“Healthcare: We’ve Had a Problem”: A Call to Action for Trust as Healthcare’s Ultimate Indicator & a Commitment to Experience Improvement to Get There

by Jason, A. Wolf, Ph.D, CPXP

“Houston, we’ve had a problem,” is an unforgettable quote reflecting a powerful moment for humankind. As the Apollo 13 astronauts discovered they were in a critical moment of their space flight, their reality was challenged and ultimately their lives were at risk. It took a commitment to understanding, a process for exploration and improvement, it took human ingenuity, ultimately it took boundless and shared trust to solve an issue that led to a successful end to that historic mission.

I would offer now we find ourselves in a similar moment for healthcare, simply stated, “healthcare, we’ve had a problem.” We find ourselves in a perfect storm of rising costs, workforces pressures, an aging population, more acute needs, and unfortunately forces that seem to be fighting against the very improvements we need to focus on to address these items. This ultimately impacts the experience people have in healthcare – the quality, safe, and compassionate outcomes they deserve. It is elevated by a broader societal conversation on affordability so crucial to people now around the world. It is all being reflected in healthcare’s ultimate indicator – trust.

The Truth on Trust

A recent PX Pulse from The Beryl Institute reveals some alarming data that seems to fit global trends we continue to see.

While 92% of people say trust is “very or extremely” important in healthcare, only 36% of people responding have complete trust in healthcare overall. And this number is declining with 31% of people reporting their trust dropped from 2024 to 2025.

92% of people say trust is “very or extremely” important in healthcare.

It is important to highlight here where trust is most challenged. People find trust in relationships. It is built through connections where they have clarity and understanding, feel heard and understood. These are the very cornerstones of experience excellence overall.

Around two-thirds of people report having “a lot or complete” trust in individuals in healthcare, specifically nurses and their primary care physicians. On the opposite end only 27% of people have the same level of trust in the systems around them and specifically in the United States this is the U.S. Department of Health and Human Services.

So, while critical moments of healthcare are fostered at the point of interactions, it is the focus of the systems that support and sustain them that influence and impact them. And those systems right now are under question. Healthcare, we have a problem.

Trust as the Ultimate Indicator

In the latest special issue of Patient Experience Journal, coming the first week of August, I offer that trust, like experience is not an end to be achieved. It exists in a constant and active state of being co-created with other people, institutions, and systems. It is built through relationship, it is grounded in interactions, and it is inspired by the presence and expression of integrity, dependability, and confidence. When those ideas thrive, we elevate trust, and when they retreat, we erode trust. Ultimately when we get the things people consistently say are essential to their human experience in healthcare and beyond right – listen to me, communicate to me in ways I can understand, treat me with dignity, give me confidence in your ability – we elevate trust.

Experience reaches further as well to the other critical issues of today, namely cost of care, the affordability issue people raise now every day, and access to care which is impacted by the former. In fact, data from another PX Pulse study, showed us that 25% of the U.S. population chose not to seek care due to cost. Our affordability issues are putting pressure on our healthcare systems globally as people opt out of seeking care, leading to new cost burdens on the system as healthcare issues are delayed and the wellbeing of our society is diminished. Healthcare we have a problem.

In the end for all these factors that drive the experience people have in healthcare, we must remember, “It is not trust that creates experience, but rather it is trust that is fostered by it.” (Article coming on 6 August, 2026). Trust is driven by relationships, by the experience we provide, the cost burdens, the accessibility issues, and I would add the way in which we seek to drive improvement. In the end I suggest trust is truly the ultimate indicator for healthcare as it reflects so much of what we strive to achieve each day, in accessible, safe, quality care. Yet that too remains at risk.

It is not trust that creates experience, but rather it is trust that is fostered by it.

A Call to Action

Outcomes in healthcare matter, and if we see trust as an ultimate indicator, we have some work to do. The investments we are focusing on in healthcare, the narrative being created, and directly the cuts being made especially around healthcare improvement have a significant bearing on the very outcomes we seek. There are some particularly troubling actions taking place, specifically in the United States.

Recent reductions in investment, including the full out cancellation of grant support by CMS for efforts to research, identify, and expand efforts to achieve experience excellence (and specifically support of AHRQ which has supported and influenced global efforts to achieve experience improvement for decades,) are further undermining the trust that already sits at low levels.

Cutting efforts to understand the solutions for improvements, the paths to ensure quality outcomes, the means to fulfill our obligations and commitments in healthcare to ensure safe, equitable care will have an inverse effect. While some may see these efforts as “cost savings” we must return to the idea that affordability and cost, trust, and outcomes are all connected.

When we undervalue or fully remove a commitment to improvement, we open new risks, new costs, new challenges – a cost burden for mistakes made, a reduction in a safety commitment, a loss of quality. Ultimately, we are undervaluing a commitment to overall experience and replacing it with pure operational efficiency. Yet people are not cogs traveling the conveyor belt of healthcare. Each unique interaction requires an open ear to hear them, a warm heart to feel them, a rigorous mind to heal them. Healthcare remains at its core human beings caring for human beings.

People are not cogs traveling the conveyor belt of healthcare. Each unique interaction requires an open ear to hear them, a warm heart to feel them, a rigorous mind to heal them. Healthcare remains at its core human beings caring for human beings.

So, we must underline these types of cuts to grants and access to information drastically diminishes the potential for the outcomes essential to healthcare excellence, not the cost of healthcare itself. These cuts diminish trust. As the ultimate indicator it tells us so much about what we need to know. We have an opportunity to understand and impact this conversation, I hope you will do so.

[Authors note: to learn more about this impact of current cuts and how you can engage in the conversation in supporting experience excellence I encourage you to follow the PX Policy Forum at The Beryl Institute and you can learn more through the updates and actions of Academy Health.]

Where We Go from Here

If we truly want healthcare that is affordable, safe, equitable, and effective then we must recognize that research, improvement and quality are the very mechanisms through which better healthcare is and will continue to be created. We must also understand the path to affordability is not built by knowing less.

It is built by learning faster, improving continuously, and investing in the evidence that helps us deliver better care for every person. It is built ultimately by ensuring the best in experience for every human we have the privilege to serve in healthcare no matter where we stand in the world. No one person deserves any less.

So where do we go from here, it brings me back to trust as our ultimate indictor. In my editorial in PXJ I offer that:

• Trust is the predictor of confidence in our healthcare systems around the world.
• Trust is our true north in healthcare transformation and improvement.
• Trust is the ultimate driver in people’s healthcare choices and has an impact on the healthcare outcomes we create in our organizations, systems and countries to ensure the health and well-being of all our citizens.
• Trust is earned in the way we show up, in the decisions we make, in the relationship we build, in the care we show.

I also believe that the healthcare organizations and national systems that commit to invest in learning the fastest, will ultimately deliver the highest quality care, provide the most affordable care, create the most viable health systems and ultimately achieve highest level of trust – the ultimate indicator for healthcare.

Yes “healthcare, we’ve had a problem” but as the Apollo 13 crew and team around them showed, with ingenuity, calm, commitment, a willingness to bring people together, an ability to listen for the little things, and a willingness to hear all voices, profound solutions can emerge from the most unexpected places. I believe that is the power of our community, The Beryl Institute community, the global healthcare community. This is not a problem we can avoid, but it too is one we can solve. And we must do so together.