First, do no harm: institutional betrayal and trust in health care organizations

Purpose: Patients' trust in health care is increasingly recognized as important to quality care, yet questions remain about what types of health care experiences erode trust. The current study assessed the prevalence and impact of institutional betrayal on patients' trust and engagement in health care. Participants and methods: Participants who had sought health care in the US in October 2013 were recruited from an online marketplace, Amazon's Mechanical Turk. Participants (n = 707; 73% Caucasian; 56.8% female; 9.8% lesbian, gay, or bisexual; median age between 18 and 35 years) responded to survey questions about health care use, trust in health care providers and organizations, negative medical experiences, and institutional betrayal. Results: Institutional betrayal was reported by two-thirds of the participants and predicted disengagement from health care (r = 0.36, p < 0.001). Mediational models (tested using boot-strapping analyses) indicated a negative, nonzero pathway between institutional betrayal and trust in health care organizations (b = -0.05, 95% confidence interval [CI] = [-0.07, -0.02]), controlling for trust in physicians and hospitalization history. These negative effects were not buffered by trust in one's own physician, but in fact patients who trusted their physician more reported lower trust in health care organizations following negative medical events (interaction b = -0.02, 95% CI = [-0.03, -0.01]). Conclusion: Clinical implications are discussed, concluding that institutional betrayal decreases patient trust and engagement in health care.