Measuring the Impact of Humanistic Care: A Six-Item Scale to Enhance Patient Trust

Abstract

UAB Medicine, a leading health system serving over 1.5 million patients annually, conducted a study to identify factors driving trust in primary care and family medicine. This joint initiative between UAB's Office of Patient Experience and Engagement, Department of Primary Care and Family Medicine, and the School of Health Professions aimed to measure trust and develop behavior-based guidelines to enhance patient interactions. Findings from the 2-phase study highlighted that clinicians who demonstrate concern, address patient questions, and remain fully present during encounters are significantly more likely to foster patient satisfaction. By operationalizing trust through observable clinician behaviors, this work extends beyond measurement to inform practical, scalable strategies for strengthening humanistic care. Building on these insights, UAB Medicine is expanding this work to examine trust-building across additional specialties to strengthen health outcomes.

Introduction

UAB Medicine, a leading academic medical center with over 2 million annual ambulatory visits, is committed to advancing humanistic healthcare by leveraging clinician and patient feedback. Through its Office of Patient Experience and Engagement, UAB launched a comprehensive listening program in 2020, collecting real-time insights via surveys and a video feedback tool. This effort revealed key priorities: clinicians desire actionable ways to improve care, while patients place high value on empathetic, clear communication. The initiative aimed to align these priorities to strengthen the patient–clinician connection.

Patient comments frequently included terms like “trust” and “love,” along with sentiments such as “they always listen” and “I feel like they truly care about me as a person.” These insights led to the hypothesis that specific clinician behaviors could help foster trust. As a result, UAB Medicine launched a 3-month pilot within its ambulatory practice service line to test a 6-item scale designed to measure and enhance trust through humanistic care.

Trust has long been recognized as a foundational element of effective healthcare relationships. Within the humanism literature, trust is often conceptualized as a relational construct shaped through interpersonal interactions, ethical practice, and perceived authenticity. ¹ Scholars have emphasized that trust is built through consistent, compassionate engagement and is reinforced when patients feel heard, respected, and valued as partners in their care.

Why Trust Matters for All Clinicians and Healthcare Systems

In today's healthcare landscape, building and maintaining patient trust is essential for both patient retention and organizational sustainability. Trust lies at the heart of humanism, which The Arnold P. Gold Foundation defines as clinically excellent care that is kind, safe, and trustworthy. Research has linked humanism to improved patient outcomes, ² increased engagement, ³ stronger medication adherence, ⁴ enhanced clinician well-being, ⁵ and better financial performance at the institutional level. ⁶

Importantly, trust is not a static attribute but a dynamic, relational process that unfolds through everyday clinical interactions. It is shaped not only by what clinicians do, but by how patients interpret those actions within the context of their lived experiences, expectations, and sense of psychological safety.^7–9

Trust is essential, but it is also fragile. Eighty percent of patients say they would not return to a clinician after a trust-eroding experience, and 55% report having had such an experience. ¹⁰ Sixty percent would even switch clinicians in pursuit of more trust and respect. ⁷ Patient turnover carries real financial consequences, costing practices approximately $200 per unused appointment and up to $150 000 annually in no-shows for a single physician practice.^11,12

Beyond financial impact, trust drives meaningful health behaviors. For instance, 82% of high-trust patients engage in preventive care, ¹³ and 67% adhere to prescribed medications—compared to just 14% among low-trust patients. ⁷ Yet, when compassion or presence is lacking, between 64.1% and 81.8% of patients admit to withholding important information from their clinician. ⁸ A study of over half a million US adults found that trust in healthcare declined during the COVID-19 pandemic, contributing to reduced vaccination rates for both COVID-19 and flu. ⁹

Taken together, these findings underscore why humanizing healthcare, and fostering genuine trust between patients and clinicians, is essential. Trust not only shapes patient satisfaction and outcomes but also directly influences engagement, safety, and organizational performance. ¹⁴

Method

The current study aimed to explore and quantify patient trust in clinical interactions, with the goal of informing actionable strategies to enhance humanistic care at UAB Medicine. Specifically, the study aimed to: (1) measure trust quantitatively; (2) translate patient feedback into behavior-based guidelines for clinicians; (3) empower clinicians to act on patient experience data; (4) educate clinical staff on behaviors that enhance patient and caregiver experience; (5) provide insights beyond traditional satisfaction metrics such as “likelihood to recommend”; and (6) develop enhanced training and coaching resources for clinical teams.

This study employed a 2-phase observational design using cross-sectional survey data collected from patients receiving care in UAB Medicine's primary care and family medicine clinics. Data were collected during 2 time periods—August to October 2023 and February to April 2024—to assess consistency of findings over time and to inform opportunities for program expansion.

