Why Patient Trust Is Healthcare’s Most Valuable Asset

Dr. William England on the value of trust in healthcare

In healthcare, trust is everything. Unlike other industries where a disappointing product or service may simply earn a brand a negative review or lose them a customer, healthcare carries far greater stakes.  

Patients place not only their money but also their health, well-being, and even their lives in the hands of providers. When expectations fall short, the damage to trust can be profound—and difficult to repair. 

That’s the central theme of a recent NRC Health nSight, Negotiating the Trust Cliff: The High Cost of Low Reliability in Healthcare Experiences. The findings were the focus of a recent episode of the Becker’s Healthcare Podcast, featuring Dr. William England, Strategic Advisor, Research at NRC Health.  

In the conversation, Dr. England shared why reliability is essential to building lasting patient loyalty and how health systems can bridge the gap between brand promises and care delivery. 

Published in Becker’s Hospital Review

Dr. England explains that patient trust often hinges on reliability—the ability to deliver on promises consistently across care settings. While a disappointing restaurant experience might prompt someone to simply try another eatery, healthcare doesn’t work that way. Unlike diners, patients can’t afford repeated missteps. 

“Excellence without reliability feels more like luck than consistency,” Dr. England notes. “Organizations that bake reliability into their culture—through hiring, training, recognition, and accountability—are the ones that sustain trust over time.” 

Research also shows that expectation violations—when brand promises don’t align with real experiences—cause the steepest erosion of trust. This disconnect, known as the “trust cliff,” can quickly turn loyal patients into skeptics. 

Using a combination of market perception data and patient experience feedback, NRC Health identified four distinct patterns that illustrate how brand image and care delivery interact to shape trust:

1. The Gold Standard—High expectations and consistently excellent experiences. Trust is reinforced, and patients remain loyal.
2. The Pleasant Surprise—Lower brand perceptions, but strong patient experiences. Skeptical patients leave impressed, offering organizations an opportunity to build reputation
3. Low Expectations Met—Weak brand image and disappointing care. These organizations face an uphill battle to rebuild confidence and must first improve the basics.
4. The Trust Cliff—High brand image but poor frontline experiences. Trust plummets when patients expect great care but encounter inconsistency. In NRC Health’s sample, only 66% of patients in this quadrant maintained trust—the lowest percentage of any group.

The trust cliff is especially alarming, says Dr. England, because “it’s where the gap between promise and reality is most damaging to patient loyalty.” 

Five Strategies to Strengthen Patient Trust 

NRC Health’s report outlines five strategic imperatives for health system leaders to move toward the gold standard of trust: 

1. Audit Brand-Experience Alignment—Ensure that marketing messages match real patient experiences. Too often, marketing and patient experience teams work in silos, missing opportunities to bridge perception and reality. 
2. Train for Consistency—Reliability requires cultural adoption. From frontline staff to leadership, training should emphasize the delivery of consistent, repeatable excellence. 
3. Celebrate Successes—Recognize areas where care teams are excelling, and share these stories internally and externally. Reinforcing good work builds pride and accountability.
4. Target Areas of Weakness—Use patient feedback and brand perception data to identify where expectations outpace delivery. These are the most urgent opportunities for improvement. 
5. Recalibrate Messaging—When experiences are strong but brand image lags, organizations should better communicate their successes to the community.

Of these, Dr. England points to auditing brand-experience alignment as the most critical first step. “There’s often really good work happening inside healthcare organizations,” he says, “but if it isn’t reflected in how the brand is communicated, opportunities to build trust are missed.” 

Healthcare doesn’t exist in a vacuum. Patients increasingly compare their care encounters to experiences in banking, retail, or hospitality. Speed, transparency, personalization, and clarity—once considered “nice to haves”—are now table stakes. 

This shift is particularly evident among younger, digitally savvy patients. However, NRC Health’s research shows that older generations are adopting the same expectations. For health systems, this means that reliability, transparency, and consistency are no longer differentiators—they’re essentials. 

The organizations that stand out will be those that not only deliver excellent care, but also communicate authentically, reinforcing that what’s promised is exactly what patients receive—every time.

Ultimately, the goal for every health system is to reach the gold standard quadrant, where high expectations meet consistently strong care experiences. While the path there can be challenging, NRC Health’s research confirms that progress is possible. 

For leaders, this means taking a holistic view: integrating marketing with patient experience, prioritizing reliability, and celebrating success while addressing gaps head-on. As Dr. England puts it, “How you make reliability part of your organization’s DNA, and how you communicate that, will determine whether you build lasting trust.” 

In a healthcare landscape where loyalty is fragile and expectations are rising, trust remains the foundation of every meaningful patient relationship. With the right strategies, health systems can not only avoid the trust cliff but climb steadily toward the gold standard. 

Listen Now: Becker’s Podcast with NRC Health 

“Building Trust in Healthcare with Insights from NRC Health” featuring Dr. William England.

Explore the Report: 

• nSight Report