“Trust starts with truth and ends with truth.” —Santosh Kalwar, author
Today, healthcare institutions are not only responsible for advancing the well-being of patients and employees, but also for ensuring trust and transparency within their care networks. In recent years, this trust has been tested — by a public health crisis, growing skepticism toward institutions and their leaders, and concerns such as data privacy and financial transparency.
Only 25% of Americans believe hospitals prioritize patient care over profits. This is a drop of over 50 percentage points since 2021, according to Jarrard Inc’s State of Play survey. Even worse, just 16% believe payers prioritize patients over profits.
If we are to rebuild confidence in healthcare, government institutions, public officials and leaders, we must begin with a renewed commitment to honest and trustworthy communication and systems.
At Hospital Sisters Health System (Springfield, Ill.), a 150-year-old Catholic healthcare delivery system, we’ve seen firsthand how genuine transparency can strengthen trust. We’ve also learned that when information is incomplete or inaccurate, it can create a misperception of transparency — a situation that breeds confusion and mistrust. Here are a few examples from our experience.
Cyber ‘in’ security
In 2024, there were 607 reported cybersecurity attacks on healthcare providers, continuing to cause legitimate fear and concerns for boards, colleagues, patients and communities. That same year, over 275 million healthcare records were breached — equivalent to 80% of the American population, according to DeepStrike’s Healthcare Data Breaches 2025 report.
In August 2023, HSHS was under attack. Within an hour of learning our fate, we engaged our team of cybersecurity experts, and our board convened by phone. As our cyber experts worked around the clock to contain the attack and begin remediation efforts, we met with our board almost daily during the first two weeks. We did not shy away from open dialogue with the board or any other stakeholder.
Contemporaneously, we stood up incident commands across the system to focus on our top priority — our patients — as we ensured horizontal and vertical communication with leadership. We were candid about what was happening and asked our operators and clinicians to rally together to continue providing high-quality care, despite no more access to any system, including the EHR.
Within the first days, we stood up a website with FAQs for the public and proactively contacted our clinical partners, vendors and regulators. I called my counterparts to explain what happened, where we were and why it was safe and important to reconnect to us to ensure continuity of care. We remained visible on our floors to reassure caregivers, patients and their families that we would continue to serve them.
We shared what we could to protect HSHS and our patients. When the dust settled, and all systems were restored, we built a modernized cybersecurity program for our board to oversee.
Financial transparency as a trust builder
In parallel, financial operations should also reflect a commitment to integrity. At HSHS, we are investing in practical solutions to help improve financial transparency related to our revenue cycle through a true partnership with an organization called Ensemble. To accomplish this, we are doing or proposing the following:
- Double jeopardy of claims must stop. If the payer authorizes the inpatient stay and receives concurrent clinical documentation, and has access via Epic to the record, there should not be retrospective denials — something that accounts for roughly 25% of inpatient denials today. The American Hospital Association reports that hospitals and health systems spent an estimated $19.7 billion in 2022 trying to overturn denied claims, including many that were pre-approved during prior authorization.
- Payers must make their entire clinical review policies transparent, available and in formats that lead to true collaboration to help our community populations.
Another little-known issue to the public, but one that’s creating a huge trust gap between providers and payers, is called precertification — which is the process healthcare providers perform to obtain approval from an insurance company before giving a specific medical service or treatment. We would recommend that if “no precert” is required, the payer should not retroactively deny the claim for medical necessity.
Additionally, brokers and payers should be required to disclose the calculation of premium increases. Right now, there’s a misperception that “bad hospitals and doctors drive up pricing.” This misdirection of blame is causing unjustified mistrust in the healthcare industry for hospitals.
Community benefit
The tax-exempt status of nonprofit hospitals is not merely a fiscal designation — it reflects our mission-driven commitment to community well-being. In 2020, nonprofit general hospitals provided approximately $129 billion in community benefits, nearly nine times the estimated $13.2 billion in federal revenue foregone due to their tax-exempt status, according to reports by the AHA. These benefits encompass uncompensated care, health education, community outreach and services that operate at a financial loss but are vital to public health — such as inpatient mental health, obstetrics and emergency care.
While AHA reports that nearly 7% of nonprofit hospital expenses went to support financial assistance and Medicaid underpayments in 2022, there are wide and continuous distortions of the investments health systems are making to benefit the community.
Again, transparency matters. Not all nonprofit hospitals spend equally on community benefit, and health systems should be evaluating their community benefit investments in comparison to their tax exemption benefit. At HSHS, we’ve made a point of ensuring that our operating board is monitoring our community benefit investments and tax exemption value, which advances both transparency and accountability.
Call to action
In closing, rebuilding trust is not the sole responsibility of one person. It requires a culture of integrity across all levels of an organization, each sector of our economy and society overall. It means ensuring that your internal communications are accurate, timely and respectful. It means challenging misinformation when we see it — whether in a staff meeting or on social media. And it means supporting media partners who report responsibly on healthcare issues, rather than sensationalizing them.
I invite you to take this message forward — actively and visibly. Let’s commit to the following:
- Model transparency in every communication, especially during times of uncertainty.
- Champion integrity by ensuring our teams have the tools and support to communicate truthfully and respectfully.
- Give intentionally by ensuring that your community benefit efforts are measurably addressing community needs. Monitor total community benefit spending and compare it on a set schedule to the financial benefit of your tax-exempt status.
- Lead with empathy and acknowledge that events like cyber breaches are unsettling. Be transparent and share appropriate information to align stakeholders.
- Bring clarity and offer consistent opportunities for conversation. Stay visible at the bedside, on the floor, in the boardroom and in the community.
- Reinforce financial accountability through transparency by continuously reviewing and sharing billing and collection practices. Make fairness, compassion and reasonableness your guiding principles through end-to-end revenue cycle management.
Together, we can restore and strengthen the trust that is foundational to our country. Let’s lead with clarity, courage and conviction. It’s about helping one another, and healing begins ultimately with trust.
Damond W. Boatwright is president and CEO of Hospital Sisters Health System, a Catholic nonprofit with 13 hospitals and 130 care sites in Illinois and Wisconsin.