The study leveraged UAB Medicine's existing postvisit survey infrastructure to examine how specific clinician behaviors influence patient trust and satisfaction. ¹⁴ The Medallia–Gold Humanism Trust Scale, ¹⁵ a validated 6-item, 5-point Likert scale, was embedded within the standard postvisit survey to assess patient perceptions of humanistic clinician behaviors (Figure 1). This approach enabled evaluation of trust-related behaviors within routine care delivery rather than through a standalone research instrument, supporting real-world applicability. This design also supports ecological validity by evaluating trust-related behaviors within routine clinical workflows.

Figure 1.

The Medallia–Gold Humanism Trust Scale.

Patient satisfaction served as the primary outcome variable and was measured using a standard overall satisfaction item routinely included in the postvisit survey, consistent with widely used patient experience measurement practices. The analytic approach focused on examining relationships between patient-reported trust behaviors and overall satisfaction across 2 data collection periods. This design allowed for assessment of consistency in observed patterns over time while maintaining alignment with real-world clinical workflows.

To assess these relationships, ordered logistic regression models were used. This approach was selected due to the ordinal nature of the outcome variable and its suitability for evaluating proportional differences across response categories. Models controlled for demographic variables including age, gender, race, and marital status to account for potential confounding effects.

Of the 13 863 patients seen during the study periods, 1065 completed the trust scale survey. Response rates were consistent across both data collection periods. As with all voluntary survey research, response bias remains a potential limitation and is addressed further in the Discussion.

Results

During the 2 phases of the study, a total of 13 863 patients were seen within UAB Medicine's Primary Care and Family Medicine clinics. Of these, 1065 patients completed the trust scale survey. The demographic profile of survey participants closely mirrored that of the broader primary care patient population (Figures 2), suggesting representativeness across variables such as age, gender, race/ethnicity, and marital status.

Figure 2.

Demographics for all primary care patients who participated in the study.

To evaluate the relationship between clinician behaviors and patient satisfaction, the research team employed ordered logistic regression models. Six humanistic care behaviors were analyzed, controlling for demographic factors including gender, race, marital status, and age. The analysis was conducted across 2 distinct study periods: Group 1 (August-October 2023) and Group 2 (February-April 2024).

Clinician Behavior and Patient Satisfaction

Among the 6 behaviors examined, demonstrating concern emerged as the strongest predictor of patient satisfaction. Patients who perceived their clinician as demonstrating genuine concern were 14.5 times more likely to report high satisfaction with their care (P < .001). Other significant predictors included addressing patient questions (OR = 3.9, P = .001) and being fully present during the encounter (OR = 2.7, P = .020).

Table 1 summarizes the associations between each clinician behavior and patient satisfaction, highlighting the relative strength of each behavior while controlling for key demographic variables.

Table 1.

Association Between Humanistic Clinician Behaviors and Patient Satisfaction.

Clinician Behavior	Odds Ratio	P Value	Interpretation
Demonstrated genuine concern	14.5	<.001	Strongest predictor of patient satisfaction; reflects the importance of emotional presence and empathy in clinical encounters.
Addressed patient questions	3.9	.001	Meaningfully increases satisfaction by supporting understanding and engagement in care decisions.
Was fully present during the visit	2.7	.020	Reinforces patient perception of attentiveness and respect during clinical interactions.

Note. Models controlled for age, gender, race, and marital status.

These findings suggest that interpersonal behaviors reflecting attentiveness, empathy, and engagement play a central role in shaping patients’ perceptions of care quality. Notably, behaviors that communicate emotional presence and responsiveness appear to have a stronger influence on satisfaction than task-oriented aspects of care alone.

Demographic Factors and Satisfaction

Male patients were 46% less likely to report satisfaction than female patients (P = .042). Marital status also played a role: patients who were divorced or legally separated were 8.2 times more likely to report satisfaction compared to those who were single (P = .001), while married or partnered patients were 2.1 times more likely to report satisfaction than single patients (P = .037). Race and age were not statistically significant predictors in the overall model.

These findings suggest that relational and social context may influence how patients perceive and experience care. For example, individuals with established social support structures may approach clinical interactions with different expectations or levels of engagement, which may shape perceptions of trust and satisfaction. Conversely, patients who are single or lack consistent support may experience healthcare encounters differently, potentially influencing their sense of trust or connection with clinicians.

The absence of statistically significant differences across age and race should be interpreted cautiously. While these variables did not emerge as predictors within this sample, this does not imply that identity-related factors are unimportant. Rather, trust may be shaped by a broader constellation of experiences, including cultural context, prior healthcare interactions, and individual readiness to engage in care—factors not directly measured in this analysis.

