I learned long ago that nothing destroys trust in a healthcare organization faster than when patients and families discover there is inadequate communication between the parties caring for a patient.
It can be something small. The doctor increases the diet from full liquid to regular, but never places the order. The patient expects the change and gets pudding instead of a salad and burger.
But sometimes the stakes are higher. Discharge plans. Medication changes. Activity level increases. One person tells the patient one thing. Another tells them something different. Trust erodes.
My Brother’s Story
I experienced this situation recently when my brother was hospitalized with pneumonia and a very high temperature. His group home manager told me to set up his Healthcare Power of Attorney. Within hours, hospital social services called me to come and sign papers naming me as his legal healthcare power of attorney. The signature had to be witnessed.
When I got to the hospital, nobody had any information about the papers. I asked for the social worker on duty.
He told me I didn’t need to sign anything at all! That I’d been misinformed. “A power of attorney is just between the patient and his doctor,” he said. He apologized for “the care team member who called you. She is misinformed about how power of attorney works.”
I had cancelled meetings and driven 40 miles to sign papers that apparently didn’t exist.
But here’s what bothered me more: my brother can’t advocate for himself. He’s a disabled adult living in a group home. If something goes wrong like he needs end-of-life decisions made, who has the authority to make them?
The hospital said that this was between him and the doctor. My brother can name anyone on the planet. A rock star. Someone he’s never met. Meanwhile, when he was on a ventilator last year, the hospital was asking me about end-of-life decisions. We had no power of attorney document. We had to figure it out in a crisis.
And nobody in the system communicated to us about any of this.
What Patients Experience
I’ve seen this pattern over and over in our mystery shopping work. In one culture assessment, where we had researchers observing inpatient experiences, an elderly patient’s daughter told us, “This is why I can never leave when mom is admitted. The left hand doesn’t know what the right hand is doing. I never feel safe.” Her mom was NPO for a pending emergency surgery. The information was written on the white board, and yet a tray full of food was delivered and set up for the patient.
This breakdown made the daughter feel she had to stay by her mother’s bedside the entire time to ensure her safety. Not because the care was bad. But because different departments, different shifts, different people were giving different information about the same patient and their care.
That shouldn’t be the cost of hospitalization: a family member who can’t work, can’t rest, and can’t leave because they can’t trust the communication.
The Trust Crisis
A national survey of more than 443,000 U.S. adults found that trust in physicians and hospitals fell more than 30 percentage points between 2020 and 2024—from 72% to 40%.
Thirty points. Across multiple demographic groups. Everyone.
That’s not a small decline. That’s a trust crisis.
And a lot of it comes down to this: the left hand not knowing what the right hand is doing.
We have tools now that are supposed to help. AI. Ambient scribes. Electronic records that should connect everyone.
But tools don’t always fix miscommunication. They can facilitate it, but they don’t fix it.
What fixes poor communication is culture.
It’s someone saying: “Before this patient goes anywhere, I have to make sure the next person knows what I know. That the patient knows what’s happening. That everyone is on the same page.”
Patients and family members often decide whether to trust you based on a single conversation—and whether they receive conflicting information.
The question is: What are you doing to prevent communication breakdowns that undermine trust? Trust doesn’t erode gradually. It can disappear quickly—and once it’s gone, it’s incredibly hard to rebuild.
Tags: Communication, healthcare culture, healthcare leadership, leadership development, Patient Experience, Patient Trust
