “People watch what we fight for, not just what we fund,” noted Dr. Aletha Maybank, AMA Chief Health Equity Officer. Consequently, moral leadership must be practiced institutionally—not individually.

Memory work also involves policy correction. At Kaiser Permanente, historical billing data was reviewed to identify—and refund—patients who had been overcharged due to algorithmic bias. Ochsner Health replaced a race-adjusted kidney function formula after an internal review found it delayed access to transplants for Black patients. These moves restore trust by showing systems willing to repair—not just rebrand. “Restorative justice is not a fringe idea—it’s a healthcare standard,” said Dr. Camara Jones. Ultimately, moral leadership requires more than vision. It demands repair. Therefore, leadership must begin where harm occurred.

Using Metrics to Make Trust Visible

Trust is measurable—and must be measured. While trust has historically been viewed as intangible, executives now have access to validated tools that quantify perception, confidence, and loyalty. The Advisory Board recommends tracking “trust equity” alongside net promoter score (NPS) and HCAHPS. Health systems like Geisinger and UCHealth have created dashboards that disaggregate patient trust by race, gender, language, and insurance type. This allows leaders to identify gaps and design targeted interventions. “What gets measured gets managed,” said Peter Drucker—and trust is no exception.

Measurement must extend beyond patients. Staff trust in leadership predicts retention, innovation, and error reporting. At Baystate Health, quarterly pulse surveys include items like “I trust my leaders to act in our best interest” and “Our organization is transparent in hard times.” Results are shared publicly, and action plans follow. Likewise, Cook County Health includes trust metrics in its equity dashboard and board reviews. Data is not the answer—but it opens the door to better questions. Accordingly, trust must be treated as a strategic performance domain.

Importantly, trust metrics must lead to investment. If gaps are identified, resources must follow. Mount Sinai expanded its Spanish-speaking care navigators after trust surveys showed Latino patients reported lower satisfaction despite similar outcomes. Yale New Haven Health extended clinic hours in response to trust data from working-class patients needing evening appointments. These interventions are tangible demonstrations that feedback matters. “Measurement without action is manipulation,” said Dr. Ronald Wyatt. Therefore, data must not only describe trust—it must deliver it.

Educating the Next Generation of Trust-Builders

Rebuilding trust is not just today’s challenge—it’s tomorrow’s curriculum. Healthcare education must prepare leaders to navigate complexity, acknowledge bias, and build relationships. Yet most programs still treat trust as a soft skill, not a core competency. Brown University’s School of Public Health has added a required course on “Leadership, Legitimacy, and Listening” that uses case studies from hospital scandals and restorations. Duke-NUS in Singapore trains executives in narrative medicine, teaching them to elicit and integrate patient stories in strategic decisions. “We must teach power as a variable, not a default,” said Dr. Danielle Allen, political theorist and health policy scholar. Clearly, trust-building must begin in the classroom.

Clinical training must also evolve. At Johns Hopkins, a new rotation places residents in community boards and housing clinics to experience structural determinants firsthand. At Rush, the leadership fellows program includes modules on crisis communication, anti-racism, and institutional memory. These programs expose emerging leaders to the moral weight of their authority. “It’s not enough to do no harm—we must also undo harm,” said Dr. Janice Sabin. Trust-building requires cultural fluency, political literacy, and self-awareness. Therefore, educational design must reflect ethical complexity.

Faculty must also be trained to teach trust. Mass General Brigham has launched a Teaching Trust series for instructors, exploring empathy, disclosure, and bias in pedagogy. University of Chicago has added community partners as guest faculty in leadership courses. These moves not only diversify voices—they de-center authority. “Students need to see trust modeled, not just taught,” said Dr. Megan Ranney, Dean of the Yale School of Public Health. As such, education is the scaffolding of long-term credibility.

Leading with Humility, Restoring with Vision

Trustworthy leadership in healthcare today requires more than competence—it requires character, humility, and the courage to disrupt the status quo. Leaders must navigate competing pressures from payers, regulators, clinicians, and communities while maintaining a clear moral compass. At CommonSpirit Health, former CEO Lloyd Dean emphasized spiritual grounding and equity alignment in every decision, often quoting, “We are not just a healthcare company—we are a healing ministry.” Similarly, Montefiore Health System CEO Dr. Philip Ozuah is renowned for walking hospital floors daily and hosting small group conversations with staff to model transparent communication. These behaviors aren’t symbolic—they represent a leadership philosophy that centers humanity over hierarchy. Executive humility can be codified through self-assessments, 360 reviews, and culture audits. Yet humility is more than tone—it’s the willingness to yield power, admit limits, and prioritize the public good. “Leadership isn’t about being right—it’s about being real,” said Dr. Vivek Murthy, U.S. Surgeon General. Accordingly, humility is the foundation upon which trust can be restored.

Vision, on the other hand, must move beyond reactive statements and enter the domain of systemic redesign. Rebuilding trust requires painting a picture of what healthcare can become—not just fixing what’s broken. Systems like Northwell Health are embracing this by setting long-range ESG targets tied to board compensation, including carbon neutrality, DEI benchmarks, and community investment ratios. Sutter Health has mapped a five-year “trust roadmap” that includes public trust reports, staff equity scorecards, and patient-led policy councils. These visionary plans are paired with accountability metrics, community co-authorship, and budgetary alignment. Trust cannot be rebuilt on vague goals—it must be scaffolded with clear timelines and visible action. Visionary leadership also involves resilience, especially in navigating backlash, uncertainty, and complexity. “If you want to build something lasting, you have to be willing to be misunderstood for a while,” said Jeff Bezos—a sentiment now adopted by long-game healthcare leaders. Therefore, vision must be brave, not just strategic.

Examples of vision and humility working together are already reshaping U.S. healthcare. At Boston Medical Center, leaders eliminated executive bonuses during COVID-19 and redirected funds to frontline support—a move widely praised as ethical leadership. Meanwhile, OSF Healthcare opened a “trust lab” with patient and staff feedback loops tested in real time across its innovation hub. These approaches recognize that trust is a dynamic process—not a fixed attribute. Rebuilding trust is less about a single strategy and more about a posture of listening, repair, and accountability. As Dr. Don Berwick said, “We have to earn the privilege of care, every day.” That requires humility to learn and vision to lead. Ultimately, trust isn’t a deliverable—it’s the result of delivering with dignity. Consequently, rebuilding trust is the most strategic, moral, and human responsibility in healthcare leadership today.