Discussion

This study reinforces the critical role of trust in shaping patient experience and highlights specific clinician behaviors that can strengthen humanistic care. Through use of the Medallia–Gold Humanism Trust Tool, ¹⁵ developed in partnership with the Arnold P. Gold Foundation, UAB Medicine was able to identify 6 measurable behaviors that influence how patients perceive and engage with care. Among these, “demonstrating concern,” “patiently addressing questions,” and “being fully present” emerged as the strongest predictors of satisfaction.

Importantly, this work extends beyond validation of an existing measurement instrument. By applying the Medallia–Gold Humanism Trust Scale within a real-world clinical environment, this study demonstrates how a validated tool can be operationalized to generate actionable insights at the point of care. Rather than serving solely as a framework for measurement, the tool functioned as a mechanism for identifying concrete, behavior-level opportunities to strengthen trust across everyday clinical interactions.

The significance of these findings lies in their practical application. While broad organizational strategies remain important, this research suggests that small, consistent clinician behaviors can meaningfully influence trust and satisfaction. Even a single behavior—such as taking time to address patient questions—was associated with a measurable improvement in patient-reported experience. These findings support the view that trust is not only a systemic priority, but a moment-to-moment opportunity embedded within each clinical encounter.

By translating abstract concepts such as trust and humanism into observable behaviors, this work advances how healthcare organizations can move from measurement to meaningful action. Trust becomes not merely an outcome to monitor, but a capability that can be intentionally cultivated through routine clinical practice.

From an operational perspective, these findings offer guidance for how trust-based insights can be integrated into clinical improvement efforts. Shifting from reactive, score-based measurement toward a proactive, competency-based approach may require consistent practice standards, ongoing professional development, and aligned feedback mechanisms. Within this framework, behavior-based trust measures can support clinician coaching, professional development, and care team conversations, enabling providers to translate patient feedback into concrete improvements at the point of care.

This study also underscores the importance of clinician involvement in the design and implementation of experience improvement initiatives. At UAB Medicine, physician codesign throughout the study process fostered ownership, alignment with clinical priorities, and feasibility of implementation. Engaging clinicians in defining behavioral standards and feedback practices may enhance acceptance and utilization of trust-related insights, particularly when embedded within existing professional development and peer review structures. Such approaches may be especially relevant in academic medical centers, where these methods can also inform teaching and training models for learners.

The social validity of this approach further supports its relevance. Clinicians responded more positively to feedback framed around specific, human-centered behaviors than to traditional satisfaction metrics alone. Behavior-based insights were perceived as more constructive, actionable, and aligned with clinicians’ intrinsic motivation to provide compassionate care—an important distinction in environments where traditional scores may feel abstract or disconnected from daily practice.

Finally, these findings advocate for a broader shift in experience measurement practices. Traditional satisfaction metrics such as likelihood to recommend may overlook the relational and emotional dimensions that define human-centered care. Trust-based tools grounded in behavioral science offer a more nuanced and actionable view of care delivery. By embedding trust measurement into routine workflows and translating insights into observable behaviors, healthcare organizations can support both patient experience and clinician engagement, reinforcing trust as a shared responsibility rather than a unidirectional outcome.

Limitations

While this study presents valuable insights, several limitations should be noted. First, the research was conducted at a single academic medical center and focused solely on primary care and family medicine. As a result, generalizability to other specialties and healthcare settings may be limited.

Second, although the Medallia–Gold Humanism Trust Tool provides a validated framework for assessing trust-building behaviors, patients may interpret items differently depending on personal experiences, cultural background, or communication style. Trust is inherently relational and influenced by contextual factors that extend beyond individual clinician behaviors, including prior healthcare experiences, expectations, and perceived psychological safety.

Additionally, while demographic trends were explored, the influence of variables such as age, race, and socioeconomic status on perceptions of trust warrants deeper analysis. The current study did not assess factors such as patient activation, readiness to engage in care, or prior experiences with the healthcare system, all of which may meaningfully shape how trust is formed and expressed. Future studies would benefit from a broader sample and stratified approaches to better understand trust disparities and intersectionality across diverse patient populations.

Finally, this study did not capture dimensions of identity (eg, sexual orientation or gender identity) that may influence how patients experience trust and connection in healthcare settings. Future research should more intentionally examine these intersecting identities to better understand how trust is built, or hindered, across diverse populations.

Conclusion

Trust is foundational to patient experience and health outcomes, yet it is often measured in ways that are difficult for clinicians to act on. This study shows that specific humanistic behaviors (ie, demonstrating concern, addressing patient questions, and being fully present) are strongly associated with patient satisfaction when assessed within routine postvisit workflows. By translating trust into observable, behavior-based feedback, healthcare organizations can move beyond score-based monitoring toward practical coaching and improvement at the point of care. Future research should assess generalizability across specialties and examine relationships with downstream outcomes (eg, adherence, retention, provider burnout).